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Coronary heart disease
 
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Watch & Learn:Chest pain

Coronary heart disease

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

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

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  • Causes

    Coronary heart disease (CHD) is the leading cause of death in the United States for men and women.

    Coronary heart disease 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

    Symptoms may be very noticeable, but sometimes 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 may include:

    • Coronary angiography -- an invasive test that evaluates the heart arteries under x-ray
    • Echocardiogram stress test
    • Electrocardiogram (ECG)
    • Electron-beam computed tomography (EBCT) to look for calcium in the lining of the arteries -- the more calcium, the higher your chance for CHD
    • Exercise stress test
    • Heart CT scan
    • Nuclear stress test
  • Treatment

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

    Goals for treating these conditions in people who have coronary artery disease:

    • The most commonly used blood pressure target for people with heart disease is below 130 to 140/80 mmHg.
    • If you have diabetes, your HbA1c levels will be monitored and brought down to the level your doctor 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 health care 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:

    • Angioplasty and stent placement, called percutaneous coronary interventions (PCIs)
    • Coronary artery bypass surgery
    • Minimally invasive heart surgery
  • 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 doctor about prevention and possible treatment steps.

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

    • Angina or chest pain
    • Shortness of breath
    • Symptoms of a heart attack

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References

Greenland P, Alpert JS, Beller GA, et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2010;122(25)e584-e636.

Hansson GK, Hamsten A. Atherosclerosis, thrombosis, and vascular biology. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 70.

James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. doi:10.1001/jama.2013.284427.

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;123:1243-1262.

Stone NJ, Robinson J, Lichtenstein AH, et al. 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. Circulation. 2013;00:000–000.

Ridker PM, Libby P, Buring J. Risk markers and the primary prevention of cardiovascular disease. In: Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 42.

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Review Date: 8/12/2014  

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, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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