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Coronary heart disease

Show Alternative Names
Heart disease, Coronary heart disease, Coronary artery disease
Arteriosclerotic heart disease
CHD
CAD

Coronary heart disease is a narrowing of the blood vessels that supply blood and oxygen to the heart. Coronary heart disease (CHD) is also called coronary artery disease.

Coronary Artery Disease Quiz

  • Coronary artery disease is …

    Correct Answer
    The correct answer is all of the above. Coronary artery disease (CAD) and coronary heart disease describe the same condition: the buildup of plaque in the arteries that carry blood and oxygen to the heart. These are called the coronary arteries. Over time, they can become narrow, slowing or stopping blood flow to the heart.

  • What causes plaque to build up in the arteries?

    Correct Answer
    The correct answer is all of the above. Any of these factors cause damage to the inside walls of the coronary arteries. Cholesterol and other chemicals in the blood then build up on these injured areas as plaque. This process is called atherosclerosis.

  • You can have CAD and not have any symptoms.

    Correct Answer
    The correct answer is true. Plaque buildup occurs slowly over time, so you can have the disease and not have any symptoms. This is especially true in the early stages of heart disease. Sometimes, a heart attack is the first sign of CAD.

  • What are the noticeable symptoms of CAD?

    Correct Answer
    The correct answer is all of the above. Angina (chest heaviness, pressure, or pain) is the most common symptom. It often occurs during activity or stress and goes away with rest or when you take an angina medicine (most often nitroglycerin under your tongue). You also may feel shortness of breath, fatigue, or weakness.

  • Angina is another name for a heart attack.

    Correct Answer
    The correct answer is false. Angina is a sign that your heart isn't getting enough oxygen. A heart attack occurs when heart muscle cells die due to a blocked artery. Having angina means you are at risk for a heart attack. If you have angina, and your chest pain doesn't go away minutes after rest or medicine, call 911.

  • Which heart problems can be caused by CAD?

    Correct Answer
    The correct answer is all of the above. Reduced blood flow can damage the heart in different ways. Heart failure occurs when the weakened heart muscle can't pump enough blood to the rest of the body. CAD can damage the heart's electrical system, causing arrhythmias. A blocked artery can cause a heart attack.

  • If you have heart disease, you are at higher risk for depression.

    Correct Answer
    The correct answer is true. It's unclear why, but there is a link between depression and heart disease, angina, and heart attack. Being depressed may make it harder to follow your treatment plan, and treating depression can help you better manage heart disease. If you think you may be depressed, talk with your doctor.

  • How may CAD be treated?

    Correct Answer
    The correct answer is all of the above. Your treatment depends on your symptoms and how much artery blockage you have. For some people, lifestyle changes alone can treat CAD. Others may need medicine, angioplasty, or surgery. Talk with your doctor about the best treatment for you.

  • Which lifestyle change WON'T help treat CAD?

    Correct Answer
    The correct answer is following a gluten-free diet. Most people don't need to follow a gluten-free diet, and avoiding gluten certainly won't help treat CAD. Follow a plant-based diet low in sodium, cholesterol, and trans and saturated fats. Talk with your doctor about other changes that can help your heart.

  • Plaque buildup can begin in childhood.

    Correct Answer
    The correct answer is true. It may seem hard to believe, but plaque starts building up on artery walls in our childhood and teen years. That's why it's never too early to eat a healthy diet, get regular exercise, and manage stress. And if you never start smoking in the first place, you never have to quit!

Causes

CHD is the leading cause of death in the United States for men and women.

CHD is caused by the buildup of plaque in the arteries to your heart. This may also be called hardening of the arteries or atherosclerosis.

  • Fatty material and other substances form a plaque buildup on the walls of your coronary arteries. The coronary arteries bring blood and oxygen to your heart.
  • This buildup causes the arteries to get narrow.
  • As a result, blood flow to the heart can slow down or stop.

A risk factor for heart disease is something that increases your chance of getting it. You cannot change some risk factors for heart disease, but you can change others.

Symptoms

In some cases, symptoms may be very noticeable. But, you can have the disease and not have any symptoms. This is more often true in the early stages of CHD.

Chest pain or discomfort (angina) is the most common symptom. You feel this pain when the heart is not getting enough blood or oxygen. The pain may feel different from person to person.

  • It may feel heavy or like someone is squeezing your heart. You may feel it under your breast bone (sternum). You may also feel it in your neck, arms, stomach, or upper back.
  • The pain most often occurs with activity or emotion. It goes away with rest or a medicine called nitroglycerin.
  • Other symptoms can include shortness of breath and fatigue with activity (exertion), or even feeling lightheaded or passing out with exertion.

