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In coronary artery disease (CAD), the arteries that supply blood and oxygen to your heart muscle grow hardened and narrowed. You may try treatments such as lifestyle changes, medicines, and angioplasty, a procedure to open the arteries. If these treatments don't help, you may need coronary artery bypass surgery.

The surgery creates a new path for blood to flow to the heart. The surgeon takes a healthy piece of vein from the leg or artery from the chest or wrist. Then the surgeon attaches it to the coronary artery, just above and below the narrowed area or blockage. This allows blood to bypass (get around) the blockage. Sometimes people need more than one bypass.

The results of the surgery usually are excellent. Many people remain symptom-free for many years. You may need surgery again if blockages form in the grafted arteries or veins or in arteries that weren't blocked before. Lifestyle changes and medicines may help prevent arteries from becoming clogged again.

NIH: National Heart, Lung, and Blood Institute

Heart surgery can correct certain heart problems when other treatments haven't worked or can't be used.

In some cases, heart surgery may be a medical emergency. For example, surgery for a severe heart attack may need to be done right away. In other cases, you can plan heart surgery ahead of time. Some heart surgeries are major operations, such as heart bypass surgery for blocked arteries in the heart. Other surgeries are more minor heart procedures, such as putting in a pacemaker.

There are different types of heart surgery that can help treat many heart conditions:

• An implantable cardioverter defibrillator (ICD) to help prevent sudden cardiac arrest.
• A biventricular pacemaker to coordinate the heart's pumping action so it's more powerful.
• A ventricular assist device to help the heart pump blood.
• A total artificial heart to pump blood for the heart.

The approach a surgeon uses to do heart surgery depends on your heart problem, your general health, and other factors. Approaches to heart surgery include:

• Open-heart surgery (also called traditional heart surgery) is when the surgeon cuts the chest open to reach the heart. Because it's difficult to operate on a beating heart, medicines are used to stop the heart. A heart-lung bypass machine keeps oxygen-rich blood pumping through the body during the surgery.
• Off-pump heart surgery is open-heart surgery on a beating heart without using a heart-lung bypass machine. The surgeon holds the heart steady with a device. Surgeons may use off-pump heart surgery to do coronary artery bypass grafts (CABG), but only in certain cases.
• Minimally invasive heart surgery uses small cuts between the ribs. The cuts may be as small as 2 to 3 inches. The surgeon inserts tools into the chest through the cuts. This type of heart surgery may or may not use a heart-lung bypass machine.
• Robotic-assisted surgery is a type of minimally invasive surgery. The surgeon uses a computer to control tools on the arms of a robot. This allows the surgeon to be very accurate when doing difficult operations.

Like all surgery, heart surgery has risks even though the results are often excellent. The risks include:

• Bleeding
• Infection, fever, and swelling
• A problem from anesthesia (medicine that makes you sleep during surgery)
• Arrhythmia
• Damage to the heart, kidneys, liver, and lungs
• Stroke

The risks of heart surgery tend to be higher if:

• The surgery is an emergency.
• You have other medical conditions, including:
  • Diabetes
  • Kidney diseases
  • Lung diseases
  • Peripheral artery disease (PAD)

NIH: National Heart, Lung, and Blood Institute

Coronary artery disease (CAD) is the most common type of heart disease. It is the leading cause of death in the United States in both men and women.

CAD happens when the arteries that supply blood to heart muscle become hardened and narrowed. This is due to the buildup of cholesterol and other material, called plaque, on their inner walls. This buildup is called atherosclerosis. As it grows, less blood can flow through the arteries. As a result, the heart muscle can't get the blood or oxygen it needs. This can lead to chest pain (angina) or a heart attack. Most heart attacks happen when a blood clot suddenly cuts off the hearts' blood supply, causing permanent heart damage.

Over time, CAD can also weaken the heart muscle and contribute to heart failure and arrhythmias. Heart failure means the heart can't pump blood well to the rest of the body. Arrhythmias are changes in the normal beating rhythm of the heart.

