Many people put an unusual bout of tiredness down to a long week, and a heavy feeling in the chest down to acidity. Most of the time, that is exactly what it is. But sometimes these small signals point to coronary artery disease (CAD), a slow narrowing of the arteries that feed the heart, and catching it early can make a big difference.
There is also a common fear that a CAD diagnosis automatically means surgery. We spoke to heart specialists about the signs worth noticing, how the condition is diagnosed, and what the treatment options really look like.
What is coronary artery disease?
"Coronary artery disease, or CAD, occurs when the blood vessels supplying the heart become narrowed due to the buildup of cholesterol, fat and other substances in their walls," says Dr. Gajinder Kumar Goyal, Program Clinical Director, Cardiology, Marengo Asia Hospitals, Faridabad. "In simple terms, CAD is like a blockage developing in the pipes that supply blood to the heart," he explains.
As the arteries narrow, "the heart muscle receives less oxygen-rich blood, particularly during physical activity or emotional stress," Dr. Goyal says. "If a plaque suddenly ruptures and a blood clot blocks the artery, it can lead to a heart attack," he adds.
Early signs that are easy to miss
"One of the biggest challenges is that the early symptoms of CAD are not always dramatic," Dr. Goyal says, adding that people may experience unusual tiredness, breathlessness while climbing stairs, discomfort in the chest, or a feeling of heaviness after walking.
Some people describe it as "gas, acidity, indigestion, or pressure rather than pain," he says, and the discomfort may spread to the arms, shoulders, back, neck or jaw. "Symptoms that repeatedly appear during physical exertion and improve with rest should never be ignored," Dr. Goyal says. Not every episode of acidity, he adds, is a heart problem, but persistent or recurring symptoms deserve proper medical evaluation.
Chest pain isn't always the first sign either. CAD can sometimes show up as "breathlessness, unexplained fatigue, reduced exercise capacity, sweating, nausea or discomfort in the upper abdomen," Dr. Goyal says. Women, older adults and people with diabetes may be more likely to have these less typical symptoms.
When symptoms need prompt attention
According to the expert, symptoms that come and go should not automatically be considered harmless. "If chest discomfort, breathlessness or unusual fatigue repeatedly occurs during walking, climbing stairs or other physical activity, the person should arrange a medical assessment promptly," he advises.
Some situations are more urgent. "If the discomfort is new, occurs at rest, becomes more frequent or severe, or lasts longer than usual, it may indicate an acute heart problem," he says. In that case, or if there is chest pressure with breathlessness, cold sweating, nausea or faintness, "they should seek emergency care immediately rather than waiting for the symptoms to settle or trying to treat them as acidity," Dr. Goyal says. "Do not drive yourself if a heart attack is suspected," he adds.
How CAD is diagnosed
"The evaluation begins with a detailed medical history, an assessment of risk factors and a physical examination," Dr. Goyal says. An ECG can show signs of a heart attack or other abnormalities, while blood tests, including cholesterol, blood sugar and kidney function, help assess overall risk. "Depending on the clinical situation, an echocardiogram, exercise stress test, stress imaging or CT coronary angiography may be recommended," he says.
Not everyone needs every test. "The aim is to choose the right investigation for the right patient rather than subjecting everyone to unnecessary testing," he explains.
Does CAD always mean surgery?
"CAD does not always require surgery," says Dr. Aditya Kumar Singh, Director, Minimally Invasive & Robotic Heart Surgeon, Max Smart Super Speciality Hospital, New Delhi. "The decision depends on how severely the heart arteries are blocked, which arteries are affected, symptoms, and how well the heart pumps blood," he explains.
There are two main procedures, Dr. Singh says: "coronary artery bypass grafting (CABG), performed by a cardiac surgeon, and angioplasty with a stent (PCI), performed by an interventional cardiologist."
Bypass surgery may be recommended in certain situations, he says, such as a significant blockage in the left main coronary artery, or three-vessel or complex multivessel disease, where "bypass may offer better long-term outcomes than stenting in suitable patients, especially when diabetes is present." It may also help "in selected patients who have severe pumping weakness and multivessel disease," Dr. Singh says.
Surgery or a stent may also be needed "if chest pain continues despite appropriate treatment," he says, or when "blockages are too complex for effective stenting or an earlier procedure has not worked."
Everyday habits that protect the heart
Heart protection begins with everyday habits. “Eat a balanced diet rich in vegetables, fruits, whole grains, pulses, nuts and other healthy foods. Reduce salt, excess sugar, deep-fried foods and trans fats," Dr. Goyal advises. "Aim for at least 150 minutes of moderate physical activity each week, building up gradually according to your health and fitness," he says, adding that one should avoid tobacco completely, maintain a healthy weight, get adequate sleep and manage stress.
It is equally important to monitor blood pressure, blood sugar and cholesterol, and to take prescribed medicines regularly. People with diabetes, high blood pressure, high cholesterol or a strong family history may need more frequent check-ups. For otherwise healthy adults, preventive check-ups should be tailored to age and individual risk rather than relying on one fixed annual package.
