Coronary Heart Disease

What is coronary heart disease?

Coronary heart disease happens 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 life. This thickening is called atherosclerosis. It can reduce 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 (myocardium). 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.

Coronary heart disease is also called coronary artery disease.

What causes coronary heart disease?

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.

Who is at risk for coronary heart disease?

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.

What are the symptoms of coronary 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 oxygen-richblood 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.

The symptoms of coronary heart disease include:

• 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.

• Too much sweating

• Chest pain that eases with rest.

• Chest pain that happens even at rest.

• Dizziness or feeling lightheaded.

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

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

How is coronary heart disease diagnosed?

Your health care 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 shows heart muscle damage.

Echocardiogram 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 health care provider puts a thin tube (catheter) into the coronary arteries of your heart. The provider then takes X-rays after injecting contrast material into an artery. This test can show narrowing, blockages, and other problems. It’s considered the best test for finding artery disease. The provider may also be able to treat certain 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 material is injected through an IV to help see blood flow through the heart artery.

How is coronary heart disease treated? 

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. It can also include exercising, losing weight, and eating healthy foods, such as lean meats, fruits, and vegetables. Taking 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. These can also help to prevent coronary heart disease.

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 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.

What are possible problems caused by coronary heart disease?

Problems caused by coronary heart disease include:

• Heart attack.

• Heart failure.

• Abnormal heart rhythms.

• Death.

How can I help prevent coronary heart disease?

You can help prevent coronary heart disease by controlling your risk factors. These include:

• Not smoking.

• Exercising regularly.

• Eating a heart-healthy diet.

• Maintaining a healthy weight.

• Managing stress.

• Keeping your cholesterol, blood sugar, and blood pressure in a healthy range.

Key points about coronary heart disease

• 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 reduce 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.

Next steps

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

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• If you can, 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 and when you should report them to your health care provider.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is advised 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.