NIH: National Heart, Lung, and Blood Institute

Sudden cardiac arrest (SCA) is a condition in which the heart suddenly stops beating. When that happens, blood stops flowing to the brain and other vital organs. If it is not treated, SCA usually causes death within minutes. But quick treatment with a defibrillator may be lifesaving.

A heart attack is different from an SCA. A heart attack happens when blood flow to the heart is blocked. During a heart attack, the heart usually doesn't suddenly stop beating. With an SCA, the heart stops beating.

Sometimes an SCA can happen after or during recovery from a heart attack.

Your heart has an electrical system that controls the rate and rhythm of your heartbeat. An SCA can happen when the heart's electrical system is not working right and causes irregular heartbeats. Irregular heartbeats are called arrhythmias. There are different types. They may cause the heart to beat too fast, too slow, or with an irregular rhythm. Some can cause the heart to stop pumping blood to the body; this is the type that causes SCA.

Certain diseases and conditions can cause the electrical problems that lead to SCA. They include:

• Ventricular fibrillation, a type of arrhythmia where the ventricles (the heart's lower chambers) don't beat normally. Instead, they beat very fast and very irregularly. They can't pump blood to the body. This causes most SCAs.
• Coronary artery disease (CAD), also called ischemic heart disease. CAD happens when the arteries of the heart cannot deliver enough oxygen-rich blood to the heart. It is often caused by the buildup of plaque, a waxy substance, inside the lining of larger coronary arteries. The plaque blocks some or all of the blood flow to the heart.
• Some types of physical stress can cause your heart's electrical system to fail, such as
  • Intense physical activity in which your body releases the hormone adrenaline. This hormone can trigger SCA in people who have heart problems.
  • Very low blood levels of potassium or magnesium. These minerals play an important role in your heart's electrical system.
  • Major blood loss
  • Severe lack of oxygen
• Certain inherited disorders which can cause arrhythmias or problems with the structure of your heart
• Structural changes in the heart, such as an enlarged heart due to high blood pressure or advanced heart disease. Heart infections can also cause changes to the structure of the heart.

You are at higher risk for SCA if you:

• Have coronary artery disease (CAD). Most people with SCA have CAD. But CAD usually doesn't cause symptoms, so they may not know that they have it.
• Are older; your risk increases with age
• Are a man; it is more common in men than women
• Are Black or African American, especially if you have other conditions such as diabetes, high blood pressure, heart failure, or chronic kidney disease
• Have a personal history of heartbeats that aren't regular (arrhythmia)
• Have a personal or family history of SCA or inherited disorders that can cause arrhythmia
• Have a problem with drug or alcohol use
• Have had a heart attack
• Have heart failure

Usually, the first sign of SCA is loss of consciousness (fainting). This happens when the heart stops beating.

Some people may have a racing heartbeat or feel dizzy or light-headed just before they faint. And sometimes people have chest pain, shortness of breath, nausea, or vomiting in the hour before they have an SCA.

SCA happens without warning and requires emergency treatment. Health care providers rarely diagnose SCA with medical tests as it's happening. Instead, it is usually diagnosed after it happens. Providers do this by ruling out other causes of a person's sudden collapse.

If you are at high risk for SCA, your provider may refer you to a cardiologist, a doctor who specializes in heart diseases. The cardiologist may ask you to get various heart health tests to see how well you heart is working. He or she will work with you to decide whether you need treatment to prevent SCA.

SCA is an emergency. A person having SCA needs to be treated with a defibrillator right away. A defibrillator is a device sends an electric shock to the heart. The electric shock can restore a normal rhythm to a heart that's stopped beating. To work well, it needs to be done within minutes of the SCA.

Most police officers, emergency medical technicians, and other first responders are trained and equipped to use a defibrillator. Call 9-1-1 right away if someone has signs or symptoms of SCA. The sooner you call for help, the sooner lifesaving treatment can begin.

