Coronary artery disease

The Lifeblood of Our Heart

The coronary arteries

The coronary arteries play a critical role in maintaining a healthy heart by supplying oxygen-rich blood to its muscles. However, when these arteries become diseased, it can have serious consequences.

The symptoms and complications of coronary artery disease (CAD) vary depending on the extent and location of the disease within the heart arteries.

The heart primarily has two main arteries, the left coronary artery and the right coronary artery. The left coronary artery further branches into the left anterior descending artery and the left circumflex artery, ensuring adequate blood flow to the entire heart. The specific artery affected determines the symptoms experienced, including chest pain, shortness of breath, fatigue, or asymptomatic cases.

Tailoring the best treatment strategy, whether through lifestyle changes, medications, stents, or bypass surgery, is crucial and based on a personalized assessment of the affected coronary artery/arteries. This emphasizes the importance of individualized care and management in addressing CAD.

Unmasking the Silent Intruder

plaque build-up

Coronary artery disease (CAD) is a widespread condition characterized by the narrowing or blockage of the coronary arteries, which supply oxygen-rich blood to the heart muscle. One of the primary culprits behind CAD is the gradual accumulation of lipid plaque within the arterial walls. In this section, we shed light on this process and its potential consequences, leading to restricted blood flow or even an acute myocardial infarction (AMI).

The initiation:

Coronary artery disease starts with artery damage caused by risks including smoking, high blood pressure, diabetes or high cholesterol.

Plaque development:

In response to injury, cholesterol and other substances infiltrate the damaged area, initiating formation of plaques that may cause narrowings.

Progressive accumulation:

Over time, the plaques accumulate layers of cholesterol, calcium, and cellular debris, causing the artery walls to thicken and narrow.

Restricted flow:

As the plaque enlarges, it restricts the flow of blood to the heart muscle, leading to symptoms such as chest pain (angina) or shortness of breath.

The tipping point:

In some cases, plaque can rupture, causing a clot to form. If this becomes large enough to completely block the artery, it can result in a heart attack.

Coronary Artery Disease

Common symptoms

Recognizing common symptoms of CAD, such as chest pain (angina), shortness of breath, and silent ischemia, is vital for early detection. Myocardial infarction (heart attack) is a severe complication. When in doubt or experiencing persistent symptoms, seeking advice from a healthcare professional is crucial. Early detection and management are key to improving outcomes and preventing complications.

Chest Pain - Angina

Angina can feel pressure, tightness, squeezing, or a burning sensation in the chest. It is typically triggered by physical exertion or emotional stress and tends to subside with rest.

Shortness of Breath

This may  occur during physical activity or even at rest. The reduced blood flow to the heart muscle due to narrowed arteries can lead to less oxygen supply, causing breathlessness.

Silent Ischemia

Some cases, particularly those with diabetes mellitus, may experience silent ischemia. This refers to a lack of typical symptoms despite reduced blood flow to the heart with minimal to no symptoms. 

Myocardial Infarction

Symptoms of a heart attack may include intense and prolonged chest pain, tightness or discomfort, shortness of breath, sweating, nausea, vomiting and pain radiating to the arms, jaw, or back. 

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Medicines Hub

Medications for managing
coronary artery disease

Let's delve into the diverse range of medications used in the management of coronary artery disease (CAD) and associated symptoms like angina. These medications play a crucial role in improving symptoms and preventing complications. Always discuss medicines with your doctor and pharmacist.

looking inside blockages

From the inside

Here we present a video demonstrating some innovative research using a technology called optical coherence tomography (OCT for short). This technology utilizes near infrared light to scan within the arteries of the heart and can visualize plaques in high resolution. Professor Barlis discusses the use of OCT to better understand how plaques develop and cause complications.


What are heart stents?

The specific characteristics of heart stents can vary depending on the manufacturer and the advancements in stent technology. It is essential for healthcare professionals to determine the most appropriate stent size, length, and type based on individual patient needs and the severity of the coronary artery disease. Here are some basic statistics:

Stents act to prop open narrowed arteries caused by plaque build-up in the wall of the heart arteries

Usually made of biocompatible metals, such as stainless steel or cobalt-chromium alloys

Heart stents typically range in length from 8 to 48 millimeters, depending on the specific needs of the patient and the location of the blockage within the coronary artery

Stent diameter can range from as small as 2.25 millimeters to as large as 5.0 millimeters

Future Developments

3D printed
heart stents

In recent years, 3D printing technology has emerged as a groundbreaking tool in the medical field, offering exciting possibilities for personalized healthcare solutions. One area where 3D printing holds immense promise is in the development of personalized heart stents.

Traditional heart stents come in predetermined sizes and designs, which may not always perfectly match the anatomical variations of each patient's coronary arteries. However, 3D printing enables the creation of custom-designed stents tailored to the unique specifications of an individual's arterial anatomy.

By utilizing advanced imaging techniques, such as computed tomography (CT) scans or optical coherence tomography (OCT), we can generate detailed 3D models of a patient's coronary arteries. These models serve as a blueprint for designing stents that precisely fit the patient's vessels, optimizing the stent's effectiveness and reducing the risk of complications.

Dr Eric Poon, BEng, PhD

Chief Biomedical Engineer, Vascutech Pty Ltd.

and Honorary Researcher, Graeme Clark Institue

The University of Melbourne

1.3+ Million youtube views

All about heart stents

This informative and engaging video delves into the intricate details of heart stents, providing viewers with a comprehensive understanding of their significance in cardiovascular health. With its compelling visuals, expert narration, and accessible explanations, the video has successfully captured the attention of a wide audience, highlighting the ever-growing importance of heart health education in today’s digital age.

