What it is
Coronary artery disease (CAD) is a condition in which the arteries supplying blood to the heart become narrowed or blocked, usually through a gradual buildup of fatty material along the artery walls. When the heart muscle doesn't get enough blood flow, people may notice chest discomfort, shortness of breath or unusual tiredness. Some people notice nothing at all.
A heart attack happens when blood flow to part of the heart is suddenly reduced or blocked, which can injure the heart muscle. It is a medical emergency. CAD is one common background for a heart attack, but not everyone with CAD has one.
Many factors can shape a person's risk, including family history, blood pressure, cholesterol, blood sugar, smoking, activity level and, in some families, inherited traits. Genetic heart testing is one tool some people discuss with a clinician when heart disease runs in the family. It shows risk or carrier status and does not diagnose CAD on its own.
How it’s traditionally been approached
Evaluation usually begins with a conversation about symptoms, personal and family history, a physical exam and bloodwork. An electrocardiogram (ECG) and imaging, such as an echocardiogram or a scan of the heart or arteries, may also be used to see how the heart is working.
A stress test looks at how the heart responds when it is made to work harder, through exercise or medication. If more detail is needed, cardiac catheterization lets a clinician look at the coronary arteries directly using a thin tube guided through a blood vessel. Whether any of these tests is appropriate is a decision for a licensed clinician.
When an artery is significantly narrowed, approaches have traditionally included medications, lifestyle changes, a stent placed during catheterization, or bypass surgery that reroutes blood around a blockage. Which path fits a person depends on many individual factors, and many of these are FDA-regulated devices and drugs. A licensed cardiologist decides what is appropriate after an evaluation.
How the right cardiologist may help
The right cardiologist may help by putting the pieces together: your symptoms, history, family background, exam and test results. A first visit generally involves questions about when symptoms happen, what makes them better or worse, what runs in your family and what medicines you take. Bringing a written list and past records can make the visit more useful.
Your cardiologist may explain which tests, if any, could be helpful and why, and what each one can and cannot show. If heart disease appears in several relatives, they may discuss whether genetic heart testing and a genetic counselor could be worthwhile. They can also coordinate with other specialists, such as an interventional cardiologist or a cardiac surgeon.
Helpful questions to ask include: What do my results mean for me? What are my options, and what are the trade-offs of each? What symptoms should send me to the emergency room? How might this affect my daily life and work? Will my insurer cover this? Coverage varies by insurer, state and diagnosis, so confirm with your insurer and provider.
The whole-person view
The heart and the mind are closely connected. Chest pain, a scary test result or a family history of heart problems can bring worry, and ongoing stress can affect sleep, habits and how the body feels. These influences work in both directions, so caring for the whole person can matter alongside medical care.
Some people find body-based support helpful for calming a tense nervous system, such as the practitioners at Somatic Experiences. Others value talk therapy to work through fear or life changes after a heart scare, such as the professionals at Therapists.plus. These are complementary options to discuss with your care team, not replacements for medical care.
Somatic Experiences: nervous system regulation →Somatic Experiences: embodiment and movement →Therapists.plus: anxiety panic and ocd →Therapists.plus: mind body connection →
Keep in mind
- This page is educational only and is not medical advice; licensed professionals should guide all decisions about testing and treatment.
- For chest pain, pressure, trouble breathing, fainting or other possible heart attack signs, call 911 right away rather than waiting.
- If you are in emotional distress or crisis, call or text 988 to reach the Suicide & Crisis Lifeline.
- Genetic tests show risk or carrier status and don't diagnose heart disease alone. A negative result doesn't rule out risk, and a variant of uncertain significance is not a diagnosis. GINA protects against genetic discrimination in US health insurance and employment, but not life, disability or long-term-care insurance, so ask about those before testing.
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Frequently asked questions
What is coronary artery disease?
Coronary artery disease is a condition in which the arteries that supply blood to the heart become narrowed or blocked, often from a gradual buildup along the artery walls. Some people have symptoms like chest discomfort or breathlessness, while others have none. A cardiologist can evaluate whether it may be present.
What does a cardiologist do for chest pain?
A cardiologist may review your symptoms, history and family background, perform an exam and discuss whether tests such as an ECG, imaging or a stress test could help. They aim to understand the possible cause and explain your options. Sudden or severe chest pain is an emergency, so call 911.
What is the difference between a stent and bypass surgery?
A stent is a small mesh tube placed in a narrowed artery during catheterization to help keep it open, while bypass surgery creates a new route for blood to flow around a blockage. Each is used in different situations. Only a licensed cardiologist or surgeon can say which, if either, is appropriate for you.
What is a stress test and what does it show?
A stress test looks at how your heart responds when it works harder, using exercise or medication, often along with ECG or imaging. It may give clues about blood flow to the heart muscle. It is one piece of the picture, and your clinician decides if it is right for you.
Can genetic heart testing tell me if I will have a heart attack?
No, genetic heart testing cannot tell you whether you will have a heart attack. It may show inherited risk or carrier status, and results must be interpreted with your history, exam, imaging and bloodwork by a qualified clinician or genetic counselor. A negative result doesn't rule out risk, and genetic counseling before and after testing is recommended.
Will insurance cover heart testing and procedures?
Coverage varies by insurer, state and diagnosis, so it's best to confirm with your insurer and your provider before testing or procedures. For genetic testing, GINA protects against discrimination in US health insurance and employment, but not life, disability or long-term-care insurance. Ask about those before testing.
Educational resource. CardioGenes shares general information and connects people with independent cardiologists. It is not medical advice, diagnosis or treatment. Talk with a licensed professional about your health.