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Coronary heart disease

Definition

Coronary heart disease (CHD) is a narrowing of the small blood vessels that supply blood and oxygen to the heart. CHD is also called coronary artery disease.

Video: Coronary artery disease - overview

Coronary Artery Disease Facts

Coronary artery disease is …

The correct answer is all of the above. Coronary artery disease (CAD) and coronary heart disease describe the same condition: the buildup of plaque in the arteries that carry blood and oxygen to the heart. These are called the coronary arteries. Over time, they can become narrow, slowing or stopping blood flow to the heart.

What causes plaque to build up in the arteries?

The correct answer is all of the above. Any of these factors cause damage to the inside walls of the coronary arteries. Cholesterol and other chemicals in the blood then build up on these injured areas as plaque. This process is called atherosclerosis.

You can have CAD and not have any symptoms.

The correct answer is true. Plaque buildup occurs slowly over time, so you can have the disease and not have any symptoms. This is especially true in the early stages of heart disease. Sometimes, a heart attack is the first sign of CAD.

What are the noticeable symptoms of CAD?

The correct answer is all of the above. Angina (chest heaviness, pressure, or pain) is the most common symptom. It often occurs during activity or stress and goes away with rest or when you take an angina medicine (most often nitroglycerin under your tongue). You also may feel shortness of breath, fatigue, or weakness.

Angina is another name for a heart attack.

The correct answer is false. Angina is a sign that your heart isn't getting enough oxygen. A heart attack occurs when heart muscle cells die due to a blocked artery. Having angina means you are at risk for a heart attack. If you have angina, and your chest pain doesn't go away minutes after rest or medicine, call 9-1-1.

Which heart problems can be caused by CAD?

The correct answer is all of the above. Reduced blood flow can damage the heart in different ways. Heart failure occurs when the weakened heart muscle can't pump enough blood to the rest of the body. CAD can damage the heart's electrical system, causing arrhythmias. A blocked artery can cause a heart attack.

If you have heart disease, you are at higher risk for depression.

The correct answer is true. It's unclear why, but there is a link between depression and heart disease, angina, and heart attack. Being depressed may make it harder to follow your treatment plan, and treating depression can help you better manage heart disease. If you think you may be depressed, talk with your doctor.

How may CAD be treated?

The correct answer is all of the above. Your treatment depends on your symptoms and how much artery blockage you have. For some people, lifestyle changes alone can treat CAD. Others may need medicine, angioplasty, or surgery. Talk with your doctor about the best treatment for you.

Which lifestyle change WON'T help treat CAD?

The correct answer is following a gluten-free diet. Most people don't need to follow a gluten-free diet, and avoiding gluten certainly won't help treat CAD. Follow a plant-based diet low in sodium, cholesterol, and trans and saturated fats. Talk with your doctor about other changes that can help your heart.

Plaque buildup can begin in childhood.

The correct answer is true. It may seem hard to believe, but plaque starts building up on artery walls in our childhood and teen years. That's why it's never too early to eat a healthy diet, get regular exercise, and manage stress. And if you never start smoking in the first place, you never have to quit!

Alternative Names

Heart disease, Coronary heart disease, Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD

Causes

Coronary heart disease is the leading cause of death in the United States for men and women.

Coronary heart disease is caused by the buildup of plaque in the arteries to your heart. This may also be called hardening of the arteries.

  • Fatty material and other substances form a plaque buildup on the walls of your coronary arteries. The coronary arteries bring blood and oxygen to your heart.
  • This buildup causes the arteries to get narrow.
  • As a result, blood flow to the heart can slow down or stop.

A risk factor for heart disease is something that increases your chance of getting it. You cannot change some risk factors for heart disease, but you can change others.

Symptoms

In some cases, symptoms may be very noticeable. But, you can have the disease and not have any symptoms. This is more often true in the early stages of heart disease.

Chest pain or discomfort (angina) is the most common symptom. You feel this pain when the heart is not getting enough blood or oxygen. The pain may feel different from person to person:

  • It may feel heavy or like someone is squeezing your heart. You may feel it under your breast bone (sternum). You may also feel it in your neck, arms, stomach, or upper back.
  • The pain most often occurs with activity or emotion. It goes away with rest or a medicine called nitroglycerin.
  • Other symptoms include shortness of breath and fatigue with activity (exertion).

Video: Angina causes and symptoms

Some people have symptoms other than chest pain, such as:

  • Fatigue
  • Shortness of breath
  • General weakness

Video: Heart failure

Exams and Tests

Your health care provider will examine you. You will often need more than one test before getting a diagnosis.

Tests may include:

Treatment

You may be asked to take one or more medicines to treat blood pressure, diabetes, or high cholesterol levels. Follow your provider's directions closely to help prevent coronary artery disease from getting worse.

Goals for treating these conditions in people who have coronary artery disease:

  • The most commonly used blood pressure target for people with heart disease is below 140/90 mmHg, but sometimes less than 130/80.
  • If you have diabetes, your HbA1c levels will be monitored and brought down to the level your provider recommends.
  • Your LDL cholesterol level will be lowered with statin drugs.

Treatment depends on your symptoms and how severe the disease is. You should know about:

Never stop taking your medicines without first talking to your health care provider. Stopping heart medicines suddenly can make your angina worse or cause a heart attack.

You may be referred to a cardiac rehabilitation program to help improve your heart's fitness.

Procedures and surgeries used to treat CHD include:

Outlook (Prognosis)

Everyone recovers differently. Some people can stay healthy by changing their diet, stopping smoking, and taking their medicines as prescribed. Others may need medical procedures such as angioplasty or surgery.

In general, early detection of CHD generally leads to a better outcome.

When to Contact a Medical Professional

If you have any risk factors for CHD, talk to your health care provider about prevention and possible treatment steps.

Call your health care provider, call the local emergency number (such as 911), or go to the emergency room right away if you have:

Images

Heart, section through the middle
Heart, front view
Anterior heart arteries
Posterior heart arteries
Acute MI
Cholesterol producers

References

Greenland P, Alpert JS, Beller GA, et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2010;122(25)e584-e636. PMID: 21098427 www.ncbi.nlm.nih.gov/pubmed/21098427.

Hansson GK, Hamsten A. Atherosclerosis, thrombosis, and vascular biology. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 70.

James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-20. PMID: 24352797 www.ncbi.nlm.nih.gov/pubmed/24352797.

Morrow DA, Boden WE. Stable ischemic heart disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 54. 

Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women--2011 Update:a guideline from the American Heart Association. Circulation. 2011;123:1243-1262. PMID: 21325087 www.ncbi.nlm.nih.gov/pubmed/21325087.

Ridker PM, Libby P, Buring J. Risk markers and the primary prevention of cardiovascular disease. In: Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 42.

Rosendorff C, Lackland DT, Allison M, et al; on behalf of the American Heart Association, American College of Cardiology, and American Society of Hypertension. Treatment of hypertension in patients with coronary artery disease: a scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. Circulation. 2015;131:e435–e470. PMID: 25829340 www.ncbi.nlm.nih.gov/pubmed/25829340.

Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S1-5.

Review Date: 
7/14/2015
Reviewed By: 
Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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