Obstructive CAD is a major risk factor for severe, potentially fatal heart difficulties. Early diagnosis and treatment can preserve your heart health and quality of life.

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Having obstructive coronary artery disease (CAD) means there’s significant blockage in the arteries that supply blood to your heart muscle. Significant blockage or stenosis of a coronary artery means that more than 50% of the artery is blocked. This can lead to a heart attack and other serious health difficulties.

Obstructive CAD is the most common type of heart disease, affecting an estimated 1 out of every 20 adults in the United States.

Obstructive CAD can be treated with surgery and other procedures. You may also be able to manage this condition through healthy lifestyle choices and following the advice of a healthcare team.

Obstructive CAD may not have any noticeable symptoms because it tends to progress gradually. Severely restricted blood flow in the heart may lead to angina. Angina is chest pain caused by a reduction in oxygenated blood reaching the heart muscle.

Physical exertion may bring on episodes of angina, though in cases of “unstable angina,” chest pain may come on without an obvious trigger.

When CAD leads to a heart attack, symptoms may include:

  • dizziness or lightheadedness
  • fatigue
  • intense chest pain, pressure, or tightness
  • pain in one or both arms, jaw, or neck
  • shortness of breath
  • weakness

Obstructive coronary artery disease (CAD) is usually the result of atherosclerosis. Atherosclerosis is the buildup of plaque in the walls of your arteries. Plaque is made up of cholesterol, fats, and other substances, and it can gradually form in any artery of the body.

When there’s considerable plaque buildup in the coronary arteries, circulation to the heart becomes restricted, as the opening for blood to flow, known as the “lumen,” grows narrower.

Obstructive CAD differs from nonobstructive coronary artery disease (CAD) in terms of how narrow the coronary arteries are and what’s causing the arteries to narrow. Narrowed arteries indicate a condition known as “stenosis.”

Obstructive CAD means there’s a significant amount of plaque buildup in one or more coronary arteries, causing reduced circulation through a narrowed lumen.

In nonobstructive CAD there may be plaque present, but there’s not enough to significantly restrict blood flow. Instead, other conditions may cause the arteries to narrow in people who have nonobstructive CAD.

Possible causes of nonobstructive CAD include:

  • Coronary vasospasm: an abnormal, sudden constriction of the coronary arteries
  • Endothelial dysfunction: damage to the inner lining of the arteries
  • Myocardial bridging: pressure on the coronary arteries from nearby heart muscle tissue

Although nonobstructive CAD is less dangerous than obstructive CAD, both conditions may lead to angina, heart attack, and heart failure.

To diagnose obstructive CAD, a doctor will review your symptoms, if any, as well as your medical history and your family’s medical history. Heart disease can run in families.

Then, various tests may be administered to confirm or rule out the presence of obstructive CAD. These tests may include:

  • Cardiac MRI scan: A cardiac MRI scan is also helpful in diagnosing microvascular disease, as well as nonobstructive and obstructive CAD.
  • Coronary angiography: A coronary angiography involves contrast dye injected directly into the coronary arteries, which allows the doctor to see the inside of the arteries on an X-ray screen. This test is usually only done if obstructive CAD is strongly suspected.
  • Coronary artery calcium CT scan: A coronary artery calcium procedure measures calcium inside the arteries. The score is often used for people who smoke or for people who have no major CAD symptoms.
  • Exercise stress test: An exercise stress test measures heart function and blood flow through your coronary arteries during physical exertion.

If obstructive CAD is diagnosed, the goal of treatment will be to improve blood flow to the heart. There are two main treatment options: coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI).

With CABG, a heart surgeon will use blood vessels taken from elsewhere in the body to create a detour for blood to flow around the blockage. During this procedure, a heart surgeon attaches (or grafts) a blood vessel to the affected artery to reroute the blood.

With PCI, a doctor uses a catheter to insert a stent in the area of the blockage, pushing the plaque against the artery wall and restoring better blood flow. A stent is a flexible mesh tube.

Engaging in heart-healthy behaviors and taking medications to manage your blood pressure, cholesterol, and blood glucose levels are also important to complement these procedures.

Obstructive CAD is an avoidable condition for many people. The strategies to preventing it are the same as those recommended to prevent atherosclerosis.

Some of the more effective preventive strategies include:

  • eat a balanced, heart-healthy diet, such as the Mediterranean-style eating plan
  • get daily exercise, such as a brisk 30-minute walk or other aerobic activity
  • get 7–9 hours of sleep per night
  • maintain a moderate weight
  • manage stress
  • consider quitting smoking, if you already smoke
  • take medications as prescribed by a doctor

Obstructive CAD may lead to a heart attack and subsequent heart difficulties when left untreated. The earlier you respond to symptoms, the more likely you are to avoid a heart attack. Bypass surgery and stenting can be done as preventive measures or in response to a heart attack.