Coronary heart disease

What is coronary heart disease?

Coronary heart disease is a condition that affects the main arteries around the heart (coronary arteries). It is characterized by atherosclerosis, a narrowing and hardening of the arteries that leads to a reduction in the flow of blood to the heart muscle. People with coronary heart disease are at risk of heart attacks and heart failure.

What are the main symptoms?

Chest pain, also referred to as angina pectoris (Latin for "strangling of the chest"), is a symptom typically associated with coronary heart disease. The pain starts suddenly, often as a result of physical activity or emotional stress, and may radiate to the arms, shoulders, neck and teeth or, less frequently, to the abdomen.

Physicians refer to a patient's angina pectoris as stable or unstable, depending on whether the symptoms remain constant over a period of months or even years, or whether they get worse quite suddenly. The latter may be a sign of an impending heart attack.
A patient suffering an angina pectoris attack may experience the following symptoms:

• Stabbing chest pains or a squeezing sensation in the chest, a burning sensation behind the sternum (breastbone)
• Sudden weakness and dyspnea
• Sweating
• Anxiety
• Certain people, e.g. people with diabetes, may only experience very mild symptoms, or may not experience any symptoms at all ("silent" angina)

What are possible causes?

The underlying cause of coronary heart disease is the narrowing and hardening of at least one of the coronary arteries. Physicians refer to this as atherosclerosis, or coronary sclerosis, a condition that develops over many years, and affects people with the following risk factors:

• High blood pressure
• Diabetes
• Abnormalities in lipid metabolism (raised cholesterol levels)
• Smoking
• Excess weight
• Genetic predisposition
• Psychosocial factors, e.g. depression

Diagnosis of coronary heart disease

The diagnosis of coronary heart disease consists of a number of diagnostic steps including:

• Medical history, physical examination and blood tests
• Resting ECG
• Exercise ECG (stationary bike): many patients show distinctive ECG changes in response to exercise.
• Ambulatory ECG
• Echocardiogram (cardiac ultrasound scan) to assess heart muscle function
• In some cases, specialist imaging technologies such as scintigraphy, MRIs or CT scans.
• Cardiac catheterization procedures (coronary angiography), particularly in cases of coronary heart disease that can be treated by widening narrowed arteries.

Treatment for coronary heart disease

Treatment for coronary heart disease usually consists of a number of different treatment strategies:

• Nitrates
• Blood-thinning medication
• Lifestyle changes
• Catheter-based interventions
• Bypass surgery

Nitrates

Nitrates are among the medications typically used to treat coronary heart disease. Whether available in capsule-form or as a spray, these substances alleviate the symptoms of an angina pectoris attack by opening the arteries. They can be either fast-acting, relieving symptoms in a matter of minutes, or they may be long-acting, helping to prevent attacks from occurring altogether.

Blood-thinning medication

Most patients will receive blood-thinning medicines such as aspirin (acetylsalicylic acid), which prevents the coronary arteries from becoming blocked (thrombosis). Many patients also receive beta blockers, which reduce the heart rate, thereby also reducing the amount of oxygen required by the heart muscle. Depending on concomitant disease, the physician may also prescribe other medicines, such as cholesterol-lowering or blood pressure-lowering drugs.

Lifestyle changes
Treatment will always include lifestyle modification measures. These may involve losing weight or quitting smoking, and are always aimed at the reduction of the risk factors associated with coronary heart disease. Such lifestyle modifications also include the patient changing certain lifestyle habits in order to control their blood pressure.

Catheter-based interventions
These procedures involve the use of an inflatable balloon to widen narrowed coronary arteries. In most cases, the physician will insert a stent to support the walls of the affected artery.

Bypass surgery
Bypass surgery can re-establish blood flow to the heart muscle by surgically inserting a blood vessel from elsewhere in the body to bypass the blocked artery.