What is coronary heart disease (CHD)?
Coronary heart disease (CHD), also known as coronary artery disease (CAD) or ischemic heart disease, is the leading cause of death in the U.S. and around the world. It is a condition in which the blood vessels responsible for the oxygen and blood supply to your heart muscle become narrow or blocked. This blockage is primarily caused by the buildup of plaque—a combination of fat, cholesterol, and other substances—in your arteries. This process is known as atherosclerosis.
When plaques partially or totally block blood flow to your heart’s arteries, it can lead to chest pain (angina), shortness of breath, or other symptoms. A complete blockage can cause a heart attack (myocardial infarction), which occurs when your heart muscle is damaged due to not getting enough oxygen. CHD can also lead to abnormal heart rhythms (arrhythmias) or heart failure.
Risk factors for developing CHD include smoking, high blood pressure, high cholesterol, diabetes, obesity, physical inactivity, unhealthy diet, and a family history of cardiovascular disease. Managing these risk factors through lifestyle changes and medications can help reduce your risk of developing CHD.
What causes coronary heart disease?
CHD is primarily caused by atherosclerosis, which is the buildup of plaque within your coronary arteries. This plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, this plaque hardens and narrows the arteries, reducing the flow of oxygen-rich blood to the heart muscle. Some risk factors include:
- High cholesterol and triglycerides
- High blood pressure
- Smoking
- Diabetes
- Obesity
- Lack of exercise
- Unhealthy diet
- Age, especially after middle age
- Male sex, with women’s risk rising after menopause
- Family history of early heart disease
- Chronic stress
- Alcohol abuse
- Sleep apnea
- Autoimmune diseases such as lupus or rheumatoid arthritis
Addressing these risk factors through lifestyle changes and medication can significantly reduce the likelihood of developing CHD.
What are the symptoms of coronary heart disease?
Symptoms may not appear until the disease is advanced. Common symptoms include:
- Angina (chest pain or discomfort felt in chest, shoulders, arms, neck, jaw, or back)
- Shortness of breath or extreme fatigue with activity
- Heart attack, marked by severe chest pain, sweating, nausea, vomiting, and breathlessness
- Palpitations (irregular or rapid heartbeats)
- Weakness, dizziness, or fainting
- Nausea accompanying other symptoms
Angina may be triggered by exertion or stress and typically improves with rest or nitroglycerin. Seek immediate medical attention if you experience heart attack symptoms.
How is coronary heart disease diagnosed?
- Medical history and physical exam
- Electrocardiogram (ECG or EKG)
- Stress testing (treadmill or exercise ECG)
- Echocardiogram (heart ultrasound)
- Blood tests for cardiac enzymes and lipid levels
- Cardiac catheterization and coronary angiogram
- CT scan of the heart and blood vessels
- Cardiac MRI for detailed structural and functional imaging
These tests help confirm a diagnosis, assess severity, and guide treatment planning.
How is coronary heart disease treated?
Lifestyle Changes
- Heart-healthy diet low in saturated fats, cholesterol, and sodium
- Regular physical activity
- Smoking cessation
- Weight management
- Stress reduction techniques
Medications
- Statins to lower cholesterol
- Aspirin and other blood thinners to prevent clots
- Beta-blockers to reduce heart rate and oxygen demand
- ACE inhibitors to lower blood pressure
- Calcium channel blockers to relax blood vessels
- Nitroglycerin to relieve angina
Procedures and Surgery
- Coronary angioplasty and stent placement
- Coronary artery bypass grafting (CABG)
- Heart transplant in end-stage disease
Regular follow-up with your healthcare provider is important to monitor disease progression and treatment effectiveness.
Sources
- Coronary Heart Disease. National Heart, Lung, and Blood Institute. Accessed Apr. 15, 2024.
- What is Coronary Heart Disease? American Heart Association. Accessed Apr. 15, 2024.
- Coronary Heart Disease. National Health Service (UK). Last reviewed Mar. 10, 2020. Accessed Oct. 13, 2023.
- Coronary Artery Disease (CAD). Centers for Disease Control and Prevention. Accessed Apr. 15, 2024.
- Coronary Artery Atherosclerosis. Medscape. Accessed Apr. 15, 2024.