in the early stages of CHD.
(angina), or milder pressure, tightness, squeezing, burning,
aching, or heaviness in the chest, lasting from 30 seconds to
5 minutes. The pain or discomfort is usually located in the center
of the chest just under the breastbone, and may radiate down
the arm (usually the left arm), up into the neck, or along the
jaw line. The pain is generally brought on by exertion or stress
and stops with rest. The amount of exertion required to produce
angina is reproducible and predictable.
of breath, dizziness, or a choking sensation, accompanying chest
increase in the severity of angina, or angina at rest, is a sign
of unstable angina that requires immediate medical attention
because a heart attack may shortly occur.
When To Call Your Doctor
an ambulance if you experience crushing chest pain with or without
nausea, vomiting, profuse sweating, shortness of breath, weakness,
or intense feelings of dread.
an ambulance if chest pain from previously diagnosed angina does
not subside after 10 to 15 minutes.
an ambulance the first time you experience intense chest pain.
your doctor if attacks of previously diagnosed angina become
more frequent or more severe or occur at rest.
What Is It?
Coronary heart disease (CHD), the leading cause
of death in the United States, is a narrowing of the coronary
arteries, the blood vessels that supply blood and oxygen to the
heart. This arterial narrowing limits the supply of oxygenated
blood to the heart, and can lead to angina (chest pain) or a
Coronary heart disease is generally due to the
buildup of plaques in the arterial walls, a process known as
atherosclerosis. Plaques are composed of cholesterol-rich fatty
deposits, collagen and other proteins, and excess smooth muscle
cells. Atherosclerosis, which usually progresses very gradually
over a lifetime, thickens and narrows the arterial walls, impeding
the flow of blood. Blood clots form more easily on arterial walls
roughened by plaque deposits. The clots may block the narrowed
coronary artery completely and cause a heart attack. Arteries
may also narrow suddenly as a result of an arterial spasm. Spasms
are most commonly triggered by smoking.
Symptoms of CHD usually develop insidiously. In
the early stages of the disease, there are generally no symptoms.
As the disease progresses, angina may develop during periods
of physical activity or emotional stress, because the narrowed
arteries cannot supply the heart with the increased amount of
blood and oxygen necessary at those times. Angina usually subsides
quickly with rest, but over time, symptoms arise with less exertion,
and CHD may eventually lead to a heart attack. However, in a
third of CHD cases, angina never develops, and a heart attack
can occur suddenly with no prior warning.
Although CHD can be a life-threatening condition,
the outcome of the disease can be managed. Damage to the arteries
can be slowed or halted with lifestyle changes, including smoking
cessation, dietary modifications, and regular exercise, or by
medications to lower blood pressure and cholesterol levels. Additional
goals of treatment, which may involve medication and sometimes
surgery, are to relieve symptoms, improve blood circulation,
and prolong life.
What Causes It?
the development of plaque in the arteries. It also increases
the likelihood of angina by increasing the amount of carbon monoxide
in the bloodstream and decreasing the amount of oxygen available
to the heart.
cholesterol levels lead to CHD. Low density lipoprotein (LDL)
cholesterol enters the lining of the arterial walls where, after
being chemically altered, it is incorporated into plaque.
pressure increases the risk of CHD.
diabetes are at greater risk for atherosclerosis.
Lack of exercise
(a sedentary lifestyle) may encourage atherosclerosis.
Men are at
greater risk than women for CHD, although the risk for postmenopausal
women approaches that of men as estrogen production decreases
age 35 who take oral contraceptives and smoke cigarettes have
a higher risk of atherosclerosis.
A family history
of premature heart attacks (before age 55 in men and before age
65 in women) is associated with greater CHD risk.
A spasm of
the muscular layer of the arterial walls may cause an artery
to contract and produce angina. Spasms may be induced by smoking,
extreme emotional stress, or exposure to cold air.
Eat a diet
low in saturated fat, cholesterol, and salt.
Pursue a program
of moderate aerobic exercise for at least 30 minutes, three days
a week. People over age 50 who have led a sedentary lifestyle
should check with a doctor before beginning an exercise program.
if you are overweight.
See your doctor
regularly to have your blood pressure and cholesterol measured.
may advise you to take a low dose of aspirin every day if you
are at risk for CHD. Aspirin reduces the tendency of the blood
to clot, thereby decreasing the risk of heart attack. However,
such a regimen should only be initiated under a doctors
and physical examination. If you suffer a heart attack, diagnosis
will often be made immediately upon examination by a doctor or
emergency medical technician.
(ECG) may be performed to measure changes in the electrical activity
of the heart resulting from abnormalities in the flow of blood
or a prior heart attack. In some cases your doctor may provide
you with a portable ECG device, known as a Holter monitor, in
order to record the electrical activity of the heart over a 24-hour
testing. Blood pressure, heartbeat, and breathing rates are measured
by ECG while you walk on a treadmill. If you cannot exercise
adequately, a medication may be injected to mimic the effect
of exercise on the heart.
of a radioisotope such as thallium may be given after an exercise
stress test to gauge blood flow to the heart.
which uses ultrasound waves to create moving images of the heart,
may be performed.
may be performed to determine the presence of narrowing in the
coronary arteries. In this procedure a tiny catheter is inserted
into an artery in the groin and threaded up into the coronary
arteries. A contrast material is then injected from the end of
the catheter into the coronary arteries, and x-rays are taken.
and immediate hospitalization is necessary if a heart attack
occurscommonly signaled by crushing, persistent chest pain.
tips for a heart-healthy lifestyle, including a low-fat diet
and regular physical exercise. Avoid excessive alcohol consumption,
nasal decongestants, and diet pills, all of which may raise blood
nitrates, such as nitroglycerin, or longer-acting nitrates like
isosorbide dinitrate may be prescribed to dilate blood vessels
and relieve or prevent symptoms of angina. A nitroglycerin tablet
placed under the tongue (sublingually) at the onset of an angina
attack usually relieves the pain within minutes. Sublingual nitroglycerin
may also be taken just prior to activities that commonly provoke
angina. However, for any given angina attack, you should not
take more than three nitroglycerin tablets at five-minute intervalspain
lasting longer than this may signal a heart attack. Intravenous
nitrates may be administered in patients with unstable angina.
Nitrates may also be prescribed in the form of patches or ointments
for continuous protection.
such as propranolol or metoprolol are prescribed to reduce the
hearts oxygen demand by slowing the heart rate and lowering
such as enalapril may be prescribed to reduce blood pressure
and dilate blood vessels.
blockers such as verapamil, diltiazem, or nifedipine may be prescribed
to reduce the hearts oxygen demands and to increase blood
flow to the heart.
such as heparin or warfarin are administered to reduce the risk
of blood clots in patients with unstable angina.
such as captopril, enalapril, or hydralazine may be prescribed
to expand blood vessels, thus reducing blood pressure and facilitating
coronary artery may be opened by percutaneous transluminal coronary
angioplasty (PTCA). In this procedure a small balloon is inserted
into an artery in the groin via a catheter and guided to the
site of the arterial blockage. The balloon is then inflated,
compressing the plaque; this widens the passageway and improves
blood flow. PTCA usually requires an overnight hospital stay.
surgery may be performed to improve blood flow to the heart.
A mammary artery or a vein taken from the leg is grafted onto
the damaged coronary artery to circumvent a narrowed or blocked
A heart transplant
may be advised in severe cases in which the heart muscle has
been badly damaged. The survival rate for heart transplant is
85 percent after one year and 65 percent after five years.
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