Coronary heart disease (CHD), chronic circulatory disorders of the heart muscle or chronic ischemic heart disease is a heart disease caused by arteriosclerosis and circulatory disorders in the heart muscle. This results in an undersupply of oxygen to the heart, so that important functions of the cardiovascular system can no longer be performed. Seen in this way, coronary artery disease can lead to angina pectoris or heart attack.
What is coronary artery disease?
Coronary artery disease, or CAD for short, is a cardiovascular disease and is referred to as ischemic. It broadly involves a narrowing of the coronary arteries, as a result of which an undersupply of the heart muscle becomes apparent. If not treated, this will inevitably result in an infarction of the heart in the case of coronary artery disease. It is a serious disease, which in most cases in Germany is to be considered as a cause of death.
Causes
Among the causes of coronary heart disease is atherosclerosis, a type of calcification of the arteries. The inner walls of the vessels become narrowed by fat-laden material, in which the life-threatening calcium is later deposited. As a result of the narrowing of the blood vessels, the blood cannot circulate, and tissue particles die as a consequence. This condition is called arteriosclerosis, but it can spread to all vessels. When this happens and the heart vessels are affected, experts refer to it as coronary artery disease. People who are heavy smokers are also at great risk of developing coronary heart disease. This also applies to people who eat a high-fat diet suffer from high blood pressure and are under constant stress. Further causes of coronary heart disease can be seen in the clinical picture of obesity (overweight). In this clinical picture, it is not uncommon for patients to have significantly elevated cholesterol levels and to suffer from an efficient disturbance of fat metabolism. Causes of coronary heart disease can also be excessive sugar levels, as occurs in diabetes mellitus.
Symptoms, complaints, and signs
Coronary artery disease (CAD) can manifest itself in a variety of symptoms. Here, it is important to know that the signs can be very nonspecific, especially when the disease is not yet advanced. This means that a symptom such as pallor can, for example, indicate an iron deficiency, a cold, too little sleep, but also coronary heart disease. Clarification by a general practitioner or, if necessary, a specialist is therefore important if symptoms persist or become more severe. This applies in particular if risk factors such as obesity, smoking or a family history of heart attack or stroke are added to the symptoms. A typical symptom of coronary heart disease is angina pectoris. The term refers to a tightness in the chest that can, but does not have to, radiate to the neck and jaw, arms and shoulders. There are also silent courses of CHD. Often this tightness is also associated with anxiety, with sweating, or a drop in blood pressure called hypotension. A fast heartbeat (medical term: tachycardia) and shortness of breath (dyspnea) are also classic signs. In women, the symptoms are often more unspecific. Here, upper abdominal discomfort, paleness or nausea can also indicate angina pectoris. Therefore, a visit to the doctor is always advisable in case of doubt, in order to exclude coronary heart disease and its sometimes dangerous complications or to treat it with appropriate measures.
Disease progression
The course of coronary heart disease is always chronic, because a slowly progressive deterioration of the clinical picture occurs due to the advanced arteriosclerosis. In the same course, in most cases, the quality of life of the affected patients also sings. The first signs of coronary heart disease are not easily recognizable, because the disease progresses insidiously. The only obvious symptoms are shortness of breath during exertion, which is due to the undersupply of blood to the heart. Patients feel a tightness in the heart area, experts speak here in this case of angina pectoris.
Complications
Coronary artery disease (CAD) can result in serious complications.Early effects include instability of the heart associated with cardiac arrhythmias. Acute myocardial infarction is a particularly serious complication of CHD. The reason for this is the narrowing of coronary vessels within the vessel wall due to plaque formation. If the plaque ruptures abruptly, blood clotting starts locally, which leads to the buildup of the plaque. After that, it does not take long for the affected coronary vessel to become occluded. A lack of oxygen occurs in the parts of the heart that were previously supplied by this coronary vessel, which doctors refer to as acute coronary insufficiency. An acute heart attack is usually manifested by sweating, shortness of breath, nausea and a feeling of mortal fear. In such a case, a hospital with a cardiac catheterization laboratory must be visited immediately. The severe effects of CHD also include ventricular fibrillation. This occurs in about 80 percent of all people who die due to cardiac arrest during a heart attack. The risk of this complication is particularly pronounced in the first hours of the infarction. A later sequela of coronary artery disease is cardiac rupture, in which the wall of the heart muscle breaks through. This reveals a hematoma within the pericardium.
When should you go to the doctor?
If symptoms such as palpitations, shortness of breath, and sweating are noticed, coronary artery disease may be underlying. Medical advice is needed if the signs of illness persist for more than a few days or increase in intensity as they progress. If further symptoms and complaints develop, such as chest pain or nausea, it is best to consult the family doctor immediately. Even non-specific symptoms that affect well-being and quality of life should be clarified quickly. People suffering from arteriosclerosis are particularly susceptible to the development of coronary heart disease and should have the aforementioned complaints examined quickly and treated if necessary. The same applies to diabetes and hypertension patients. An unhealthy lifestyle is associated with an increased risk of developing heart disease, which is why smokers, people with obesity and alcoholics also need to seek medical advice. The right person to contact is the family doctor or a cardiologist. If the disease is already advanced, it may need to be treated in a specialist heart disease clinic.
