Obstructive Coronary Artery Disease
It is the gradual narrowing or closing of arteries that supply the heart with blood. This blockage is usually caused by a build-up of plaque in your arteries (atherosclerosis), and can begin as early as your teens, slowly worsening in some people and more quickly in others.
If the blockage gets severe enough, it can limit or block the flow of oxygen-rich blood needed by the heart’s muscle. Sometimes a blockage can occur acutely. This is a heart attack and requires immediate medical attention.
Obstructive coronary artery disease is sometimes called coronary heart disease (CHD), though that term can include additional conditions as well. CHD is the leading cause of death in women and men. While men are more likely than women to have a heart attack, women are more likely to die from their heart attack.
Some people may not develop any symptoms from coronary artery disease, while others may experience:
- Chest pain (also called angina). This is a discomfort that can occur anywhere in the chest and feels different to different people. Many describe it as a heaviness, pressure, or tightness, and it is sometimes confused with heartburn or indigestion.
- There are three possible types:
- Stable angina: Usually occurs because of predictable reasons like physical activity or emotional stress, and stops when those triggers end – such symptoms should prompt a medical checkup
- Unstable angina: Chest pain that is worsening in frequency and/or severity, sometimes to the point that it is even occurring at rest – this may indicate an impending heart attack and should be evaluated urgently
- Heart attack: Sudden onset of severe and unrelenting chest pain – requires immediate medical attention – call the ambulance
- Pain in the arms, neck, jaw, or back
- Shortness of breath
- Unexplained nervousness or anxiety
Non-Obstructive Coronary Artery Disease
With non-obstructive coronary artery disease, the arteries develop problems such as damaged linings (endothelial dysfunction), inappropriate constriction (coronary vasospasm) malfunctions in their tiny branches (microvascular dysfunction) or squeezing from overlying heart muscle (myocardial bridging).
Non-obstructive conditions can still cause the same symptoms as obstructive disease. At least one out of five people undergoing a coronary angiogram have clear arteries but still report chest pain. While non-obstructive disease is more common in women, men can develop it as well. It poses a diagnostic challenge, and much work remains to verify risk factors, causes, and the best tests and treatments.
Symptoms of Non-Obstructed Coronary Artery Disease
As with arteries narrowed or blocked by plaque (atherosclerosis), chest pain, or angina, is a common symptom of non-obstructive coronary artery disease. This chest pain will usually occur during physical activity or with emotional stress. The pain will usually resolve once the physical activity or emotional stress ends, but sometimes it can be prolonged — often lasting 10 minutes or more.
Coronary vasospasm is unique in that it generally causes chest pain at rest, classically in the early morning hours. If you have prolonged chest pain and are not under a doctor’s care, you should seek medical attention.
Other symptoms can include:
- Pain in the back, arms, or jaw
- Shortness of breath
- Palpitations (sensation of heart beating funny)
Spontaneous Coronary Artery Dissection (SCAD)
When a coronary artery spontaneously dissects, its inner layers split apart. Blood continues to flow, but goes in between these layers, creating a false channel, or lumen. The new pathway compresses the proper channel and can even close it if it fills with enough blood. The supply of blood to the heart muscle is reduced or blocked, potentially causing a heart attack and damage to the heart muscle.
Spontaneous coronary artery dissection (SCAD) generally causes a heart attack. The reduction in blood flow from SCAD can also cause sudden cardiac arrest, in which the heart develops a life-threatening heart rhythm. Survivors of sudden cardiac arrest may be considered for implantation of a defibrillator, which shocks the heart out of a bad rhythm and back into a normal one.
SCAD can develop in more than one artery and is commonly mistaken for other artery problems, such as coronary vasospasm or atherosclerosis. Women represent an estimated 90% of the population with SCAD.
Spontaneous Coronary Artery Dissection (SCAD) Symptoms
Spontaneous coronary artery dissection (SCAD) develops without warning and is usually diagnosed after causing a heart attack or sudden cardiac arrest. Seek help immediately if you think you are experiencing a heart attack, particularly if you feel chest pain.
While other conditions can cause similar symptoms, signs of a heart attack in women can include:
- Chest pain or pressure
- Pain in your arms, back, neck, or jaw
- Shortness of breath
- Nausea and/or vomiting
- Lightheadedness or dizziness
- Excessive sweating
- Extreme fatigue