Coronary artery disease: symptoms, tests, treatment and which doctor to see
What coronary artery disease is, the warning signs, the tests that find it, how it is treated, and when chest pain is an emergency.
Also known as: Arteriosclerosis, Coronary; Atherosclerosis, Coronary; CAD; Coronary Arteriosclerosis; Coronary atherosclerosis; Coronary heart disease
What coronary artery disease is
The coronary arteries are the blood vessels that supply the heart muscle itself. In coronary artery disease, fatty deposits called plaque build up inside their walls over many years, narrowing them and making them stiffer. When the heart works harder — climbing stairs, hurrying or during emotional stress — a narrowed artery cannot deliver enough blood, and the heart muscle protests.
A plaque can also crack. A blood clot then forms on it and can block the artery suddenly. That is a heart attack, and the heart muscle beyond the blockage starts to die within minutes to hours unless blood flow is restored.
Coronary artery disease is also called coronary heart disease or ischaemic heart disease. It is a long-term condition, but treatment can relieve symptoms, slow the build-up of plaque and lower the chance of a heart attack.
Symptoms
Many people have no symptoms until the arteries are badly narrowed, or until a heart attack. When symptoms do appear, the typical one is angina:
- Chest pain, pressure, heaviness or tightness, often in the centre of the chest, that comes on with exertion and settles with rest
- Discomfort spreading to the arm, shoulder, jaw, neck or back
- Breathlessness on exertion that is new or getting worse
- Sweating, nausea or a feeling of indigestion with exertion
- Tiredness, or palpitations
Women, older people and people with diabetes are more likely to have less typical symptoms, such as breathlessness, unusual tiredness, discomfort in the upper abdomen or a feeling of 'gas'. Many heart attacks in India are first treated at home as acidity. If the discomfort is new, comes with exertion or does not settle, get it checked.
Who is at higher risk in India
People of South Asian background tend to develop coronary artery disease earlier in life than people of European background, and it is not unusual for it to appear in the forties or even the thirties. Your risk is higher if you:
- Smoke cigarettes or bidis, or chew tobacco, gutka or paan masala
- Have diabetes or prediabetes
- Have high blood pressure or high cholesterol
- Carry extra weight around the waist
- Are physically inactive
- Have a father or brother who had heart disease before about 55, or a mother or sister before about 65
- Have chronic kidney disease
Diets rich in refined starches, fried snacks and sweets, high salt, long working hours and air pollution add to the picture. Most of these factors can be changed, which is why prevention matters as much as treatment.
How it is diagnosed
The doctor starts with your symptoms, your risk factors and an examination. The tests chosen depend on how likely the disease is and how stable your symptoms are. Common ones include:
- ECG — a quick recording of the heart's electrical activity. It can be normal between episodes of angina.
- Echocardiogram — an ultrasound scan of the heart that shows how well the muscle and valves are working.
- Treadmill test (exercise stress test) — an ECG recorded while you walk on a treadmill, to see whether exertion brings on changes. Stress echocardiography or a nuclear scan is used for some people.
- CT coronary angiogram — a CT scan with contrast dye that shows the coronary arteries without a catheter.
- Coronary angiography — a thin tube is passed from the wrist or groin to the heart and dye is injected to show narrowings in detail. It is often done when a stent may be needed.
If a heart attack is suspected, a blood test for troponin, a protein released by damaged heart muscle, is done along with repeated ECGs. Blood tests for cholesterol, sugar and kidney function are part of every assessment.
Which doctor to see
A general physician can assess your risk, manage blood pressure, sugar and cholesterol, and refer you on. A cardiologist diagnoses and treats coronary artery disease, performs angiography and angioplasty, and follows you up afterwards. See a cardiologist if you have chest discomfort with exertion, an abnormal ECG, or a strong family history.
When bypass surgery is advised, a cardiothoracic surgeon performs it. You can find cardiologists in Bengaluru or cardiothoracic surgeons in Bengaluru on The Doctor Index, each with a registration you can check.
Treatment
Treatment has two goals: relieving symptoms, and lowering the risk of a heart attack and death. Almost everyone needs lifestyle changes and medicines; some also need a procedure.
Lifestyle changes
Stopping tobacco in every form is the single most important step. The National Tobacco Quit Line (1800-112-356) offers free counselling, including in regional languages. Eat more vegetables, fruit, pulses and whole grains, with less fried food, salt and sugar; stay active in the way your doctor advises; and keep blood pressure, sugar and weight in check.