Some people have symptoms other than chest pain, such as:

  • Fatigue
  • Shortness of breath
  • General weakness

Chest pain - Animation

When people have chest pain, they're often concerned they're having a heart attack. I'm Dr. Alan Greene and I'd like to talk to you for a moment about the different kinds of chest pain and when it may be an emergency. It turns out, there are lots of different kinds of chest pain. In fact, almost everything in the chest can hurt in one way or another. Some of the causes are really nothing more than a minor inconvenience. Some of them though are quite serious, even life threatening. You can have chest pain sure from the heart, but also from pneumonia. You can have chest pain from asthma. You can have chest pain from a blood clot in the lungs. It can be from nothing more than a strain of some of the muscles between the ribs, or nerves. You can also have chest pain that comes from acid reflux of from a stomach ulcer, gallstones. Many, many things can cause chest pain. You want to call 911 if you are having sudden, crushing chest pain or if your chest pain radiates into the jaw or the left arm. You want to call 911 if your chest pain also causes shortness of breath, or dizziness, nausea, or vomiting. You want to call 911 if you know you have heart disease and you do occasionally have pain but your pain is getting significantly worse than it is ordinarily. Or comes on with less activity than it does otherwise. But whatever the cause of chest pain, unless you're sure what causing it, it's worth contacting your physician to find out what may be going on. It's not a symptom to ignore.

Exams and Tests

Your health care provider will examine you. You will often need one or more tests before getting a diagnosis.

Tests to evaluate for CHD may include:

Treatment

You may be asked to take one or more medicines to treat blood pressure, diabetes, or high cholesterol levels. Follow your provider's directions closely to help prevent CHD from getting worse.

Goals for treating these conditions in people who have CHD:

  • The most commonly used blood pressure target for people with heart disease is less than 130/80, but your provider may recommend a different blood pressure target.
  • If you have diabetes, your HbA1c (glycohemoglobin A1c) blood levels will be monitored and brought down to the level your provider recommends.
  • Your LDL cholesterol level will be lowered with statin or other medicines.

Treatment depends on your symptoms and how severe the disease is. You should know about:

Never stop taking your medicines without first talking to your provider. Stopping heart medicines suddenly can make your angina worse or cause a heart attack.

You may be referred to a cardiac rehabilitation program to help improve your heart's fitness.

Procedures and surgeries used to treat CHD include:

Outlook (Prognosis)

Everyone recovers differently. Some people can stay healthy by changing their diet, stopping smoking, and taking their medicines as prescribed. Others may need medical procedures such as angioplasty or surgery.

In general, early detection of CHD generally leads to a better outcome.

When to Contact a Medical Professional

If you have any risk factors for CHD, talk to your provider about prevention and possible treatment steps.

Call your provider, call the local emergency number (such as 911), or go to the emergency room right away if you have:

  • Angina or chest pain
  • Shortness of breath
  • Symptoms of a heart attack
  • Sudden loss of consciousness

Prevention

Take these steps to help prevent heart disease.

  • If you smoke or use tobacco, stop. There are many resources available to help you stop smoking or using tobacco.
  • Learn how to eat a heart-healthy diet by making simple substitutions. For example, choose heart-healthy fats over butter and other saturated fats.
  • Get regular exercise, ideally at least 30 minutes five days per week. If you have heart disease, talk with your provider about starting an exercise routine.
  • Maintain a healthy body weight.
  • Lower high cholesterol with lifestyle changes, and if needed, statin or other medicines.
  • Lower high blood pressure using diet and medicines.
  • Talk with your provider about aspirin therapy.
  • If you have diabetes, keep it well-managed to help prevent heart attack and stroke.

Even if you already have heart disease, taking these steps will help protect your heart and prevent further damage.

Review Date: 3/31/2024

Reviewed By

Larry A. Weinrauch MD, Assistant Professor of Medicine, Harvard Medical School, Cardiovascular Disease and Clinical Outcomes Research, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

References

Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. [published correction appears in Circulation. 2019;140(11):e649-e650] [published correction appears in Circulation. 2020;141(4):e60] [published correction appears in Circulation. 2020;141(16):e774]. Circulation. 2019 2019;140(11):e596-e646. PMID: 30879355 pubmed.ncbi.nlm.nih.gov/30879355/.

Boden WE. Angina pectoris and stable ischemic heart disease. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 56.

Marks AR. Cardiac and circulatory function. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 41.

Morrow DA, de Lemos J. Stable ischemic heart disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 40.

Virani SS, Newby LK, Arnold SV, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the management of patients with chronic coronary disease: A report of the American Heart Association/American College of Cardiology joint committee on clinical practice guidelines. Circulation. 2023;148:e9–e119.

Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;72(3):e33. PMID: 29133354 pubmed.ncbi.nlm.nih.gov/29133354/.

Disclaimer

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. No warranty of any kind, either expressed or implied, is made as to the accuracy, reliability, timeliness, or correctness of any translations made by a third-party service of the information provided herein into any other language. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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Chest pain

Chest pain

Animation

Heart - section through the middle - Illustration Thumbnail

Heart - section through the middle

The interior of the heart is composed of valves, chambers, and associated vessels.

Illustration

Heart - front view - Illustration Thumbnail

Heart - front view

The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.

