Coronary heart disease (CHD) is a disease in which a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle.
When plaque builds up in the arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis). The buildup of plaque occurs over many years.
Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart.
If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. Over time, ruptured plaque also hardens and narrows the coronary arteries.
Angina is chest pain or discomfort. It may feel like pressure or squeezing in your chest. The pain also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.
A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle is cut off. If blood flow isn’t restored quickly, the section of heart muscle begins to die. Without quick treatment, a heart attack can lead to serious health problems or death.
Over time, CHD can weaken the heart muscle and lead to heart failure and arrhythmias (ah-RITH-me-ahs). Heart failure is a condition in which your heart can't pump enough blood to meet your body’s needs. Arrhythmias are problems with the rate or rhythm of the heartbeat.
CHD is the most common type of heart disease. In the United States, CHD is the #1 cause of death for both men and women. Lifestyle changes, medicines, and medical procedures can help prevent or treat CHD. These treatments may reduce the risk of related health problems.
Research suggests that coronary heart disease (CHD) starts when certain factors damage the inner layers of the coronary arteries. These factors include:
Plaque might begin to build up where the arteries are damaged. The buildup of plaque in the coronary arteries may start in childhood.
Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause angina (chest pain or discomfort).
If the plaque ruptures, blood cell fragments called platelets (PLATE-lets) stick to the site of the injury. They may clump together to form blood clots.
Blood clots can further narrow the coronary arteries and worsen angina. If a clot becomes large enough, it can mostly or completely block a coronary artery and cause a heart attack.
In the United States, coronary heart disease (CHD) is the #1 cause of death for both men and women. Each year, more than 400,000 Americans die from CHD.
Certain traits, conditions, or habits may raise your risk for CHD. The more risk factors you have, the more likely you are to develop the disease.
You can control many risk factors, which may help prevent or delay CHD.
Although older age and a family history of early heart disease are risk factors, it doesn't mean that you’ll develop CHD if you have one or both. Controlling other risk factors often can lessen genetic influences and help prevent CHD, even in older adults.
Researchers continue to study other possible risk factors for CHD.
High levels of a protein called C-reactive protein (CRP) in the blood may raise the risk of CHD and heart attack. High levels of CRP are a sign of inflammation in the body.
Inflammation is the body's response to injury or infection. Damage to the arteries' inner walls may trigger inflammation and help plaque grow.
Research is under way to find out whether reducing inflammation and lowering CRP levels also can reduce the risk of CHD and heart attack.
High levels of triglycerides (tri-GLIH-seh-rides) in the blood also may raise the risk of CHD, especially in women. Triglycerides are a type of fat.
Other conditions and factors also may contribute to CHD, including:
For more detailed information, go to the Health Topics Coronary Heart Disease Risk Factors article.
A common symptom of coronary heart disease (CHD) is angina. Angina is chest pain or discomfort that occurs if an area of your heart muscle doesn't get enough oxygen-rich blood.
Angina may feel like pressure or squeezing in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. The pain tends to get worse with activity and go away with rest. Emotional stress also can trigger the pain.
Another common symptom of CHD is shortness of breath. This symptom occurs if CHD causes heart failure. When you have heart failure, your heart can't pump enough blood to meet your body’s needs. Fluid builds up in your lungs, making it hard to breathe.
The severity of these symptoms varies. They may get more severe as the buildup of plaque continues to narrow the coronary arteries.
Some people who have CHD have no signs or symptoms—a condition called silent CHD. The disease might not be diagnosed until a person has signs or symptoms of a heart attack, heart failure, or an arrhythmia (an irregular heartbeat).
A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle is cut off. This can happen if an area of plaque in a coronary artery ruptures (breaks open).
Blood cell fragments called platelets stick to the site of the injury and may clump together to form blood clots. If a clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.
If the blockage isn’t treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.
The most common heart attack symptom is chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest that often lasts for more than a few minutes or goes away and comes back.
The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. The feeling can be mild or severe. Heart attack pain sometimes feels like indigestion or heartburn.
The symptoms of angina can be similar to the symptoms of a heart attack. Angina pain usually lasts for only a few minutes and goes away with rest.
Chest pain or discomfort that doesn’t go away or changes from its usual pattern (for example, occurs more often or while you’re resting) might be a sign of a heart attack. If you don’t know whether your chest pain is angina or a heart attack, call 9–1–1.