Medicines
The main families are statins to lower cholesterol and stabilise plaque; antiplatelet medicines such as aspirin to reduce clotting; beta blockers and other medicines that ease angina by reducing the heart's workload; nitrates for quick relief of chest pain; and medicines for blood pressure and diabetes. Do not stop any of these on your own, particularly antiplatelet medicines after a stent, because stopping them early can cause the stent to block suddenly.
Procedures
Angioplasty opens a narrowed artery with a balloon, usually leaving a stent (a small mesh tube) to keep it open. Coronary artery bypass surgery uses a vein or artery from elsewhere in the body to route blood around blockages, and is often preferred when several arteries are affected or in some people with diabetes. Not everyone with stable angina needs a procedure; your cardiologist will decide based on your symptoms, test results and overall health. A second opinion before a planned (non-emergency) procedure is reasonable.
Living with it: recovery and follow-up
Cardiac rehabilitation — a supervised programme of exercise, education and support after a heart attack, stent or bypass — helps people recover faster and return to work and daily life with confidence. Ask whether your hospital offers one.
- Regular reviews with your cardiologist or physician, more often in the first year
- Cholesterol, sugar and kidney checks as advised
- Blood pressure at every visit
- A clear plan for what to do if chest pain returns
Low mood and anxiety are common after a heart attack. Mention them — they are treatable and they affect recovery.
When it is an emergency
Call 112 or 108 straight away if you or someone with you has:
- Chest pain, pressure or tightness lasting more than a few minutes, or that comes on at rest
- Chest discomfort with sweating, breathlessness, nausea or a feeling of doom
- Angina that is more frequent, comes on with less effort or does not settle with your usual spray or tablet
- Fainting, or sudden severe breathlessness
Do not drive yourself to hospital and do not wait to see if it settles. Heart attack treatment works best in the first hours. If the emergency operator or a doctor advises you to chew aspirin, follow their instructions.
Questions to ask at your appointment
- How sure are we that my symptoms come from the heart?
- Which arteries are affected, and how severely?
- Do I need a procedure, or can medicines alone control this?
- What does each medicine do, and for how long must I take it?
- What cholesterol and blood pressure ranges should I aim for?
- What activity is safe for me, and when can I return to work?
- Is there a cardiac rehabilitation programme I can join?
Common questions
Questions people ask
- Does a stent or bypass cure coronary artery disease?
- No. A stent or bypass improves blood flow past specific blockages and relieves symptoms, but the underlying disease remains in the arteries. Medicines and lifestyle changes are still needed to slow it and prevent new blockages.
- Can a normal ECG rule out heart disease?
- No. An ECG is often normal between episodes of angina, and even in some people with significantly narrowed arteries. If your symptoms suggest angina, your doctor may recommend a stress test, a CT coronary angiogram or other tests.
- Is chest pain after meals always acidity?
- Not always. Heart pain can feel like indigestion and is sometimes brought on by a heavy meal. Pain with exertion, sweating or breathlessness, or any new chest discomfort in someone with risk factors, should be checked by a doctor promptly.
- Do I need to take statins for life?
- Usually, yes, if you have coronary artery disease. Statins lower the risk of heart attack and stroke as long as they are taken. If you have side effects, discuss them with your doctor rather than stopping, as alternatives are available.
This condition is usually assessed by a cardiologist. Every profile shows the doctor’s registration and what has been checked.
Sources
- MedlinePlus, US National Library of Medicine — Coronary Artery Disease
- World Health Organization — Cardiovascular diseases fact sheet
- National Tobacco Control Programme, MoHFW — National Tobacco Quit Line Services
- MedlinePlus, National Library of Medicine — Coronary Artery Disease — Public-domain health-topic summary
Coronary artery disease: symptoms, tests, treatment and which doctor to see is original text by The Doctor Index; the compiled source draft was used for research. Source: MedlinePlus, National Library of Medicine. Orphadata Science: Free access data from Orphanet. © INSERM 1999; July 2026 data, CC BY 4.0. This product uses the Human Phenotype Ontology (hp/releases/2026-09-01). Only sources listed for this article apply. Source material has been selected and arranged; HPO definitions are reproduced without alteration. No source organisation endorses this compilation. Köhler S et al. The Human Phenotype Ontology project: linking molecular biology and disease through phenotype data. Nucleic Acids Research 2014;42(D1):D966–D974. doi:10.1093/nar/gkt1026.
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