Many public places such as schools, businesses, and airports have automated external defibrillators (AEDs). AEDs are special defibrillators that untrained people can use if they think that someone has had SCA. AEDS are programmed to give an electric shock if they detect a dangerous arrhythmia. This prevents giving a shock to someone who may have fainted but isn't having SCA.

If you see someone who you think has had SCA, you should give cardiopulmonary resuscitation (CPR) until defibrillation can be done.

People who are at risk for SCA may want to consider having an AED at home. Ask your cardiologist to help you decide whether having an AED in your home might help you.

If you survive SCA, you'll likely be admitted to a hospital for ongoing care and treatment. In the hospital, your medical team will closely watch your heart. They may give you medicines to try to reduce the risk of another SCA.

They will also try to find out what caused your SCA. If you're diagnosed with coronary artery disease, you may have an angioplasty or coronary artery bypass surgery. These procedures help restore blood flow through narrowed or blocked coronary arteries.

Often, people who have had SCA get a device called an implantable cardioverter defibrillator (ICD). This small device is surgically placed under the skin in your chest or abdomen. An ICD uses electric pulses or shocks to help control dangerous arrhythmias.

You may be able to lower your risk of SCA by following a heart-healthy lifestyle. If you have coronary artery disease or another heart disease, treating that disease can also lower your risk of SCA. If you have had an SCA, getting an implantable cardioverter defibrillator (ICD) can lower your chance of having another SCA.

NIH: National Heart, Lung, and Blood Institute

Angioplasty is a procedure to improve blood flow in coronary arteries that have become narrow or blocked. Your coronary arteries supply oxygen-rich blood to the heart. If you have coronary artery disease, a sticky material called plaque builds up in the coronary arteries. Plaque is made of cholesterol, calcium, and other substances in your blood. Over time, it can narrow your arteries or fully block them. When this happens, some parts of your heart don't get enough blood.

Angioplasty widens the blocked part of the artery so more blood can get through. It is also called percutaneous coronary intervention (PCI).

Doctors use angioplasty to:

• Reduce chest pain from blockages in the coronary arteries. This type of pain is called angina. There are different types of angina. Angioplasty treats certain types.
• Limit damage to the heart during or right after a heart attack. In this case, angioplasty is an emergency treatment.

Angioplasty does not cure coronary artery disease. To help prevent more plaque blockages, you'll need to take any prescribed medicines, eat healthy foods, and get regular exercise.

Most people have angioplasties in a hospital in a special room called a cardiac catheterization, or cath, lab. You will be awake and lying down. You'll get medicine to help you relax through an intravenous (IV) line. This is a small tube that goes into a vein in your hand or arm.

Angioplasty is done through a blood vessel in your arm, wrist, or groin. Your doctor will:

• Make a small opening in that area to insert a thin tube (a catheter) into a blood vessel.
• Thread the tube through the vessel to your heart, using x-rays as a guide.
• Inject contrast dye inside your arteries. The dye highlights your heart and blood vessels in the x-rays.
• Replace the first tube with another one that has a small, deflated balloon on the end.
• Guide the balloon inside the blockage and inflate it to push the plaque flat against the artery wall. This makes the artery wider and improves blood flow.
• Sometimes put a small, mesh tube into the artery to help keep it open. The tube is called a stent. Some stents have a coating of medicine that helps prevent blood clots from forming.

If you had an angioplasty for chest pain, you'll go to a recovery room for a few hours. You may stay in the hospital overnight. Your doctor will probably prescribe medicines to prevent blood clots. Most people can return to their usual activities after a week.

If you had an emergency angioplasty for a heart attack, you'll need to stay in the hospital for about a few more days.

Angioplasty is very safe. You may get a bruise, feel sore, or have some bleeding where the tubes were inserted. More serious problems don't happen very often, but they are possible. They can include serious bleeding, blood clots, and narrowing of the artery again.

