Coronary heart disease

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1 1 of 9 12/30/ :58 PM PubMed Health. A service of the National Library of Medicine, National Institutes of Health. A.D.A.M. Medical Encyclopedia. Atlanta (GA): A.D.A.M.; Coronary heart disease Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD Last reviewed: June 22, 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. Causes, incidence, and risk factors 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 build-up 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 others you can change. See: Heart disease - risk factors Symptoms Symptoms may be very noticeable, but sometimes you can have the disease and not have any symptoms. This is especially 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. How bad the pain is varies from person to person. It may feel heavy or like someone is squeezing your heart. You may feel it under your breast bone (sternum), but also in your neck, arms, stomach, or upper back. The pain usually occurs with activity or emotion, and goes away with rest or a medicine called nitroglycerin. Other symptoms include shortness of breath and fatigue with activity (exertion). Women, elderly people, and people with diabetes are more likely to have symptoms other than chest pain, such as: Fatigue Shortness of breath General weakness Signs and tests Your doctor or nurse will examine you. Your doctor will often order more than one test before making 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

2 2 of 9 12/30/ :58 PM 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: Blood pressure less than or equal to 140/90 (even lower for patients with diabetes, kidney disease, or heart failure) HbA1c levels if you have diabetes at a level recommended by your doctor LDL cholesterol level less than or equal to 100 mg/dl (even lower for some patients) Treatment depends on your symptoms and how severe the disease is. Your doctor may give you one or more medicines to treat heart disease, blood pressure, diabetes, or high cholesterol. Follow your doctor's directions closely to help prevent coronary artery disease from getting worse. Never stop taking your medicines without talking to your doctor first. Stopping heart medicines suddenly can make your angina worse or cause a heart attack. Your doctor may refer you 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 Expectations (prognosis) Everyone recovers differently. Some people can maintain a healthy life by changing their diet, stopping smoking, and taking medications exactly as the doctor prescribes. Others may need medical procedures such as angioplasty or surgery. Although everyone is different, early detection of CHD generally results in a better outcome. Calling your health care provider If you have any risk factors for CHD, contact your doctor to discuss prevention and possible treatment. Immediately contact your health care provider, call the local emergency number (such as 911), or go to the emergency room if you have: Angina or chest pain Shortness of breath Symptoms of a heart attack References Gaziano JM, Ridker PM, Libby P. Primary and secondary prevention of coronary heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P,eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 49. Greenland P, Alpert JS, Beller GA, et al ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Forceon Practice Guidelines. Circulation. 2010;122(25)e584-e636. Hansson GK, Hamsten A. Atherosclerosis, thrombosis, and vascular biology. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 70. Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women Update:a guideline from the American Heart Association.

3 3 of 9 12/30/ :58 PM Circulation.2011;123(11); Reviewed by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

4 4 of 9 12/30/ :58 PM Figures Heart, section through the middle The interior of the heart is composed of valves, chambers, and associated vessels. Review Date: 7/11/2012. Reviewed by: David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc. Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington.

5 5 of 9 12/30/ :58 PM Heart, front view 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. Review Date: 7/11/2012. Reviewed by: David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc. Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington.

6 6 of 9 12/30/ :58 PM Acute MI 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. Reviewed by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

7 7 of 9 12/30/ :58 PM Posterior heart arteries 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. Reviewed by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

8 8 of 9 12/30/ :58 PM Cholesterol producers 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. Reviewed by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

9 9 of 9 12/30/ :58 PM Anterior heart arteries 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. Reviewed by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc. A.D.A.M., Disclaimer Copyright 2012, A.D.A.M., Inc.

Coronary Artery Disease

Coronary Artery Disease This information is at http://www.nhlbi.nih.gov/health/dci/diseases/cad/cad_all.html and is provided by the NHLBI, one of the Institutes of the National Institutes of Health. To