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  Augusto E. Villa, MD, FACC, FSCAI
Diplomate American Board of Cardiovascular Diseases,
Interventional Cardiology, Endovascular Medicine,
and Internal Medicine.

600 University Boulevard, Suite 200, Jupiter, FL. 33458
Ph. (561) 627-2912 • Fax (561) 627-2207
 
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What is Coronary Heart Disease?
 

What Is Coronary Heart Disease?

Coronary heart disease (CHD), also called coronary artery disease, is a condition in which plaque builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle.

Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. When plaque builds up in the arteries, the condition is called atherosclerosis. The buildup of plaque occurs over many years.

Over time, plaque hardens and narrows your coronary arteries. This limits the flow of oxygen-rich blood to your heart muscle.

Eventually, an area of plaque can rupture. This causes a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.

What Causes Coronary Heart Disease?

Research suggests that coronary heart disease (CHD) starts when certain factors damage the inner layers of the coronary arteries. These factors include:

  • Smoking
  • High levels of certain fats and cholesterol in the blood
  • High blood pressure
  • High levels of sugar in the blood due to insulin resistance or diabetes

When damage occurs, your body starts a healing process. The healing may cause plaque to build up where the arteries are damaged.

The buildup of plaque in the coronary arteries may start in childhood. Over time, plaque can narrow or block some of your coronary arteries. This reduces the flow of oxygen-rich blood to your heart muscle.

Eventually, an area of plaque can rupture. If this happens, blood cell fragments called platelets will stick to the site of the injury and may clump together to form blood clots. Blood clots narrow the coronary arteries even more and worsen angina or cause a heart attack.

Who Is at Risk for Coronary Heart Disease?

In the United States, coronary heart disease (CHD) is the #1 cause of death for both men and women. Each year, more than half a million Americans die from CHD.

Certain traits, conditions, or habits known as risk factors may raise your risk for CHD. The more risk factors you have, the more likely you are to develop the disease.

You can control many risk factors, which may help prevent or delay CHD.

Major Risk Factors

  • Unhealthy blood cholesterol levels: This includes high LDL cholesterol (sometimes called “bad” cholesterol) and low HDL cholesterol (sometimes called “good” cholesterol).
  • High blood pressure: Blood pressure is considered high if it stays at or above 140/90 mmHg over time. If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher.
  • Smoking: Smoking can damage and tighten blood vessels, lead to unhealthy cholesterol levels, and raise blood pressure. Smoking also can limit how much oxygen reaches the body"s tissues.
  • Insulin resistance: This condition occurs if the body can"t use its own insulin properly. Insulin is a hormone that helps move blood sugar into cells where it"s used as an energy source. Insulin resistance may lead to diabetes.
  • Diabetes: With this disease, the body"s blood sugar level is too high because the body doesn"t make enough insulin or doesn"t use its insulin properly.
  • Overweight or obesity: The terms “overweight” and “obesity” refer to body weight that’s greater than what is considered healthy for a certain height.
  • Metabolic syndrome: Metabolic syndrome is the name for a group of risk factors that raises your risk for CHD and other health problems, such as diabetes and stroke.
  • Lack of physical activity: Lack of physical activity can worsen other risk factors for CHD, such as unhealthy blood cholesterol levels, high blood pressure, diabetes, and overweight or obesity.
  • Unhealthy diet: An unhealthy diet can raise your risk for CHD. Foods that are high in saturated and trans fats, cholesterol, sodium (salt), and sugar can worsen other risk factors for CHD.
  • Older age: As you get older, your risk for CHD increases. Genetic or lifestyle factors cause plaque to build up in your arteries as you age. By the time you"re middle-aged or older, enough plaque has built up to cause signs or symptoms.
    • In men, the risk for CHD increases after age 45.
    • In women, the risk for CHD increases after age 55.
  • Family history of early heart disease: Your risk increases if your father or a brother was diagnosed with CHD before 55 years of age, or if your mother or a sister was diagnosed with CHD before 65 years of age.

Although older age and a family history of early heart disease are risk factors, it doesn"t mean that you’ll develop CHD if you have one or both. Controlling other risk factors often can lessen genetic influences and prevent CHD, even in older adults.

What are the Signs and Symptoms of Coronary Heart Disease?

A common symptom of coronary heart disease (CHD) is angina. Angina is chest pain or discomfort that occurs if an area of your heart muscle doesn"t get enough oxygen-rich blood.

Angina may feel like pressure or squeezing in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. The pain tends to get worse with activity and go away with rest. Emotional stress also can trigger the pain.

Another common symptom of CHD is shortness of breath. This symptom happens if CHD causes heart failure. When you have heart failure, your heart can"t pump enough blood to meet your body’s needs. Fluid builds up in your lungs, making it hard to breathe.

