How does coronary artery disease cause heart failure

Coronary heart disease (CHD) is usually caused by a build-up of fatty deposits (atheroma) on the walls of the arteries around the heart (coronary arteries).

Table of Contents Show

High blood pressure
High cholesterol
High lipoprotein (a)
Lack of regular exercise
Coronary Artery Disease Symptoms
Risk Factors for Coronary Artery Disease
Diagnosing Coronary Artery Disease
Treatment Options for Coronary Artery Disease
Managing CAD after an Interventional Procedure
Does coronary artery disease cause CHF?
How does coronary heart disease affect the heart?
How are coronary arteries involved in heart disease?
What is the difference between coronary artery disease and congestive heart failure?

The build-up of atheroma makes the arteries narrower, restricting the flow of blood to the heart muscle. This process is called atherosclerosis.

Your risk of developing atherosclerosis is significantly increased if you:

smoke
have high blood pressure (hypertension)
have high cholesterol
have high levels of lipoprotein (a)
do not exercise regularly
have diabetes

Other risk factors for developing atherosclerosis include:

being obese or overweight
having a family history of CHD – the risk is increased if you have a male relative under the age of 55, or a female relative under 65, with CHD

Smoking

Smoking is a major risk factor for coronary heart disease. Both nicotine and carbon monoxide (from the smoke) put a strain on the heart by making it work faster. They also increase your risk of blood clots.

Other chemicals in cigarette smoke can damage the lining of your coronary arteries, leading to furring of the arteries. Smoking significantly increases your risk of developing heart disease.

Read about how to stop smoking and stop smoking treatments.

High blood pressure

High blood pressure (hypertension) puts a strain on your heart and can lead to CHD.

High cholesterol

Cholesterol is a fat made by the liver from the saturated fat in your diet. It's essential for healthy cells, but too much in the blood can lead to CHD.

High lipoprotein (a)

Like cholesterol, lipoprotein (a), also known as LP(a), is a type of fat made by the liver. It's a known risk factor for cardiovascular disease and atherosclerosis.

The level of LP(a) in your blood is inherited from your parents. It's not routinely measured, but screening is recommended for people with a moderate or high risk of developing cardiovascular disease.

Heart UK has more information about high lipoprotein (a).

Lack of regular exercise

If you're inactive, fatty deposits can build up in your arteries.

If the arteries that supply blood to your heart become blocked, it can lead to a heart attack. If the arteries that supply blood to your brain are affected it can cause a stroke.

Read about the physical activity guidelines for adults aged 19 to 64.

Diabetes

A high blood sugar level may lead to diabetes, which can more than double your risk of developing CHD.

Diabetes can lead to CHD because it may cause the lining of blood vessels to become thicker, which can restrict blood flow.

Thrombosis

A thrombosis is a blood clot in a vein or artery.

If a thrombosis develops in a coronary artery it prevents the blood supply from reaching the heart muscle. This usually leads to a heart attack.

Page last reviewed: 10 March 2020
Next review due: 10 March 2023

Coronary Artery Disease (CAD) develops when the arteries that supply blood to your heart become narrowed or blocked by a build-up of fatty deposits called plaque. As a result, it gets harder for the arteries to supply blood to the heart.

Coronary Artery Disease Symptoms

Symptoms of CAD may include:

Chest pain (angina)
Shortness of breath
Heaviness in the chest
Pain in the jaw or down the arms
Heartburn
Nausea
Vomiting
Heavy sweating

Risk Factors for Coronary Artery Disease

There are several risk factors for CAD. Certain risk factors are beyond your control, including:

Age
Family history of heart disease

However, majority of risk factors can be controlled. When addressed successfully, these factors can reduce the risk of further heart disease:

Smoking decreases the amount of oxygen delivered to the heart, and increases the risk of developing deadly blood clots.
Obesity or excess body fat, particularly around the waist, can be a cause of increased blood pressure and high blood cholesterol.
Lack of physical activity or an inactive lifestyle may contribute to CAD.
High blood pressure places a strain on the heart and directly damages blood vessels, making it easier
for plaque to form. Diabetes causes excess sugar to build up in blood vessels and damages nerves.
High cholesterol in the blood can lead to atherosclerosis, or the build-up of thick, fatty plaque that clogs arteries.

Diagnosing Coronary Artery Disease

If your doctor suspects that you have CAD, you’ll likely be asked to take a physical exam to check your heart and see how well it is working. Some of the tests used to diagnose CAD include:

1. Electrocardiogram (ECG)
Records your heart’s electrical activity to identify an abnormal heartbeat or damage to the heart muscle.

2. Stress test
Evaluates your heart rate and rhythm while you are exercising.

3. Echocardiogram
Measures the chambers and heart function using sound waves and check your valves and major blood vessels.