NIH: National Heart, Lung, and Blood Institute

Atherosclerosis is a condition in which plaque builds up inside your arteries. Plaque is a sticky substance made up of cholesterol, fat, blood cells, calcium, and other substances found in the blood. Over time, plaque hardens and causes your arteries to narrow. That limits the flow of oxygen-rich blood to your body.

Some people may confuse atherosclerosis and arteriosclerosis, but they are not the same thing:

• Arteriosclerosis is hardening of the arteries, which means that the arteries thicken and become less flexible. It can have several different causes.
• Atherosclerosis, which develops from plaque buildup, is a common type of arteriosclerosis.

Atherosclerosis can affect most of the arteries in the body. It has different names, based on which arteries are affected:

• Coronary artery disease (CAD) is plaque buildup in the arteries of your heart.
• Peripheral artery disease (PAD) is plaque buildup in the arteries that carry blood away from the heart to other parts of the body. It most often affects the arteries of your legs, but it can also affect the arteries of your arms or pelvis.
• Carotid artery disease is plaque buildup in the neck arteries. It reduces blood flow to the brain.
• Renal artery stenosis is plaque buildup in the arteries that supply blood to your kidneys.
• Vertebral artery disease is plaque buildup in the arteries that supply blood to the back of your brain.
• Mesenteric artery ischemia is plaque buildup in the arteries that supply your intestines with blood.

Plaque often starts to build up during childhood and gets worse with age. The exact cause is unknown, but researchers believe that this buildup happens when there is damage to the arteries. This damage may be caused by unhealthy lifestyle habits, medical conditions, and your genes.

You may be more likely to develop atherosclerosis if you:

• Have certain medical conditions, including:
  • High blood pressure
  • High blood cholesterol
  • Diabetes
  • Metabolic syndrome
  • Inflammatory diseases such as rheumatoid arthritis and psoriasis
• Have a family history of high blood cholesterol
• Eat a lot of foods high in saturated fats
• Smoke or chew tobacco
• Are older - the risk increases after age 45 men and age 55 in women

In the early stages, atherosclerosis often does not cause any symptoms. You may first notice some symptoms at times when your body needs more oxygen. For example, this could be when you are having physical or emotional stress.

Your symptoms will depend on which arteries are affected and how much blood flow is blocked:

• With coronary artery disease, the symptoms may include angina (a type of chest pain), palpitations (racing or pounding heart), and shortness of breath.
• With carotid artery disease, you may have a bruit. This is a whooshing sound that your health care provider hears when using a stethoscope. You could also have a transient ischemic attack (TIA), sometimes called a mini-stroke.
• With peripheral artery disease, you may have pain, aching, heaviness, or cramping in the legs when walking or climbing stairs.
• With vertebral artery disease, you may have problems with thinking and memory, weakness or numbness on one side of the body or face, and vision trouble. You could also have a transient ischemic attack.
• With mesenteric artery ischemia, the symptoms can include severe pain after meals, weight loss, and diarrhea.

For men, erectile dysfunction (ED) is an early warning sign that you may be at higher risk for atherosclerosis and its complications. If you have ED, talk with your provider about your risk of plaque buildup.

Atherosclerosis can cause other health problems, or complications. For example, if a plaque bursts, a blood clot may form. The clot could block the artery completely or travel to another part of the body. Other possible complications can vary, depending on which arteries are affected. For example, blockages in different parts of the body can lead to complications such as a heart attack, stroke, vascular dementia, or limb loss.

