A comprehensive guide to understanding CAD: the coronary arteries, how plaque develops, what symptoms to watch for, and how it's treated.
Chest pain or discomfort triggered by reduced blood flow to the heart, what it feels like, what causes it, and when to seek help.
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Both can cause chest pain but they are very different in cause, urgency and treatment. Understanding the distinction could save a life.
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Often confused, but fundamentally different events. One is a plumbing problem, the other an electrical one, and the response to each is not the same.
Read more →The coronary arteries play a critical role in maintaining a healthy heart by supplying oxygen-rich blood to its muscles. When these arteries become diseased, it can have serious consequences.
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 (LAD) 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 in some cases no symptoms at all. Tailoring the best treatment strategy, whether through lifestyle changes, medications, stents or bypass surgery, is based on a personalised assessment of which coronary arteries are involved.
Understanding which arteries are affected helps explain your symptoms and why your cardiologist has recommended a particular treatment approach. Don't hesitate to ask which vessel is involved and what role it plays in your heart's blood supply.
Coronary Artery Anatomy
CAD is characterised by the narrowing or blockage of the coronary arteries due to the gradual accumulation of lipid plaque within the arterial walls. Here's how that process unfolds, and why it matters.
CAD starts with artery damage caused by risk factors including smoking, high blood pressure, diabetes or high cholesterol. This injury triggers an inflammatory response in the vessel wall.
In response to injury, cholesterol and other substances infiltrate the damaged area, initiating the formation of plaques that may cause narrowings inside the artery.
Over time, plaques accumulate layers of cholesterol, calcium and cellular debris, causing the artery walls to thicken and narrow the channel through which blood flows.
As plaque enlarges, it restricts blood flow to the heart muscle, leading to symptoms such as chest pain (angina) or shortness of breath, especially with exertion.
In some cases, plaque can rupture, causing a blood clot to form rapidly. If the clot becomes large enough to completely block the artery, it can result in a heart attack (myocardial infarction).
Understanding Plaque Build-up
Optical Coherence Tomography (OCT) uses near-infrared light to scan within coronary arteries and visualise plaques in high resolution enabling cardiologists to better understand how plaques develop and cause complications. Professor Barlis and his team have pioneered its use to guide treatment decisions.
Plaque: From the Inside: OCT Imaging
Recognising common symptoms of CAD is vital for early detection. Symptoms vary depending on the extent and location of disease, and many people have no symptoms at all until a significant event occurs.
Women are more likely to experience atypical symptoms. These can include jaw pain, nausea, extreme fatigue, back discomfort rather than classic chest tightness. These can easily be misattributed to other causes. If anything feels off with your heart, seek assessment regardless of whether your symptoms fit the textbook description.
Understanding your risk factors helps you take steps to protect your heart health. Some cannot be changed but many can be effectively managed through lifestyle changes or treatment.
Smoking
Damages blood vessels and significantly increases heart disease risk; one of the most powerful modifiable risk factors.
High Blood Pressure
Puts extra strain on your heart and arteries, increasing the risk of heart attack and accelerating plaque formation.
High 'Bad' Cholesterol
Elevated LDL cholesterol contributes directly to plaque build-up in the artery walls.
Diabetes
High blood sugar can damage arteries and accelerate atherosclerosis significantly.
Obesity
Excess body weight is linked to high blood pressure, diabetes and elevated cholesterol.
Physical Inactivity
Lack of exercise is linked to multiple risk factors — blood pressure, weight and cholesterol all worsen with a sedentary lifestyle.
Excess Alcohol
Heavy drinking raises blood pressure and can damage the heart muscle directly.
Poor Diet
Diets high in saturated fats, sugar and salt increase cardiovascular risk across multiple pathways.
Age
Risk increases with age, especially after 45 for men and 55 for women.
Gender
Men and post-menopausal women have higher risk of cardiovascular disease.
Family History
Having a close relative with early heart disease raises your personal risk meaningfully.
Ethnicity
Some populations have a higher genetic predisposition to heart disease and should be monitored more proactively.
Having multiple risk factors doesn't simply add risk, it can multiply it. Ask your cardiologist about your overall cardiovascular risk score, which considers all your factors together. Addressing even one or two modifiable risks can make a significant difference to your long-term heart health.
A range of medications are used in the management of coronary artery disease and its symptoms, including angina. These play a crucial role in improving symptoms and preventing complications. Always discuss your medicines with your doctor and pharmacist.
Anti-platelet medications play a crucial role in preventing blood clot formation and reducing the risk of serious cardiovascular events such as heart attacks and strokes. Commonly used agents include aspirin, clopidogrel and ticagrelor.
Aspirin inhibits platelet activation, reducing the likelihood that platelets will clump together and form clots. It is widely used for both primary and secondary prevention of heart attacks and strokes.
Clopidogrel blocks specific receptors on platelets to prevent aggregation. It is commonly prescribed for patients with acute coronary syndrome, those undergoing stent placement, and some individuals with peripheral arterial disease.
