Medically reviewed by Nachiket J. Patel, MD, FACC, FSCAI. Last reviewed July 2026.
Coronary artery disease, often shortened to CAD, develops when plaque builds up inside the arteries that supply the heart muscle. The narrowing may happen gradually, and symptoms can be easy to dismiss at first.
Some people notice chest pressure or shortness of breath with activity. Others mainly feel tired, lose stamina, or have no obvious warning until testing finds a problem. Diabetes and other conditions can make the symptoms less typical.
At Flow Heart & Vascular in Mesa, Arizona, Nachiket J. Patel, MD, FACC, FSCAI, evaluates the whole picture: your symptoms, risk factors, prior tests, and the effect the problem is having on your life. The goal is to identify meaningful disease and choose treatment that is likely to help.
What happens in coronary artery disease?
The coronary arteries run along the surface of the heart and deliver oxygen-rich blood to the heart muscle. With atherosclerosis, cholesterol, calcium, inflammatory cells, and other material collect within an artery wall and form plaque.
A plaque may slowly limit blood flow, particularly when the heart is working harder. A plaque can also rupture suddenly and trigger a blood clot. That abrupt loss of blood flow can cause a heart attack.
The amount of narrowing is only part of the story. The location of the disease, whether it limits blood flow, the character of the plaque, and the patient’s symptoms all matter when deciding what to do next.
What symptoms can CAD cause?
Angina is the classic symptom. People describe it in different ways: pressure, heaviness, squeezing, burning, tightness, or an uncomfortable fullness in the chest. It may spread to the shoulder, arm, back, neck, or jaw.
Symptoms often appear with walking, climbing stairs, emotional stress, or another activity that makes the heart work harder. They may improve with rest. Not everyone follows that pattern, and some people experience an angina equivalent rather than chest discomfort.
- Shortness of breath with activity
- A noticeable decline in exercise tolerance
- Unusual fatigue or weakness
- Nausea, sweating, or lightheadedness
- Discomfort in the arm, shoulder, back, neck, or jaw
- Symptoms that occur at rest or wake you from sleep
When is chest discomfort an emergency?
Call 911 for new, severe, persistent, or worsening chest pressure; chest discomfort with shortness of breath, sweating, nausea, or faintness; or symptoms that occur at rest. Do not drive yourself if a heart attack may be occurring.
An outpatient cardiology visit is appropriate for stable concerns, risk assessment, or follow-up. It is not a substitute for emergency evaluation when symptoms could represent an active heart attack.
Who is more likely to develop CAD?
Risk increases as several factors accumulate. Some can be changed; others, such as age and family history, cannot. Knowing both types helps build a realistic prevention plan.
- Tobacco use
- High LDL cholesterol or another lipid disorder
- High blood pressure
- Diabetes or insulin resistance
- Chronic kidney disease
- Limited physical activity
- Excess body weight
- Sleep apnea
- A strong family history of early cardiovascular disease
How is coronary artery disease diagnosed?
The evaluation starts with a careful history. When do symptoms occur? How long do they last? What brings them on or relieves them? The examination, an electrocardiogram, and laboratory results provide additional context.
Depending on the situation, testing may include an echocardiogram, exercise or pharmacologic stress testing, a coronary calcium score, coronary CT angiography, or invasive coronary angiography. These tests answer different questions, so ordering every test is rarely useful.
If previous imaging already exists, Dr. Patel can review the report and, when available, the actual images. Comparing those findings with the patient’s symptoms helps prevent both undertreatment and unnecessary procedures.
How is CAD treated?
Treatment begins with reducing the chance of heart attack and stroke. That may include stopping tobacco, improving activity and nutrition, treating blood pressure and diabetes, and using cholesterol-lowering or antiplatelet medication when appropriate.
Medicines can also reduce angina and help people stay active. The right combination depends on heart rate, blood pressure, kidney function, other medical conditions, and how often symptoms occur.
A coronary stent may be helpful when a significant blockage is causing symptoms or when the anatomy presents a higher-risk situation. Some patterns of disease are better treated with bypass surgery. Not every visible narrowing needs a stent, and treatment should be based on expected benefit rather than the picture alone.
What to expect at a coronary evaluation
Bring an updated medication list and copies of prior stress tests, CT scans, angiograms, or procedure reports if you have them. Be ready to describe the activity that brings on symptoms and how your ability to exercise has changed.
After reviewing the information, Dr. Patel will explain what is known, what remains uncertain, and whether another test would change the plan. Patients are encouraged to ask why a medication, test, or procedure is being recommended.
Frequently asked questions
Can coronary artery disease exist without chest pain?
Yes. CAD can cause shortness of breath, fatigue, or reduced exercise tolerance without classic chest pain. Some people have no symptoms and are diagnosed through testing.
Does a high calcium score mean I need a stent?
No. A calcium score estimates plaque burden and future risk; it does not show by itself that a specific narrowing needs treatment. Symptoms and additional testing may be needed.
Can lifestyle changes reverse CAD?
Healthy habits and appropriate medication can stabilize disease, slow progression, and lower risk. Whether plaque shrinks is less important than preventing heart attack and preserving function.
Related heart and vascular information
Schedule an appointment
If you have a stable heart or circulation concern, request an appointment with Flow Heart & Vascular in Mesa, Arizona. Call 911 for emergency symptoms.
This page provides general education and does not replace individualized medical advice.
