Coronary heart disease (CHD): Description.
Coronary artery disease (CAD) is a serious disease of the heart that causes circulatory problems in the heart muscle. The reason for this is narrowed coronary arteries. These arteries are also called “coronary arteries” or “coronaries”. They surround the heart muscle in the form of a ring and supply it with oxygen and nutrients.
Coronary artery disease: definition
Coronary artery disease (CAD) is defined as a condition in which arteriosclerosis (“hardening of the blood vessels”) causes a deficiency in blood flow, resulting in a mismatch between oxygen supply and oxygen consumption (coronary insufficiency) in parts of the heart muscle.
Coronary artery disease: classification:
Depending on the extent of atherosclerotic changes, coronary artery disease can be classified into the following degrees of severity:
- Coronary artery disease – branch vessel disease: Two of the three main branches of the coronary arteries are affected by one or more narrowing points (stenoses).
- Coronary artery disease – three-vessel disease: all three main branches of the coronary arteries are affected by one or more narrowings (stenoses).
The main branches also include their outgoing branches, i.e. the entire flow area where they supply the heart muscle.
Coronary artery disease: symptoms
Chest pain
Cardiac arrhythmias
Coronary heart disease not infrequently also triggers cardiac arrhythmias. The lack of oxygen in the heart muscle also impairs the electrical impulses (conduction of excitation) in the heart. Cardiac arrhythmias caused by coronary artery disease can be confirmed by an ECG (electrocardiogram) and assessed for their potential danger. This is because many people have harmless cardiac arrhythmias and do not suffer from CHD.
Coronary heart disease: causes and risk factors
Coronary heart disease (CHD) develops over the years due to the interaction of various causes and risk factors. Numerous scientific studies prove that coronary heart disease is related to the risk factors mentioned here. Many of these can be avoided by adopting an appropriate lifestyle. This can drastically reduce the risk of developing CHD.
Influenceable risk factors for coronary artery disease:
| Risk factor | Explanation |
| Unhealthy diet and obesity | |
| Lack of exercise | Sufficient exercise lowers blood pressure, improves cholesterol levels and increases insulin sensitivity in muscle cells. Lack of exercise lacks these protective effects and coronary heart disease can result years later. |
| Smoking | |
| Increased blood pressure | High blood pressure (hypertension) directly damages the walls of blood vessels. |
| Elevated cholesterol levels | High LDL cholesterol levels and low HDL cholesterol levels promote plaque formation. |
| Diabetes mellitus | Poorly controlled diabetes (diabetes) leads to permanently elevated blood glucose levels, which in turn damage blood vessels and promote coronary heart disease. |
Risk factors for coronary heart disease that cannot be influenced:
| Risk Factor | Explanation |
| Male gender | |
| Genetic predisposition | Some families have a high incidence of cardiovascular disease, so genes are likely to play a role in coronary heart disease. |
| Age | The incidence of disease in men increases from the age of 45, and in women from the age of 50. The older a person is, the more likely coronary artery disease is present. |
Coronary heart disease: examinations and diagnosis
Medical history (anamnesis):
Before the actual examination, the doctor asks a few questions to learn more about the nature and duration of the current complaints. Any previous illnesses or accompanying symptoms are also relevant for the doctor. Describe the nature, duration and severity of the discomfort and, most importantly, in what situations it occurs. The doctor will ask various questions, for example:
- What are your symptoms?
- When (in which situation) do the complaints occur?
- What medications are you taking?
- Are there similar symptoms or known coronary heart disease in your family, for example in parents or siblings?
- Have there been any abnormalities in your heart in the past?
- Do you smoke? If so, how much and for how long?
- Are you active in sports?
- What is your diet like? Do you have a history of elevated cholesterol or blood lipids?
Physical examination
Further examinations:
Whether coronary artery disease is present can be clearly answered primarily by specific measurements and imaging of the heart and its vessels. Further examinations include:
Blood pressure measurement
Doctors often also perform a long-term blood pressure measurement. Patients are fitted with a blood pressure monitor by the practice team and go home with it. There, the device measures the blood pressure in regular intervals. Hypertension is present when the average value from all measurements is above 130 mmHg systolic and 80 mmHg diastolic.
Blood test:
Resting Electrocardiogram (Resting ECG)
A basic examination is the resting ECG. Here, the electrical excitations of the heart are derived via electrodes on the skin. Coronary artery disease (CAD) can sometimes show typical changes in the ECG.
However, the ECG can also be normal even though coronary artery disease is present!
Exercise electrocardiogram (stress ECG)
Heart ultrasound (echocardiography)
Myocardial scintigraphy
Cardiac catheterization (coronary angiography)
Further imaging procedures
In some cases, special imaging procedures are needed to determine the extent of coronary artery disease (CAD). These include:
- Positron emission tomography (myocardial perfusion PET)
- Cardiac multislice computed tomography (cardiac CT)
- Cardiac magnetic resonance imaging (cardio-MRI)
Diagnostics for suspected myocardial infarction
Coronary artery disease: treatment
Coronary heart disease may also trigger mental illnesses such as depression. Psychological stress, in turn, has a negative effect on coronary heart disease. Therefore, in the case of coronary heart disease, any psychological problems are also taken into account during treatment. In addition to the targeted elimination of risk factors, the treatment of coronary heart disease primarily involves medication and often surgery.