4. Coronary Angiography
Coronary angiography is a procedure to visualize the coronary arteries. The coronary arteries are the blood vessels that supply blood to the heart muscles. On ordinary chest X-ray films, the heart appears as a silhouette and the coronary arteries cannot be seen.

To see the coronary arteries, a special dye or contrast medium is injected through a small tube (catheter) inserted via a large artery in the groin or the wrist. The catheter is then advanced to the heart and positioned at the openings of the coronary arteries before the injection is performed.

After the catheter placement and filming, which normally takes about 15 to 30 minutes, the catheters will be removed.

Upon removal, the doctor will discuss his findings with you. If necessary and you are agreeable, he may proceed directly to coronary angioplasty.

Treatment Options for Coronary Artery Disease

Treatment of CAD usually begins with lifestyle changes and/or medications that help the heart work more efficiently and improve blood flow to the heart muscle.

If these initial treatments are unable to control the symptoms of CAD, an interventional procedure may be required. The same is true if the narrowing of the artery is so great that the lack of blood flow is starving the heart muscle of oxygen.

Interventional procedures that are “minimally invasive” include balloon angioplasty, coronary artery stenting, and a Bioresorbable Vascular Scaffold (BVS). Depending on your medical history or the condition of your blocked artery, coronary bypass surgery may be preferred. This uses a healthy blood vessel taken from the chest, leg, or arm to redirect the flow of blood around a section of the blocked artery within the heart.

Balloon Angioplasty – a small balloon is inflated within the narrowed portion of a blocked artery, pushing plaque against the artery walls and improving blood flow to the heart.

Bare Metal Stent – a metallic mesh tube that is delivered on an angioplasty balloon to the narrowed portion of an artery to permanently support the artery walls and improve blood flow.

Drug-eluting Stent – a metallic coronary artery stent, permanently implanted in an artery, which has been coated with medication to prevent an overgrowth of the artery lining that can occur as a reaction to stent implantation.

Bioresorbable Vascular Scaffold (BVS) – the latest advance in CAD therapy, a non-metallic mesh tube that is delivered on an angioplasty balloon to treat a narrowed artery, similar to a stent, but slowly dissolves once the blocked artery can function naturally again and stay open on its own.

Managing CAD after an Interventional Procedure

Once a CAD care plan has been established by your doctor, its success depends on your willingness to see it through.

If you smoke, create a plan to stop. There are support groups you can contact to help encourage you, as well as medications to make stopping easier.

Try to lose weight, even if it’s only a few kilograms. Remember that even a 2.5 to 5 kg weight loss can significantly reduce your risk of heart disease.

Make moderate exercise a part of your daily routine. Regular physical activity is a great way to burn fat. It also releases natural chemicals such as endorphins and vasodilators that help to maintain healthy blood vessels.

Monitor your blood pressure, cholesterol, and blood sugar. In addition to having your blood pressure, cholesterol, and blood sugar checked regularly, be sure to limit your sodium intake, eat healthy foods, exercise regularly, maintain a healthy weight, and take all medications prescribed by your doctor.

Visit your doctor regularly. After being diagnosed with CAD, it’s important to have regular check-ups with your doctor.

Don’t try to become a new person overnight. Instead, select an area or two to work on and go from there. By setting achievable goals, you may be surprised at the level of success you’ll reach.

Make changes gradually. If you want to lose weight, work steadily towards a realistic goal – every kilogram you lose is a step in the right direction. If you want to reduce sugar in your diet, eliminate desserts a few days a week, but not every day. Small changes over time increase the chance of making a permanent change.

Enlist the support of friends or family members. If your goal is to take more walks or join a gym, ask a friend to accompany you. You’ll be much more likely to stick with an activity when it’s social and fun.

Download Coronary Angiography and Angioplasty: A Patient’s Guide to Pre-and-Post Procedure (English)

Download Coronary Angiography and Angioplasty: A Patient’s Guide to Pre-and-Post Procedure (Chinese)

Read next here:

What is Coronary Angiography?

Does coronary artery disease cause CHF?

The most common cause of congestive heart failure is coronary artery disease. Risk factors for coronary artery disease include: high levels of cholesterol and/or triglyceride in the blood.

How does coronary heart disease affect the heart?

CAD happens when coronary arteries struggle to supply the heart with enough blood, oxygen and nutrients. Cholesterol deposits, or plaques, are almost always to blame. These buildups narrow your arteries, decreasing blood flow to your heart. This can cause chest pain, shortness of breath or even a heart attack.

How are coronary arteries involved in heart disease?

Since coronary arteries deliver blood to the heart muscle, any coronary artery disorder or disease can have serious implications by reducing the flow of oxygen and nutrients to the heart muscle. This can lead to a heart attack and possibly death.

What is the difference between coronary artery disease and congestive heart failure?

One of the biggest differences is that heart disease happens gradually over time while a heart attack occurs suddenly and is an emergency. Heart failure occurs when the muscles of the heart become weak and have difficulty pumping enough blood to nourish your body's many cells.