All chest pain should be checked by a doctor.
Other common signs and symptoms of a heart attack include:
For more information, go to the Health Topics Heart Attack article.
Heart failure is a condition in which your heart can't pump enough blood to meet your body’s needs. Heart failure doesn't mean that your heart has stopped or is about to stop working.
The most common signs and symptoms of heart failure are shortness of breath or trouble breathing; fatigue; and swelling in the ankles, feet, legs, stomach, and veins in the neck.
All of these symptoms are the result of fluid buildup in your body. When symptoms start, you may feel tired and short of breath after routine physical effort, like climbing stairs.
For more information, go to the Health Topics Heart Failure article.
An arrhythmia is a problem with the rate or rhythm of the heartbeat. When you have an arrhythmia, you may notice that your heart is skipping beats or beating too fast.
Some people describe arrhythmias as a fluttering feeling in the chest. These feelings are called palpitations (pal-pih-TA-shuns).
Some arrhythmias can cause your heart to suddenly stop beating. This condition is called sudden cardiac arrest (SCA). SCA usually causes death if it's not treated within minutes.
For more information, go to the Health Topics Arrhythmia article.
Your doctor will diagnose coronary heart disease (CHD) based on your medical and family histories, your risk factors for CHD, a physical exam, and the results from tests and procedures.
No single test can diagnose CHD. If your doctor thinks you have CHD, he or she may recommend one or more of the following tests.
An EKG is a simple, painless test that detects and records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through the heart.
An EKG can show signs of heart damage due to CHD and signs of a previous or current heart attack.
During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can't exercise, you may be given medicine to raise your heart rate.
When your heart is working hard and beating fast, it needs more blood and oxygen. Plaque-narrowed arteries can't supply enough oxygen-rich blood to meet your heart's needs.
A stress test can show possible signs and symptoms of CHD, such as:
If you can't exercise for as long as what is considered normal for someone your age, your heart may not be getting enough oxygen-rich blood. However, other factors also can prevent you from exercising long enough (for example, lung diseases, anemia, or poor general fitness).
As part of some stress tests, pictures are taken of your heart while you exercise and while you rest. These imaging stress tests can show how well blood is flowing in your heart and how well your heart pumps blood when it beats.
Echocardiography (echo) uses sound waves to create a moving picture of your heart. The picture shows the size and shape of your heart and how well your heart chambers and valves are working.
Echo also can show areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.
A chest x ray takes pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels.
A chest x ray can reveal signs of heart failure, as well as lung disorders and other causes of symptoms not related to CHD.
Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels might be a sign that you're at risk for CHD.
Electron-beam computed tomography (EBCT) is a test that looks for specks of calcium (called calcifications) in the walls of the coronary arteries. Calcifications are an early sign of CHD.
The test can show whether you're at increased risk for a heart attack or other heart problems before other signs and symptoms occur.
EBCT isn't routinely used to diagnose CHD because its accuracy isn't yet known.
Your doctor may recommend coronary angiography (an-jee-OG-rah-fee) if other tests or factors show that you're likely to have CHD. This test uses dye and special x rays to show the insides of your coronary arteries.
To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization (KATH-eh-ter-ih-ZA-shun).
A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream.
Special x rays are taken while the dye is flowing through your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels.
Cardiac catheterization usually is done in a hospital. You're awake during the procedure. It usually causes little or no pain, although you may feel some soreness in the blood vessel where your doctor inserts the catheter.
Treatments for coronary heart disease (CHD) include lifestyle changes, medicines, and medical procedures. Treatment goals may include:
Making lifestyle changes often can help prevent or treat CHD. Lifestyle changes might be the only treatment that some people need.
For information about healthy eating, go to the National Heart, Lung, and Blood Institute's (NHLBI's) Aim for a Healthy Weight Web site. This site provides practical tips on healthy eating, physical activity, and controlling your weight.
Therapeutic Lifestyle Changes (TLC). Your doctor may recommend TLC if you have high blood cholesterol. TLC is a three-part program that includes a healthy diet, physical activity, and weight management.
With the TLC diet, less than 7 percent of your daily calories should come from saturated fat. This kind of fat is found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods.
No more than 25 to 35 percent of your daily calories should come from all fats, including saturated, trans, monounsaturated, and polyunsaturated fats.
