What are the types of coronary artery disease?

Coronary artery disease is the medical term for CAD, the most common type of heart disease in the U.S. But most people only know about one type.

Coronary artery disease develops when your coronary arteries, the blood vessels that supply blood to your heart, narrow. This narrowing can occur for several reasons, all of which are considered different types of CAD. Diseases of the heart receive leading-edge treatments from our cardiologists and heart surgeons at Aurora Health Care.

Types of coronary heart disease

Many people think of coronary artery disease as plaque buildup in your arteries, or atherosclerosis. But plaque buildup occurs in only one type of coronary heart disease.

There are three types of coronary heart disease, including:

• Obstructive coronary artery disease
• Nonobstructive coronary artery disease
• Spontaneous coronary artery dissection

Obstructive coronary artery disease

Obstructive coronary artery disease occurs when your coronary arteries gradually narrow due to plaque buildup. It’s the most common and well-understood type of coronary artery disease.

As artery narrowing increases, it can eventually block blood flow to your heart. A sudden blockage is an emergency. It’s known as a heart attack, which requires immediate medical attention to minimize heart damage. If you think you are experiencing a heart attack, call 911 immediately.

Nonobstructive coronary artery disease

Nonobstructive coronary artery disease isn’t the result of plaque buildup. Instead, it occurs because of other coronary artery problems, such as:

• Constrictions at inappropriate times (coronary vasospasm)
• Damage to your artery lining (endothelial dysfunction)
• Malfunctions in your smaller artery branches (microvascular dysfunction)
• Squeezing or compression on your coronary arteries from your heart muscle (myocardial bridging)

Nonobstructive coronary artery disease can still cause many of the well-known symptoms of coronary artery disease, such as shortness of breath or chest pain. Many people with nonobstructive coronary artery disease experience chest pain. While nonobstructive heart disease can develop in anyone, it’s more common in females than males.

Spontaneous coronary artery dissection

Spontaneous coronary artery dissection (SCAD) occurs when a tear in the wall of your coronary artery partially or completely blocks blood flow. This tear happens unexpectedly and often presents as a heart attack.

SCAD and heart attack symptoms can vary from person to person but may include:

• Chest pain, especially on the left side or center of your chest
• Neck, back or jaw pain
• Pain that extends from your chest through your shoulders or arms
• Sensations of pressure, fullness or squeezing in your chest
• Shortness of breath, even at rest
• Weakness or lightheadedness

Coronary artery disease treatment

Coronary artery disease treatment can vary depending on the type of CAD you have. Some people only need to make lifestyle changes, while others need minimally invasive or surgical treatments. Your health care provider can help you find the right treatment plan for you.

Treatment for obstructive coronary artery disease

Depending on the extent of the artery blockage, you may manage obstructive coronary artery disease with noninvasive treatments, including:

• Achieving and maintaining a healthy weight
• Eating a heart-healthy diet
• Exercising regularly
• Quitting smoking
• Reducing your alcohol intake
• Sleeping seven to eight hours each night
• Taking medicines that lower your blood pressure or cholesterol, control diabetes or reduce your risk of blood clots

Minimally invasive procedures

If needed, our interventional cardiologists offer minimally invasive and catheter-based procedures to clear blockages and restore blood flow, including:

• Percutaneous coronary intervention (PCI): We send a catheter with a deflated balloon to your coronary artery. When in place, your physician opens the balloon to compress the plaque and widen the artery (angioplasty). They may also place a stent, a small mesh tube coated with medicine, to keep the artery open and prevent blood clots.
• Atherectomy: Sometimes, plaque hardens to the point that a PCI won’t be effective. In these cases, our physicians insert a small drill-like device or laser through a catheter to break up plaque, remove it and open the blocked area.

Open-heart surgery

You may need an open-heart surgery called coronary artery bypass graft (CABG). During CABG, your physician uses a blood vessel from another part of your body to reroute blood flow around the blocked artery.

Depending on how many arteries are blocked, you may need more than one bypass. A bypass restores blood flow to your heart. We perform nearly 1,000 CABG procedures each year with excellent results.

Treatment for nonobstructive coronary artery disease

Most people with nonobstructive coronary artery disease need medications to manage symptoms. You may also benefit from lifestyle changes, such as increasing your physical activity or eating a healthier diet.

You may need surgery if you have nonobstructive coronary artery disease due to heart muscle compression (myocardial bridging). Heart surgeons use a procedure called unroofing to gently move the section of the heart muscle that’s compressing your artery.

Treatment for spontaneous coronary artery dissection

Spontaneous coronary artery dissection treatment focuses on restoring blood flow to your heart. The type of treatment you need depends on the location and size of the artery tear. Sometimes, SCAD heals on its own. Some people may take medications to relieve symptoms while they are healing.

For more severe tears, you may need minimally invasive procedures, such as a PCI, or open-heart surgery, such as CABG, to restore blood flow. After SCAD treatment, it’s common for your provider to recommend cardiac rehabilitation to help you recover. In cardiac rehab, our specialists help you adopt healthy lifestyle habits and safely increase your activity levels.