Coronary heart disease (CHD) is a disorder of the coronary vessels (coronary arteries) that supply the heart with blood. Due to constrictions in the coronary arteries, the heart can no longer be properly supplied with blood and thus with oxygen and nutrients. This reduced blood flow is known as ischemia, which is why coronary heart disease is also called ischemic heart disease.
As a result of the undersupply, the performance of the heart and therefore the entire body decreases. A life-threatening complication is a heart attack. In a heart attack, entire areas of heart muscle die and scar. The reduced pumping power is called cardiacinsufficiency.
In most cases, arteriosclerosis ("hardening of the arteries", "vascular calcification") is responsible for the narrowing of the heart vessels. Deposits lead to a thickening of the vessel walls and, as a result, to a reduced vessel cross-section. These constrictions are also known as stenoses.
If the narrowing progresses further, it can also lead to complete blockage of the vessel. Risk factors are particularly those that promote the development of arteriosclerosis. These include
Other causes may include an enlarged heart or various tumors that exert pressure on the blood vessels, or diseases in which the oxygen content in the blood is reduced, such as respiratory insufficiency. However, coronary heart disease can also develop in leukemia, some heart diseases, hyperthyroidism, high blood pressure and infectious diseases.
Symptoms occur when the narrowing severely restricts the oxygen supply to an area of the heart. The pain that then occurs in the chest, known as angina pectoris (chest tightness), can radiate to other parts of the body (e.g. shoulder area, lower jaw or back).
Other symptoms are of a rather unspecific nature. They can include
- shortness of breath,
- drop in blood pressure,
- accelerated heart rate,
- anxiety or
- sweating
may occur. In some patients, the symptoms only occur during physical exertion when the heart has an increased need for oxygen.
In older patients and diabetics in particular , the symptoms may be completely absent, meaning that complications such as heart attacks are noticed too late.
The diagnosis should be made by a cardiologist. Coronary heart disease is often suspected on the basis of the symptoms alone. In addition to a detailed physical examination and the determination of certain laboratory values (such as blood sugar and blood lipids), the recording of an electrocardiogram (ECG) at rest and during exercise is particularly important.
The changes in the ECG can be used to confirm the suspicion of coronary heart disease. In addition, imaging examinations such as MRI, CT or ultrasound examinations of the heart may be necessary. Coronary angiography can be used to visualize the coronary arteries and assess stenoses.
Treatment depends on the severity of the symptoms, the extent of the narrowing and the risk of complications such as a heart attack.
Drug treatment for CHD consists of administering drugs that reduce the heart's oxygen consumption. The best-known example of this is nitrates. However, the administration of beta-blockers, which actually reduce the heart rate, also indirectly reduces oxygen consumption.
If the symptoms cannot be adequately treated with medication or if the narrowing in the coronary arteries is already very advanced, there are several surgical treatment options. Coronary angioplasty is used to widen the coronary arteries at the narrowing points. The implantation of a stent prevents the vessel from closing again. During a bypass operation, a bypass is created around the narrowed or blocked area in the vessel.
The first step is to eliminate risk factors (such as obesity, high blood pressure, diabetes mellitus). This includes quitting smoking, losing weight if you are overweight, getting enough exercise and changing your diet.
Furthermore, the administration of antiplatelet agents (e.g. ASA) reduces the risk of thrombosis and thus a heart attack. Cholesterol-lowering drugs can help to reduce cholesterol levels.