To find out if you have atherosclerosis, your provider:

• Will ask about your medical and family health history
• Will ask about your lifestyle and risk factors for plaque buildup in the arteries
• Will do a physical exam, which will include listening to your heart and the blood flow in your arteries
• Will likely order tests, such as blood tests and heart health tests

If you have atherosclerosis, your provider will work with you to create a treatment plan that works for you. Your plan will depend on which arteries are affected, how much the blood flow is blocked, and what other medical conditions you have. Possible treatments may include:

• Heart-healthy lifestyle changes.
• Medicines to:
  • Manage your risk factors.
  • Treat atherosclerosis or its complications.
  • Treat any medical conditions you have that can worsen plaque buildup.
• Procedures or surgeries to treat diseases or complications that were caused by plaque buildup. The specific type of procedure or surgery will depend on which arteries are affected.
• Cardiac rehabilitation, if you have had certain complications from atherosclerosis.

There are steps you can take to try to prevent atherosclerosis:

• Choose heart-healthy foods, such fruits, vegetables, and whole grains. Limit foods that are high in saturated fats, salt, and added sugars.
• Do regular physical activity. But before you start an exercise program, ask your provider what level of physical activity is right for you.
• Aim for a healthy weight.
• Limit how much alcohol you drink. Drinking less is better for health than drinking more. Men should limit their intake to 2 drinks or less in a day. Women should drink 1 drink or less per day.
• Manage stress.
• If you smoke, quit smoking.
• Avoid secondhand smoke.
• Get enough good-quality sleep.

NIH: National Heart, Lung, and Blood Institute

Each year almost 800,000 Americans have a heart attack. A heart attack happens when blood flow to the heart suddenly becomes blocked. Without the blood coming in, the heart can't get oxygen. If not treated quickly, the heart muscle begins to die. But if you do get quick treatment, you may be able to prevent or limit damage to the heart muscle. That's why it's important to know the symptoms of a heart attack and call 911 if you or someone else is having them. You should call, even if you are not sure that it is a heart attack.

The most common symptoms in men and women are:

• Chest discomfort. It is often in center or left side of the chest. It usually lasts more than a few minutes. It may go away and come back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion.
• Shortness of breath. Sometimes this is your only symptom. You may get it before or during the chest discomfort. It can happen when you are resting or doing a little bit of physical activity.
• Discomfort in the upper body. You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach.

You may also have other symptoms, such as nausea, vomiting, dizziness, and lightheadedness. You may break out in a cold sweat. Sometimes women will have different symptoms then men. For example, they are more likely to feel tired for no reason.

The most common cause of heart attacks is coronary artery disease (CAD). With CAD, there is a buildup of cholesterol and other material, called plaque, on their inner walls or the arteries. This is atherosclerosis. It can build up for years. Eventually an area of plaque can rupture (break open). A blood clot can form around the plaque and block the artery.

A less common cause of heart attack is a severe spasm (tightening) of a coronary artery. The spasm cuts off blood flow through the artery.

At the hospital, health care providers make a diagnosis based on your symptoms, blood tests, and different heart health tests. Treatments may include medicines and medical procedures such as coronary angioplasty. After a heart attack, cardiac rehabilitation and lifestyle changes can help you recover.

NIH: National Heart, Lung, and Blood Institute

Heart disease is a general term that includes many types of heart problems. It's also called cardiovascular disease, which means heart and blood vessel disease.

Coronary artery disease (also called coronary heart disease) is the most common type of heart disease in both men and women. It happens slowly over time when a sticky substance called plaque builds up in the arteries that supply your heart muscle with blood. The plaque narrows or blocks blood flow to the heart muscle and can lead to:

• Angina - chest pain from lack of blood flow
• Heart attacks - when part of the heart muscle dies from loss of blood flow
• Heart failure - when your heart can't pump enough blood to meet your body's needs
• Arrhythmia - a problem with the rate or rhythm of your heartbeat

In the United States, heart disease is the number one cause of death in women. But women are often not diagnosed with heart disease as quickly as men are. That's because:

• Women are more likely than men to have "silent" heart disease, meaning that they don't have symptoms.
• Health care providers may not recognize heart disease in women because women's symptoms may be different from men's symptoms.
• Women are more likely than men to have certain types of heart disease that can be harder to diagnose.