The severity of these symptoms varies. They may get more severe as the buildup of plaque continues to narrow the coronary arteries.

Signs and Symptoms of Heart Problems Related to Coronary Heart Disease

Some people who have CHD have no signs or symptoms, a condition called silent CHD. The disease may not be diagnosed until a person has signs or symptoms of a heart attack, heart failure, or an arrhythmia.

Heart Attack

A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked. This can happen if an area of plaque in a coronary artery ruptures.

Blood cell fragments called platelets stick to the site of the injury and may clump together to form blood clots. If a clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.

If the blockage isn’t treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long lasting problems.

The most common heart attack symptom is chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest that often lasts for more than a few minutes or goes away and comes back.

The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. The feeling can be mild or severe. Heart attack pain sometimes feels like indigestion or heartburn.

The symptoms of angina can be similar to the symptoms of a heart attack. Angina pain usually lasts for only a few minutes and goes away with rest.

Chest pain or discomfort that doesn’t go away or changes from its usual pattern can be a sign of a heart attack.

Other common signs and symptoms of a heart attack include:

  • Upper body discomfort in one or both arms, the back, neck, jaw, or upper part of the stomach
  • Shortness of breath, which may occur with or before chest discomfort
  • Nausea (feeling sick to your stomach), vomiting, light-headedness or fainting, or breaking out in a cold sweat
  • Sleep problems, fatigue (tiredness), or lack of energy

Heart Failure

Heart failure is a condition in which your heart can"t pump enough blood to meet your body’s needs. Heart failure doesn"t mean that your heart has stopped or is about to stop working.

The most common signs and symptoms of heart failure are shortness of breath or trouble breathing; fatigue; and swelling in the ankles, feet, legs, stomach, and veins in the neck.

All of these symptoms are the result of fluid buildup in your body. When symptoms start, you may feel tired and short of breath after routine physical effort, like climbing stairs.

Arrhythmia

An arrhythmia is a problem with the rate or rhythm of the heartbeat. When you have an arrhythmia, you may notice that your heart is skipping beats or beating too fast.

Some people describe arrhythmias as a fluttering feeling in the chest. These feelings are called palpitations.

Some arrhythmias can cause your heart to suddenly stop beating. This condition is called sudden cardiac arrest. SCA usually causes death if it"s not treated within minutes.

How Is Coronary Heart Disease Diagnosed?

Your doctor will diagnose coronary heart disease (CHD) based on your medical and family histories, your risk factors for CHD, a physical exam, and the results from tests and procedures.

No single test can diagnose CHD. If your doctor thinks you have CHD, he or she may recommend one or more of the following tests:

EKG (Electrocardiogram): An EKG is a simple, painless test that detects and records the heart"s electrical activity. The test shows how fast the heart is beating and its rhythm. An EKG also records the strength and timing of electrical signals as they pass through each part of the heart.

An EKG can show signs of heart damage due to CHD and signs of a previous or current heart attack.

Stress Testing: During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can"t exercise, you’ll get medicine to speed up your heart rate.

When your heart is working hard and beating fast, it needs more blood and oxygen. Plaque-narrowed arteries can"t supply enough oxygen-rich blood to meet your heart"s needs.

A stress test can show possible signs and symptoms of CHD, such as:

  • Abnormal changes in your heart rate or blood pressure
  • Shortness of breath or chest pain
  • Abnormal changes in your heart rhythm or your heart"s electrical activity

If you can"t exercise for as long as what is considered normal for someone your age, your heart may not be getting enough oxygen-rich blood. However, other factors also can prevent you from exercising long enough.

As part of some stress tests, pictures are taken of your heart while you exercise and while you rest. These imaging stress tests can show how well blood is flowing in your heart and/or how well your heart pumps blood when it beats.

Echocardiography: Echocardiography uses sound waves to create a moving picture of your heart. The test provides information about the size and shape of your heart and how well your heart chambers and valves are working.

Echo also can show areas of poor blood flow to the heart, areas of heart muscle that aren"t contracting normally, and previous injury to the heart muscle caused by poor blood flow.

Chest X Ray: A chest x ray takes pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels.

A chest x ray can reveal signs of heart failure, as well as lung disorders and other causes of symptoms not related to CHD.

Blood Tests: Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels may be a sign that you"re at risk for CHD.

Electron-Beam Computed Tomography: Electron-beam computed tomography (EBCT) is a test that looks for specks of calcium (called calcifications) in the walls of the coronary arteries. Calcifications are an early sign of CHD. The test can show whether you"re at increased risk for a heart attack or other heart problems before other signs and symptoms occur.

Coronary Angiography and Cardiac Catheterization: Dr. Villa may recommend coronary angiography if other tests or factors show that you"re likely to have CHD. This test uses dye and special x rays to show inside your coronary arteries.