Ticagrelor also inhibits platelet activation and is typically used in the treatment of acute coronary syndrome — often prescribed alongside aspirin to provide dual anti-platelet therapy and further reduce the risk of heart-related events.
Beta blockers — such as metoprolol, propranolol, atenolol, carvedilol and bisoprolol — play a crucial role in managing angina. These medications work by blocking specific receptors in the heart, slowing the heart rate and reducing the strength of each contraction.
This results in a lower oxygen demand by the heart and helps relieve chest pain associated with angina. Beta blockers are highly effective in both relieving symptoms and preventing angina episodes.
However, they may cause side effects in some individuals, including tiredness, worsened asthma symptoms, more vivid dreams and erectile dysfunction in some males. Consult your healthcare provider to determine whether beta blockers are a suitable option for your situation.
Nitrates are widely used to treat angina and provide quick relief from chest pain. They are commonly available as sublingual sprays or tablets, skin patches and long-acting tablets.
Nitrates work by dilating blood vessels, allowing for increased blood flow and reduced vascular resistance. This reduces the heart's workload and lowers its oxygen demand, offering prompt relief from angina symptoms.
Sublingual nitrates act quickly and are typically used at the onset of angina symptoms, while patches and long-acting tablets are used for ongoing prevention. Common side effects include headaches, dizziness and flushing — these often improve with continued use.
Calcium channel blockers — including amlodipine, felodipine, diltiazem (Cardizem) 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, causing them to relax. This relaxation leads to the widening of blood vessels, improving blood flow and reducing blood pressure.
For people with angina, calcium channel blockers reduce the heart's workload and oxygen demand, helping to relieve chest pain and prevent angina episodes. Side effects may include headaches, dizziness, facial flushing and ankle swelling.
Lipid-lowering therapies are essential in managing CAD. Among the most commonly prescribed are statins, which reduce cholesterol production in the liver and significantly lower the risk of heart attacks and strokes.
Other medications target different aspects of lipid metabolism:
Together, these therapies provide a range of options to personalise treatment and improve cardiovascular outcomes.
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. These include agents such as ranolazine and ivabradine, which work through different mechanisms to reduce angina frequency and improve exercise tolerance.
Your cardiologist will advise whether any of these medications is appropriate based on your specific symptoms, heart function and tolerance of other treatments.
Further reading on medications relevant to coronary artery disease:
What is Clopidogrel used for?
Jun 2025Ticagrelor (Brilinta): Understanding Your Heart Medication
Sep 2023The Timing of Cholesterol-Lowering Medications: Does Nighttime Dosing Make a Difference?
Jun 2024What is Amiodarone? Uses, Administration, Side Effects and Precautions
Jul 2025Understanding Spironolactone: A Helpful Medicine for the Heart and More
Apr 2023Understanding the Difference Between Warfarin and NOACs
Many people with CAD take several medications daily. Understanding what each one does and why it matters significantly improves long-term adherence, one of the most important factors in protecting against future cardiac events. Never stop a medication without first discussing it with your cardiologist.
Stents are small mesh tubes placed inside narrowed coronary arteries to prop them open and restore blood flow. Their specific characteristics vary depending on the manufacturer and advances in stent technology.
Coronary Stents: What You Need to Know
Stents prop open narrowed arteries caused by plaque build-up. A tiny balloon is first inflated at the blockage to compress the plaque, then the stent is expanded and deployed thereby holding the artery open. Most modern stents are drug-eluting, slowly releasing medication to prevent re-narrowing.
Most people go home the same day or the following morning. You will typically need dual antiplatelet therapy for 6–12 months. Never stop these medications without speaking to your cardiologist.
Bypass surgery (coronary artery bypass grafting, or CABG) is a surgical procedure that may be recommended for certain cases of CAD, particularly multivessel disease or involvement of the left main coronary artery. It creates new pathways using blood vessels from other parts of the body to bypass blocked arteries and restore blood flow to the heart.
CABG is typically considered for multivessel disease, involvement of the left main coronary artery, or when anatomy makes stenting technically complex or less durable long-term.
A vein from the leg (saphenous vein) or chest wall artery (internal mammary artery) bypasses the blocked segment. Recovery typically takes 6–12 weeks; cardiac rehabilitation is strongly recommended.
Professor Jai Raman
Cardiothoracic Surgeon
"Bypass surgery has transformed the lives of countless patients with complex coronary disease. When performed at the right time and for the right patient, it offers durable, long-term relief and a genuine return to quality of life."
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If you experience chest pain, shortness of breath, or any symptom that concerns you — it is never silly to seek help. Most of the time it will turn out to be nothing serious, and that is absolutely fine. You are never wasting anyone's time by getting checked. Emergency services would always rather you call. In Australia dial 000, UK 999, USA and Canada 911, Europe 112.
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