Coronary Heart Disease

Coronary heart disease is also called coronary artery disease. It
is the number one killer of both men and women in the U.S.

Coronary heart disease is when the innermost layer of the coronary
arteries becomes inflamed and narrowed. This is caused by a buildup of fatty
deposits called plaque. These deposits may start in childhood and continue to
thicken and enlarge throughout the life span. This thickening is called
atherosclerosis. It can cut or block blood flow to the heart. A blood clot may also
form on top of the plaque. Either of these can lead to a heart attack and even
death.

The coronary arteries supply blood to the heart muscle. Like all
other tissues in the body, the heart muscle needs oxygen-rich blood to work, and
oxygen-depleted blood must be carried away. The coronary arteries run along the
outside of the heart. They have small branches that supply blood to the heart
muscle. The 2 main coronary arteries are the left main and right coronary arteries.

The most common cause of coronary heart disease is
atherosclerosis. That’s when the inner lining of an artery becomes inflamed and
builds up with plaque. It causes the artery to narrow or become blocked.

You may be at risk for coronary heart disease if you:

  • Smoke
  • Have high LDL cholesterol, high triglyceride levels, and
    low HDL cholesterol
  • Have high blood pressure
  • Are not physically active
  • Are obese or overweight
  • Eat a diet high in saturated fat
  • Have diabetes
  • Have a family history of heart disease

The symptoms of coronary heart disease will depend on the severity
of the disease. Some people have no symptoms. Others have episodes of mild chest
pain (angina) when they are active. Some people have more severe chest pain even at
rest.

If too little oxygenated blood reaches the heart, you may have
angina. When the blood supply is completely cut off, the result is a heart attack.
The heart muscle starts to die. Some people may have a heart attack and never notice
the symptoms. This is called a “silent” heart attack.

These are the symptoms of coronary heart disease:

  • Heaviness, tightness, pressure, burning, or pain in the
    chest behind the breastbone
  • Pain spreading to the arms, shoulders, jaw, neck, or
    back
  • Shortness of breath
  • Weakness and severe tiredness (fatigue) especially during
    periods of activity
  • Nausea
  • Sweating
  • Chest pain that eases with rest
  • Chest pain that happens even at rest

Fainting (syncope) may be a symptom of a heart attack in elderly
adults.

The symptoms of coronary heart disease may look like other health
problems. Always see your healthcare provider for a diagnosis.

Your healthcare provider will ask about your health history and do
a physical exam. You may also need these tests:

Electrocardiogram (ECG)

This test records the heart’s electrical activity, shows
abnormal rhythms (arrhythmias), and finds heart muscle damage.

Stress test

This is also called an exercise echocardiogram or stress
echocardiogram. This test takes ultrasound pictures of your heart while you rest
and while you walk on a treadmill. It is done to see if your heart muscle is
getting weak. It’s more sensitive and more specific than ECG by itself. A stress
test may be used to find heart disease. Or it may be used to figure out safe
levels of exercise after a heart attack or heart surgery. 

Cardiac catheterization

The healthcare provider puts a wire into the coronary arteries
of your heart. The provider then takes X-rays after injecting a contrast dye
into an artery. This test can find narrowing, blockages, and other problems.
It’s considered the best for finding artery disease. The provider may also be
able to fix problems during the test.

Nuclear scanning (myocardial perfusion imaging)

The provider injects radioactive material into a vein. The
material acts as a tracer for blood flow in the heart muscle. The provider takes
images of the heart at rest with a special camera. Those images are compared
with stress images. Stress on the heart can be brought on through exercise or
with medicine. Damaged areas of the heart or areas of decreased blood flow don’t
take up the tracer very well. This can help find areas of past heart attack or
areas at risk for a heart attack. 

CT scan

This is also called calcium scoring or CT angiography. This
test uses X-rays from a CT scanner to help see the heart arteries and look for
calcium. Calcium is often found in heart artery disease. How much calcium you
have can help tell how severe your heart disease is. For CT angiography,
contrast dye is injected through an IV to help see blood flow through the heart
artery.

Treatment for coronary heart disease may include:

Lifestyle changes

Living a heart-healthy lifestyle may help you slow or stop
coronary heart disease. This may include quitting smoking, if you smoke. You may
also have to start exercising, lose weight, and eat healthier foods such as lean
meats, and fruits and vegetables. These steps can also help lower your
cholesterol and blood pressure levels.

Medicines

Many medicines may be used to treat coronary heart disease.
These include antiplatelets, such as aspirin. These lower the risk for blood
clotting. You may also take medicines that lower your blood pressure, lower
cholesterol levels, and treat diabetes.

Percutaneous coronary intervention (PCI)

This procedure uses catheters, balloons, and other tools to
open the blocked blood vessel and improve heart artery blood flow.  There are
several types of PCI:

  • Balloon angioplasty. A
    small balloon is inflated inside the blocked artery to open the blocked
    part.
  • Coronary artery stent.
    A tiny mesh coil is expanded inside the blocked artery to open the blocked
    part. It is left in place to keep the artery open. This is done with balloon
    angioplasty
  • Atherectomy. The
    blocked part inside the artery is cut away by a tiny device on the end of a
    catheter.
  • Laser angioplasty. A
    laser is used to “vaporize” the blockage in the artery.

Coronary artery bypass graft

This treatment is also simply called bypass surgery. During
this surgery, a bypass is created by grafting a pieces of arteries or veins
above or below the blocked part of a coronary artery. It lets blood flow around
the blockage. Veins are often taken from the leg. Arteries are taken from the
chest or arm. Sometimes you may need several bypasses to fully restore blood
flow to all parts of the heart.

Complications of coronary heart disease include:

  • Heart attack
  • Heart failure
  • Abnormal heart rhythms
  • Death

You can help prevent coronary heart disease by controlling your
risk factors, such as:

  • Not smoking
  • Exercising regularly
  • Eating a heart-healthy diet
  • Maintaining a healthy weight
  • Keeping your cholesterol, blood sugar, and blood pressure in
    a healthy range
  • Coronary heart disease is when the innermost layer of the
    coronary arteries become inflamed and narrowed from a buildup of plaque, or
    fatty deposits.
  • The main cause is atherosclerosis. It can cut or block the
    flow of blood to the heart.
  • Unhealthy lifestyle habits raise the risk for this disease.
    These include smoking and not being physically active.
  • High blood pressure, diabetes, and high cholesterol can also
    raise the risk for it.
  • Coronary heart disease runs in families.
  • Symptoms include chest pain and shortness of breath.
  • Treatment includes medicines that lower blood pressure,
    control diabetes and lower cholesterol. Procedures may also be done to open the
    coronary arteries, letting blood flow to the heart.

Tips to help you get the most from a visit to your healthcare
provider:

  • Know the reason for your visit and what you want to
    happen.
  • Before your visit, write down questions you want
    answered.
  • Bring someone with you to help you ask questions and
    remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and
    any new medicines, treatments, or tests. Also write down any new instructions
    your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how
    it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the
    results could mean.
  • Know what to expect if you do not take the medicine or have
    the test or procedure.
  • If you have a follow-up appointment, write down the date,
    time, and purpose for that visit.
  • Know how you can contact your provider if you have
    questions.