CAD: Coronary Artery Disease: Symptoms and Treatments

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Be wary of cardiologists thinking in the “traditional way”


The way we think about Coronary Artery Disease (CAD) and its treatment is in the midst of a major shift, and today, some cardiologists have completely moved to the “new way” of thinking, while others are still stuck in the “traditional way.” The differences between these two schools of thought largely explain much of the debate currently taking place among cardiovascular specialists about who to test for CAD, how to test them, who needs to be treated for CAD, and how to treat them.

Unfortunately, doctors still mired in the traditional way of thinking are missing the boat — and as a result, are subjecting many of their patients to both undertreatment and overtreatment.

The Traditional Way of Thinking About CAD

Traditionally, CAD means there are one or more blockages in the coronary arteries. These blockages can restrict blood flow, which can produce angina (chest discomfort), and, if severe, the blockages can suddenly become complete, causing the heart muscle supplied by that artery to die, which is called a “myocardial infarction” or heart attack. Since the chief problem is the blockage, the chief treatment is to relieve the blockage, which can be done with bypass surgery or stenting. The traditional view of CAD, then, focuses on blockages, which means that precise anatomic location and degree of blockages is critical in assessing CAD. Diagnostic tests that do not provide this information and treatments that do not relieve the blockages are not fully adequate.

Cardiologists who think traditionally tend to insist on cardiac catheterizations as the only adequate diagnostic test and stenting as the only adequate therapy, though they will reluctantly allow that sometimes the cardiac surgeon needs to get involved for particularly extensive or difficult blockages.

The New Way of Thinking About CAD

We now know that CAD is about far more than just blockages. CAD is a chronic, progressive disease that tends to be far more widespread within the coronary arteries than is implied by the presence or absence of actual blockages. Plaques are often present in arteries that appear “normal” on cardiac catheterization. In fact, some patients, especially women, can have widespread CAD that produces a generalized narrowing of the coronary arteries without any actual blockages. Furthermore, heart attacks are produced when a plaque ruptures and causes a clot to form that suddenly blocks the artery — and often this occurs at plaques that are not causing blockages prior to their rupture and would have been called “insignificant” on cardiac catheterization. The key to CAD is not whether specific blockages are present, but whether coronary artery plaques (which often do not cause significant blockages) are present.

What This Means for You

While actual blockages can and do cause angina and heart attacks and while treating specific blockages is often important, therapy aimed at treating blockages is often neither necessary nor sufficient to adequately treat CAD. Evidence is building that with intensive medical therapy — largely based on statins but also including aggressive risk-factor modification — CAD can be halted or even reversed, and plaques can be “stabilized” to reduce the odds that they will rupture.

In these individuals, exercise, smoking cessation, weight loss, blood pressure control and (most experts believe) cholesterol control are especially important.

The key, then, is to decide whether an individual is likely to have active CAD, that is, whether plaques are likely to be present, and then direct therapy accordingly. To a large extent, deciding whether plaques are likely to be present can be accomplished noninvasively. Begin with a simple assessment of risk to decide whether your risk is low, intermediate or high. ( Here’s how to assess your risk simply and easily.) People in the low-risk categories probably need no further intervention.

People in the high-risk categories should be treated aggressively***(with statins and risk-factor modification), as they are very likely to have plaques. People in the intermediate risk category should consider noninvasive testing with EBT scanning (calcium scans): if calcium deposits are present on the coronary arteries, then they have plaques and should be treated aggressively.

***When taking Statin drugs, always take Coenzyme Q10 supplements.++This is one of the most potent and purest forms of CoQ10. To read more about this pure form of CoQ10, click the image. It will take you to another page, then click “other Supplements”.

What is CoQ10?

Coenzyme Q10 (CoQ10) is a natural antioxidant synthesized by the body, found in many foods, and available as a supplement. It comes in two forms: ubiquinol, the active antioxidant form, and ubiquinone, the oxidized form, which the body partially converts to ubiquinol. Many multi-ingredient supplements contain both forms of CoQ10. In general, coenzymes support enzymes in their various biochemical functions. Coenzyme Q10 is a vital participant in the chain of metabolic chemical reactions that generate energy within cells. It is found in every cell of the body (the name ubiquinone stems from its ubiquity), but is present in higher concentrations in organs with higher energy requirements such as the kidneys, liver, and heart.

