Coronary Heart Disease

CHD happens when the arteries that supply blood to heart muscle become hardened and narrowed. This is due to the buildup of cholesterol and other material, called plaque, on their inner walls. This buildup is called atherosclerosis. As it grows, less blood can flow through the arteries. As a result, the heart muscle can’t get the blood or oxygen it needs. This can lead to chest pain (angina) or a heart attack. Most heart attacks happen when a blood clot suddenly cuts off the hearts’ blood supply, causing permanent heart damage.

Over time, CHD can also weaken the heart muscle and contribute to heart failure and arrhythmias. Heart failure means the heart can’t pump blood well to the rest of the body. Arrhythmias are changes in the normal beating rhythm of the heart.

Prevention

You can prevent and control coronary heart disease (CHD) by taking action to control your risk factors with heart-healthy lifestyle changes and medicines. Examples of risk factors you can control include high blood cholesterol, high blood pressure, and overweight and obesity. Only a few risk factors—such as age, gender, and family history—can’t be controlled.

Your risk for CHD increases with the number of risk factors you have.

TO REDUCE YOUR RISK OF CHD AND HEART ATTACK, TRY TO CONTROL EACH RISK FACTOR YOU HAVE BY ADOPTING THE FOLLOWING HEART-HEALTHY LIFESTYLES:

• Heart-healthy eating
• Maintaining a healthy weight
• Managing stress
• Physical activity
• Quitting smoking

Know your family history of health problems related to CHD. If you or someone in your family has CHD, be sure to tell your doctor. If lifestyle changes aren’t enough, you also may need medicines to control your CHD risk factors.

Risk Factors

Certain traits, conditions, or habits may raise your risk for CHD. The more risk factors you have, the more likely you are to develop the disease.

You can control many risk factors, which may help prevent or delay CHD.

MAJOR RISK FACTORS

• Unhealthy blood cholesterol levels.
• High blood pressure.
• Smoking.
• Diabetes.
• Overweight or obesity.
• Metabolic syndrome.
• Lack of physical activity.
• Unhealthy diet.
• Older age.
• A family history of early coronary heart disease is a risk factor for developing coronary heart disease, specifically if a father or brother is diagnosed before age 55, or a mother or sister is diagnosed before age 65.

Although older age and a family history of early heart disease are risk factors, it doesn’t mean that you’ll develop CHD if you have one or both. Controlling other risk factors often can lessen genetic influences and help prevent CHD, even in older adults.

Causes

Research suggests that coronary heart disease starts when certain factors damage the inner layers of the coronary arteries.

THESE FACTORS INCLUDE:

• Smoking
• High levels of certain fats and cholesterol in the blood
• High blood pressure
• High levels of sugar in the blood due to insulin resistance or diabetes
• Blood vessel inflammation

Plaque might begin to build up where the arteries are damaged. The buildup of plaque in the coronary arteries may start in childhood.

Over time, plaque can harden or rupture. Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart.

If the plaque ruptures, blood cell fragments called platelets stick to the site of the injury. They may clump together to form blood clots.

Blood clots can further narrow the coronary arteries and worsen angina. If a clot becomes large enough, it can mostly or completely block a coronary artery and cause a heart attack.

Symptoms

A common symptom of coronary heart disease (CHD) is angina. Angina is chest pain or discomfort that occurs if an area of your heart muscle doesn’t get enough oxygen-rich blood.

Another common symptom of CHD is shortness of breath. This symptom occurs if CHD causes heart failure.

The severity of these symptoms varies. They may get more severe as the buildup of plaque continues to narrow the coronary arteries.

Some people who have CHD have no signs or symptoms—a condition called silent CHD. The disease might not be diagnosed until a person has signs or symptoms of a heart attack, heart failure, or an arrhythmia.

The most common heart attack symptom is chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest that often lasts for more than a few minutes or goes away and comes back.

The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. The feeling can be mild or severe. Heart attack pain sometimes feels like indigestion or heartburn.

Chest pain or discomfort that doesn’t go away or changes from its usual pattern (for example, occurs more often or while you’re resting) might be a sign of a heart attack. If you don’t know whether your chest pain is angina or a heart attack, call 9–1–1.

OTHER COMMON SIGNS AND SYMPTOMS OF A HEART ATTACK INCLUDE:

• Upper body discomfort in one or both arms, the back, neck, jaw, or upper part of the stomach
• Shortness of breath, which may occur with or before chest discomfort
• Nausea, vomiting, light-headedness or fainting, or breaking out in a cold sweat
• Sleep problems, fatigue, or lack of energy

Diagnosis

Your doctor will diagnose coronary heart disease (CHD) based on your medical and family histories, your risk factors for CHD, a physical exam, and the results from tests and procedures.

No single test can diagnose CHD.

Treatment

Treatments for coronary heart disease include heart-healthy lifestyle changes, medicines, medical procedures and surgery, and cardiac rehabilitation.

Your doctor may recommend heart-healthy lifestyle changes if you have coronary heart disease.

HEART-HEALTHY LIFESTYLE CHANGES INCLUDE:

• Heart-healthy eating
• Maintaining a healthy weight
• Managing stress
• Physical activity
• Quitting smoking