Definition and Overview

Also known as ischemic heart disease, atherosclerosis, or coronary artery disease, coronary heart disease is a cardiovascular disorder characterized by blood flow impairment as a waxy substance primarily made up of cholesterol and other fatty deposits build up in the coronary arteries (plaques).

According to Centers for Disease Control and Prevention, coronary heart disease is the most common of all cardiovascular disorders. With more than 300,000 people dying from it every year, it is the main cause of death among men and women in the United Sates.

The disease may begin to develop while the patient is still young and progress very slowly. Initial symptoms such as sudden heart attack may not appear until coronary heart disorder is already in its advanced stage.

Although it does not have a cure, scientific and technological advancements make treatment and management more efficient so patients may enjoy longer quality of life.

Causes of Condition

The main cause of coronary heart disease is atherosclerosis or the build-up of plaque in the walls of the arteries.

The heart is a hollow muscular organ, and its primary role is to pump oxygen-rich blood to different parts of the body through the arteries, allowing the cells and tissues to perform their vital functions. Blood also goes back to the heart via the veins. As a muscle (myocardium), however, the heart also requires oxygen to do its work.

When there is excessive cholesterol in the blood, these fatty deposits (atheroma) start to clog the arteries by sticking themselves to the walls. The body’s immune system responds to the build-up by releasing white blood cells to eliminate the threat. As the process is repeated over the years, plaque forms in the coronary arteries. Plaque then narrows the blood’s passageway, reducing or even cutting off the supply of oxygen to the heart.

Sometimes plaque bursts and forms a blood clot (thrombosis), which also blocks oxygen delivery to the heart.

Coronary heart disease affects anyone, but some individuals are more at risk than others because of the following:

  • Elevated blood pressure and cholesterol
  • Extra weight (overweight or obese)
  • Smoking (including second-hand smoking)
  • Age (between 45 and 55 years old)
  • Gender (it occurs earlier in men than in women)
  • Diabetes
  • Lack of physical activity
  • Family history
  • Unhealthy diet with excessive consumption of saturated and trans fat

Key Symptoms

  • Angina (the feeling of chest tightening, squeezing, discomfort or pain)
  • Feeling of indigestion
  • Pain in the back, arms, and shoulders
  • Arrhythmia (irregular heartbeat)
  • Heart failure
  • Shortness of breath due to build-up of fluid in the lungs (advanced stages of heart failure)

Some people develop silent CHD. The disease progresses without showing any symptoms until they suffer from a heart attack.

While the heart attack is typically sudden, sometimes it occurs gradually. It is therefore essential that the patient and his family are aware of the initial key symptoms. These include:

  • Feeling of tightness or fullness in the chest that may be sudden or intermittent (the feeling goes away but comes back repeatedly)
  • Shortness of breath even without angina
  • Nausea and vomiting
  • Cold sweats
  • Extreme feeling of tiredness and fatigue
  • Light-headedness or feeling of passing out
  • Pressure in the upper back
  • Nagging pain in the limbs that may begin in the hand that gradually affects the arms and back

Who to See and Treatments Available

A person at risk of coronary artery or heart disease is referred to a cardiologist, a doctor who specializes in the cardiovascular system and monitoring the progression of the disease.

Cardiologists request for CAD screening to determine the severity of the disease. It is composed of many types of tests such as the following:

  • Electrocardiogram (EKG) - it is a simple examination that detects the level of electrical activity in the heart.

  • Treadmill stress test – also known as exercise cardiac arrest test, it measures the capacity of the heart to handle stress. The doctor asks the patient, who is connected to an EKG machine, to run on a treadmill with settings such as elevation and speed adjusted over time. The doctor then identifies potential blockage and monitors levels of oxygen supply throughout the procedure.

Other tests include:

  • Angiogram – it is a cardiovascular X-ray examination that allows the doctor to see if the coronary arteries or blocked or narrowed.

  • Echocardiogram – it is an imaging test that determines the heart’s condition through the use of ultrasound waves.

  • Other diagnostic tests such as blood cholesterol and lipid panels, fasting blood sugar, and blood pressure monitoring

Treatments for CHD delay the progression of the disease and prevent serious complications such as a heart attack. These treatments include:

  • Medications – beta-blockers, ACE inhibitors, and ARBs help control blood pressure levels while ibuprofen and aspirin decrease the risk of thrombosis. Statins are usually given to patients with chronic high cholesterol levels.

  • Surgery – angioplasty dilates the arteries by inflating a device that pushes the plaque against the artery walls. Bypass grafting of the coronary arteries provides a new passageway for the blood by bypassing narrowed or damaged arteries. Adding an ICD (implantable cardiac defibrillator) may be recommended for patients with arrhythmia.

Doctors strongly encourage CHD patients to adopt a healthier lifestyle, and this can be achieved by doing the following:

  • Quit smoking.
  • Avoid a diet that is high in sugar, bad fat and sodium.
  • Exercise at least 30 minutes a day three times a week.
  • Follow the DASH (dietary approaches to stop hypertension) diet.
  • Undergo routine body exam to monitor blood glucose, cholesterol, and blood pressure levels especially if you are already considered a high risk or have a family history.
  • Avoid second-hand smoke.
  • See a nutritionist that can help design a customized weight loss plan.
  • Reduce stress through meditation and enough sleep and rest.
    Resources:

  • http://www.nhs.uk/Conditions/Coronary-heart-disease/Pages/Introduction.aspx

  • http://www.nhlbi.nih.gov/health/health-topics/topics/cad/names
  • http://www.heartfoundation.org.au/your-heart/cardiovascular-conditions/Pages/coronary-heart-disease.aspx
  • http://www.heart.org/HEARTORG/Conditions/Cholesterol/WhyCholesterolMatters/AtherosclerosisUCM305564_Article.jsp
  • http://depts.washington.edu/uwcoe/healthtopics/cardio.html
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