The key symptom of Coronary Artery Disease (CAD) is ANGINA PECTORIS, a pressurelike discomfort or pain originating in the central chest and often radiating up the arm into the jaw and through the shoulder area to the back.
At this stage, medical or surgical interventions can head off CAD-induced heart attack. For many people, however, the first indication of CAD is heart attack, which can occur when an atherosclerotic coronary artery ruptures or a blood clot lodges in a section of a coronary artery where CAD has narrowed the passageway. The resulting blockage, or occlusion, interrupts blood flow to a portion of the heart and the heart tissue dies.
CARDIAC CATHETERIZATION and ANGIOGRAM provide definitive diagnosis. These procedures allow the cardiologist to visualize the path of blood through the coronary arteries, highlighting constricted or blocked areas. Severe CAD also causes ARRHYTHMIA (disturbance of the heart’s electrical activity), which a person may experience as PALPITATIONS and that show up on ELECTROCARDIOGRAM (ECG).
Exercise STRESS TEST, particularly radionuclide testing, reveals the functional limitations resulting from the Coronary Artery Disease (CAD). ECHOCARDIOGRAM often reveals the dysfunction of the walls of the
heart served by diseased coronary arteries, as well as decreased heart function if there has already been damage, and with Doppler ULTRASOUND may show restrictions in the flow of blood.
A variation of CT scan, ELECTRON BEAM COMPUTED TOMOGRAPHY (EBCT) SCAN, can detect calcification in the arterial walls. Calcification indicates longstanding accumulations of plaque that have solidified within the intima, a sign of well-established CAD that, while perhaps not causing symptoms, is significant enough to pose the risk of heart attack. Of equal, and perhaps greater, concern to cardiologists is the accumulation of soft, unstable atherosclerotic plaque, sometimes called vulnerable atheroma.
These soft accumulations appear to cause continued irritation to the arterial wall, with resulting clot formation and the risk that the atherosclerotic plaques will rupture, spilling particles and debris into the blood circulation.