3 Coronary Artery Disease
Learn how coronary artery disease affects blood flow to the heart, how to assess and respond to angina, and how to support safe treatment and risk reduction.
How affects the heart
develops when narrows or blocks the coronary arteries. This reduces oxygen-rich blood flow to the heart muscle and can cause and .
During activity, the heart needs more oxygen. If narrowed arteries cannot increase blood flow enough to meet that demand, ischemia and chest discomfort may result.
Recognizing concerning chest discomfort
A person’s usual pattern of chest discomfort matters. New pain at rest, worsening symptoms, or pain that does not resolve may signal an and requires urgent evaluation.
A change from predictable discomfort during activity to an episode at rest is concerning. Do not delay care by asking the person to exert themselves to test whether symptoms worsen.
Assessing and responding to symptoms
If a patient with known develops chest pressure during activity, stop the activity and help the patient rest. Stay with the patient, promptly assess symptoms and vital signs, and follow the facility’s chest-pain or emergency protocol, including escalation when indicated.
Focused symptom assessment
Ask about:
Onset and duration.
Location, quality, and radiation of the discomfort.
Factors that trigger, relieve, or worsen it.
Associated symptoms, such as shortness of breath, nausea, sweating, or lightheadedness.
Whether the patient has had a similar pattern before and whether the pattern has changed.
A focused history helps characterize the episode and identify changes from the usual pattern. It does not replace prompt assessment or an emergency response when indicated.
Using medicines safely
Teach patients to use prescribed medicines according to their individualized treatment plan, rather than changing use based on whether they feel well. Risk-reducing medicines, including prescribed cholesterol-lowering therapy, may remain important when a person has no symptoms. Encourage patients to discuss medication changes, barriers, or adverse effects with the prescriber; they should not change doses independently.
For prescribed , explain that the patient should place it under the tongue or use it as directed on the prescription. Sitting or lying down can reduce injury from dizziness or low blood pressure. The patient should follow the individualized prescription, not take more than prescribed, and seek emergency help if symptoms are severe, worsening, or not resolving. Patients should tell their care team about other medicines because some combinations can be unsafe.
Supporting risk reduction and follow-up
Risk-reduction measures that can support heart health include:
Stop smoking and avoid secondhand smoke.
Follow a heart-healthy eating pattern and limit saturated fat and sodium.
Monitor blood pressure, cholesterol, and blood glucose and work with the care team to manage them.
Work toward a healthy weight.
Participate in physical activity appropriate to the person’s health and care plan.
Activity should be individualized. Patients with symptoms or known should follow their clinician’s guidance; avoiding all physical activity indefinitely is not the recommended approach described here.
Education should also cover symptoms that require emergency help, changes to report to the care team, and the patient-specific plan for prescribed medicines. Ask the patient to explain the plan back in their own words, and reinforce follow-up for blood pressure, cholesterol, and blood glucose.