Coronary heart disease: What you need to know

Once the coronary arteries are too small, coronary heart disease (CHD), or coronary artery disease, occurs. Coronary arteries are the vessels of the blood which supply the heart with oxygen and blood.

CHD begins to accumulate as cholesterol builds up, forming plaques on the walls of the arteries. Such plaques cause narrowing of the arteries, which decreases blood flow to the heart. Often a clot will block the flow of blood, causing serious health problems.

Coronary arteries form the network of blood vessels on the heart surface which feed it with oxygen. If these arteries narrow, the heart can not get enough blood rich in oxygen, particularly during physical activity.

Often CHD can cause heart attack. It is the “most common form of heart disease in the US,” where it accounts for over 370,000 deaths per year.

Causes

CHD occurs due to damage in the coronary artery that leads to plaque buildup.
CHD occurs due to damage in the coronary artery that leads to plaque buildup.

CHD occurs in the inner layer of a coronary artery as a result of injury or damage. Such damage is causing plaque to build up fatty deposits at the injury site.

These deposits consist of cholesterol, as well as other cell waste materials. The building up is known as atherosclerosis.

In an effort to patch the blood vessel, platelets will accumulate in the region if plaque fragments break off or burst. The cluster can obstruct the artery, reducing or preventing blood flow, which can result in a heart attack.

Symptoms

CHD can lead to angina. This is a type of chest pain linked to heart disease.

Angina may cause the following feelings across the chest:

  • squeezing
  • pressure
  • heaviness
  • tightening
  • burning
  • aching

Angina might also cause the following symptoms:

  • indigestion
  • heartburn
  • weakness
  • sweating
  • nausea
  • cramping

CHD can also lead to breath shortage. When not enough oxygen is supplied to the heart and other organs, any sort of exertion can become very tiring, which can cause a person to gasp for air.

Complications

Heart attack happens when not enough blood or oxygen is in the heart muscle, such as when a blood clot forms from plaque in one of the coronary arteries.

Blood clot formation is called coronary thrombosis. When this clot is large enough, it can interrupt blood flow to the heart.

Symptoms include a heart attack:

  • chest discomfort
  • mild or crushing chest pain
  • coughing
  • dizziness
  • shortness of breath
  • a gray pallor in the face
  • general discomfort
  • panic
  • nausea and vomiting
  • restlessness
  • sweating
  • clammy skin

The first symptom is generally chest pain that extends to the throat, chin, head, arms and wrists and probably to the blades of the shoulder, back or abdomen.

It is unlikely that a change of position, sitting or lying down would bring relief. Sometimes the pain is continuous but can come and go. It can last for several hours, from a few minutes.

A heart attack is a medical condition which may lead to death or serious heart injury. If a person has signs of a heart attack, it is important to urgently contact the emergency services.

Treatment

CHD does not have treatment. There are nevertheless ways a person can handle the condition.

Treatment tends to require making improvements to the healthier lifestyle, such as avoiding smoking, taking a balanced diet and daily exercise.

Many people may need to take medicine, however, or undergo medical procedures.

Medications

Various medications are available to treat CHD
Various medications are available to treat CHD

Medications that people can take to reduce the risk or impact of CHD include:

  • Beta-blockers: A doctor may prescribe beta-blockers to reduce blood pressure and heart rate, especially among people who have already had a heart attack.
  • Nitroglycerin patches, sprays, or tablets: These widen the arteries and reduce the heart’s demand for blood, as well as soothe chest pain.
  • Angiotensin-converting enzyme inhibitors: These bring down blood pressure and help slow or stop the progression of CHD.
  • Calcium channel blockers: These will widen the coronary arteries, improving blood flow to the heart and reducing hypertension.
  • Statins: These may have a positive impact on outcomes in CHD. One 2019 review found that although taking statins cannot reduce the overall risk of death from CHD, they can prevent development and reduce the risk of non-fatal heart attacks. However, they might not be effective for people with cholesterol disorders such as hyperlipidemia.

Many people used aspirin in the past to lower their risk of CHD, but existing guidelines suggest that only for patients with a high risk of heart attack, stroke, angina or other cardiovascular events. That is because aspirin is a thinner in the blood, which raises the risk of bleeding on a human.

Doctors also advocate focussing on nutrition approaches such as taking a balanced diet and having mild to heavy exercise on a regular basis. Those approaches can reduce atherosclerosis risk.

