Coronary Heart Disease

Coronary heart disease (CHD), also called coronary artery disease (CAD), is a condition that affects arteries that deliver blood, oxygen and nutrients to the heart muscle.

Coronary heart disease (CHD) results when a fibrous tissue, called plaque, builds up inside the arterial walls, causing a partial or complete obstruction of blood flow. This condition is commonly called atherosclerosis. When the heart muscle is deprived of oxygen-carrying blood, a symptom called angina may occur. Angina is characterized by a sensation of pain, burning, pressure or other type of discomfort, which is generally felt in the chest area and may radiate to the left arm, neck or jaw.

Angina may be the first indication that (CHD) is present. For this reason, chest pain should never be ignored, even when it seems to come and go. Other, less fortunate people with (CHD) may get no warning that they have the disease, until they suffer a full-blown heart attack. Our Cardiocare Tracker is a convenient tool for tracking angina and other symptoms connected with common heart conditions such as coronary heart disease.

When a heart attack, or myocardial infarction occurs, the heart muscle’s supply of oxygen is completely cut off by a blood clot, resulting in permanent tissue death for a portion of the heart muscle.

Symptoms of Coronary Heart Disease

A person affected with coronary heart disease (CHD) may have a wide range of symptoms. Some people don’t have symptoms and are not aware that they have heart disease. Others may experience mild chest discomfort or shortness of breath, while some persons with CHD have frequent chest pain that interferes with their daily activities.

The classic symptom associated with CHD is called angina. Angina is usually described as a chest discomfort that can be experienced as a “pressure,” “squeezing,” “burning” or “heaviness” sensation in the center of the chest area, underneath the rib cage. The discomfort can sometimes spread to the neck, jaw or left arm. Other symptoms that may accompany angina include sweating, lightheadedness, nausea, shortness of breath and palpitations.

Angina is sometimes classified into two types: stable and unstable based on the occurrence of symptoms.

Stable angina is usually somewhat predictable. It may occur with increased exertion or extreme emotion, or following a large meal. The symptoms do not last long (usually one to five minutes) and are relieved by a period of rest or by nitroglycerin.

Unstable angina is less predictable. It may occur with little exertion or during rest, it often comes and goes at frequent intervals, and may be accompanied by more severe symptoms.

Once you are diagnosed with CHD, your doctor will give you specific guidelines for when to seek medical care for chest pain or other symptoms of coronary heart disease. Since the extent of CHD does not always match the duration and severity of chest discomfort, it is important for anyone who has chest pain to see a doctor. Once the diagnosis and extent of your CHD is determined, your doctor can give you specific guidelines for managing chest pain.

Risk Factors for Coronary Heart Disease

Coronary heart disease currently affects more than 7 million Americans, making it the most common form of coronary heart disease (CHD). Men initially have a greater risk for developing CHD than women. Once a woman reaches menopause, however, her risk for heart disease eventually equals or surpasses that of a man. Experts believe this may be due in part to a decrease in the production of estrogen, a female sex hormone that appears to offer some protection against heart disease.

Coronary heart disease remains the number one cause of death for both men and women in the United States, accounting for more than 500,000 deaths from heart attacks each year. Experts agree that many of these deaths can be prevented by lifestyle changes, which can directly reduce your chances for developing CHD

Risk factors for CHD are circumstances or conditions that increase the likelihood of your developing this disease. Risk factors are generally divided into two groups: controllable and uncontrollable.

Controllable risk factors

  • High blood pressure (hypertension).
  • High blood cholesterol (hyperlipidemia)
  • Smoking
  • Obesity
  • Sedentary lifestyle (too little physical activity)
  • Diabetes
  • Stress
  • HDL cholesterol less than 40 mg/dl

Uncontrollable risk factors

  • Gender (males are at greater risk initially)
  • Heredity (family history of premature CHD less than age 55 in men and less than age 65 in women)
  • Age (risk increases with age)

In rarer instances, CHD can result from other medical conditions. Some examples include the formation of a blood clot in the coronary artery due to an abnormal blood clotting condition, inflammation of the coronary arteries due to an autoimmune disorder, spasms of the coronary arteries secondary to cocaine abuse and congenital (meaning you are born with it) abnormalities of the coronary arteries.

Diagnosing Coronary Heart Disease

The diagnosis of coronary heart disease is made based patient history, physical examination, symptoms and the results of diagnostic testing. Many times, coronary heart disease produces few if any symptoms. For this reason, it is important for all adults to have regular examinations by a physician, which should include not only a physical exam but also a medical screening (which includes blood pressure and weight measurements, specific blood tests and lifestyle evaluation) to evaluate your overall risk for heart disease.

If your physician suspects that you have coronary artery disease the following diagnostic tests may be ordered:

Electrocardiogram (EKG) — An EKG is a recording of the electrical activity of the heart. It can help to detect abnormalities in heart rate and rhythm and can give information about whether your heart muscle is receiving enough oxygen and blood.

Stress Test — A stress test is performed on a treadmill or exercise bicycle; it evaluates the heart and blood pressure’s response to exercise. During a stress test, the individual is connected to a blood pressure monitor, while their level of physical activity is slowly increased. Changes in the EKG during this exam can identify stress-related abnormalities of the heart muscle that might not be evident on a resting electrocardiogram.

Nuclear scanning — A nuclear scan is sometimes used to evaluate the heart’s ability to pump blood and to show damaged areas of heart muscle. This test involves injecting a small amount of radioactive material (usually into an arm vein). After the radioactive material has been taken up by the heart muscle, a special camera is used to scan the heart and detect areas of unhealthy tissue.

Coronary Angiogram — A coronary angiogram or cardiac catherization is considered the most accurate method for diagnosing the severity of coronary artery disease. This procedure involves the insertion of a long, thin catheter (usually inserted through an artery in the forearm or groin), which is guided into the coronary arteries of the heart. Dye is then injected into the catheter, to visualize the coronary arteries. Narrowed areas and blockages in the arteries can be detected.

Following a complete medical evaluation, your doctor will have a more complete picture, indicating whether you have coronary heart disease and its severity. Based on this information, an individualized plan of treatment will be recommended.