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What're the symptoms of coronary artery disease?

In most patients, the most common symptom of coronary artery disease is the type of chest pain called angina, or angina pectoris. Angina usually is described as a squeezing, pressing or burning chest pain that tends to be focused either in the center of the chest or just below the center of the rib cage. It also can spread to the arms (especially the left arm), abdomen, neck, lower jaw or neck. Other symptoms can include sweating, nausea, dizziness or light-headedness, breathlessness or

palpitations (often associated with the symptoms of a heart attack). Sometimes, when coronary artery disease produces burning chest pain and nausea, a patient may mistake heart symptoms for indigestion.

Angina that occurs regularly with activity, upon awakening, or at other predictable times is termed stable angina and is associated with high grade narrowings of the heart arteries. The symptoms of angina are often treated with nitrate preparations such as nitroglycerin, which come in short-acting and long-acting forms, and may be administered transdermally, sublingually or orally. Many other more effective treatments, especially of the underlying atheromatous disease, have been developed. Angina that changes in intensity, character or frequency is termed unstable. Unstable angina may precede myocardial infarction, and requires urgent medical attention. It is treated with oxygen, intravenous nitroglycerin, and morphine. Interventional procedures such as Percutaneous Transluminal Coronary Angioplasty may be done.

There are two types of chest pain related to coronary artery disease — stable angina and acute coronary syndrome.

In stable angina, chest pain follows a predictable pattern, usually occurring after extreme emotion, overexertion, a large meal, cigarette smoking or exposure to extreme hot or cold temperatures. Symptoms usually last one to five minutes, and they disappear after a few minutes of rest. Stable angina is caused by a smooth plaque that partially obstructs blood flow in one or more coronary arteries. Acute coronary syndrome (ACS) is much more dangerous. In most cases of ACS, fatty plaque inside an artery has developed a tear or break. The uneven surface can cause blood to clot on top of the disrupted plaque. This sudden blockage of blood flow results in unstable angina or a heart attack (myocardial infarction). In unstable angina, chest pain symptoms are more pronounced and less predictable compared to stable angina. Chest pains occur more frequently, often at rest, and last several minutes to hours. In addition, people with unstable angina frequently develop profuse sweating with aching in the jaw, shoulders and arms.

Many people with coronary artery disease, especially women, do not have any symptoms or have unusual symptoms. In these people, the only sign of coronary artery disease may be a suspicious change in the pattern of a test called an electrocardiogram (EKG), which records the heart's electrical activity. The test can be done at rest or during exercise (exercise stress test). The stress test is able to detect the problem in the coronary artery because exercise increases the heart muscle's demand for blood, a demand that can't be met when the coronary arteries are significantly narrowed. In areas of the heart affected by narrowed coronary arteries, the heart muscle starves for blood and oxygen, and its electrical activity changes. This altered electrical activity is reflected in the patient's EKG results. If the problem is not discovered, the first symptom of coronary artery narrowing may be the severe chest pain of a heart attack. If a heart attack occurs, the patient has a 15 percent chance of dying before receiving medical attention.

Women may have symptoms that differ greatly from men. While chest pain is often a key warning sign of a heart attack, some women who have a heart attack do not experience chest pain. A woman’s pain may be in the back, arm, neck, shoulder, and/or throat. Also, women will typically have more "non-pain" symptoms than men. These include vomiting, nausea, fatigue and shortness of breath. It is also surprisingly common for people to experience no symptoms at all. This is especially true of diabetics and those over the age of 75. We recommend that these individuals visit their family physician and/or cardiologist on a regular basis to continually monitor their health.

More information on coronary artery disease

What is coronary artery disease? - Coronary artery disease is a heart disease condition that results when the coronary arteries are narrowed or occluded, caused by atherosclerotic deposits of fibrous and fatty tissue.
What're the symptoms of coronary artery disease? - In most patients, the most common symptom of coronary artery disease is the type of chest pain called angina, or angina pectoris.
What're the risk factors for coronary artery disease? - Risk factors of coronary artery disease include advancing age, male sex, and a family history of early coronary artery disease.
How is coronary artery disease diagnosed? - The diagnosis of coronary artery disease requires a careful history, physical examination, and an electrocardiogram (ECG).
What're the treatments for coronary artery disease? - Medical treatment for coronary artery disease generally includes medications, risk factor reduction, along with close follow-up with your health care team.
How is coronary artery disease prevented? - Prevention of coronary artery disease centers on the modifiable risk factors: blood sugar, lipoprotein transport systems, obesity, homocysteine, hypertension.
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