Coronary Heart Disease (CHD) - Symptoms & Treatment of Heart Disease

In most cases, atherosclerosis (“hardening of the arteries,” “vascular calcification”) is responsible for the narrowing of the coronary arteries. Deposits cause the vessel walls to thicken, resulting in a reduced vessel cross-sectional area. These narrowings are also referred to as stenoses.

If the narrowing progresses further, it can lead to complete blockage of the vessel. Risk factors include, in particular, the risk factors that promote the development of atherosclerosis. These include

• a genetic predisposition
• advanced age
• gender
• elevated cholesterol levels
• lipid metabolism disorders
• Overweight
• Diabetes mellitus (diabetes)
• High blood pressure
• Smoking
• Lack of physical activity

Other causes may include, for example, an enlarged heart or various tumors that exert pressure on the blood vessels, or conditions in which the oxygen content in the blood is reduced, such as respiratory failure. Coronary heart disease can also develop in cases of leukemia, certain heart diseases, hyperthyroidism, high blood pressure, and infectious diseases.

Symptoms occur when the narrowing severely restricts the oxygen supply to a part of the heart. The resulting chest pain, known as angina pectoris, can radiate to other parts of the body (e.g., the shoulder area, lower jaw, or back).

Other symptoms tend to be more nonspecific in nature. For example,

• shortness of breath,
• a drop in blood pressure,
• rapid heart rate,
• anxiety, or
• sweating
• cardiac arrhythmias
• Pain behind the breastbone
• in women, nausea and upper abdominal pain may also occur

may occur. In some patients, symptoms occur only during physical exertion, when the heart has an increased need for oxygen. If left untreated, the risk of having a heart attack increases.

Especially in older patients and those with diabetes, symptoms may be completely absent, meaning that complications such as a heart attack are detected too late.

The diagnosis should be made by a cardiologist. Coronary heart disease is often suspected based on the symptoms alone. In addition to a thorough physical examination and the assessment of certain laboratory values (such as blood sugar and blood lipids), an electrocardiogram (ECG) performed at rest and during exercise is particularly important.

Changes in the ECG can confirm the suspicion of coronary heart disease. In addition, imaging tests, such as MRI, CT, or ultrasound of the heart, may be necessary. Coronary angiography can be used to visualize the coronary arteries and assess any narrowings.

Treatment depends on the severity of symptoms, the extent of the narrowing, and the risk of complications such as a heart attack. The goals include treating stable angina pectoris and preventing acute events.

Drug therapy for CHD involves the use of medications that reduce the heart’s oxygen consumption. The best-known example of this is nitrates. However, beta-blockers—which primarily lower the heart rate—also indirectly reduce oxygen consumption. As a result, more oxygen is indirectly made available to the heart muscle.

If symptoms cannot be adequately managed with medication or if the narrowing of the coronary arteries is already very advanced, there are several surgical treatment options. Coronary angioplasty is used to widen the coronary arteries at the narrowed sites. The implantation of a stent prevents the artery from closing again. During bypass surgery, a detour is created around the narrowed or blocked section of the artery.

The first step is to eliminate risk factors (such as obesity, high blood pressure, and diabetes mellitus). This includes quitting smoking, losing weight if overweight, getting sufficient exercise to lower blood pressure, and making dietary changes. A balanced diet plays a central role in this.

Furthermore, the use of antiplatelet agents (e.g., aspirin) reduces the risk of thrombosis and, consequently, of a heart attack. Cholesterol-lowering medications can help reduce cholesterol levels. These measures help prevent coronary heart disease and, in the long term, avoid cardiovascular diseases.

1. What are the typical symptoms of coronary heart disease?
The most common signs of coronary heart disease include chest pain (angina pectoris), shortness of breath, and a feeling of pressure or tightness in the chest, especially during physical exertion. This heart condition often first becomes apparent only during physical exertion.

2. What causes chronic coronary heart disease?
Chronic coronary heart disease is usually caused by atherosclerosis, a condition in which deposits (plaques) form in the blood vessels and narrow the coronary arteries.

3. How is coronary heart disease diagnosed?
If coronary heart disease is suspected, the diagnosis is made through a physical examination, an ECG, and imaging procedures such as coronary angiography.

4. What is the treatment for coronary heart disease?
Treatment for coronary heart disease ranges from medication to procedures such as stent implantation or bypass surgery, depending on the severity of the condition.