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How to Be a Caregiver for Someone with Coronary Artery Disease

You can help lower their risk of heart attack and other complications


spinner image an older couple smiles at each other as they sit on a floral sofa.
Kay Young has helped her husband Don through 31 years of health challenges, including cancer and heart disease. The couple is pictured in their St. Charles, Missouri, home.
Theo R. Welling

Don Young and his wife, Kay, of St. Charles, Missouri, are not always on the same page when it comes to protecting his health after five heart artery stents and a heart valve replacement.

Kay, 75, would like Don, 80, to eat less salt — but Don still eats potato chips. Kay would like Don to listen to his doctor and stop doing lawn work on hot days. Don says when his lawn needs mowing, he does it.

But Don says he does value Kay’s caregiving — including the many hours she’s spent with him in hospitals, tracking every drug and procedure and, he says, warding off disaster. She’s helped him through 31 years of health challenges that started with throat cancer and got more complicated when he developed coronary artery disease nearly 20 years ago.  

Don, who speaks with a device called an electrolarynx, says: “If it wasn’t for my wife, I’d be dead.”

When someone has coronary artery disease — the kind of heart disease that is usually caused by blocked arteries and can lead to chest pain, heart attacks, and other complications — family caregivers can make a big difference, research suggests.

“People who have a lot of support from their family actually recover better, they recover faster, and they do better long term,” after a crisis like a heart attack, says Vinoy Prasad, M.D., director of interventional cardiology and cardiac rehabilitation at Loma Linda University International Heart Institute in California.

So, if you care for someone with coronary artery disease, which is sometimes called coronary heart disease, here’s what you can do to support them.

Learn about coronary artery disease

Your coronary arteries, which wrap around and branch into your heart, deliver oxygen-rich blood to the heart muscle. When that blood flow is reduced, you can get symptoms like chest pain, shortness of breath, and fatigue. When the flow stops or is severely restricted, depriving the heart of oxygen, that’s a heart attack.

The most common cause of coronary artery disease is atherosclerosis, or the buildup of plaque in arteries. Plaque is a sticky substance made of fats, cholesterol, calcium, and other substances. It can build up over many years, narrowing arteries and reducing blood flow. A complete blockage sometimes happens when a piece of plaque breaks off and produces a blood clot.

Learn the Signs of Heart Attack

Anyone with coronary heart disease is at risk for a first or repeat heart attack. Here are some possible signs, from the American Heart Association:

  • Pain, pressure, squeezing, or fullness in the chest.
  • Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
  • Shortness of breath, with or without chest discomfort.
  • Other signs such as nausea, vomiting, lightheadedness, and cold sweats.
  • When you see the warning signs, call 911. An ambulance crew can start treatment if needed.

High levels of unhealthy cholesterol, high blood pressure, smoking, diabetes, obesity and a family history of the condition raise your risk for this kind of heart disease, according to the American Heart Association.

Some less common types of coronary artery disease, called nonobstructive coronary artery disease, include damaged artery linings and artery spasms that restrict blood flow without plaque buildup.

Too many people find out they have coronary artery disease only when they have a heart attack, says Seth Martin, M.D., a cardiologist and professor of medicine at Johns Hopkins University.  Others, he says, find out when symptoms lead them to get a CT scan called a coronary angiogram that can show narrowed arteries. Cardiac catheterization, where a long, thin tube is threaded through blood vessels, dye is injected, and then an X-ray is used show any blockages, can also diagnose the condition.

With catheterization, routinely done after a heart attack, the blockages can be fixed right away, often by widening the artery with a mesh tube called a stent. In some cases, bypass surgery is needed to make a new path for blood around the blockage.

If your loved one has a heart attack today — and gets to a hospital quickly — they stand to benefit from “a tremendous evolution" in care, that has greatly improved survival and lowered the risk of repeat heart attacks, Martin says. Fast reversal of blockages can limit heart damage, he says.

Today’s medications, which include many drugs to lower cholesterol and blood pressure and to improve heart function, also are extending lives, Prasad says.

Be a member of the care team

Heart patients who have an involved caregiver are more likely to take those medications and follow other instructions, and more likely to get to their appointments, says Lisa Kitko, dean of University of Rochester School of Nursing and coauthor of a 2022 heart association scientific statement on engaging families in cardiovascular care.

If possible, caregivers should go with patients to appointments or connect virtually, with a video call or speaker phone, the experts agree. 

“Two sets of ears are better than one,” Kitko says. And caregivers often have information to share, she says: “They are going to see changes that practitioners are not going to pick up on.”

It’s also ideal to be there or check in frequently during any hospitalization, the experts say.

“The more the patient and the family understand, the more likely they're going to be able to follow the treatment plan after they leave the hospital,” Martin says.

