Coronary Artery Disease —
Causes, Diagnosis & Treatment
What is Coronary Artery Disease?
Coronary artery disease (CAD), also known as coronary heart disease or ischaemic heart disease, occurs when the arteries that supply blood to the heart muscle become narrowed or blocked. This is usually caused by a gradual build-up of fatty deposits, known as plaque, within the artery walls.
Over time, this plaque can restrict the flow of blood to the heart, leading to symptoms such as chest pain (angina), shortness of breath or, in more serious cases, a heart attack.
Coronary artery disease is one of the leading causes of death in Australia. However, a diagnosis does not necessarily mean that a heart attack has occurred or will occur.
"Having coronary artery disease does not always mean you will present with a heart attack. Sometimes the growth of cholesterol plaque is slow and it is important that we detect and treat it before you have a major event.”
Emergency: If you have chest pain that lasts for more than 10 minutes call Triple Zero (000).
What Causes Coronary Artery Disease?
Coronary artery disease develops over time as the inner walls of the coronary arteries become damaged and plaque gradually builds up. A number of factors can contribute to this damage. High cholesterol and high blood pressure both place extra strain on the artery walls, encouraging plaque to form, while smoking damages the artery lining and speeds the process up further. Diabetes also raises your risk by affecting the blood vessels, and if heart disease runs in your family, you may be more likely to develop it too. Lifestyle plays a big part as well, as a sedentary routine, a diet high in processed and fast foods, and carrying excess weight all add to the burden on your cardiovascular system over time.
"It's never too early to start looking after your heart. We're now seeing people having heart attacks at a younger age and I think education is key. We are living more sedentary and high stress lifestyles. We lack sleep and sometimes forget to take care of ourselves. We have easy access to processed and fast foods.”
How is Coronary Artery Disease Diagnosed?
Your cardiologist may use one or more of the following tests to assess whether you have coronary artery disease:
- Exercise Stress Test — monitors your heart’s response to physical exertion
- Stress Echocardiography — uses ultrasound imaging during exercise or medication-induced stress to assess heart function
- CT Calcium Score — a low-dose CT scan that detects calcium deposits in the coronary arteries, an early marker of plaque
- CT Coronary Angiography (CTCA) — a detailed scan of the coronary arteries to visualise any narrowing
- Coronary Angiography (Angiogram) — a catheter-based procedure that provides the most detailed view of the coronary arteries
"Through various testing methods — through exercise stress testing, CT imaging of the heart, or angiograms — we can determine whether narrowings are significant enough to require invasive treatment."
Treatment Options for Coronary Artery Disease
Treatment depends on the severity of the disease, the symptoms you are experiencing, and your overall health. Your cardiologist will work with you to determine the most appropriate treatment pathway.
Medical Management
For many patients, coronary artery disease is best managed with a combination of medication and lifestyle modification.
"Medical management is as important as invasive management of heart disease. We use medications to – lower cholesterol, lower blood pressure, improve heart function and manage diabetes. Lifestyle modification includes smoking cessation, eating a diet that limits saturated fats and processed foods, weight loss, improving sleep, and regular exercise. These therapies are just as important to prevent future heart attacks."
Medications may include:
- Statins — to lower cholesterol and stabilise plaque
- Blood pressure medications — to reduce strain on the arteries
- Antiplatelets (e.g. aspirin) — to help prevent blood clots
- Other medications — tailored to your individual risk factors
Lifestyle Modification
Lifestyle changes are one of the most powerful tools you have in managing coronary artery disease. Eating a heart-healthy diet, staying physically active and maintaining a healthy weight all help take pressure off your heart and slow the build-up of plaque in your arteries. Quitting smoking is one of the single best things you can do for your heart, and learning to manage stress can make a real difference too. None of these changes happen overnight, but small, consistent steps add up, and your cardiologist and care team are there to support you along the way.
Coronary Angioplasty and Stenting
If the narrowing in the coronary arteries is severe and causing significant symptoms or risk, your cardiologist may recommend coronary angioplasty, which is a minimally invasive procedure where a small balloon is used to open the narrowed artery, and a stent (small mesh tube) is placed to keep it open.
Coronary Artery Bypass Surgery
In some cases, particularly when there is extensive disease in multiple arteries, your cardiologist may recommend referral to a cardiothoracic surgeon for coronary artery bypass grafting (CABG).
"In certain cases such as disease in multiple arteries or in particular arteries, we would recommend treatment with open heart surgery. If that is the case we would have a multidisciplinary discussion with our cardiothoracic colleagues to determine the best treatment option.
Prevention and Long-Term Management
Prevention is a central part of managing coronary artery disease, both for people who have not yet developed the condition and for those who have.
"As an interventional cardiologist it may seem that I want to do more stents and procedures, but I try to only do an intervention if it is necessary. Prevention is the key to good heart health. Medications and getting on top of your lifestyle factors are even more important in some cases than stents."
Your first point of contact for heart health assessment should be your GP, who can assess your risk factors and refer you to a cardiologist if needed.
"Seeing a GP is the most important initial step to determine your risk of coronary artery disease. GPs can also make initial recommendations for medications and lifestyle changes. They will look at your cardiovascular risk factors and how to address them.
Frequently Asked Questions
Not necessarily. A diagnosis of coronary artery disease means plaque has been detected in the coronary arteries. With appropriate treatment — whether medication, lifestyle changes, or a procedure — many patients manage the condition effectively and reduce their risk of future events.
While plaque cannot typically be completely removed, it can be stabilised and managed with medication (particularly statins) and lifestyle changes. In some cases, the severity of narrowing can be reduced over time.
Your cardiologist will assess whether your narrowings are significant enough to require intervention, using a combination of imaging, symptoms, and functional tests. Not everyone with coronary artery disease needs a stent.
Stopping smoking, managing cholesterol and blood pressure, maintaining a healthy weight, eating a balanced diet, and regular physical activity are the most impactful changes.
Concerned About Your Heart Health?
Queensland Cardiovascular Group offers comprehensive cardiac assessment, diagnosis and treatment across multiple Brisbane locations. Our team of specialist cardiologists will work with you and your GP to develop the right management plan for your heart.
What do I do if I have angina?
- As soon as you feel angina symptoms, immediately stop and rest.
- If rest alone doesn’t relieve the symptoms, take a dose of your angina medicine. Sit or lie down before using your spray or tablet, because it can make you dizzy. Use the smallest dose you normally take (e.g. a full, half, or even quarter of a tablet).
- Wait 5 minutes. If the angina is not relieved, take another dose of your angina medicine.
- Wait another 5 minutes.
- Talk – if someone is with you tell them how you’re feeling, or call a relative or friend.
- Call Triple Zero (000) if your angina:
- is not completely better within the 10 minutes you have waited;
- is severe;
- gets worse quickly.
Ask for an ambulance. Don’t hang up. Wait for advice from the operator.
