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Coronary heart disease

Heart disease, Coronary heart disease, Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD

Coronary heart disease is a narrowing of the small blood vessels that supply blood and oxygen to the heart. Coronary heart disease (CHD) is also called coronary artery disease.

 

Coronary Artery Disease Facts

  • Coronary artery disease is …

     

    A. A buildup of plaque in the arteries that carry blood to the heart

     

    B. The same thing as coronary heart disease

     

    C. Sometimes called hardening of the heart’s arteries

     

    D. The leading cause of death in the U.S. for men and women

     

    E. All of the above

    Correct Answer
  • What causes plaque to build up in the arteries?

     

    A. Smoking

     

    B. High blood pressure

     

    C. High cholesterol

     

    D. High blood sugar

     

    E. All of the above

    Correct Answer
  • You can have CAD and not have any symptoms.

     

    A. True

     

    B. False

    Correct Answer
  • What are the noticeable symptoms of CAD?

     

    A. Chest pain or pressure, called angina

     

    B. Shortness of breath

     

    C.   Fatigue

     

    D. Weakness

     

    E. All of the above

    Correct Answer
  • Angina is another name for a heart attack.

     

    A. True

     

    B. False

    Correct Answer
  • Which heart problems can be caused by CAD?

     

    A. Heart failure

     

    B. Arrhythmia (abnormal heart rhythm)

     

    C. Heart attack

     

    D. All of the above

    Correct Answer
  • If you have heart disease, you are at higher risk for depression.

     

    A. True

     

    B. False

    Correct Answer
  • How may CAD be treated?

     

    A. Healthy lifestyle changes

     

    B. Medicines

     

    C. Angioplasty, a procedure to open blocked arteries

     

    D. Heart bypass surgery

     

    E. All of the above

    Correct Answer
  • Which lifestyle change WON'T help treat CAD?

     

    A. Quitting smoking

     

    B. Eating a healthy, low-fat, low-sodium, high-fiber diet

     

    C. Getting regular exercise

     

    D. Managing stress

     

    E. Maintaining a healthy weight

     

    F. Following a gluten-free diet

    Correct Answer
  • Plaque buildup can begin in childhood.

     

    A. True

     

    B. False

    Correct Answer

Causes

CHD is the leading cause of death in the United States for men and women.

CHD is caused by the buildup of plaque in the arteries to your heart. This may also be called hardening of the arteries.

  • Fatty material and other substances form a plaque buildup on the walls of your coronary arteries. The coronary arteries bring blood and oxygen to your heart.
  • This buildup causes the arteries to get narrow.
  • As a result, blood flow to the heart can slow down or stop.

A risk factor for heart disease is something that increases your chance of getting it. You cannot change some risk factors for heart disease, but you can change others.

Symptoms

In some cases, symptoms may be very noticeable. But, you can have the disease and not have any symptoms. This is more often true in the early stages of heart disease.

Chest pain or discomfort (angina) is the most common symptom. You feel this pain when the heart is not getting enough blood or oxygen. The pain may feel different from person to person.

  • It may feel heavy or like someone is squeezing your heart. You may feel it under your breast bone (sternum). You may also feel it in your neck, arms, stomach, or upper back.
  • The pain most often occurs with activity or emotion. It goes away with rest or a medicine called nitroglycerin.
  • Other symptoms include shortness of breath and fatigue with activity (exertion).
 

Some people have symptoms other than chest pain, such as:

  • Fatigue
  • Shortness of breath
  • General weakness
 

Exams and Tests

Your health care provider will examine you. You will often need more than one test before getting a diagnosis.

Tests to evaluate for CHD may include:

Treatment

You may be asked to take one or more medicines to treat blood pressure, diabetes, or high cholesterol levels. Follow your provider's directions closely to help prevent CHD from getting worse.

Goals for treating these conditions in people who have CHD:

  • The most commonly used blood pressure target for people with heart disease is less than 130/80, but your provider may recommend a different blood pressure target.
  • If you have diabetes, your HbA1c levels will be monitored and brought down to the level your provider recommends.
  • Your LDL cholesterol level will be lowered with statin drugs.

