Coronary Heart Disease

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Coronary heart disease is a narrowing of the small blood vessels that supply blood and oxygen to the heart. This happens when a waxy substance called plaque builds up inside the coronary arteries, which can eventually lead to a heart attack if the arteries become blocked. More than 60% of the global burden of coronary heart disease occurs in developed countries.

Symptoms of coronary heart disease are often very noticeable, and can manifest as chest pain, heart failure or a heart attack. It is extremely important to know the warning signs, as these often signal serious or life-threatening situations.

This section contains more detailed information about coronary heart disease, and the diagnostic tools used to detect the disease. Treatment for coronary heart disease usually involves lifestyle changes and, if necessary, drugs and certain medical procedures. Learn about the various treatment options by reading on.

Adopting a healthy lifestyle, such as exercising regularly, quitting smoking and managing stress, is the best way to keep your arteries strong and to prevent coronary heart disease. For tips on how to fight against this disease, see Prevention.

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Symptoms of coronary heart disease are often very noticeable, but sometimes you can have the disease and not have any symptoms. This is especially true in the early stages of heart disease. Generally, the signs and symptoms are:

  • Chest pain or discomfort (known as angina): This is the most common symptom, and occurs when the heart is not getting enough blood or oxygen. You may feel pressure or tightness in your chest, as if someone were squeezing your heart or standing on your chest. You may also feel it in your shoulders, arms, neck, jaw, or back. This pain is usually triggered by physical or emotional stress, and typically goes away within minutes of rest.
  • Shortness of breath: If your heart can't pump enough blood to meet your body's needs, you may develop shortness of breath or extreme fatigue with exertion. Women, elderly people, and people with diabetes are more likely to experience these symptoms.
  • Heart attack: If a coronary artery becomes completely blocked, you may have a heart attack. The classic signs and symptoms of a heart attack include crushing pressure in your chest and pain in your shoulder or arm, sometimes accompanied with shortness of breath and sweating. Women are more likely than men are to experience less typical signs and symptoms of a heart attack, including nausea and back, neck or jaw pain. Heart attacks may also occur without any apparent signs or symptoms.
  • Heart failure: Heart failure can also occur in people with coronary heart disease when the heart becomes too weak to pump blood around the body, which can cause fluid to build up in the lungs that makes it increasingly difficult to breathe. The most common signs and symptoms of heart failure are shortness of breath or trouble breathing, fatigue, and swelling in the ankles, feet, legs, stomach, and veins in the neck.
  • Heart palpitations (arrhythmia): An arrhythmia is a problem with the rate or rhythm of the heartbeat. When you have an arrhythmia, you may notice that your heart is skipping beats or beating too fast. This is sometimes described as a fluttering feeling in the chest.

Chest pain or discomfort that doesn’t go away or changes from its usual pattern might be a sign of a heart attack. If you are experiencing inexplicable chest pain, seek immediate medical attention. All chest pain should be checked by a doctor, so that a proper diagnosis can be made and the condition can be appropriately treated.

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Coronary heart disease is a disease in which a waxy substance called plaque builds up inside the coronary arteries. These arteries are the major blood vessels that supply the heart with the oxygen-rich blood and nutrients it needs to function.

Any of the coronary arteries can be narrowed by a buildup of fatty plaque, which occurs over many years. By narrowing your coronary arteries, these deposits restrict blood flow to the heart. Eventually, the decreased blood flow may cause chest pain (known as angina), while a complete blockage can lead to a heart attack.

In addition, coronary heart disease can lead to heart failure, which is a chronic condition in which a weakened heart causes shortness of breath, fatigue, and fluid accumulation. It may also bring about abnormal heart rhythms or cardiac arrest.

Causes of coronary heart disease

According to the National Heart, Lung, and Blood Institute , coronary heart disease starts when certain factors damage the inner layers of the coronary arteries. The damage may be caused by various factors, including:

  • Smoking
  • High blood pressure
  • High levels of certain fats and cholesterol in the blood
  • Insulin resistance or diabetes
  • Blood vessel inflammation
  • Radiation therapy to the chest used for certain types of cancer

Once the inner wall of an artery is damaged, plaques begin to build up at the site of the injury. If the surface of these plaques breaks open, blood cells called platelets will clump at the site to try to repair the artery by forming blood clots. This clump can block the artery, leading to a heart attack.

