Coronary Artery Disease
Coronary artery disease (CAD) — also known as ischaemic heart disease — is the most common form of heart disease and one of the leading causes of death globally. It occurs when the coronary arteries, which supply oxygen-rich blood to the heart muscle, become narrowed or blocked due to the gradual build-up of atherosclerotic plaques — deposits of fat, cholesterol, calcium, and other substances within the arterial wall.
How it develops
Atherosclerosis is a slow, progressive process that begins as early as childhood and adolescence, though it typically does not cause symptoms until middle age or later. Plaque build-up gradually narrows the coronary arteries, reducing blood flow to the heart muscle. When the restriction becomes significant, the heart may receive insufficient oxygen during periods of increased demand — such as physical exertion or emotional stress — leading to chest pain (angina). If a plaque ruptures suddenly, a blood clot forms at the site, which can completely block the artery and cause a heart attack (myocardial infarction).
Risk factors
The major modifiable risk factors are well established: high blood pressure, high LDL cholesterol, type 2 diabetes and insulin resistance, smoking, obesity, physical inactivity, an unhealthy diet, and excessive alcohol consumption. Non-modifiable risk factors include advancing age, male sex (though risk in women rises sharply after the menopause), and a family history of early heart disease.
Symptoms
Classic angina presents as a squeezing or heavy pressure in the centre of the chest, often radiating to the left arm, jaw, or back, typically triggered by exertion and relieved by rest. Some people — particularly women, older adults, and those with diabetes — experience atypical symptoms such as breathlessness, nausea, fatigue, or discomfort in the upper abdomen. A heart attack typically presents with more severe, persistent chest pain accompanied by sweating, breathlessness, nausea, and a sense of impending doom.
Diagnosis
Investigations include a resting ECG, exercise stress testing, echocardiography, CT coronary angiography (a non-invasive scan of the coronary arteries), and invasive coronary angiography (where a catheter is passed into the coronary arteries to directly visualise and measure the degree of narrowing).
Treatment
Lifestyle modification and medications — including statins, antiplatelets (aspirin or clopidogrel), beta-blockers, ACE inhibitors, and nitrates — form the cornerstone of management. When medical therapy is insufficient, coronary revascularisation may be appropriate: percutaneous coronary intervention (PCI or angioplasty, often with stent placement) is a catheter-based procedure, while coronary artery bypass grafting (CABG) is the surgical alternative for more complex or extensive disease.
Choosing where to be treated
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