Conditions & Treatments

Coronary Heart Disease

Coronary heart disease occurs when cholesterol builds up within the walls of the heart’s arteries (coronary arteries), forming what is called plaque.

Coronary Heart Disease

What are the coronary arteries?

Coronary arteries supply blood to the heart muscle. Like all other tissues in the body, the heart muscle needs oxygen-rich blood to function, and oxygen-depleted blood must be carried away. The coronary arteries run along the outside of the heart and have small branches that supply blood to the heart muscle.

What are the different coronary arteries?

Illustration showing the outside of the heart and the coronary arteries
Click Image to Enlarge

The two main coronary arteries are the left main and right coronary arteries.

  • Left main coronary artery (LMCA). The left main coronary artery supplies blood to the left side of the heart muscle (the left ventricle and left atrium). The left main coronary artery divides into branches:

    • the left anterior descending artery, which branches off the left coronary artery and supplies blood to the front of the left side of the heart.

    • the circumflex artery, which branches off the left coronary artery and encircles the heart muscle. This artery supplies blood to the lateral side and back of the heart.

  • Right coronary artery (RCA). The right coronary artery supplies blood to the right ventricle, the right atrium, and the SA (sinoatrial) and AV (atrioventricular) nodes, which regulate the heart rhythm. The right coronary artery divides into smaller branches, including the right posterior descending artery and the acute marginal artery.

Additional smaller branches of the coronary arteries include the obtuse marginal (OM), septal perforator (SP), and diagonals.

Why are the coronary arteries important?

Since coronary arteries deliver blood to the heart muscle, any coronary artery disorder or disease can have serious implications by reducing the flow of oxygen and nutrients to the heart, which may lead to a heart attack and possibly death. Atherosclerosis (a buildup of plaque in the inner lining of an artery causing it to narrow or become blocked) is the most common cause of heart disease.

Illustration of the heart and arteries, as well as plaque build-up in arterial wall
Click Image to Enlarge

What is coronary artery disease?

Coronary heart disease, or coronary artery disease (CAD), is characterized by the accumulation of fatty deposits along the innermost layer of the coronary arteries. The fatty deposits may develop in childhood and continue to thicken and enlarge throughout the life span. This thickening, called atherosclerosis, narrows the arteries and can decrease or block the flow of blood to the heart.

The American Heart Association estimates that over 16 million Americans suffer from coronary artery disease--the number one killer of both men and women in the U.S.

What are the risk factors for coronary artery disease?

Risk factors for CAD often include:

  • Smoking

  • High LDL cholesterol, high triglycerides levels, and low HDL cholesterol

  • High blood pressure (hypertension)

  • Physical inactivity

  • Obesity

  • High saturated fat diet

  • Diabetes

Controlling risk factors is the key to preventing illness and death from CAD.

What are the symptoms of coronary artery disease?

The symptoms of coronary heart disease will depend on the severity of the disease. Some people with CAD have no symptoms, some have episodes of mild chest pain or angina, and some have more severe chest pain.

If too little oxygenated blood reaches the heart, a person will experience chest pain called angina. When the blood supply is completely cut off, the result is a heart attack, and the heart muscle begins to die. Some people may have a heart attack and never recognize the symptoms. This is called a "silent" heart attack.

When symptoms are present, each person may experience them differently. Symptoms of coronary artery disease may include:

  • Heaviness, tightness, pressure, and/or pain in the chest behind the breastbone

  • Pain radiating in the arms, shoulders, jaw, neck, and/or back

  • Shortness of breath

  • Weakness and fatigue

How is coronary artery disease diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for coronary artery disease may include any, or a combination of, the following:

  • Electrocardiogram (ECG or EKG). A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.

  • Stress test (also called treadmill or exercise ECG). A test that is given while a patient walks on a treadmill to monitor the heart during exercise. Breathing and blood pressure rates are also monitored. A stress test may be used to detect coronary artery disease, and/or to determine safe levels of exercise following a heart attack or heart surgery.

  • Cardiac catheterization. With this procedure, X-rays are taken after a contrast agent is injected into an artery to locate the narrowing, occlusions, and other abnormalities of specific arteries.

  • Nuclear scanning. Radioactive material is injected into a vein and then is observed using a camera as it is taken up by the heart muscle. This indicates the healthy and damaged areas of the heart.

Treatment for coronary heart disease

Specific treatment will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Treatment may include:

  • Modification of risk factors. Risk factors that may be modified include smoking, elevated cholesterol levels, elevated blood glucose levels, lack of exercise, poor dietary habits, being overweight/obese, and elevated blood pressure.

  • Medications. Medications that may be used to treat coronary artery disease include:

    • Antiplatelet medications. Medications used to decrease the ability of platelets in the blood to stick together and cause clots. Aspirin, clopidogrel (Plavix), ticlopidine (Ticlid), and prasugrel are examples of antiplatelet medications.

    • Antihyperlipidemics. Medications used to lower lipids (fats) in the blood, particularly Low Density Lipid (LDL) cholesterol. Statins are a group of antihyperlipidemic medications, and include simvastatin (Zocor), atorvastatin (Lipitor), and pravastatin (Pravachol), among others. Bile acid sequestrants--colesevelam, cholestyramine and colestipol--and nicotinic acid (niacin) are two other types of medications that may be used to reduce cholesterol levels.

