Coronary heart disease

With coronary heart disease (CHD), the major blood vessels that supply the heart with oxygen are constricted. In medicine, these vessels are called “coronary arteries” or “coronary vessels”.

CHD can also cause secondary diseases such as heart failure or cardiac arrhythmias. However, the symptoms and risk of secondary diseases can be reduced through various measures.

Severely narrowed vessels can lead to shortness of breath and chest pain and tightness during physical exertion because the heart muscle is not getting enough oxygen. If a coronary vessel suddenly closes up, there is a risk of a heart attack. Such an occlusion can be caused by a blood clot, for example.

The symptoms of coronary heart disease range from temporary shortness of breath to nausea, dizziness and a feeling of tightness and severe pain in the chest (angina pectoris). They can spread to the arms, neck, back, upper abdomen or jaw and are frequently accompanied by a feeling of anxiety or fear.

The symptoms usually occur during physical exertion because the heart muscle needs more oxygen. Rest and medication help them to subside after a short while.

The typical symptom of chest tightness is rarer in women, the elderly and people with diabetes or heart failure. Coronary heart disease is more likely to manifest itself as shortness of breath, upper abdominal pain or palpitations.

The symptoms may occur suddenly and without physical strain (unstable angina pectoris). But they can also remain unchanged over a longer period (stable angina pectoris). Unstable angina pectoris is an emergency. There is a risk of a heart attack because the vessel can suddenly become completely blocked.

Coronary heart disease is the consequence of artherosclerosis in the coronary vessels. It develops as a result of small centers of inflammation on the wall of a blood vessel. Cells, fats and other substances are deposited here.

These deposits initially develop unseen. They only become problematic when they gradually intensify. After that, they can influence the blood flow in the affected vessel so strongly that enough blood can no longer flow through the artery to supply the heart muscle with adequate blood. Physical exertion or psychological stress may then lead to anxiety and pain in the chest (stable angina pectoris).

If chest pains also occur without any stress and in periods of rest, a blood clot has usually already formed and is partially blocking the vessel. This happens when a calcified deposit suddenly ruptures. If the clot is so large that it has completely blocked a vessel, a heart attack occurs. If the occlusion is not treated quickly, part of the heart muscle necrotizes.

The risk of coronary heart disease increases with age. Among risks not dependent on age are all factors that can generally affect the health of the heart and circulation:

• smoking
• severe overweight
• high cholesterol levels
• high blood pressure
• diabetes

Coronary heart disease becomes more common with age. Approximately 2 percent of 40–49 year olds and 22 percent of 70–79 year olds are affected, men more frequently than women.

Coronary heart disease usually develops insidiously and over several years. In most cases, it first becomes noticeable in the form of chest pain during physical exertion or psychological stress (angina pectoris). However, it can also cause a heart attack without prior symptoms.

More detailed information on the consequences of coronary heart disease can be found at gesundheitsinformation.de.

Following quite simple recommendations can help maintain heart health and prevent coronary heart disease:

• not smoking
• regular physical exercise
• a balanced diet
• avoiding weight gain

The preventive efficacy of special diets or food supplements like vitamins is not proven.

More information on what everyone can do themselves for a healthy heart can be found at gesundheitsinformation.de.

There can be a variety of causes for chest pain, for example:

• problems with the muscles or bones in the thoracic region
• heart muscle inflammations
• cardiac arrhythmia
• diseases of the lungs or respiratory tract
• diseases of the esophagus
• psychological stress and illness

The main test is an electrocardiogram (ECG) that is carried out at rest or during exercise. In some cases, imaging examinations such as an ultrasound scan of the heart (echocardiogram or “echo test”) are useful. Factors like age, pre-existing conditions and the type of symptoms determine whether and which additional examinations are needed.

If coronary heart disease is detected, the doctor arranges for further examinations. These examinations are used to assess the risk of secondary diseases – a heart attack for instance – and initiate treatment. They usually include:

• Measurement of blood pressure: with rising blood pressure, the risk of secondary diseases of coronary heart disease increases.
• Physical examination: examinations like listening to the heart may indicate other diseases or conditions, for example problems with the heart valves.
• Examination for metabolic disorders: a blood sample can be used to detect metabolic disorders like type 2 diabetes or increased blood lipids. Type 2 diabetes can greatly increase the risk of secondary diseases.
• Determination of risk factors: the doctor asks for instance about heart attacks or other circulatory diseases in the family. Lifestyle also plays a role – such as smoking and diet.

Everyone aged over 35 who has statutory health insurance has a right to a health checkup every three years. The aim of this check-up is to detect signs of cardiovascular disease, diabetes and kidney problems at an early stage. In the course of the checkup, blood and urine can for instance be examined and blood pressure measured.

The treatment of coronary heart disease has two aims:

• relieving symptoms
• preventing secondary diseases

If the disease is stable (stable angina pectoris), certain medications reduce the symptoms. These include beta-blockers, calcium channel blockers or nitrates.

If treating it with drugs is not enough, the doctor can try to expand the narrowed coronary vessel with a heart catheter during surgery. A bypass operation is also an option depending on which and how many vessels are affected. In bypass surgery, a blood vessel at another site on the body is removed and inserted into the heart to bypass the blocked coronary vessel.

Those affected can prevent secondary diseases like a heart attack or heart failure themselves, for example by ensuring they get plenty of exercise and follow a balanced diet. Smokers can try to quit. Some drugs provide additional protection against secondary diseases. These include:

• low-dose acetylsalicylic acid (ASA) to prevent blood clots
• statins to protect the vessels

On the gesundheitsinformation.de website you can read more about drug treatment of coronary heart disease and also on what happens during a heart catheterization.

Cardiac rehabilitation can be of benefit to people with coronary heart disease. It should increase physical capacity, prevent secondary diseases and generally improve quality of life.

A rehabilitation is recommended especially in the following situations:

• after a heart attack
• after a procedure (bypass or stent)
• if the disease has already caused heart failure
• if there is a high risk of other heart conditions
• in the event of depression as a result of a heart attack
• if the symptoms make a normal everyday life impossible 

The rehabilitation program is managed by specialists from medicine, physiotherapy, nutrition science and psychotherapy. It includes movement exercises, training events for handling the disease and its risk factors, and additional psychological care.

The application is made to the funder concerned along with the doctor, so usually to the statutory health insurance or pension fund.

Once they have completed rehab, people with coronary heart disease can attend an outpatient heart group. Such groups meet at least once a week for instructor-led exercise sessions.

People with heart problems often have the impression that they need to turn their whole lives upside down. They get a lot of well-meaning advice but such major change is usually unrealistic. A change of lifestyle is more successful if one goal at a time is set. Small steps are often more sensible than attempting a radical change of life overnight.

Even though coronary heart disease is a chronic illness, it does not have to control everyday life. It helps to have a good understanding about it. It is thus easier to have a handle on the treatment and detect potential problems in good time.

For people with statutory health insurance suffering from coronary heart disease, there are structured treatment programs, sometimes also termed “disease management programs“ (DMP). The aim is improving quality of life and ensuring high-quality treatment. If you would like to take part in a DMP, you can contact your health insurance provider.

Detailed information for adults with chronic CHD, their relatives and other trusted individuals is provided by the “Chronic coronary heart disease” patient guideline.