To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization.

A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream.

Special x rays are taken while the dye is flowing through your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels.

Cardiac catheterization usually is done in a hospital. You"re awake during the procedure. It usually causes little to no pain.

How Is Coronary Heart Disease Treated?

Treatments for coronary heart disease (CHD) may include lifestyle changes, medicines, and medical procedures. The goals of treatments are to:

  • Relieve symptoms.
  • Reduce risk factors in an effort to slow, stop, or reverse the buildup of plaque.
  • Lower the risk of blood clots forming.
  • Widen or bypass clogged arteries.
  • Prevent complications of CHD.

Lifestyle Changes

Making lifestyle changes often can help prevent or treat CHD. For some people, these changes may be the only treatment needed.

Follow a Healthy Diet: A healthy diet is an important part of a healthy lifestyle. Following a healthy diet can prevent or reduce high blood pressure and high blood cholesterol and help you maintain a healthy weight.

Therapeutic Lifestyle Changes (TLC): Your doctor may recommend TLC if you have high blood cholesterol. TLC is a three-part program that includes a healthy diet, physical activity, and weight management.

Dietary Approaches to Stop Hypertension (DASH): Your doctor may recommend the DASH eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium.

DASH also focuses on fat-free or low-fat milk and dairy products, fish, poultry, and nuts. The DASH eating plan is reduced in red meats (including lean red meats), sweets, added sugars, and sugar-containing beverages. It"s rich in nutrients, protein, and fiber.

Be Physically Active: Routine physical activity can lower many CHD risk factors, including LDL ("bad") cholesterol, high blood pressure, and excess weight.

Physical activity also can lower your risk for diabetes and raise your HDL cholesterol level. HDL is the "good" cholesterol that helps prevent CHD.

Talk with your doctor before you start a new exercise plan. Ask him or her how much and what kinds of physical activity are safe for you.

People gain health benefits from as little as 60 minutes of moderate-intensity aerobic activity per week. The more active you are, the more you will benefit.

Maintain a Healthy Weight: Maintaining a healthy weight can lower your risk for CHD. A general goal to aim for is a body mass index (BMI) of less than 25.

A BMI between 25 and 29.9 is considered overweight. A BMI of 30 or more is considered obese. A BMI of less than 25 is the goal for preventing and treating CHD.

Quit Smoking: If you smoke, quit. Smoking can raise your risk for CHD and heart attack and worsen other CHD risk factors. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.

Manage Stress: Research shows that the most commonly reported "trigger" for a heart attack is an emotionally upsetting event, particularly one involving anger. Also, some of the ways people cope with stress, such as drinking, smoking, or overeating, aren"t healthy.

Medicines

You may need medicines to treat CHD if lifestyle changes aren"t enough. Medicines can:

  • Reduce your heart’s workload and relieve CHD symptoms
  • Decrease your chance of having a heart attack or dying suddenly
  • Lower your cholesterol and blood pressure
  • Prevent blood clots
  • Prevent or delay the need for a procedure or surgery (for example, angioplasty or coronary artery bypass grafting)

Procedures and Surgery

You may need a procedure or surgery to treat CHD. Both angioplasty and CABG are used to treat blocked coronary arteries. You and your doctor can discuss which treatment is right for you.

Angioplasty: Angioplasty is a nonsurgical procedure that opens blocked or narrowed coronary arteries. This procedure also is called percutaneous coronary intervention, or PCI.

A thin, flexible tube with a balloon or other device on the end is threaded through a blood vessel to the narrowed or blocked coronary artery.

Once in place, the balloon is inflated to compress the plaque against the wall of the artery. This restores blood flow through the artery.

During the procedure, Dr. Villa may put a small mesh tube called a stent in the artery. The stent helps prevent blockages in the artery in the months or years after angioplasty.

Coronary Artery Bypass Grafting: CABG is a type of surgery. In CABG, arteries or veins from other areas in your body are used to bypass (that is, go around) your narrowed coronary arteries. CABG can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack.

Cardiac Rehabilitation: Dr. Villa may prescribe cardiac rehabilitation (rehab) for angina or after CABG, angioplasty, or a heart attack. Almost everyone who has CHD can benefit from cardiac rehab.

Cardiac rehab is a medically supervised program that may help improve the health and well-being of people who have heart problems.

The cardiac rehab team may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians or nutritionists, and psychologists or other mental health specialists.

Rehab has two parts:

  • Exercise training. This part helps you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your personal abilities, needs, and interests.
  • Education, counseling, and training. This part of rehab helps you understand your heart condition and find ways to reduce your risk of future heart problems. The rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and deal with your fears about the future.

 

 
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