Coronary heart disease

Definition of coronary heart disease

Coronary heart disease is one of the most common diseases in cardiovascular medicine. It refers to the circulatory disorder of the heart muscle caused by a narrowing of the coronary arteries. In order for the heart muscle to pump the daily blood supply of about 10,000 litres of blood into the body, the muscle must be constantly supplied with oxygen. This supply of oxygen and nutrients takes place via the coronary vessels, which are also called coronary arteries. If the coronary arteries are severely narrowed, the heart muscle can no longer be supplied with enough oxygen. The narrowing of the vessels leads to coronary heart disease (CHD).

Causes and risk factors

Coronary heart disease is caused by arteriosclerosis (hardening of the blood vessels) in the coronary arteries: When blood fats, blood clots and connective tissue become lodged in the inner walls of the vessels, blood flow is prevented. This disease process usually takes place over a longer period of time.

Depending on the severity of the narrowing, symptoms become noticeable: Only slight narrowing of the coronary arteries usually does not cause any symptoms. If the vessels acutely constrict and thus lead to occlusion so that blood flow is no longer possible, this is called a heart attack. Risk factors for the occurrence of coronary heart disease are high blood pressure, high cholesterol, smoking, excess body weight and diabetes.

Symptoms

The symptoms of coronary artery disease vary depending on how severely the coronary arteries are narrowed and where the narrowing is located. Slight narrowing usually does not cause any symptoms. If the constriction is more severe, the reduced blood flow to the heart leads to typical symptoms such as:

• Angina pectoris
• Cardiac arrhythmias
• Shortness of breath, breathing difficulties
• Dizziness
• Racing heart
• Nausea

Angina pectoris is a typical symptom of CHD. It manifests itself as a feeling of tightness in the chest, which becomes stronger under physical exertion, as the exertion leads to an imbalance between oxygen supply and oxygen consumption. This imbalance is also known as coronary insufficiency.

The tightness behind the breastbone that occurs with angina pectoris often radiates to the left arm, neck or jaw. But back pain or pain in the stomach area can also be an expression of angina pectoris. If the symptoms occur especially during physical exertion, it is called stable angina pectoris. If the symptoms are also noticeable at rest, this is called unstable angina pectoris.

If the symptoms occur while resting or last longer than 15 minutes, the patient may be suffering a heart attack. In such a situation, you must immediately seek medical help.

Diagnosis of coronary heart disease

Angina pectoris is a typical symptom of suspected coronary heart disease. In addition to the detection of this symptom, coronary heart disease is diagnosed with different examinations such as a stress ECG, echocardiography or a coronary angiography.

The ECG can also be used to rule out an acute heart attack. Furthermore, the stress ECG and the heart ultrasound can be consulted as diagnostic tools for coronary heart disease. If the suspicion of coronary heart disease is confirmed, a cardiac catheter examination should be performed.

Treatment

The treatment depends on the severity of the coronary heart disease. To eliminate the symptoms of narrowed coronary arteries, various procedures are suitable, such as:

• Bypass surgery
• Balloon dilatation
• Stent placement

Find out more in the chapter entitled Surgery on the coronary arteries.

However, these treatments do not cure the underlying disease. Therefore, after diagnosis, drug therapy should be given to stop or slow down the progression of CHD.

Within this, the two drugs aspirin and statin, in particular, should be taken for life: Aspirin thins the blood, and the cholesterol-lowering statin not only lowers cholesterol but also has a positive effect on inflammation in the blood vessels. The calcifications in the coronary vessels are thus stabilised.

In addition to drug therapy, it is also necessary to treat the risk factors: This requires a change in lifestyle. This includes changing the diet as well as regular endurance sports.

Consequences

Coronary heart disease leads to cardiac insufficiency and requires lifelong drug therapy as well as dietary and lifestyle changes. If the narrowing of the coronary vessels progresses and even leads to a blockage of the vessels, CHD can lead to a heart attack or sudden cardiac death.