Treatment depends on your symptoms and how severe the disease is. You should know about:

Never stop taking your medicines without first talking to your provider. Stopping heart medicines suddenly can make your angina worse or cause a heart attack.

You may be referred to a cardiac rehabilitation program to help improve your heart's fitness.

Procedures and surgeries used to treat CHD include:

Outlook (Prognosis)

Everyone recovers differently. Some people can stay healthy by changing their diet, stopping smoking, and taking their medicines as prescribed. Others may need medical procedures such as angioplasty or surgery.

In general, early detection of CHD generally leads to a better outcome.

When to Contact a Medical Professional

If you have any risk factors for CHD, talk to your provider about prevention and possible treatment steps.

Call your provider, call the local emergency number (such as 911), or go to the emergency room right away if you have:

Prevention

Take these steps to help prevent heart disease.

  • If you smoke, stop. There are many resources available to help you stop smoking.
  • Learn how to eat a heart-healthy diet by making simple substitutions. For example, choose heart-healthy fats over butter and other saturated fats.
  • Get regular exercise, ideally at least 30 minutes most days. If you have heart disease, talk with your provider about starting an exercise routine.
  • Maintain a healthy body weight.
  • Lower high cholesterol with lifestyle changes, and if needed, statin medicines.
  • Lower high blood pressure using diet and medicines.
  • Talk with your provider about aspirin therapy.
  • If you have diabetes, keep it well-managed to help prevent heart attack and stroke.

Even if you already have heart disease, taking these steps will help protect your heart and prevent further damage.

References

Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2014;130(19):1749-1767. PMID: 25070666 www.ncbi.nlm.nih.gov/pubmed/25070666.

Fihn SD, Gardin JM, Abrams J, et al; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines; American College of Physicians; American Association for Thoracic Surgery; Preventive Cardiovascular Nurses Association; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2012;60(24):e44-e164. PMID: 23182125 www.ncbi.nlm.nih.gov/pubmed/23182125.

Greenland P, Alpert JS, Beller GA, et al; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2010;122(25):2748-2764. PMID: 21098427 www.ncbi.nlm.nih.gov/pubmed/21098427.

Hansson GK, Hamsten A. Atherosclerosis, thrombosis, and vascular biology. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 70.

Morrow DA, Boden WE. Stable ischemic heart disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 54.

Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update:a guideline from the American Heart Association. Circulation. 2011;123(11):1243-1262. PMID: 21325087 www.ncbi.nlm.nih.gov/pubmed/21325087.

Ridker PM, Libby P, Buring JE. Risk markers and the primary prevention of cardiovascular disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 42.

Stone NJ, Robinson JG, Lichtenstein AH, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2889-2934. PMID: 24239923 www.ncbi.nlm.nih.gov/pubmed/24239923.

Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017; pii: S0735-1097(17)41519-1. PMID: 29146535 www.ncbi.nlm.nih.gov/pubmed/29146535.

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  • Chest pain

    Chest pain

    Animation

  • Angina causes and symptoms

    Angina causes and symptoms

    Animation

  • Coronary artery disease (CAD) overview

    Coronary artery disease (CAD) overview

    Animation

  • Heart, section through the middle

    Heart, section through the middle

    illustration

  • Heart, front view

    Heart, front view

    illustration

  • Anterior heart arteries

    Anterior heart arteries

    illustration

  • Posterior heart arteries

    Posterior heart arteries

    illustration

  • Acute MI

    Acute MI

    illustration

  • Cholesterol producers

    Cholesterol producers

    illustration

  • Chest pain

    Animation

  • Angina causes and symptoms

    Animation

  • Coronary artery disease (CAD) overview

    Animation

  • Heart, section through the middle

    Heart, section through the middle

    illustration

  • Heart, front view

    Heart, front view

    illustration

  • Anterior heart arteries

    Anterior heart arteries

    illustration

  • Posterior heart arteries

    Posterior heart arteries

    illustration

  • Acute MI

    Acute MI

    illustration

  • Cholesterol producers

    Cholesterol producers

    illustration

A Closer Look

 

Talking to your MD

 

Self Care

 

Tests for Coronary heart disease

 
 

Review Date: 2/13/2018

Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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