Surgical Revascularization
Coronary arery bypass grafting (CABG)

Bypass Surgery

Bypass surgery, also known as coronary artery bypass grafting (CABG), is a surgical procedure that may be recommended for certain cases of coronary artery disease (CAD). Particularly, it is considered when there is multivessel disease (narrowing or blockages in multiple coronary arteries) or involvement of the left main artery, which supplies a large portion of the heart muscle. Bypass surgery offers a potential solution by creating new pathways (grafts) using blood vessels from other parts of the body to bypass the blocked or narrowed coronary arteries, restoring improved blood flow to the heart.

Coronary Artery Disease

Useful Resources

Presenting a selection of articles on coronary artery disease (CAD) and its management. CAD is a common heart condition caused by narrowed or blocked coronary arteries, leading to complications like angina, heart attack, and heart failure. The articles cover risk factors, diagnostics, treatments, prevention, and research advancements.

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other anti-anginals

When first-line therapies for angina, such as beta blockers, calcium channel blockers, and nitrates, prove inadequate or are not well-tolerated, second-line therapies may be considered.
Perhexiline is a unique medication that enhances the heart's ability to utilize fatty acids for energy, reducing its reliance on oxygen and lowering oxygen demand. This action helps improve blood flow and alleviates chest pain in some patients with refractory angina.
Nicorandil is another second-line option with a dual mechanism of action. It opens potassium channels in smooth muscle cells, causing vasodilation and enhancing coronary blood flow. Additionally, nicorandil also stimulates nitric oxide release, further dilating blood vessels and reducing heart workload.
Trimetazidine is an anti-ischemic agent that improves cardiac efficiency by enhancing glucose metabolism and shifting the heart's energy production to a more oxygen-efficient process. As second-line therapies, these medications offer alternative approaches for managing angina in individuals who do not respond adequately to first-line treatments or those experiencing side effects from other medications.

lipid lowering therapies

Lipid-lowering therapies play a critical role in managing coronary artery disease (CAD), a condition characterized by the narrowing of blood vessels that supply the heart. Among the most commonly discussed and debated classes of medications are statins, which effectively reduce cholesterol levels and are widely prescribed to lower the risk of cardiovascular events. Alongside statins, other medications like ezetimibe, fibrates, and niacin are also utilized to target specific aspects of lipid metabolism, such as cholesterol absorption, triglyceride levels, and raising high-density lipoprotein (HDL) cholesterol. Additionally, the introduction of medications that inhibit PCSK9, an enzyme involved in cholesterol metabolism, has provided a promising new approach to further lower LDL cholesterol levels. These PCSK9 inhibitors, such as Repatha (evolocumab), have shown significant efficacy in reducing LDL cholesterol levels in patients with CAD, especially for those who may not respond well to traditional therapies.


Nitrates are widely used to treat angina and provide quick relief for chest pain. Commonly available in the form of sublingual sprays or tablets, patches, and long-acting tablets, nitrates work by dilating blood vessels, allowing for increased blood flow and reduced resistance. This dilation eases the heart's workload, leading to a decreased demand for oxygen and prompt alleviation of angina symptoms. Sublingual nitrates act rapidly and are often used to provide immediate relief during angina attacks, while patches and long-acting tablets are employed for preventive purposes. However, nitrates may cause side effects such as headaches, dizziness, and flushing, which usually subside over time.

calcium channel blockers

Calcium channel blockers, including amlodipine, felodipine, cardizem (diltiazem), and verapamil, are commonly prescribed for the treatment of angina. These medications work by inhibiting the influx of calcium into the muscle cells of the heart and blood vessels, leading to their relaxation. As a result, blood vessels widen, promoting improved blood flow and reduced blood pressure. In the context of angina, this relaxation decreases the heart's workload, lowering the demand for oxygen and alleviating chest pain. Calcium channel blockers offer a valuable treatment option for individuals with angina, but it is essential to be aware of potential side effects, which may include headaches, dizziness, flushing, and ankle swelling.

Beta blockers

Beta blockers, such as metoprolol, propranolol, atenolol, carvedilol, and bisoprolol, play a crucial role in treating angina. By blocking certain receptors in the heart, they effectively reduce heart rate and the force of contraction, thereby easing the heart's workload. This mechanism of action leads to a decreased demand for oxygen, making beta blockers highly effective in relieving chest pain associated with angina. As with any medication, it's important to consider potential side effects, including tiredness, worsened asthma, erectile dysfunction in some males, and more vivid dreams during sleep. Consult your healthcare provider to determine the suitability of beta blockers for managing your angina and overall heart health.

Anti-platelet Medications

Anti-platelet medications play a crucial role in preventing blood clot formation, reducing the risk of serious cardiovascular events such as heart attacks and strokes. Among the widely used anti-platelet drugs are aspirin, clopidogrel, and ticagrelor.

Aspirin: This well-known medication inhibits platelet activation, making it less likely for platelets to stick together and form clots. Aspirin is commonly used for primary and secondary prevention of heart attacks and strokes.

Clopidogrel: As a potent anti-platelet agent, clopidogrel works by blocking specific receptors on platelets, preventing them from aggregating. It is often prescribed to patients with acute coronary syndrome, those undergoing stent procedures, and for some cases of peripheral arterial disease.

Ticagrelor: Ticagrelor is another effective anti-platelet drug that works by inhibiting platelet activation. It is used in acute coronary syndrome, often given alongside aspirin to reduce the risk of heart-related events.