What are the types of coronary artery disease?

Coronary artery disease (CAD) is the most common type of heart disease in the U.S. It develops when your coronary arteries, the blood vessels that supply blood to your heart, narrow.

This narrowing can occur for several reasons. The underlying reasons for coronary artery narrowing are all referred to as different types of coronary artery disease. At Advocate Health Care, our cardiologists and heart surgeons offer advanced treatments for all types of coronary artery disease.

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 other artery disease types.

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, also known as atherosclerosis. It’s the type of coronary artery disease that’s most common and well-known.

As the artery narrowing worsens, it can eventually cut off blood flow to your heart. A sudden blockage is known as a heart attack, which requires immediate medical attention to minimize the heart damage.

Nonobstructive coronary artery disease

Nonobstructive coronary artery disease occurs because of other problems with your coronary arteries. It’s not caused by plaque buildup. Instead, your coronary arteries may have problems such as:

• Compression or squeezing from the heart muscle (myocardial bridging)
• Constrictions at improper times (coronary vasospasm)
• Damage to the artery lining (endothelial dysfunction)
• Malfunctions in smaller artery branches (microvascular dysfunction)

Nonobstructive coronary artery disease can still cause many of the traditional symptoms of coronary artery disease, such as chest pain or shortness of breath. Many people with nonobstructive coronary artery disease experience angina, or chest pain, related to CAD. While nonobstructive heart disease can develop in anyone, it’s most common in females.

Spontaneous coronary artery dissection

Spontaneous coronary artery dissection (SCAD) occurs when a tear in the coronary artery wall partially or completely blocks blood flow. This tear happens suddenly and often presents as a heart attack. If you think you are experiencing a heart attack, call 911 immediately.

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 that doesn’t go away with rest
• Jaw, neck or back pain
• Lightheadedness or weakness
• Pain radiating from your chest through your shoulders or arms
• Sensations of fullness, pressure or squeezing in your chest
• Shortness of breath, even at rest

Coronary artery disease treatment

Treatment for coronary artery disease can vary depending on what type of CAD you have. Some people improve symptoms through lifestyle changes alone, while others need minimally invasive treatments. Your health care provider can help you find the treatment plan that’s most effective for you.

Treatment for obstructive coronary artery disease

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

• Eating a heart-healthy diet
• Exercising regularly
• Maintaining a healthy weight
• Quitting smoking
• Reducing your alcohol consumption
• Sleeping at least seven to eight hours nightly
• Taking medications to lower your blood pressure or cholesterol, control blood sugar 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 small, hollow tube (catheter) with a deflated balloon to your coronary artery. When in position, your physician opens the balloon to compress the plaque and widen the artery. They may also place a stent, a small mesh tube coated with medication, 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 open the blocked area by breaking up and removing plaque.

Open-heart surgery

In some cases, 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 one or more blocked arteries. This restores blood flow to your heart.

Treatment for nonobstructive coronary artery disease

Most people with nonobstructive coronary artery disease need to take medications to manage symptoms. You may also benefit from lifestyle changes, such as eating a heart-healthy diet or exercising more.

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

Treatment for spontaneous coronary artery dissection

Spontaneous coronary artery dissection treatments aim to restore blood flow to your heart. The type of treatment you need depends on the size and location of the artery tear. Sometimes, the artery heals on its own without treatment. You may benefit from medications to relieve symptoms while you are healing.

For more severe tears, you may need a minimally invasive procedure, such as PCI, or an 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 increase activity levels safely.