You also should have less than 200 mg a day of cholesterol. The amounts of cholesterol and the types of fat in prepared foods can be found on the foods' Nutrition Facts labels.
Foods high in soluble fiber also are part of a healthy diet. They help prevent the digestive tract from absorbing cholesterol. These foods include:
A diet rich in fruits and vegetables can increase important cholesterol-lowering compounds in your diet. These compounds, called plant stanols or sterols, work like soluble fiber.
A healthy diet also includes some types of fish, such as salmon, tuna (canned or fresh), and mackerel. These fish are a good source of omega-3 fatty acids. These acids may help protect the heart from blood clots and inflammation and reduce the risk of heart attack. Try to have about two fish meals every week.
You also should try to limit the amount of sodium (salt) that you eat. This means choosing low-salt and "no added salt" foods and seasonings at the table or while cooking. The Nutrition Facts label on food packaging shows the amount of sodium in the item.
Try to limit drinks that contain alcohol. Too much alcohol will raise your blood pressure and triglyceride level. (Triglycerides are a type of fat found in the blood.) Alcohol also adds extra calories, which will cause weight gain.
Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is a glass of wine, beer, or a small amount of hard liquor.
For more information about TLC, go to the NHLBI's "Your Guide to Lowering Your Cholesterol With TLC."
Dietary Approaches to Stop Hypertension (DASH). Your doctor may recommend the DASH eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium.
DASH also focuses on fat-free or low-fat milk and dairy products, fish, poultry, and nuts. The DASH eating plan is reduced in red meats (including lean red meats), sweets, added sugars, and sugar-containing beverages. It's rich in nutrients, protein, and fiber.
The DASH eating plan is a good healthy eating plan, even for those who don’t have high blood pressure. For more information, go to the NHLBI’s "Your Guide to Lowering Your Blood Pressure With DASH."
Routine physical activity can lower many CHD risk factors, including LDL ("bad") cholesterol, high blood pressure, and excess weight.
Physical activity also can lower your risk for diabetes and raise your HDL cholesterol level. HDL is the "good" cholesterol that helps prevent CHD.
Talk with your doctor before you start a new exercise plan. Ask him or her how much and what kinds of physical activity are safe for you.
People gain health benefits from as little as 60 minutes of moderate-intensity aerobic activity per week. The more active you are, the more you will benefit.
For more information about physical activity, go to the U.S. Department of Health and Human Services' "2008 Physical Activity Guidelines for Americans," the Health Topics Physical Activity and Your Heart article, and the NHLBI's "Your Guide to Physical Activity and Your Heart."
Maintaining a healthy weight can lower your risk for CHD. A general goal to aim for is a body mass index (BMI) of less than 25.
BMI measures your weight in relation to your height and gives an estimate of your total body fat. You can use the NHLBI's online BMI calculator to figure out your BMI, or your doctor can help you.
A BMI between 25 and 29.9 is considered overweight. A BMI of 30 or more is considered obese. A BMI of less than 25 is the goal for preventing and treating CHD. Your doctor or other health care provider can help you set an appropriate BMI goal.
For more information about losing weight or maintaining a healthy weight, go to the Health Topics Overweight and Obesity article.
If you smoke, quit. Smoking can raise your risk for CHD and heart attack and worsen other CHD risk factors. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.
Research shows that the most commonly reported "trigger" for a heart attack is an emotionally upsetting event—particularly one involving anger. Also, some of the ways people cope with stress—such as drinking, smoking, or overeating—aren't healthy.
Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Having supportive people in your life with whom you can share your feelings or concerns can help relieve stress.
Physical activity, medicine, and relaxation therapy also can help relieve stress. You may want to consider taking part in a stress management program.
You may need medicines to treat CHD if lifestyle changes aren't enough. Medicines can:
Medicines used to treat CHD include anticoagulants (AN-te-ko-AG-u-lants), also called blood thinners; aspirin and other anticlotting medicines; ACE inhibitors; beta blockers; calcium channel blockers; nitroglycerin; glycoprotein IIb-IIIa; statins; and fish oil and other supplements high in omega-3 fatty acids.
You may need a procedure or surgery to treat CHD. Both angioplasty and CABG are used to treat blocked coronary arteries. You and your doctor can discuss which treatment is right for you.
