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.
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 .
Hardening of the arteries
Hardening of the arteries, also called atherosclerosis, occurs when fat, cholesterol, and other substances build up in the walls of arteries. These ...
- 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.
Risk factor for heart disease
Heart disease - prevention; CVD - risk factors; Cardiovascular disease - risk factors; Coronary artery disease - risk factors; CAD - risk factors...
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.
Angina
Angina is a type of chest discomfort or pain due to poor blood flow through the blood vessels (coronary vessels) of the heart muscle (myocardium). Th...
- 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:
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Coronary angiography
. An invasive test that evaluates the heart arteries under x-ray.
Coronary angiography
Coronary angiography is a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the arteries in your heart....
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Echocardiogram
stress test.
Echocardiogram
An echocardiogram is a test that uses sound waves to create pictures of the heart. The picture and information it produces is more detailed than a s...
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Electrocardiogram (ECG)
.
Electrocardiogram (ECG)
An electrocardiogram (ECG) is a test that records the electrical activity of the heart.
- Electron-beam computed tomography (EBCT) to look for calcium in the lining of the arteries. The more calcium, the higher your chance for CHD.
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Exercise stress test
.
Exercise stress test
An exercise stress test is used to measure the effect of exercise on your heart.
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Heart CT scan
.
Heart CT scan
A computed tomography (CT) scan of the heart is an imaging method that uses x-rays to create detailed pictures of the heart and its blood vessels. Th...
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Nuclear stress test
.
Nuclear stress test
Thallium stress test is a nuclear imaging method that shows how well blood flows into the heart muscle, both at rest and during activity.
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 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 140/90 mm Hg, but sometimes less than 130/80.
-
If you have diabetes, your
HbA1c
levels will be monitored and brought down to the level your provider recommends.
HbA1c
A1C is a lab test that shows the average level of blood sugar (glucose) over the previous 3 months. It shows how well you are controlling your diabe...
- 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:
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Other medicines used to treat angina
Other medicines used to treat angina
Stable angina is chest pain or discomfort that most often occurs with activity or emotional stress. Angina is due to poor blood flow through the blo...
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What to do when you have chest pain
What to do when you have chest pain
Acute coronary syndrome - chest pain; Coronary artery disease - chest pain; CAD - chest pain; Coronary heart disease - chest pain; ACS - chest pain; ...
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Being active when you have heart disease
Being active when you have heart diseas
Heart disease - activity; CAD - activity; Coronary artery disease - activity; Angina - activity
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Eating a heart-healthy diet
Eating a heart-healthy diet
A healthy diet is a major factor in reducing your risk of heart disease.
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:
-
Angioplasty and stent placement
, called percutaneous coronary interventions (PCIs)
Angioplasty and stent placement
Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart. These blood vessels are called the coronary art...
-
Coronary artery bypass surgery
Coronary artery bypass surgery
Heart bypass surgery creates a new route, called a bypass, for blood and oxygen to go around a blockage to reach your heart.
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Minimally invasive heart surgery
Minimally invasive heart surgery
Heart bypass surgery creates a new route, called a bypass, for blood and oxygen to reach your heart. Minimally invasive coronary (heart) artery bypas...
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:
- Angina or chest pain
- Shortness of breath
-
Symptoms of a heart attack
Symptoms of a heart attack
Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. The coronary arteries bring blood and oxygen to the heart. ...
References
Greenland P, Alpert JS, Beller GA, et al. 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's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016: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 . 2014;311(5):507-520. PMID: 24352797 www.ncbi.nlm.nih.gov/pubmed/24352797 .
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.
Rosendorff C, Lackland DT, Allison M, et al. Treatment of hypertension in patients with coronary artery disease: a scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. Circulation . 2015;131(19):e435-e470. PMID: 25829340 www.ncbi.nlm.nih.gov/pubmed/25829340 .
Stone NJ, Robinson JG, 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. J Am Coll Cardiol . 2014;63(25 Pt B):2889-2934. PMID: 24239923 www.ncbi.nlm.nih.gov/pubmed/24239923 .
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Chest pain
Animation
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Angina causes and symptoms
Animation
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Coronary artery disease (CAD) overview
Animation
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Heart, section through the middle - illustration
The interior of the heart is composed of valves, chambers, and associated vessels.
Heart, section through the middle
illustration
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Heart, front view - illustration
The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.
Heart, front view
illustration
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Anterior heart arteries - illustration
The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.
Anterior heart arteries
illustration
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Posterior heart arteries - illustration
The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.
Posterior heart arteries
illustration
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Acute MI - illustration
A heart attack or acute myocardial infarction (MI) occurs when one of the arteries that supplies the heart muscle becomes blocked. Blockage may be caused by spasm of the artery or by atherosclerosis with acute clot formation. The blockage results in damaged tissue and a permanent loss of contraction of this portion of the heart muscle.
Acute MI
illustration
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Cholesterol producers - illustration
Cholesterol is a waxy, fat-like material that is found in all parts of the body. It comes from two sources: our liver produces it, and we consume it in meat and dairy products.
Cholesterol producers
illustration
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Chest pain
Animation
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Angina causes and symptoms
Animation
-
Coronary artery disease (CAD) overview
Animation
-
Heart, section through the middle - illustration
The interior of the heart is composed of valves, chambers, and associated vessels.
Heart, section through the middle
illustration
-
Heart, front view - illustration
The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.
Heart, front view
illustration
-
Anterior heart arteries - illustration
The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.
Anterior heart arteries
illustration
-
Posterior heart arteries - illustration
The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.
Posterior heart arteries
illustration
-
Acute MI - illustration
A heart attack or acute myocardial infarction (MI) occurs when one of the arteries that supplies the heart muscle becomes blocked. Blockage may be caused by spasm of the artery or by atherosclerosis with acute clot formation. The blockage results in damaged tissue and a permanent loss of contraction of this portion of the heart muscle.
Acute MI
illustration
-
Cholesterol producers - illustration
Cholesterol is a waxy, fat-like material that is found in all parts of the body. It comes from two sources: our liver produces it, and we consume it in meat and dairy products.
Cholesterol producers
illustration
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Myocardial infarction
(Alt. Medicine)
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Heart failure
(In-Depth)
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Coronary artery disease
(In-Depth)
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Heart attack and acute coronary syndrome
(In-Depth)
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Heart failure
(Alt. Medicine)
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Atherosclerosis
(Alt. Medicine)
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Angina
(Alt. Medicine)
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Cholesterol
(In-Depth)
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Heart-healthy diet
(In-Depth)
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Exercise
(In-Depth)
- Diabetes - preventing heart attack and stroke
- Cholesterol and lifestyle
- Simple, heart-smart substitutions
- Angina - when you have chest pain
- Heart disease - risk factors
- Cardiac rehabilitation
- Being active when you have heart disease
- Living with heart disease and angina
- Butter, margarine, and cooking oils
- Dietary fats explained
Review Date: 7/14/2015
Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Internal review and update on 09/01/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.