Coronary heart disease

With a 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”.

A CHD can also cause secondary diseases such as heart failure or cardiac arrhythmias. But the symptoms and also risk of secondary diseases can be prevented by various measures.

Severely constricted vessels can lead to shortness of breath and chest pain during physical exertion, because the heart muscle is then supplied with insufficient oxygen. If a coronary vessel suddenly closes up, there is a risk of a heart attack. Such an occlusion can be cause by a blood clot, for example.

The symptoms of a coronary heart disease range from temporary shortness of breath to severe pains in the chest. They can spread into the arms, neck, back, upper abdomen or jaw and are frequently accompanied by a feeling of anxiety or fear. The symptoms usually occur after or during physical exertion, because the heart muscle then needs more oxygen.

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 also be completely blocked very suddenly.

A 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 with 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 for a 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 obesity
• an increased cholesterol level
• high blood pressure
• diabetes

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

CHD is one of the most common diseases: nearly 10% of people aged 40-80 years are affected, men more often than women.

A 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 (angina pectoris). But it can also cause a heart attack without prior symptoms.

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

• not smoking
• regular physical activity
• a balanced diet
• preventing 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
• lung diseases
• diseases of the esophagus 

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 which additional examinations are needed in particular cases.

If a 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 a treatment. They usually include:

• Measurement of blood pressure: with rising blood pressure, the risk of secondary diseases of a 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 diseases: with a blood sample, metabolic diseases like Type 2 diabetes or increased blood fats can be detected. 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. Signs of cardiovascular diseases, diabetes and kidney diseases can be detected early here. In the course of the checkup, blood and urine can for instance be examined and blood pressure measured.

The treatment of a coronary heart disease has two aims:

• relieving symptoms
• preventing secondary diseases

With a stable disease (stable angina pectoris), certain drugs are used to reduce the symptoms. These include beta-blockers, calcium channel blockers or nitrates.

If the treatment with drugs is not enough, the doctor can try to expand the constricted coronary vessel with a heart catheter during surgery. If there are severe constrictions or several vessels are affected, a bypass operation is also used. 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 can provide additional protection against secondary diseases. These include:

• low-dose acetylsalicylic acid (ASA) to prevent blood clots
• statins to protect the vessels
• beta-blockers to relax the heart, especially in people with heart failure or high blood pressure

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.

For those affected by a coronary heart disease, a cardiological rehabilitation can be a good idea. 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
• if the disease has already caused a cardiac insufficiency
• if the symptoms make a daily routine impossible 

Studies show that a cardiological rehabilitation with movement training can improve the quality of life and life expectancy. 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.

People with heart problems often get the impression that they would have to turn their lives upside down. They get a lot of well-meaning advice. But a total reorganization 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 if the 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 so-called structured treatment programs, sometimes also termed “disease management programs“ (DMP). The aim is improving quality of life and ensuring a high-quality treatment. Anyone who wants to take part in a DMP should contact their health insurance fund.