A closer look inside your coronary arteries

The heart muscle requires a constant supply of oxygen and nutrients to stay healthy and function as it should. It receives oxygen and nutrient-rich blood through the coronary arteries. When the arteries are healthy, they have a smooth lining, allowing blood to flow freely.

Blood contains fatty substances that can stick to the inner walls of your arteries. When the fatty matter starts to build up, the inner diameter of the artery becomes narrow and blood cannot flow as well as it should. This is coronary artery disease. It is a gradual process, and sometimes, you cannot tell that you have it.

The process of coronary artery disease Your coronary arteries are shaped like hollow tubes. Inside, they are smooth and elastic, allowing blood to flow freely. Coronary artery disease starts when you are very young. Before your teen years, fatty deposits start streaking the blood vessel walls. As you get older, the fatty matter builds up. This causes slight injury to your blood vessel walls. In an attempt to heal itself, the cells release chemicals that make the walls stickier. Other substances floating through your bloodstream start sticking to the vessel walls, such as inflammatory cells, proteins and calcium. The fat and other substances combine to form a material called plaque or atherosclerosis. The plaque builds up and narrows the artery. A condition called ischemia occurs. This is when the heart muscle becomes starved for oxygen because it’s not getting enough blood. It happens most often at times of peak exertion, like during exercise or stress. When ischemia occurs, you begin to have symptoms (such as angina). When ischemia lasts less than 10 minutes, there is no permanent damage to your heart. You may be told you have "stable coronary artery disease." Over time, the inside of the arteries develop plaques of different sizes. Many of the plaque deposits are hard on the outside and soft and mushy on the inside. The hard surface can crack or tear, exposing the soft, fatty inside. When this happens, platelets (disc-shaped particles in the blood that aid clotting) come to the area, and blood clots form around the plaque. The artery narrows further. Sometimes, the blood clot breaks apart by itself, and blood supply is restored. The blocked vessel may develop a collateral circulation: small capillary-like branches of the artery that form over time in response to narrowed coronary arteries. The collaterals "bypass" the area of narrowing and help to restore blood flow. However, during times of increased exertion, the collaterals may not be able to supply enough oxygen-rich blood to the heart muscle. In other cases, the blood clot may totally block the blood supply to the heart muscle, called a coronary thrombus or coronary occlusion - causing an acute coronary syndrome. Acute Coronary Syndrome is a name given to three types of coronary artery disease that are associated with sudden rupture of plaque inside the coronary artery. The length of time that blood flow is blocked and the amount of damage that occurs determines the type of acute coronary syndrome. An acute coronary syndrome can be caused by a small plaque, not necessarily detected by stress testing or cardiac catheterization. Prior symptoms may or may not be present. These life-threatening conditions require emergency medical care.

What are the symptoms of a heart attack?

The most common symptom of coronary artery disease is angina, also known as chest discomfort. Angina can be described as a discomfort, heaviness, pressure, aching, burning, fullness, squeezing or painful feeling. It can be mistaken for indigestion. Angina is usually felt in the chest, just beneath the sternum (breastbone), but may also be felt in the left shoulder, arms, neck, throat, jaw or back. Angina usually lasts a minute or two. If you have symptoms that last for more than 5 minutes, SEEK EMERGENCY TREATMENT WITHOUT DELAY. Angina is a symptom of a condition called myocardial ischemia

Other symptoms that can occur with coronary artery disease include:

	shortness of breath
	palpitations (irregular heart beats, skipped beats)
	a faster heart beat
	weakness or dizziness
	nausea
	perspiration

Symptoms of coronary artery disease in women:

Studies show that women's symptoms are less likely identified as heart disease related. The symptoms of coronary artery disease and heart attack can be different for women than they are in men. Women are also less likely to recognize the symptoms of a heart attack and seek treatment. By learning and recognizing the symptoms, women can become assertive in their treatment. The most common symptoms of heart disease in women are:

	Pain or pressure over the chest that travels to the arm or jaw
	A burning sensation in the chest or upper abdomen
	Shortness of breath, irregular heartbeat, dizziness, sweating, fatigue and nausea.

On average, symptoms of heart disease appear 10 years later in women than men. Women tend to have heart attacks 10 years later than men do.