Medication
Coronary artery disease can be treated with a number of medications that not only relieve symptoms (for example, angina), but also prevent complications and increase life expectancy.
Drugs by which the prognosis of coronary heart disease should be improved and heart attacks avoided:
- Beta-receptor blockers (“beta blockers”): They lower blood pressure, slow the heartbeat, thus reducing the heart’s oxygen demand and relieving the heart. After a heart attack or in the case of CHD with heart failure, the risk of mortality is reduced. In patients with coronary artery disease and hypertension, beta-blockers are the drug of choice.
Medications that relieve the symptoms of coronary artery disease:
- Nitrates: they dilate the blood vessels of the heart, giving it a better supply of oxygen. They also dilate vessels throughout the body, which is why blood flows back to the heart more slowly. The heart has to pump less and uses less oxygen. Nitrates are particularly fast-acting and are therefore suitable as an emergency medication for an acute attack of angina pectoris.
- Calcium antagonists: This group of substances also dilates the coronary vessels, lowers blood pressure and relieves the heart.
Other drugs:
- ACE inhibitors: In patients with heart failure or high blood pressure, they improve the prognosis.
- Angiotensin I receptor blockers: used when patients are intolerant to ACE inhibitors.
Cardiac catheterization and bypass surgery
In bypass surgery, the narrowing of the coronary vessel is bridged. To do this, a healthy vessel is first removed from the chest or lower leg and sutured to the coronary vessel behind the narrowing (stenosis). Bypass surgery is mainly considered when the three main branches of the coronary arteries are severely narrowed (three-vessel disease). Although the operation is costly, it significantly improves the quality of life and prognosis of most people.
Coronary artery disease can also be treated with bypass surgery or PCI if several coronary vessels are affected or if the narrowing is at the beginning of a large vessel. The decision for bypass surgery or dilatation is always made on an individual basis. In addition to the findings, it also depends on concomitant diseases and age.
Sport as therapy for CHD
Exercise therefore targets precisely the risk factors that cause coronary heart disease. But regular exercise also has a positive influence on the course of the disease. Endurance exercise can slow down the progression of the disease in CHD, stop it in some cases, and in some cases even reverse it.
Exercise initiation in CHD
If the CHD patient has had a heart attack (STEMI and NSTEMI), scientific studies recommend starting exercise early – as early as seven days after the infarction. This early mobilization supports the healing process.
In the case of bypass surgery, the affected person can begin early mobilization as early as 24 to 48 hours after the procedure. However, restrictions due to the surgery are to be expected during the first weeks. Training should start with gentle exercises.
Always discuss the start of training with your attending physician in advance if you have a heart condition.
Training plan for CHD
Cardiac exercise includes various disciplines. Depending on the state of health and individual fitness level, each patient receives a training plan. This usually includes the following components
Moderate endurance training
For CHD patients, just ten minutes of fast walking daily at around 5 km/h at the start of training is enough to reduce the risk of death by up to 33 percent. If the pace is too fast, sufferers can alternatively walk slowly (at around 3 to 4 km/h) for 15 to 20 minutes.
Suitable endurance sports for CHD include:
- (fast) walking
- Walking on a soft mat/sand
- Walking/Nordic walking
- Step aerobics
- Walking
- Cycling
- Rowing
- Swimming
It is important that cardiac patients choose short exercise phases of five to ten minutes maximum at the beginning. The duration of exertion is then slowly increased over the course of the training. This is because the greatest effects are seen in patients who exert themselves the most. Every time the activity level is doubled, the risk of death is reduced by a further ten percent within four weeks.
Make sure that they do not exceed the pulse limits that can be determined, for example, in a stress ECG. A heart rate monitor can help you to keep within the right limits and to train optimally.
Strength exercises
Gentle exercises for cardiac patients to build muscle in the upper body include:
- Strengthening the chest muscles: sit upright on a chair, press your hands against each other in front of your chest and hold for a few seconds. Then release and relax. Repeat several times
- Strengthening the shoulders: Sitting upright also on a chair, hook the fingers in front of the chest and pull outwards. Hold the pull for a few seconds, then relax completely.
You train the legs particularly gently with these exercises:
- Strengthening the abductors (extensors): Sit upright on a chair and press against your knees with your hands from the outside. The legs work against the hands. Hold the pressure for a few seconds and then relax.
Light circuit training
In cardiac sports groups, light circuit training is also frequently performed. Here, for example, the participants complete eight different stations. Depending upon selected exercises that promotes perseverance, Kraft, mobility and co-ordination at the same time. One minute of exertion is followed by a 45-second break. After that, the athletes rotate to the next station. Depending on individual fitness, there are one or two runs.
Coronary artery disease: disease progression and prognosis
If coronary heart disease (CHD) is discovered late or is insufficiently treated, heart failure may develop as a secondary disease. In this case, the prognosis worsens. Untreated CHD also increases the risk of a heart attack.