Surgery

If they have become very small, or if symptoms do not respond to medication, the following surgical procedures will open or bypass blocked arteries:

  • Laser surgery: This involves making several very small holes in the heart muscle. These encourage the formation of new blood vessels.
  • Coronary bypass surgery: A surgeon will use a blood vessel from another part of the body to create a graft that bypasses the blocked artery. The graft may come from the leg, for example, or an inner chest wall artery.
  • Angioplasty and stent placement: A surgeon will insert a catheter into the narrowed part of the artery and pass a deflated balloon through the catheter to the affected area. When they inflate the balloon, it compresses the fatty deposits against the artery walls. They may leave a stent, or mesh tube, in the artery to help keep it open.

Another individual can require a heart transplant on rare occasions. However, that is only if there is serious harm to the heart and treatment doesn’t work.

Prevention

Controlling blood cholesterol levels can help lower the risk of CHD in a person. To track blood cholesterol levels better:

  • be more physically active
  • limit alcohol intake
  • avoid tobacco
  • adopt a diet with less sugar, salt, and saturated fats

People who already have CHD should make sure certain factors are monitored by following the advice of the doctor.

Risk factors

The following factors increase a person’s risk of developing CHD:

  • having high blood pressure, or hypertension
  • having high levels of low-density lipoprotein, or “bad,” cholesterol
  • having low levels of high-density lipoprotein, or “good,” cholesterol
  • having a diagnosis of diabetes, in which the body cannot effectively remove sugar from the bloodstream
  • having obesity
  • smoking, which increases inflammation and increases cholesterol deposits in the coronary arteries

Some risk factors are not lifestyle-related. These may include:

  • having high levels of the amino acid homocysteine, which one 2015 study linked to a higher incidence of CHD
  • having high levels of fibrinogen, a blood protein that encourages the clumping of platelets to form blood clots
  • having a family history of CHD
  • for women, having been through menopause
  • for men, being over 45 years of age

Having high levels of lipoprotein(a) specifically is also linked to a higher risk of cardiovascular disease and CHD.

Here, read more about how the DASH diet can reduce the risk of CHD.

Diagnosis

Cardiac stress test
A stress test can help a doctor diagnose CHD.

A doctor will do a physical exam, take a detailed medical history and order multiple tests to diagnose CHD. For instance:

  • Electrocardiogram: This records the electrical activity and rhythm of the heart.
  • Holter monitor: This is a portable device that a person wears under their clothes for 2 days or more. It records all the electrical activity of the heart, including the heartbeat.
  • Echocardiogram: This is an ultrasound scan that monitors the pumping heart. It uses sound waves to provide a video image.
  • Stress test: This may involve the use of a treadmill or medication that stresses the heart in order to test how it functions when a person is active.
  • Coronary catheterization: A specialist will inject dye through a catheter they have threaded through an artery, often in the leg or arm. The dye shows narrow spots or blockages on an X-ray.
  • CT scans: These help the doctor visualize the arteries, detect calcium within fatty deposits, and characterize any heart anomalies.
  • Nuclear ventriculography: This uses tracers, or radioactive materials, to create an image of the heart chambers. A doctor will inject the tracers into the vein. The tracers then attach to red blood cells and pass through the heart. Special cameras or scanners trace the movement of the tracers.
  • Blood tests: Doctors can run these to measure blood cholesterol levels, especially in people at risk of high blood cholesterol levels.

Summary

When coronary arteries are too small CHD grows. The disease induces blockages in the heart’s arteries, which feed oxygen-rich blood.

CHD can be hard to handle, and can result in a heart attack or stroke. However, through frequent exercise, taking a balanced diet, and avoiding or stopping cigarettes, people may take steps to reduce their risk of CHD.

People should seek medical attention immediately if they have chest pain and breathlessness, as this can mean a heart attack.

Q:

Is CHD the most dangerous cardiovascular disease?

A:

CHD is the most dangerous cardiovascular disease, as it causes the most deaths of any heart disease in the United States.

Having undetected or untreated high blood pressure or high cholesterol can lead to a heart attack without causing any prior symptoms. Be sure to see a doctor regularly and seek regular blood tests.

Even those who consider themselves to be healthy may have high cholesterol and not know it. Debra Sullivan, PhD, MSN, RN, CNE, COI

Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

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