A delay in diagnosis may mean a delay in medical care that could help prevent serious problems, such as a heart attack. That's why it's important to learn about your risk for heart disease, the symptoms in women, and how to keep your heart healthy.

Women can get any type of heart disease. Like men, the most common type of heart disease among women is coronary artery disease. But there are certain types of heart disease which are less common, but affect women more often than men:

• Coronary microvascular disease - Chest pain from spasms (sudden tightening) in the smallest arteries of the heart that pinch off blood flow. It typically happens during rest or routine activities. This serious condition increases your risk of having a heart attack or other heart diseases. This type may be harder to diagnose since blockages in smaller arteries can be harder to see on imaging tests.
• Broken heart syndrome - Strong chest pain or other signs that look like a heart attack. It's caused by the stress of powerful emotions, such as deep grief, anger, or surprise. It can happen even if you're healthy. It mostly affects women after menopause and usually doesn't cause any lasting damage.
• Variant angina - A rare type of strong chest pain from spasms in the heart arteries. The pain usually happens in a pattern during sleep. Variant angina rarely causes a heart attack.

Your risk for developing heart disease increases with:

• Menopause. Women can develop heart disease at any age, but your risk increases after your periods stop, usually by age 55. Before menopause, your body makes more estrogen (a female hormone) which helps protect against heart disease. That's why women generally develop coronary artery disease 10 years later than men. During and after menopause, estrogen levels drop and your risk for heart diseases goes up. If your periods stop before age 40, your risk will be higher than other women your age.
• Family history of heart disease. Your risk for heart disease may be higher if your:
  • Mother or sister had heart disease before age 65.
  • Father or brother had heart disease before age 55.
• Problems during pregnancy, such as high blood pressure, gestational diabetes, anemia, and high blood pressure.
• Use of hormonal birth control (pills, patches, or vaginal rings with estrogen and progesterone).
• Endometriosis.
• Polycystic ovary syndrome.
• Inflammatory and autoimmune diseases.
• Metabolic syndrome.
• Mental health issues, such as stress, anxiety, or depression.
• Health risks from a lack physical activity.
• Obesity or being overweight.
• Diabetes.
• Low HDL cholesterol levels.
• Mild to moderate high blood pressure.
• Smoking.

If you have one or more risks for heart disease, ask your health care provider for help understanding your risk level. Ask if you need any heart tests to help catch heart disease early.

When women have symptoms of heart disease, they may include:

• Pain or discomfort in the chest that may be dull and heavy or sharp
• Pain in the neck, jaw, throat, upper belly, or back
• Nausea or vomiting
• Unusual fatigue
• Shortness of breath (feeling like you can't get enough air) during physical activity

Women who have coronary artery disease are more likely than men to have chest pain when resting or doing daily activities, rather than during exercise. They're also more likely than men to feel chest pain from mental stress.

Symptoms of a heart attack in women may also be different than in men. Chest pain is the most common symptom for both sexes. It may feel like crushing or squeezing. But women are somewhat less likely than men to have chest pain.

During a heart attack, women may feel:

• Pressure or tightness in the chest
• Pain in the upper back, arms, neck, jaw or throat
• Dizziness
• Unusual fatigue
• Indigestion, heartburn, nausea, or vomiting
• Stomach pain
• Shortness of breath

Heart attacks usually don't look like the sudden, dramatic events we see in the movies. The symptoms may be mild or strong. They may start slowly. They can stop and then come back.

You can help lower your risk by:

• Learning how to prevent heart disease and making heart-healthy habits part of your daily life.
• Asking your provider about your personal risk for heart disease and the best way to manage your heart health.

Remember, women can have heart disease without symptoms. But if you pay attention to your risk for heart disease, you can take action to prevent problems or keep them from getting worse.

NIH: National Heart, Lung, and Blood Institute