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Coronary heart disease
Alternative namesCoronary artery disease; Arteriosclerotic heart disease; CHD; CAD
Coronary heart disease (or coronary artery disease) is a narrowing of the small blood vessels that supply blood and oxygen to the heart (coronary arteries). Coronary disease usually results from the build up of fatty material and plaque ( atherosclerosis ). As the coronary arteries narrow, the flow of blood to the heart can slow or stop. The disease can cause chest pain ( stable angina ), shortness of breath, heart attack , or other symptoms.
Causes, incidence, and risk factors
Coronary heart disease (CHD) is the leading cause of death in the United States for men and women. According to the American Heart Association, about every 29 seconds someone in the US suffers from a CHD-related event, and about every minute someone dies from such event. The lifetime risk of having coronary heart disease after age 40 is 49% for men and 32% for women. As women get older, the risk increases almost to that of men. (See also heart disease and women .)
There are many factors which increase the risk for CHD. Some of the risks are based on family history (genetics), and others are more controllable. Risk factors include the following:
SymptomsThe symptoms associated with coronary heart disease may be pronounced, but they can also occur without any noticeable symptoms.
Chest pain ( angina ) is the most common symptom, and it results from the heart not getting enough blood or oxygen. The intensity of the pain varies from person-to-person. Chest pain may be typical or atypical. Typical chest pain is felt under the sternum and is characterized by a heavy or squeezing feeling, it is precipitated by exertion or emotion, and it is relieved by rest or nitroglycerin.
Atypical chest pain can be located in the left chest, abdomen, back, or arm and is fleeting or sharp. Atypical chest pain is unrelated to exercise and is not relieved by rest or nitroglycerin. Atypical chest pain is more common in women.
The typical nature of the chest pain and the person's age are indicators of the chances of having CHD. For example, a 65-year-old woman with typical angina has a 91% chance of having CHD, while a 55-year-old woman with atypical angina has a 32% chance of having CHD.
Other symptoms include:
Signs and tests
There are many tests that may help to diagnose CHD. Usually, more than one test will be done before a definitive diagnosis can be made. Some of the tests include:
TreatmentThe treatment for CHD varies depending on the symptoms and how much the disease has progressed. The general treatments include lifestyle changes, medications, and sometimes surgery.
Lifestyle changes may include:
Medications may include:
Percutaneous Coronary Interventions (PCI's) include:
Coronary brachytherapy consists of delivering beta or gamma radiation into the coronary arteries. This new treatment is reserved for patients who have undergone stent implantation in a coronary artery and but developed problems, such as diffuse in-stent restenosis. Brachytherapy is a promising technique but is currently limited by certain complications. In addition, the long-term effects of radiation are unknown, as coronary brachytherapy was only approved by the FDA in late 2000. FDA approval of brachytherapy is currently restricted to treatment of stent-related problems, although in some medical centers brachytherapy is being studied as a first-line treatment of coronary disease.
Surgical procedures include:
Expectations (prognosis)The outcome is variable. Some people can maintain a healthy life by changing diet, stopping smoking, and taking medications as long as they are closely monitored. Others may require more drastic measures, such as surgery. Everyone is different, but one important caveat is detecting CHD early and treating it appropriately.
Calling your health care providerIf you have any of the risk factors for CHD, you should contact your health care provider for appropriate prevention and treatment. If you experience angina, shortness of breath, or symptoms of a heart attack, contact your health care provider, call 911 or go to the emergency room immediately.
Update Date: 2/13/2004Fabian Arnaldo, M.D., Department of Cardiology, Henry Ford Hospital, Detroit, MI. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT