Did You Know: Coronary Heart Disease (CHD)

1. What is coronary heart disease?
Coronary heart disease  (CHD) is a chronic condition of the heart caused by atherosclerotic changes (calcification) in the coronary arteries. These changes gradually narrow the affected arteries, leading to reduced blood flow to the heart muscle.  Coronary heart disease is one of the leading causes of death in Western industrialized countries.
2. Risk Factors and Lifestyle

The underlying condition of coronary heart disease is atherosclerosis, also known as arterial calcification. In this process, cholesterol  and other fats accumulate as so-called plaques on the inner walls of the arteries, narrowing the vessel diameter and impairing blood flow.

Risk factors include:

  • Smoking
  • Lack of physical activity
  • 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 would like to learn more about high cholesterol and atherosclerosis, we recommend our mediteo quizzes about cholesterol.

3. Classification and Symptoms
In the early stages of coronary heart disease, those affected often experience no symptoms, as blood flow to the heart is still sufficient. Symptoms typically appear only once the narrowing of the coronary arteries becomes more advanced.  Depending on the severity and type of the condition, coronary heart disease is classified into two main categories, each with distinct symptoms: chronic and acute coronary syndrome. With chronic coronary syndrome,  symptoms triggered by reduced blood flow to the heart muscle (angina pectoris) usually occur during physical exertion and subside at rest. Depending on the stage and progression of the disease, symptoms may initially appear only during intense physical activity such as brisk walking or climbing stairs. Later on, they may occur during normal or even mild physical activity, or even at rest. These symptoms can include a sensation of pressure or tightness, mild to severe chest pain, or a burning feeling in the chest. The pain may also radiate to other parts of the body , such as the left arm, neck, throat, back, or even the jaw.  In women, atypical symptoms such as nausea, shortness of breath, and upper abdominal pain are more common. The acute coronary syndrome  on the other hand, is a critical  and life-threatening condition that requires immediate medical attention. Typical signs include severe chest pain that, unlike in the chronic form, lasts longer than 20  minutes and may be very intense. In addition to chest pain, symptoms such as anxiety, heavy sweating, nausea, and vomiting may occur. Heart failure (cardiac insufficiency)  may also accompany an acute coronary syndrome, especially when the heart can no longer pump effectively due to reduced blood supply. If acute heart failure occurs, additional symptoms may include shortness of breath, dizziness, altered consciousness, low blood pressure, pale skin, and cold sweats.
4. Secondary Conditions

Coronary heart disease can lead to various secondary conditions that can significantly affect the health and quality of life of those affected.  Below are some of the most common complications.

Acute Coronary Syndrome and Heart Attack

Acute coronary syndrome can also develop from the progression of chronic coronary syndrome.  A heart attack is one of the most serious consequences of coronary heart disease. It occurs when a coronary artery suddenly becomes completely blocked, preventing the heart muscle from receiving enough oxygen. This can lead to severe chest pain, shortness of breath, and other life-threatening symptoms.

Stroke

The increased risk of stroke in people with  coronary heart disease  is closely linked to the underlying atherosclerosis. The narrowing of the arteries can affect not only the coronary vessels but also the arteries that supply the brain. This can impair blood flow to the brain and increase the risk of stroke. In addition, plaques in the arteries can become unstable and detach  from the vessel wall. These plaques can travel through the bloodstream to other parts of the body, potentially causing an embolism. If this occurs in the brain, it can result in a stroke.

Heart Failure (Cardiac Insufficiency)

Coronary heart disease can reduce the heart’s ability to pump blood effectively due to insufficient oxygen supply to the heart muscle. Depending on which part of the heart is affected, different symptoms may occur. Blood may back up in the veins of the systemic circulation, causing fluid retention in the legs, abdominal cavity, or liver.  Alternatively, blood may back up in the vessels leading from the lungs, resulting in shortness of breath — especially during physical activity.

Cardiac Arrhythmias

Coronary heart disease can disrupt the heart’s normal rhythm. This is known as a cardiac arrhythmia and may present as palpitations, a racing heart, fatigue, or dizziness. The most common form is atrial fibrillation, which can lead to the formation of blood clots in the heart.

5. Examinations and Reference Values

The diagnosis of coronary heart disease involves both invasive and non-invasive procedures. Non-invasive methods include ECG  electrocardiogram), exercise ECG, echocardiography (ultrasound of the heart), and cardiac CT (computed tomography of the heart).  Invasive procedures include,  among others, coronary angiography, which provides a direct view of the coronary arteries.

6. Prevention

Preventing coronary heart disease involves managing risk factors through a healthy lifestyle. This includes a balanced diet, regular physical activity, quitting smoking, and managing stress. A healthy lifestyle can significantly reduce the risk of developing coronary heart disease.

7. Treatment

The treatment of coronary heart disease focuses on relieving symptoms and preventing the condition from  progressing.  The exact therapy is always tailored to the individual needs  of each patient.  Treatment options include:

Lifestyle changes:

  • Healthy diet (low-fat nutrition
  • Regular physical activity
  • Achieving a healthy weight
  • Quitting smoking
  • Stress management

Standard medication therapy:

  • Antiplatelet agents  such as aspirin
  • Beta blockers
  • ACE inhibitors or angiotensin II receptor blockers (sartans) ACE inhibitors or angiotensin II receptor blockers (sartans)
  • Nitrates
  • Calcium channel blockers

Invasive procedures:

  • Cardiac catheterization
  • Stent placement
  • Bypass surgery

Important: Changes to your medication should  never be made without first  consulting  your doctor. If you feel that you are not tolerating a medication well or that it is not having the desired effect, please speak with your physician.

8. Prognosis

The prognosis of coronary heart disease depends on various factors, including the extent of arterial narrowing and the frequency of angina pectoris attacks. Early diagnosis and treatment can improve quality of life and increase life expectancy.

9. Conclusion

Coronary heart disease (CHD) is a serious condition caused by a combination of genetic factors and lifestyle. Through preventive measures, early diagnosis, and appropriate treatment, the impact of coronary heart disease can be reduced and the quality of life of those affected can be improved.

Coronary heart disease (CHD) is a serious condition caused by a combination of genetic factors and lifestyle . Through  preventive measures, early diagnosis, and appropriate treatment , the impact of coronary heart disease can be reduced and the quality of life of those affected can be improved.