    • Antihypertensives. Medications used to lower blood pressure. There are several different groups of medications which act in different ways to lower blood pressure

  • Coronary angioplasty. With this procedure, a balloon is used to create a bigger opening in the vessel to increase blood flow. Although angioplasty is performed in other blood vessels elsewhere in the body, percutaneous coronary intervention (PCI) refers to angioplasty in the coronary arteries to permit more blood flow into the heart. PCI is also called percutaneous transluminal coronary angioplasty (PTCA). There are several types of PCI procedures, including:

    • Balloon angioplasty. A small balloon is inflated inside the blocked artery to open the blocked area.

    • Coronary artery stent. A tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open.

    • Atherectomy. The blocked area inside the artery is cut away by a tiny device on the end of a catheter.

    • Laser angioplasty. A laser used to "vaporize" the blockage in the artery.

  • Coronary artery bypass. Most commonly referred to as simply "bypass surgery"  or CABG (pronounced "cabbage"), this surgery is often performed in people who have angina (chest pain) and coronary artery disease (where plaque has built up in the arteries). During the surgery, a bypass is created by grafting a piece of a vein above and below the blocked area of a coronary artery, enabling blood to flow around the obstruction. Veins are usually taken from the leg, but arteries from the chest or arm may also be used to create a bypass graft.

Treatment Programs


Massachusetts General Hospital understands that a variety of factors influence patients' health care decisions. That's just one reason why we're dedicated to ensuring patients understand their diagnosis and treatment options. Because a single option might not serve all patients, we offer a wide range of coordinated treatments and related services across the hospital. Patients should consult with their primary care doctor or other qualified health care provider for medical advice and diagnosis information.

Select a treatment program for more information:



Digestive Healthcare Center

  • Weight Center
    The Massachusetts General Hospital Weight Center is a fully integrated center within the Digestive Healthcare Center that supports the spectrum of needs for people of all ages seeking help with obesity and weight loss.
Heart Center

  • Lipid Management
    Lipid Management services at the Massachusetts General Hospital Corrigan Minehan Heart Center care for patients who have disorders of lipid metabolism, which include high cholesterol, high blood triglyceride, low HDL cholesterol or a combination of these conditions.
  • Cardiovascular Performance Program
    The Cardiovascular Performance Program at the Massachusetts General Hospital Corrigan Minehan Heart Center offers specialized cardiac care for athletes, including leading treatments for suspected or confirmed heart disease, detailed pre-participation safety screenings and exercise assessments.
  • Coronary Artery Disease Program
    The Coronary Artery Disease Program at the Massachusetts General Hospital Corrigan Minehan Heart Center treats coronary artery disease, the blockage of the heart's arteries due to cholesterol build-up.
  • Cardiovascular Genetics
    The Cardiovascular Genetics Service specializes in clinical and genetic screening for inherited cardiovascular diseases and counseling of patients with inherited conditions.
  • Heart Failure and Cardiac Transplant Program
    The Heart Failure and Cardiac Transplant Program at the Massachusetts General Hospital Corrigan Minehan Heart Center evaluates and manages a range of heart disease conditions that result in heart failure.
  • Corrigan Women's Heart Health Program
    The Elizabeth Anne and Karen Barlow Corrigan Women's Heart Health Program at the Massachusetts General Hospital Corrigan Minehan Heart Center cares for women of all ages through prevention and early detection of heart disease.
  • Cardiovascular Disease Prevention Center
    The Cardiovascular Disease Prevention Center at the Massachusetts General Hospital Corrigan Minehan Heart Center takes a prevention-as-treatment approach to caring for the heart and overall cardiovascular system.
Imaging

  • Heart Imaging
    The Heart Imaging Program at Massachusetts General Hospital Imaging provides comprehensive diagnostic cardiac imaging, using state-of-the-art CT and MRI technology and with expert interpretation by specialty-trained cardiovascular radiologists.
MassGeneral Hospital for Children

  • Psychology Assessment Center
    The pediatric neuropsychology specialists at Massachusetts General Hospital’s Psychology Assessment Center provide neuropsychological assessments to aid in the diagnosis and treatment of neurological, medical, genetic and developmental disorders.
Obstetrics and Gynecology

  • Midlife Women's Health Center
    The Massachusetts General Hospital Midlife Women’s Health Center brings together experts from more than 15 specialties to improve, promote and advance health care for women at menopause and beyond through research, collaboration and education.
Benson Henry Institute for Mind Body Medicine

  • Cardiac Wellness Program: Reduce Cardiac Risk
    Heart disease is the number one cause of death in the U.S. for both men and women. Although genetics plays a role in the development of heart disease, lifestyle choices have been proven to significantly influence the health of your heart. The more risk factors you have, the greater your chance of having a heart attack or stroke. This program is held at MGH West in Waltham, MA.
General and Gastrointestinal Surgery

  • Bariatric and Metabolic Surgery Program
    The Bariatric and Metabolic Surgery Program at Massachusetts General Hospital offers a full spectrum of safe and effective surgical procedures for obesity, weight disorders and metabolic disease.

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