Coronary heart disease

Coronary heart disease (or coronary artery disease) is a narrowing of the small blood vessels that supply blood and oxygen to the heart (coronary arteries). Coronary disease usually results from the build up of fatty material and plaque ( atherosclerosis ). As the coronary arteries narrow, the flow of blood to the heart can slow or stop. The disease can cause chest pain ( stable angina ), shortness of breath, heart attack , or other symptoms.

Alternative Names

Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD

Causes, incidence, and risk factors

Coronary heart disease (CHD) is the leading cause of death in the United States for men and women. According to the American Heart Association, about every 29 seconds someone in the US suffers from a CHD-related event, and about every minute someone dies from such event. The lifetime risk of having coronary heart disease after age 40 is 49% for men and 32% for women. As women get older, the risk increases almost to that of men. (See also Heart disease and women .) There are many factors which increase the risk for CHD. Some of the risks are based on family history (genetics), and others are more controllable. Risk factors include the following:

  • Family history of coronary heart disease (especially before age 50)
  • Male gender
  • Age (65 and greater)
  • Tobacco smoking
  • High blood pressure
  • Diabetes
  • High cholesterol levels (specifically, high LDL cholesterol and low HDL cholesterol)
  • Lack of physical activity or exercise
  • Obesity
  • High blood homocysteine levels
  • Menopause in women
  • Infection that causes inflammatory response in the artery wall. (There is some evidence that suggests this, but the theory is being studied.)

    • Signs and tests

    There are many tests that may help to diagnose CHD. Usually, more than one test will be done before a definitive diagnosis can be made. Some of the tests include:

  • Electrocardiogram (ECG)
  • Exercise stress test
  • Echocardiogram
  • Nuclear scan
  • Coronary angiography/arteriography
  • Electron-beam computed tomography (EBCT) -- the purpose of this test is to identify calcium within the plaque found in the arteries. The more calcium seen, the higher the likelihood for CHD.

    • Treatment

    The treatment for CHD varies depending on the symptoms and how much the disease has progressed. The general treatments include lifestyle changes, medications, and sometimes surgery. Lifestyle changes may include:

  • A weight reduction program
  • A low saturated fat / low cholesterol diet to help reduce cholesterol
  • Reducing sodium (i.e., salt) ingestion to keep high blood pressure under control
  • A routine exercise regimen
  • Permanently discontinuing cigarette smoking
    • Medications may include:
  • Cholesterol-lowering medication
  • Antiplatelet agents such as aspirin, ticlopidine, or clopidogrel to reduce the risk of blood clots
  • Glycoprotein IIb-IIIa inhibitors such as abciximab, eptifibatide, or tirofiban, to reduce the risk of blood clots
  • Antithrombin agents such as blood-thinners (low-molecular heparin, unfractionated heparin), to reduce the risk of blood clots
  • Beta-blockers to decrease heart rate and to lower oxygen consumption by the heart
  • Nitrates such as nitroglycerin to dilate the coronary arteries and improve blood supply to the heart.
  • Calcium-channel blockers to relax the coronary arteries and all systemic arteries and thus reduce the workload for the heart.
  • ACE inhibitors, diuretics, or other medications to lower blood pressure.
    • Interventions may include:
  • Percutaneous Coronary Interventions (PCI's):
  • Coronary angioplasty
  • (Balloon PTCA).
  • Coronary atherectomy.
  • Ablative laser-assisted angioplasty.
  • Catheter-based thrombolysis and mechanical thrombectomy.
  • Coronary stenting (placing a tube in the artery to keep it open).
  • Coronary radiation implant or coronary brachytherapy: Brachytherapy consists of the intracoronary delivery of beta or gamma radiation. This new treatment strategy is reserved for patients who have undergone stent implantation in a coronary artery and then have developed problems such as diffuse in-stent restenosis. Coronary brachytherapy is a promising technique but currently limited by certain complications such as edge restenosis and late thrombotic occlusion. In addition, the long-term effects of radiation are still unknown as coronary brachytherapy was only approved by the FDA for clinical use in late 2000. The FDA approval of brachytherapy is currently restricted to treatment of problems involving sents, although in some medical centers brachytherapy is being studied as a first-line treatment of coronary disease.
  • Surgical Interventions:
  • Coronary artery bypass surgery
  • .
  • Minimally invasive heart surgery
  • .

    • Expectations (prognosis)

    The outcome is variable. Some people can maintain a healthy life by changing diet, stopping smoking, and taking medications as long as they are closely monitored. Others may require more drastic measures, such as surgery. Everyone is different, but one important caveat is detecting CHD early and treating it appropriately.

    Complications

  • Heart attack
  • Unstable angina
  • Sudden death

    • Calling your health care provider

    If you have any of the risk factors for CHD, you should contact your health care provider for appropriate prevention and treatment. If you experience angina, shortness of breath, or symptoms of a heart attack, contact your health care provider, call 911 or go to the emergency room immediately.

    Prevention

  • See your health care provider regularly
  • Don't smoke
  • Eat a low fat, low cholesterol diet
  • Eat well-balanced meals that include several daily servings of fruits and vegetables
  • Develop a routine exercise regimen. Short, frequent sessions of exercise are preferable to a complete sedentary lifestyle. Walking instead of driving, taking the stairs instead of the elevator, and parking far from building entrances are all measures that most people can incorporate into their busy routines
  • Keep blood pressure under control
  • Maintain weight appropriate for your frame and build
  • Inquire about what vitamin supplements may be helpful in the prevention of CHD
  • Manage stress

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