Illustration

Acute MI - Illustration Thumbnail

Acute MI

A heart attack or acute myocardial infarction (MI) occurs when one of the arteries that supplies the heart muscle becomes blocked. Blockage may be caused by spasm of the artery or by atherosclerosis with acute clot formation. The blockage results in damaged tissue and a permanent loss of contraction of this portion of the heart muscle.

Illustration

Posterior heart arteries - Illustration Thumbnail

Posterior heart arteries

The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.

Illustration

Atherosclerosis - Illustration Thumbnail

Atherosclerosis

Atherosclerosis is a disease of the arteries in which fatty material is deposited in the vessel wall, resulting in narrowing and eventual impairment of blood flow. Severely restricted blood flow in the arteries to the heart muscle leads to symptoms such as chest pain. Atherosclerosis shows no symptoms until a complication occurs.

Illustration

Cholesterol producers - Illustration Thumbnail

Cholesterol producers

Cholesterol is a waxy, fat-like material that is found in all parts of the body. It comes from two sources: our liver produces it, and we consume it in animal products.

Illustration

Anterior heart arteries - Illustration Thumbnail

Anterior heart arteries

The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.

Illustration

 
Chest pain

Chest pain

Animation

 
Heart - section through the middle - Illustration Thumbnail

Heart - section through the middle

The interior of the heart is composed of valves, chambers, and associated vessels.

Illustration

Heart - front view - Illustration Thumbnail

Heart - front view

The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.

Illustration

Acute MI - Illustration Thumbnail

Acute MI

A heart attack or acute myocardial infarction (MI) occurs when one of the arteries that supplies the heart muscle becomes blocked. Blockage may be caused by spasm of the artery or by atherosclerosis with acute clot formation. The blockage results in damaged tissue and a permanent loss of contraction of this portion of the heart muscle.

Illustration

Posterior heart arteries - Illustration Thumbnail

Posterior heart arteries

The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.

Illustration

Atherosclerosis - Illustration Thumbnail

Atherosclerosis

Atherosclerosis is a disease of the arteries in which fatty material is deposited in the vessel wall, resulting in narrowing and eventual impairment of blood flow. Severely restricted blood flow in the arteries to the heart muscle leads to symptoms such as chest pain. Atherosclerosis shows no symptoms until a complication occurs.

Illustration

Cholesterol producers - Illustration Thumbnail

Cholesterol producers

Cholesterol is a waxy, fat-like material that is found in all parts of the body. It comes from two sources: our liver produces it, and we consume it in animal products.

Illustration

Anterior heart arteries - Illustration Thumbnail

Anterior heart arteries

The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.

Illustration

 
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Chest pain - Animation

When people have chest pain, they're often concerned they're having a heart attack. I'm Dr. Alan Greene and I'd like to talk to you for a moment about the different kinds of chest pain and when it may be an emergency.

It turns out, there are lots of different kinds of chest pain. In fact, almost everything in the chest can hurt in one way or another. Some of the causes are really nothing more than a minor inconvenience. Some of them though are quite serious, even life threatening.

You can have chest pain sure from the heart, but also from pneumonia. You can have chest pain from asthma. You can have chest pain from a blood clot in the lungs. It can be from nothing more than a strain of some of the muscles between the ribs, or nerves. You can also have chest pain that comes from acid reflux of from a stomach ulcer, gallstones. Many, many things can cause chest pain.

You want to call 911 if you are having sudden, crushing chest pain or if your chest pain radiates into the jaw or the left arm. You want to call 911 if your chest pain also causes shortness of breath, or dizziness, nausea, or vomiting. You want to call 911 if you know you have heart disease and you do occasionally have pain but your pain is getting significantly worse than it is ordinarily. Or comes on with less activity than it does otherwise. But whatever the cause of chest pain, unless you're sure what's causing it, it's worth contacting your physician to find out what may be going on. It's not a symptom to ignore.

 

Chest pain - Animation

When people have chest pain, they're often concerned they're having a heart attack. I'm Dr. Alan Greene and I'd like to talk to you for a moment about the different kinds of chest pain and when it may be an emergency.

It turns out, there are lots of different kinds of chest pain. In fact, almost everything in the chest can hurt in one way or another. Some of the causes are really nothing more than a minor inconvenience. Some of them though are quite serious, even life threatening.

You can have chest pain sure from the heart, but also from pneumonia. You can have chest pain from asthma. You can have chest pain from a blood clot in the lungs. It can be from nothing more than a strain of some of the muscles between the ribs, or nerves. You can also have chest pain that comes from acid reflux of from a stomach ulcer, gallstones. Many, many things can cause chest pain.

You want to call 911 if you are having sudden, crushing chest pain or if your chest pain radiates into the jaw or the left arm. You want to call 911 if your chest pain also causes shortness of breath, or dizziness, nausea, or vomiting. You want to call 911 if you know you have heart disease and you do occasionally have pain but your pain is getting significantly worse than it is ordinarily. Or comes on with less activity than it does otherwise. But whatever the cause of chest pain, unless you're sure what's causing it, it's worth contacting your physician to find out what may be going on. It's not a symptom to ignore.

 
 
 
 

 

 
 
 
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