Arteries narrow when plaque made up of fats, cholesterol and other substances starts to deposit in the artery walls. This hardens the arteries, causing them to be unresponsive to cardiac stress. The heart cannot get the oxygen-rich blood it needs. Symptoms, such as shortness of breath and chest pain (angina pectoris), may occur during exercise, emotional stress or even at rest. As plaque grows, it can completely block the artery, preventing part of the heart muscle from receiving oxygen and causing a heart attack. Vessels are often blocked or narrowed in multiple spots. If an artery in the brain is blocked, it can lead to stroke. When arteries outside of the heart are affected, the disease is called peripheral artery disease (PAD).

• Age (over 45 for men, over 55 for women)
• A family history of heart and vascular disease
• Diabetes
• Smoking
• Hypertension (high blood pressure)
• High level of blood cholesterol (LDL, sometimes called “bad” cholesterol) and triglyceride levels (a type of fat found in blood)
• Low level of "good" cholesterol (HDL)
• Being overweight or obese
• Sedentary lifestyle
• Emotional stress

Since arteries narrow and harden gradually over the years, it can take decades before patients experience discomfort. The first symptoms usually appear when the heart is under stress, for example during exercise. Symptoms vary and may also occur at rest or during sleep.If you suspect you are having a heart attack or are experiencing chest discomfort, especially with the following symptoms, seek medical help immediately:

• Shortness of breath
• Heart palpitations
• Discomfort, pressure or pain in the center of the chest (angina pectoris) or radiating to one or both arms or jaw
• Pain in the neck, jaw, throat, abdomen, or back
• Quick exhaustion during physical activity which did not use to cause symptoms
• Dizziness
• A fast heart beat
• Nausea or vomiting
• Sweating

If you have these symptoms, even rarely or temporarily, consult your physician. Men over 45 and women over 55 should have regular check-ups.

These tests may be used to confirm coronary artery disease:

• Electrocardiography (ECG or EKG): records the electrical activity of the heart.
• Echocardiogram (ECHO): uses an ultrasound to detect how the heart is working.
• Stress test: a heart can function normally while at rest, so it is important to repeat tests while the heart is under physical or pharmacological stress.
• Catheterization of the heart (also called Coronary Angiography): a test done in a catheterization laboratory (“cath lab”) in which a cardiologist injects contrast dye into the vascular system. X-ray images of the heart then show where the coronary vessels are narrowed.
• Intravascular ultrasound (IVUS): performed in the cath lab using high-frequency ultrasound waves to shows the inside of a vessel.
• Magnetic resonance imaging (MRI): a non-invasive method to show lesions in the arteries.
• Computer tomography (CT): an X-ray scan showing the arteries at different angles.
• Blood tests: to check blood fat levels in the blood. Certain parameters can indicate damaged heart muscle cells.

Find out more about the treatment of coronary artery disease.