Many medical studies demonstrate CoQ10 benefits when taken as a supplement, most of which stem from its vital role in oxygen utilization and energy production, particularly in heart muscle cells.

Why is CoQ10 necessary?

Coenzyme Q10 is beneficial for heart health in many ways. It assists in maintaining the normal oxidative state of LDL cholesterol, helps assure circulatory health, and supports optimal functioning of the heart muscle. CoQ10 may also help support the health of vessel walls. In addition, Coenzyme Q10 may play a role in reducing the number and severity of migraine headaches, and improving sperm motility in men. Some research has indicated therapeutic value in high doses to slow the progression of Parkinson’s disease, but a 2011 study by the National Institute for Neurological Disease and Stroke found no benefit in slowing symptoms or neural degeneration. A few small clinical trials have indicated CoQ10 supplementation may help prevent and treat inflamed gums, a condition known as gingivitis.

What are the signs of a Coenzyme Q10 deficiency?

Studies in both animals and humans have associated significantly decreased levels of CoQ10 with a wide variety of diseases. Since this enzyme is found in high concentration in heart muscle cells, deficiency has been associated with cardiovascular problems including angina, arrhythmia, heart failure and high blood pressure. Problems with blood sugar regulation, gingival (gum) health, and stomach ulcers have also been associated with CoQ10 deficiency. Those who are taking statins to lower cholesterol are at particular risk for deficiency, because not only do statins reduce cholesterol levels, but they also block Coenzyme Q10 synthesis in the body. Low CoQ10 levels in patients on statins can contribute to the common side effects of statin therapy such as fatigue and aching joints and muscles.

When to Look for Blockages

Blockages in the coronary arteries are still important. Most experts think that people in the high-risk category should have a stress thallium test. If this test is suggestive of a major blockage, cardiac catheterization should be considered. A stress test or cardiac catheterization should also be strongly considered in anybody (whatever their apparent level of risk) who has symptoms of angina. Relieving blockages by surgery or stenting can be extremely effective in treating angina and, in some circumstances, can improve survival.

What Are the Symptoms of Coronary Artery Disease?

The most common symptom is angina, or chest pain.

Angina can be described as a:

  • Heaviness
  • Pressure
  • Aching
  • Burning
  • Numbness
  • Fullness
  • Squeezing
  • Painful feeling

It can be mistaken for indigestion or heartburn.

Angina is usually felt in the chest, but may also be felt in the:

Symptoms are often subtler in women. Nausea, sweating, fatigue, or shortness of breath can join the typical pressure-like chest pain.

Other symptoms that can occur with coronary artery disease include:

How Is Coronary Artery Disease Diagnosed?

Your doctor can tell if you have coronary artery disease after:

What is ischemia?

Ischemia is the medical term for what happens when your heart muscle doesn’t get enough oxygen. Ischemia usually happens because of a shortage of blood and oxygen to the heart muscle. It is usually caused by a narrowing or blockage of one or more of the coronary arteries (which supply blood to the heart muscle). In many cases ischemia is a temporary problem. Your heart may be able to get enough blood through your diseased coronary arteries while you are resting but may suffer from ischemia during exertion or stress.

What is chronic ischemia?

Your coronary arteries may become so narrowed that they limit the flow of blood to your heart all the time, even when you are at rest. If this happens, ischemia can become an ongoing (chronic) condition that can progressively weaken your heart.

What is angina?

When your heart suffers from ischemia, you will typically experience pain or discomfort in your chest. Angina is the medical term for this chest sensation, which is the most common symptom of coronary artery disease (CAD).

What is silent ischemia?

For reasons that doctors don’t fully understand, some people have ischemia but do not feel chest pain or discomfort or any other symptoms. This condition is called silent ischemia. Silent ischemia occurs most often in women, older people, and people who have diabetes.

People with silent ischemia typically find out that they have it when their doctor notices that their routine electrocardiogram (EKG), ambulatory EKG, or stress test results indicate that their hearts aren’t getting enough blood. Silent ischemia is a particular concern after a heart attack, because it increases the chance of another heart attack.


Our thinking about CAD has changed significantly over the past decade or so. It is not simply a disease of blockages that ought to be treated with stents. Treatment aimed at halting or reversing chronic CAD and at stabilizing plaques to reduce the odds that they will rupture, is very important, whether “significant” blockages are present or not.


Please visit your Health care Provider and discuss any questions or symptoms you may have. is here to inform you and give you the information to help you make better decisions about your health.