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Typically, a doctor will first ask questions about your medical and family history, conduct a physical exam and order routine blood tests. He or she may also order any of these diagnostic tests:

  • Electrocardiogram: An electrocardiogram is a painless test that measures and records electrical signals as they travel through your heart. The test shows how fast the heart is beating and its rhythm.  An electrocardiogram can show signs of heart damage due to coronary heart disease and signs of a previous or current heart attack.
  • Echocardiogram: An echocardiogram uses sound waves to create images of your heart. During an echocardiogram, your doctor can determine whether your heart chambers and valves are working normally. Parts that aren’t contracting normally may be receiving too little oxygen and can indicate coronary heart disease.
  • Stress test: If your symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an electrocardiogram. This is known as an exercise stress test. If you are unable to exercise, you may be given medication to raise your heart rate.
  • Computed tomography (CT) scans: CT technologies, such as electron beam computerised tomography (EBCT), can help your doctor visualise your arteries. EBCT can detect calcium within fatty deposits that narrow coronary arteries. If a substantial amount of calcium is discovered, coronary artery disease is likely.
  • Coronary angiography and cardiac catheterisation: Your doctor may recommend coronary angiography if other tests show that you're likely to have coronary heart disease. This test uses dye and special x-rays to view the insides of your coronary arteries and the blood flow through your heart. To inject the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterisation. This involves threading a thin, flexible tube called a catheter through an artery, usually in the leg, to the arteries in the heart. The dye outlines narrow spots and blockages on the X-ray images.
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Treatment for coronary heart disease usually involves lifestyle changes and, if necessary, drugs and certain medical procedures.

  • Lifestyle changes: Healthy lifestyle changes are the first point of attack against coronary heart disease. These include eating a heart healthy diet, quitting smoking, exercising regularly and reducing stress. For more information, see Prevention.
  • Medications: If lifestyle changes are not enough, various medications can be used to treat coronary heart disease, such as:
    • Aspirin: As aspirin is a blood thinner, your doctor may recommend taking a daily aspirin to help reduce the tendency of your blood to clot. This, in turn, may help prevent obstruction of your coronary arteries. Aspirin isn't appropriate in all cases, such as if you have a bleeding disorder or you're already taking another blood thinner, so ask your doctor before starting to take aspirin.
    • Cholesterol-modifying medications: By decreasing the amount of bad cholesterol in the blood, these medications can reduce the material that build up on the coronary arteries. These medications include statins, niacin, fibrates and bile acid sequestrants.
    • Nitroglycerin: Nitroglycerin helps to control chest pain by opening up your coronary arteries and reducing your heart's demand for blood. They come in tablets, sprays and patches.
    • Beta blockers: Beta blockers slow down your heart rate and decrease your blood pressure, which consequently reduces the pressure on your heart for oxygen. These drugs can also reduce the risk of future heart attacks.
    • Calcium channel blockers: Calcium channel blockers relax the muscles that surround your coronary arteries and cause the vessels to expand, increasing blood flow to your heart. They also control high blood pressure.
  • Medical procedures: When a more aggressive treatment is needed, these medical procedures may be used:
    • Angioplasty: Angioplasty is a nonsurgical procedure that opens blocked or narrowed coronary arteries. During this procedure, a thin, flexible tube with a balloon on the end is threaded through a blood vessel to the narrowed or blocked coronary artery. The balloon is then inflated to compress the plaque against your artery walls. This restores blood flow through the artery. During the procedure, the doctor may put a small mesh tube called a stent in the artery. The stent helps prevent blockages in the artery for months or years after angioplasty.
    • Coronary artery bypass surgery: In coronary artery bypass surgery, arteries or veins from other areas in your body are used to bypass (that is, go around) your blocked or narrowed coronary arteries. This surgery can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. However, because this requires open-heart surgery, it is most often reserved for cases of multiple narrowed coronary arteries.
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Just as it helps to treat coronary heart disease, adopting a healthy lifestyle can also prevent the disease by keeping your arteries strong and clear of plaques. To improve your heart health:

  • Maintain a healthy weight: If you're overweight or obese, work with your doctor to create a reasonable weight-loss plan. Controlling your weight helps you control coronary heart disease risk factors.
  • Stop smoking: If you smoke, quit. Smoking can damage and tighten blood vessels and raise your risk for coronary heart disease. Talk with your doctor about programs and products that can help you quit.
  • Control conditions such as high blood pressure, high cholesterol and diabetes: If you do not have coronary heart disease but do have high cholesterol, high blood pressure, diabetes or a history of family heart disease, your doctor may prescribe medication to prevent you developing heart-related problems. Take the prescribed medication, follow the correct dosage and do not stop taking your medication without consulting your doctor first. Doing so is likely to make your symptoms worse and put your health at risk.
  • Stay physically active: Generally, 30 minutes or more of moderate activity, such as bicycle riding and brisk walking, per day is a good initial goal. Aerobic exercise, which uses large muscle groups in a rhythmic, repetitive fashion for prolonged periods of time, is the best type of exercise for the heart. However, flexibility exercises and resistance exercises are also beneficial.
  • Eat a healthy, well-balanced diet: A heart healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, and beans and peas. Avoid foods that are high in salt, added sugars, solid fats, and refined grains.
  • Get sufficient sleep: Both sleep deprivation and sleep apnea have been linked with an increased risk of heart disease. Aim for the recommended 7 to 9 hours of sleep per night.
  • Reduce and manage stress: According to Harvard Health , a growing body of evidence suggests that psychological factors can impact your heart health and can contribute to cardiac risk. Stress from all sorts of challenging situations and events plays a significant role in cardiovascular symptoms and outcome, particularly heart attack risk. So while it’s not always possible to eliminate all stressful events from your life, consider making some positive changes or employing relaxation techniques that can reduce stress levels, such as meditation.
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