The underlying disease of CHD is atherosclerosis, also known as vascular calcification. Cholesterol and other fats are deposited in so-called plaques in the inner walls of the vessels, which reduces the inner diameter of the vessels and obstructs blood flow.

The risk factors include:

• smoking
• lack of exercise
• stress
• high fat diet
• high cholesterol levels
• high blood pressure
• excess weight
• diabetes
• genetic factors

Many of the risk factors can be influenced by a healthy lifestyle. If you want to learn more about high cholesterol and atherosclerosis,  we recommend our mediteo quizzes about cholesterol.

In the early stages of CHD, those affected are often symptom-free, as the blood flow to the heart is still sufficient. Only when the narrowing of the coronary arteries is more advanced do symptoms occur. Depending on the severity and type of the disease, there are two main categories of CHD, which have different symptoms: chronic and acute coronary syndrome. In chronic coronary syndrome, the symptoms triggered by reduced blood flow to the heart muscles (angina pectoris) usually occur during physical exertion and disappear again at rest. Depending on the stage and progression of the disease, a feeling of pressure or tightness, mild to severe pain or a burning sensation in the chest may initially only occur during strenuous physical activity, such as walking fast or climbing stairs, but later also during normal to light physical activity or even at rest. These symptoms can also radiate to other areas of the body, such as the left arm, neck, throat, back or jaw. In women, atypical symptoms such as nausea, shortness of breath and upper abdominal pain occur more frequently. The acute coronary syndrome, on the other hand, is a critical and life-threatening situation that requires immediate medical attention. Typical signs are severe chest pain which, in contrast to the chronic form, lasts longer than 20 minutes and can be very intense. In addition to chest pain, symptoms such as anxiety, excessive sweating, nausea and vomiting can also occur. Heart failure (cardiac insufficiency) can also be associated with acute coronary syndrome, especially if the heart can no longer pump effectively due to a reduced blood supply. In case of an acute heart failure, additional symptoms may also occur, such as shortness of breath, dizziness, loss of consciousness, low blood pressure, paleness and cold sweats.

CHD can lead to various secondary conditions that can significantly impair the health and quality of life of those affected. Some of the most common secondary diseases are described below.

Acute coronary syndrome and heart attack

Acute coronary syndrome can also occur due to the progression of chronic coronary syndrome. Heart attack is one of the most serious secondary diseases of CHD. It occurs when a coronary artery suddenly becomes completely blocked, which means that the heart muscle is no longer supplied with sufficient oxygen. This can lead to severe chest pain, shortness of breath and other life-threatening symptoms.

Stroke

The increased risk of strokes in people with CHD is closely linked to the underlying atherosclerosis. The resulting narrowing can affect not only the coronary arteries, but also the arteries that supply the brain. This can impair the blood supply to the brain and increase the risk of a stroke. In addition, the plaques in the arteries can become unstable and detach from the vascular wall. The plaques can travel with the blood flow to other parts of the body and lead to an embolism. In the brain, this can cause a stroke.

Heart failure (cardiac insufficiency)

CHD can lead to the heart no longer being able to pump enough blood due to insufficient oxygen in the heart muscle. Depending on which part of the heart is affected, different symptoms can occur. The blood either accumulates in the veins of the systemic circulation, which can lead to water retention in the legs, abdominal cavity, or liver. Alternatively, it backs up in the vessels coming from the lungs, which can lead to shortness of breath, especially during physical exertion.

Cardiac arrhythmia

CHD can cause the heartbeat to get out of sync. This is known as a cardiac arrhythmia and can manifest as palpitations, rapid heartbeat, fatigue or dizziness. The most common form is atrial fibrillation, in which blood clots can form in the heart.

The diagnosis of CHD includes both invasive and non-invasive procedures. Non-invasive methods include ECG (electrocardiogram), stress ECG, echocardiography (ultrasound of the heart) and heart CT (computed tomography). Invasive procedures include coronary angiography, in which the coronary vessels are imaged directly.

Prevention of CHD involves controlling risk factors through a healthy lifestyle. This includes a balanced diet, regular exercise, eliminating smoking, and stress management. A healthy lifestyle can significantly reduce the risk of CHD.

The treatment of CHD aims to alleviate the symptoms and prevent the disease from progressing. The therapy a patient receives is always tailored to their individual needs. The treatment options include:

Lifestyle changes:

• healthy diet (low fat)
• regular physical activity
• weight normalization
• eliminating smoking
• stress management

Basic medicinal therapy:

• platelet aggregation inhibitors such as aspirin
• beta-blockers
• ACE inhibitors or angiotensin II receptor blockers (sartans)
• nitrates
• calcium channel blockers

Invasive procedures:

• cardiac catheterization
• stent implantation
• bypass surgery

Changes to medication should never be made without consulting your doctor first! If you feel that you cannot tolerate a medication or do not feel the desired effect, please speak to your doctor.

The prognosis of CHD depends on various factors, including the extent of vasoconstriction and the frequency of angina attacks. Early diagnosis and treatment can improve the quality of life and increase life expectancy.

Coronary heart disease (CHD) is a serious condition caused by a combination of genetic and lifestyle factors. Preventive measures, early diagnosis and appropriate treatment can mitigate the effects of CHD and improve the quality of life of those affected.