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Alternative Names Return to topCoronary artery disease; Arteriosclerotic heart disease; CHD; CAD
Definition Return to top
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 Return to top
Coronary heart disease is usually caused by a condition called atherosclerosis, which occurs when fatty material and a substance called plaque build up on the walls of your arteries. This causes them to get narrow. As the coronary arteries narrow, blood flow to the heart can slow down or stop. This can cause chest pain (stable angina), shortness of breath, heart attack, and other symptoms.
Coronary heart disease (CHD) is the leading cause of death in the United States for men and women.
Many things increase your risk for heart disease:
Higher-than-normal levels of inflammation-related substances, such as C-reactive protein and fibrinogen are being studied as possible indicators of an increased risk for heart disease.
Increased levels of a chemical called homocysteine, an amino acid, are also linked to an increased risk of a heart attack.
Symptoms Return to top
Symptoms may be very noticeable, but sometimes you can have the disease and not have any symptoms.
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.
See: Heart failure for symptoms of heart failure
Exams and Tests Return to top
Many tests help diagnose CHD. Usually, your doctor will order more than one test before making a definite diagnosis.
Tests may include:
Treatment Return to top
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 those who have coronary artery disease are:
Taking aspirin with or without clopidogrel (Plavix) helps prevent blood clots from forming in your arteries and reduces your risk of having a heart attack. Ask your doctor if you should be taking these.
Treatment depends on your symptoms and how severe the disease is. Your doctor may give you one or more medicines to treat CHD, including:
NEVER ABRUPTLY STOP TAKING ANY OF THESE DRUGS. Always talk to your doctor first. Stopping these drugs suddenly can make your angina worse or cause a heart attack.
Procedures and surgeries used to treat CHD include:
Lifestyle changes are very important. Your doctor may tell you to:
See also: Healthy heart diet
Outlook (Prognosis) Return to top
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.
Possible Complications Return to top
When to Contact a Medical Professional Return to top
If you have any of the 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:
Prevention Return to top
See your health care provider regularly.
Tips for preventing CHD or lowering your risk of the disease:
Moderate amounts of alcohol (one glass a day for women, two for men) may reduce your risk of cardiovascular problems. However, drinking larger amounts does more harm than good.
If you have one or more risk factors for coronary heart disease, talk to your doctor about possibly taking an aspirin a day to help prevent a heart attack or stroke. You may be prescribed low-dose aspirin therapy if the benefit is likely to outweigh the risk of gastrointestinal side effects.
New guidelines no longer recommend hormone replacement therapy, vitamins E or C, antioxidants, or folic acid to prevent heart disease. The use of hormone replacement therapy in women who are close to menopause or who have finished menopause is controversial at this time.
References Return to top
Mosca L, Banka CL, Benjamin EJ, et al. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update. Circulation. 2007; Published online before print February 19, 2007.
Smith SC Jr, Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute. Circulation. 2006 May 16;113(19):2363-72. Erratum in: Circulation. 2006 Jun 6;113(22):e847.
Morrow DA, Gersh BJ. Chronic coronary artery disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier;2007: chap 54.
Boden WE, O'rourke RA, Teo KK, et al. Optimal Medical Therapy with or without PCI for Stable Coronary Disease. N Engl J Med. 2007 Mar 26; [Epub ahead of print].
U.S. Preventive Services Task Force. Aspirin for the prevention of cardiovascular disease: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;150:396-404.Update Date: 4/23/2009 Updated by: Steven Kang, MD, Division of Cardiac Pacing and Electrophysiology, East Bay Arrhythmia, Cardiovascular Consultants Medical Group, Oakland, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.