Angioplasty is a nonsurgical procedure that opens blocked or narrowed coronary arteries. This procedure also is called percutaneous (per-ku-TA-ne-us) coronary intervention, or PCI.
A thin, flexible tube with a balloon or other device on the end is threaded through a blood vessel to the narrowed or blocked coronary artery.
Once in place, the balloon is inflated to compress the plaque against the wall of the artery. This restores blood flow through the artery.
During the procedure, the doctor may put a small mesh tube called a stent in the artery. The stent helps prevent blockages in the artery in the months or years after angioplasty.
For more information, go to the Health Topics Angioplasty article.
CABG is a type of surgery. In CABG, arteries or veins from other areas in your body are used to bypass (that is, go around) your narrowed coronary arteries. CABG can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack.
For more information, go to the Health Topics Coronary Artery Bypass Grafting article.
Your doctor may prescribe cardiac rehabilitation (rehab) for angina or after CABG, angioplasty, or a heart attack. Almost everyone who has CHD can benefit from cardiac rehab.
Cardiac rehab is a medically supervised program that may help improve the health and well-being of people who have heart problems.
The cardiac rehab team may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians or nutritionists, and psychologists or other mental health specialists.
Rehab has two parts:
For more information, go to the Health Topics Cardiac Rehabilitation article.
Taking action to control your risk factors can help prevent or delay coronary heart disease (CHD). Your risk for CHD increases with the number of risk factors you have.
One step you can take is to adopt a healthy lifestyle. Following a healthy diet is an important part of a healthy lifestyle.
A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, and beans and peas.
A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).
If you're overweight or obese, work with your doctor to create a reasonable weight-loss plan. Controlling your weight helps you control CHD risk factors.
Be as physically active as you can. Physical activity can improve your fitness level and your health. Talk with your doctor about what types of activity are safe for you.
If you smoke, quit. Smoking can damage and tighten blood vessels and raise your risk for CHD. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke.
Know your family history of health problems related to CHD. If you or someone in your family has CHD, be sure to tell your doctor.
If lifestyle changes aren't enough, you also may need medicines to control your CHD risk factors. Take all of your medicines as prescribed.
For more information about lifestyle changes and medicines, go to "How Is Coronary Heart Disease Treated?"
Coronary heart disease (CHD) can cause serious complications. However, if you follow your doctor's advice and adopt healthy lifestyle habits, you can prevent or reduce the risk of:
For more information about lifestyle changes and medicines, go to "How Is Coronary Heart Disease Treated?"
Work closely with your doctor to control your blood pressure and manage your blood cholesterol and blood sugar levels.
A blood test called a lipoprotein panel will measure your cholesterol and triglyceride levels. A fasting blood glucose test will check your blood sugar level and show whether you're at risk for or have diabetes.
These tests show whether your risk factors are controlled, or whether your doctor needs to adjust your treatment for better results.
Talk with your doctor about how often you should schedule office visits or blood tests. Between those visits, call your doctor if you have any new symptoms or if your symptoms worsen.
CHD raises your risk for a heart attack. Learn the signs and symptoms of a heart attack, and call 9–1–1 if you have any of these symptoms:
Symptoms also may include sleep problems, fatigue (tiredness), and lack of energy.
The symptoms of angina can be similar to the symptoms of a heart attack. Angina pain usually lasts for only a few minutes and goes away with rest.
Chest pain or discomfort that doesn’t go away or changes from its usual pattern (for example, occurs more often or while you’re resting) can be a sign of a heart attack. If you don’t know whether your chest pain is angina or a heart attack, call 9–1–1.
Let the people you see regularly know you're at risk for a heart attack. They can seek emergency care for you if you suddenly faint, collapse, or have other severe symptoms.
Living with CHD may cause fear, anxiety, depression, and stress. You may worry about heart problems or making lifestyle changes that are necessary for your health.
Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you’re very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Joining a patient support group may help you adjust to living with CHD. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has helped doctors learn more about coronary heart disease (CHD), its risk factors, and ways to prevent and treat the disease.
The NHLBI continues to support research aimed at learning more about CHD. For example, NHLBI-supported research includes studies that:
Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they’re widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don’t directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You’ll learn about treatments and tests you may receive, and the benefits and risks they may pose. You’ll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you’ll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to CHD, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI’s Children and Clinical Studies Web page.
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