What Is Coronary Heart Disease?

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 

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:

• Men in their 40s have a higher risk of CHD than women. But as women get older (especially after they reach menopause), their risk increases to almost equal that of a man's risk. See: Heart disease and women
• Bad genes (heredity) can increase your risk. You are more likely to develop the condition if someone in your family has had a history of heart disease -- especially if they had it before age 50. Your risk for CHD goes up the older you get.
• Diabetes is a strong risk factor for heart disease.
• High blood pressure increases your risk of coronary artery disease and heart failure.
• Abnormal cholesterol levels: your LDL ("bad") cholesterol should be as low as possible, and your HDL ("good") cholesterol should be as high as possible.
• Metabolic syndrome refers to high triglyceride levels, high blood pressure, excess body fat around the waist, and increased insulin levels. People with this group of problems have an increased chance of getting heart disease.
• Smokers have a much higher risk of heart disease than nonsmokers.
• Chronic kidney disease can increase your risk.
• Already having atherosclerosis or hardening of the arteries in another part of your body (examples are stroke and abdominal aortic aneurysm) increases your risk of having coronary heart disease.
• Other risk factors including alcohol abuse, not getting enough exercise, and excessive amounts of stress.

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

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.

• It may feel heavy or like someone is squeezing your heart. You feel it under your breast bone (sternum), but also in your neck, arms, stomach, or upper back.
• The pain usually occurs with activity or emotion, and goes away with rest or a medicine called nitroglycerin.
• Other symptoms include shortness of breath and fatigue with activity (exertion).

Exams and Tests

Many tests help diagnose CHD. Usually, your doctor will order more than one test before making a definite diagnosis.

Tests may include:

• Electrocardiogram (ECG)
• Exercise stress test
• Echocardiogram
• Nuclear scan
• Electron-beam computed tomography (EBCT) to look for calcium in the lining of the arteries -- the more calcium, the higher your chance for CHD
• CT angiography -- a noninvasive way to perform coronary angiography
• Magnetic resonance angiography
• Coronary angiography/arteriography -- an invasive procedure designed to evaluate the heart arteries under x-ray