Having a loved one paying attention also adds a “layer of safety,” Kitko says.

Kay and Don Young say they’ve experienced that during multiple hospitalizations — like the time Kay prevented Don from getting one too many blood transfusions or the times she learned he wasn’t getting all his medications (he takes 18 pills a day, she says).

Kay says she pays close attention during regular doctors’ visits too, filling Word documents with notes after each appointment.

She says she’s often the first person to realize something isn’t right with Don — like when he complained of jaw pain two days before a planned trip to Alaska. Because he’d had that symptom when an artery needed stenting in the past, she called his cardiologist. A quick catheterization found an old stent 95 percent blocked, Kay says. She says it’s a good thing they didn’t ignore the pain and head to Alaska: “He was a dead man walking.”

spinner image two plastic storage bags filled with pill bottles. one bag is labeled day, the other labeled night.
Kay Young monitors Don's 18 daily pills for coronary artery disease.
Theo R. Welling

Encourage cardiac rehab

If your loved one has had a heart attack, a stent, coronary bypass surgery, heart valve replacement, or if they have regular chest pains (stable angina), they can qualify for an exercise and education program called cardiac rehabilitation. It’s covered by Medicare and many other insurers, Prasad says.

Over several weeks, he says, patients get counseling on diet and other lifestyle changes, along with supervised exercise.  “You have to gradually increase your activity, because having a heart attack or having a stent or surgery or some kind of cardiac event does put a lot of stress on the body,” he says.

Rehab participants “have a much better prognosis,” yet the programs are greatly underused, Martin says. Some health care systems, including his, are experimenting with apps, video visits, and other technology to make rehab more accessible, he notes.

Families can help by providing transportation and other practical support, but also by talking about how helpful rehab can be, Kitko says. One reason some people don’t want to go, she says, is that after heart treatment they feel better and don’t see the need.

One fact caregivers might share: A recent study in the Journal of Cardiopulmonary Rehabilitation and Prevention found that patients who attended any cardiac rehab sessions were 43 percent less likely to die or be readmitted to the hospital within six months.

Share in a heart-healthy lifestyle

Changing the habits that contribute to coronary artery disease can change the course of the disease, experts say.

“In the United States, the number one modifiable risk factor for coronary artery disease is smoking,” Prasad says — so helping your loved one quit can matter a lot. If you smoke or others in the household do, make quitting a shared goal, he suggests.

Eating a heart-healthier diet, one lower in sodium and sugar, with lots of fruits, vegetables, and whole grains can be a family affair, too, Kitko says: “It's easier to cook one meal,” she says, and a “win-win” for everyone’s health.

If you can manage daily walks with your loved one, do it, Prasad says: 30 to 60 minutes a day “can make a big difference,” he says and is safe, once people build up exercise tolerance.

Making such changes can be hard, Prasad says, and frustrating for families when patients aren’t on board. Try to encourage one small change at a time, he suggests: “You don't have to do everything all at once.”

spinner image Ed Frauenheim and Rowena Richie smile at the camera in front of a body of water.
Ed Frauenheim says wife Rowena Richie helps him dial down the stress after his mild heart attack.
Courtesy: Frauenheim/Richie

Attend to mental health — theirs and yours

Finding out you have coronary artery disease can be scary, especially if you find out by having a heart attack. It can be scary for families, too.

“Yesterday, you thought your family member was doing just fine,” and now they’re not, Martin says.  “It's just very disruptive to your life.”

People recovering from heart crises are at increased risk for depression, anxiety, and post-traumatic stress, according to the heart association. Their caregivers often report financial strain, sleep disturbances, and feeling overwhelmed, studies have shown.

Ed Frauenheim, 56, and his wife Rowena Richie, 54, of San Francisco can relate. Three years ago, Frauenheim was overcome with nausea, chest tightness, and fatigue while on a walk in his hilly neighborhood. He’d had a “mild heart attack,” he says, an unusual one caused by a spasm in one of his coronary arteries, not plaque build-up.

Such spasms can be caused by emotional stress, something Frauenheim knew was a problem for him. The author and speaker, who focuses on masculinity and workplace culture, has a history of anxiety and panic attacks and struggled even more in the days after the heart attack, he says: “I thought I was going to die.”

He’s seen mental health counselors, but Richie has also helped him dial down the stress. She says she regularly sits down with him, looks at his calendar, and helps him “de-bunch” and pare down his typically over-packed schedule. And most Friday nights, the two put lit candles and mats on their apartment floor and do yoga together for an hour or more. “It’s super sweet,” Richie says.

“She’s been a great care partner,” Frauenheim says.

Even great partners get tired, though. For many people, caregiving gets more intense over time, Kitko says. When that happens, she says, don’t hesitate to find help and take breaks. “Caregivers need to know that they have to take care of themselves,” she says.

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