Treatment and therapy
One can treat coronary artery disease with medication or surgery. This is basically decided by the doctors after the course of the disease and the state of the disease have been clearly established. The severity of the coronary heart disease plays the overriding role. Drug therapy involves the use of agents such as clopidogrel, beta blockers, ACE inhibitors, statins and, of course, acetylsalicylic acid, which have the sole aim of lowering cholesterol levels. Existing angina pectoris is treated with a nitroglycerin spray. Surgical therapy has the goal of improving blood flow to the heart muscle. For this purpose, doctors usually place a bypass. Coronary angioplasty followed by the insertion of a coronary stent can also be performed as therapy. This medical implant is particularly suitable for widening small constrictions of the vessels. In this very special way, the expected new occlusion of the blood vessels is efficiently prevented. These stents are available not only as supporting stents but also as coronary stents that deliver active substances that can further reduce or even prevent occlusion of the blood vessels.
Outlook and prognosis
In practice, bypasses (grafts) made from arterial material have been shown to be more stable than bypasses made from veins. More than 90% of grafts from arteries are still fully patency 10 years after surgery. In contrast, bypasses from leg veins are only 70% clear over the same period. Since the cause of coronary artery disease, arteriosclerosis, cannot be cured, the patient must make appropriate lifestyle changes. Risk factors must be minimized in order to have a good prognosis for the future and not to jeopardize the success of the operation. This naturally includes regular medical monitoring of the status quo. Furthermore, attention must be paid to body weight, because excess weight would have a negative effect.Nicotine and alcohol consumption should be discontinued if possible. Reducing stress has a positive effect. To this end, it makes sense to familiarize oneself with various stress management methods. Regular exercise and sports promote good cardio health. Health insurance companies also offer special courses, such as cardiac sports groups, which are worth attending. Fats should be avoided in food preparation. Here the patient can orientate himself well on the Mediterranean kitchen. In general, the patient should pay good attention to his own body signals and, if in doubt, consult his cardiologist or family doctor.
Prevention
How to reduce or prevent the risk of coronary artery disease? The risk of heart attack and other heart diseases can be significantly reduced with the help of the following points:
1. one should measure (have measured) his blood pressure regularly. Adults over the age of 40 in particular should have their blood pressure checked at least once a year. Too high a blood pressure puts a strain on the heart. Values below 130 over 80 are considered good. 2. one should eat a healthy diet. A conscious and healthy diet reduces the risk of a heart attack. Saturated fatty acids, especially in animal products such as butter, beans, pork, etc., should be avoided, because they increase the cholesterol level in the blood. 3. one should do sufficient sport. In particular, light endurance sports such as Nordic walking, cycling or swimming reduce the risk of heart attack. 4. if you are overweight, you should reduce your excess weight. Already 10 kilos too much have a negative effect on our health, both the blood pressure and the blood fat values increase. 5. one should give itself a smoking prohibition. Already six cigarettes per day double the risk of a heart attack, so fingers away from it! 6. you should also avoid stress as much as possible. Basically, the body withstands stressful situations quite well, nevertheless, one should not exaggerate it here, because these can lead to high blood pressure.
Aftercare
In coronary artery disease, follow-up care is almost as important as therapy. Patients need consistent follow-up care to prevent worsening of the condition, if possible. Therefore, regular check-ups with the treating physicians are indispensable. Professional contacts in this context are the internist or cardiologist, but also the family doctor. In the event of acute symptoms, the nearest hospital is the right address. Coronary heart disease often has behavioral causes. These must be included in the practice of aftercare as prevention of further crises. Abstaining from nicotine and too much alcohol is particularly significant here. In addition, patients must also ensure that they eat a low-fat diet with plenty of fruit and vegetables so that blood lipids do not rise to an unhealthy level and health is not further jeopardized. Help in this regard is provided by competent nutritional counseling. Weight and fitness should also be included in follow-up care. Weight reduction and fitness build-up can be achieved through targeted exercise. Lightly dosed endurance training or strength training with not too much weight is often helpful, but always coordinated with the treating physician. Coronary sports groups with qualified exercise instructors are specially tailored to the needs of heart patients. Stress reduction is another important factor in the consistent follow-up of coronary artery disease sufferers.
Here’s what you can do yourself
In addition to drug treatment, a healthy lifestyle plays a significant role in maintaining quality of life for a long time despite coronary artery disease. The diet should be varied and diverse; high-fiber foods with plenty of fruits, vegetables, and whole grains are preferable to high-fat and high-carbohydrate foods. Unsaturated fatty acids have a more favorable effect on blood lipid levels than saturated fatty acids, which are found in fried foods and meat products. Good examples of how to prepare healthy meals are provided by Mediterranean cuisine, in which animal fats are replaced by vegetable oils and salt by spices. It is also important to reduce risk factors: Completely abstaining from nicotine can significantly increase life expectancy, and alcohol should only be enjoyed in moderation. Physical activities help to reduce excess weight, improve fitness and help to create a positive attitude to life.Endurance sports such as cycling, jogging or swimming are ideal, and fast walking also has a positive effect on the heart and circulation. Several short sessions per week are more effective and gentler than one long session, and the intensity must be adapted to the patient’s own ability. If in doubt, it is advisable to draw up a training plan together with the doctor treating you. Stress and hectic activity damage the heart, so there should be enough room for rest and relaxation in everyday life. Maintaining social contacts also promotes well-being.
