Like any muscle, the heart must have a persistent supply of oxygen and nutrients that are carried to it by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged and are unable to give sufficient blood to the heart, the outcome is CHD.
If not enough oxygen-carrying blood gets to the heart,
the heart may answer with problems called angina. The discomfort is commonly felt in the chest or from time to time in the left arm and shoulder. (However, the same limited blood supply may give no signs or symptoms, a problem referred to as silent angina.)
When the blood supply is cut off completely, the result is a heart attack. The portion of the heart that does not obtain oxygen starts to expire, and some of the heart muscle may be permanently impaired.
So what leads to CHD? CHD is caused by a thickening of the inside walls of the coronary arteries. This thickening, referred to as atherosclerosis, narrows the space through which blood can move, lowering and sometimes totally cutting off the source of oxygen and nutrients to the heart.
Atherosclerosis generally occurs when a person has substantial amounts of cholesterol, a fat-like substance, in the blood. Cholesterol and fat, distributed in the blood, build up on the walls of the arteries. The swelling narrows the arteries and may slow or stop the course of blood. When the level of cholesterol in the blood is excessive, there is a deeper likelihood that it will be lodged onto the artery walls. This process begins in most people during childhood and the teenage years, and worsens as they get older.
In addition to high blood cholesterol, high blood pressure and smoking likewise lead to CHD. On the average, each of these increases your possibility of developing heart disease. For this reason, a person who has all three risk factors is eight times more probable to acquire heart disease than someone who has none. Weight problems and physical inactivity are other reasons that can lead to CHD. Being heavy increases the chance of acquiring high blood cholesterol and high blood pressure, and physical inactivity increases the threat of heart attack. Regular working out, good food intake, and smoking cessation are vital to controlling the risk variables for CHD.
Among its symptoms are chest pain (angina) or shortness of breath, which may be the very first clues of CHD. A person may feel heaviness, tightness, discomfort, burning, strain, or squeezing, usually behind the breastbone but sometimes also in the arms, neck, or jaws. These signs usually bring the patient to a doctor for the first time. Even so, some people suffer heart attacks without ever having any of these symptoms.
It is very important to understand that there is a wide range of severeness for CHD. Some people have no indicators at all, some have mild irregular chest pain, and some have more noticable and steady ache. Still others have CHD that is extreme enough to make typical day-to-day actions difficult.
Because CHD can vary so significantly from one person to another, the way a doctor determines and treats CHD will also change a lot. The following explanations are basic guidelines to some assessments and treatment options that may or may not be utilized, depending on the personal circumstance.
There is no one straightforward test--some or all of the following procedures may be required. These diagnostic procedures are employed to identify CHD, to figure out its scope and intensity, and to rule out other likely reasons of the symptoms.
After taking a careful medical history and being subjected to a physical examination, the doctor may make use of a number of tests to discover how advanced the CHD is. The only certain way to identify and determine the extent of CHD is coronary angiography (see below); other tests can indicate a problem but do not show exactly where it is.
An examination for CHD may include the following tests:
An electrocardiogram (ECG or EKG) is a graphic record of the electrical activity of the heart as it contracts and rests. Irregular heartbeats and some areas of damage, inadequate blood flow, and heart enlargement can be recognized on the records.
A stress test (also called a treadmill test or exercise ECG) is employed to document the heartbeat during exercise. This is accomplished because a number of heart problems only come up when the heart is working hard. In the test, an ECG is done before, during, and after exercising on a treadmill; breathing rate and blood pressure may be measured as well. Exercise tests are useful but are not completely reliable; false positives (showing a problem where none exists) and false negatives (showing no problem when something is wrong) are fairly common.
Nuclear scanning is sometimes used to show damaged areas of the heart and reveal problems with the heart's pumping action. A small amount of radioactive material is injected into a vein, usually in the arm. A scanning camera records the nuclear material that is taken up by heart muscle (healthy areas) or not taken up (damaged areas).
Coronary angiography (or arteriography) is a test used to explore the coronary arteries. A fine tube (catheter) is put into an artery of an arm or leg and passed through the tube into the arteries of the heart. The heart and blood vessels are then filmed while the heart pumps. The picture that is seen, called an angiogram or arteriogram, will display problems such as a blockage caused by atherosclerosis.
CHD is treated in a number of ways, depending on the seriousness of the disease. For many people, CHD is kept down with lifestyle changes and medications. Others with serious CHD may need surgery. In any case, once CHD develops, it demands lifelong management.
