What is Coronary Heart Disease?

In coronary artery disease, the blood vessels that supply the heart with vital oxygen narrow. The organ is weakened increasingly dangerously. The tricky thing about it is that this has been creeping up for many years. Only those who know the typical symptoms can avoid a heart att

ack .  

The heart not only supplies all organs in the body with oxygen-rich blood, but also itself. The heart does not take the oxygen-rich blood from its ventricles, but receives it via arteries that branch off directly from the nearby main artery (aorta). Since these blood vessels run like a finely branched ring around the outside of the heart, they are called coronary arteries (from the Latin corona: wreath) or coronary vessels.

Coronary heart disease (CHD for short) occurs when fats (lipids), connective tissue and calcium are deposited on the inner wall of the blood vessels in a coronary artery and the artery constricts . These so-called plaques can accumulate there and harden the elastic vessel (doctors call this arteriosclerosis or coronary sclerosis ). As a result, the bloods flow is reduced and the heart is no longer adequately supplied with oxygen-rich blood. Doctors call the circulatory disorder "ischemia", which is why coronary heart disease is also called Ischemic Heart Disease (IHK).

Since less oxygen is transported to the heart via the arteries than the heart muscle needs, a feeling of tightness and pain in the chest quickly develop, especially during physical exertion. If a coronary artery is completely closed, there is a risk of a heart attack.

According to statistics, coronary heart disease is the most common cause of death in Germany. In this country, around 3.16 million men and 2.34 million women suffer from it, and more than 59,000 people die of heart disease every year , reports the Institute for Heart Attack Research.
Men develop CHD more often and earlier (often from the age of 45). Up to the menopause, women are relatively well protected against arteriosclerosis and thus against a heart attack by the sex hormones (especially estrogen). On average, they develop these heart conditions ten to fifteen years later than men.

Coronary artery disease: symptoms

The insidious thing about the KHK is that for a long time (years or even decades) it runs slowly and unnoticed . Only when the arteriosclerosis is pronounced and a coronary artery is two-thirds narrowed does a significant reduction in blood flow to the heart arise. While the amount of blood that flows through the coronary arteries is often still sufficient in a resting position to supply the pumping organ with sufficient oxygen, physical or psychological exertion that puts more strain on the heart quickly leads to a significant lack of oxygen in the heart muscle .

Many sufferers get breathlessness and feel tightness and pain in the chest area . The pain occurs because the lack of oxygen causes the heart muscle tissue to become too acidic. Doctors refer to these symptoms as angina pectoris (Latin: "chest tightness", but primarily a tightness of the heart). It is usually the first clear indication that a patient is suffering from CAD.

Symptoms of angina pectoris:

• a tightness in your chest that may feel like a ring tightened around your chest. This often causes pain behind the breastbone or in the left side of the chest , which lasts for a few seconds or minutes, and which, through complex nerve connections, can also radiate into the left arm, neck, jaw, shoulder area and upper abdomen
• Difficulty breathing, which can extend to an attack of suffocation
• Sweats
• nausea
• an anxiety, fear of death

Warning signs are often ignored
The symptoms of angina pectoris are initially only noticeable during greater physical exertion (such as climbing stairs, dragging moving boxes or running faster) or under emotional stress (such as excitement, hectic) and usually disappear again quickly when the person concerned takes a break power. Therefore, some do not interpret the symptoms as a heart problem, but attribute them to poor physical fitness or age. Fatal, because CHD discovered early enough can often be treated well and dangerous consequences such as cardiac insufficiency or a heart attack can often be avoided.

Later, at an advanced stage, the symptoms also arise during normal physical activity and in a resting posture.

Other symptoms in women

In women, angina pectoris often manifests itself as other symptoms, such as shortness of breath, tiredness, stomach upset, and nausea . The typical chest pain, on the other hand, only occurs in a few patients.

CHD without complaints

However, it can also happen that the coronary heart disease runs without symptoms and then shows itself for the first time in the form of cardiac arrhythmias with cardiac arrest or a heart attack. Such an asymptomatic course typically arises in diabetics, as they do not feel the symptoms in the chest area due to nerve damage. 

Coronary artery disease: life expectancy

The prognosis of coronary heart diseases depend on how many arteries are affected, where the constriction originated and whether there are other risk factors:

• How many coronary arteries are affected? If only one coronary artery is affected by the vasoconstriction, the probability of survival is significantly higher than if it occurs in all three coronary vessels.
• At what position is the constriction in the arteries? It is especially dangerous if it develops at the beginning of the left coronary artery. The arterial area that branches off directly from the main artery (aorta) and is known as the main trunk. If a narrowing occurs here (this is known as main trunk stenosis), the consequences can quickly be threatening because it affects larger areas of the heart. More than thirty percent of all patients die.
• If the patient suffers from another disease that puts a strain on the cardiovascular system and thus can worsen the prognosis, such as high blood pressure ,Diabetes mellitus, an arterial circulatory disorder in other parts of the body (for example in the legs) or a (chronic) cancer disease?
•  Has the patient previously received aggressive therapies that can damage the heart, such as radiation therapy to the chest or chemotherapy ?
• Depression can also puts a strain on the heart and negatively influence the course of CHD therapy . Because it can lead to the person concerned not taking his medication regularly and maintaining an unhealthy lifestyle (e.g. with smoking, alcohol, lack of exercise). In addition, some depressed people withdraw and become lonely. This increases the risk of stroke by more than 30 percent, researchers from the University of York (Great Britain) found in a 2016 study.
• The time of diagnosis also plays a central role in the prognosis . If doctors discover the disease in good time, therapies can usually treat coronary heart disease effectively and stop it from getting worse. Adherence to therapy, i.e. that the patient takes his medication in a disciplined manner as prescribed by the doctor, and regular check-ups by the cardiologist support the success of the treatment. It is just as important that the patient succeeds in permanently changing his or her lifestyle and not smoking, eating healthily , getting enough exercise and being able to relax enough in everyday life.

Coronary artery disease: causes

The main cause of coronary heart disease is narrowing of the blood vessels (arteriosclerosis) . It develops when small inflammations develop in the inner wall of the blood vessels. In these damaged areas, fats (lipids), connective tissue and calcium can accumulate (doctors call these plaques ) and the tubular blood vessel can thicken and constrict. The blood flow is obstructed and reduced by this constriction ( stenosis in technical terms) and the heart muscle no longer receives sufficient oxygen.

Risk factors for atherosclerosis:

Some factors favor the development of arteriosclerosis. In addition to age, gender (men are more often affected by CAD than women) and a genetic predisposition, an unhealthy lifestyle is the main cause of this vascular disease .

The following factors play a central role:

• Smoking, alcohol
• (severe) overweight
• an increased cholesterol level
• Sedentary lifestyle
• stressful stress

In addition, other diseases such as high blood pressure, diabetes mellitus, an underactive thyroid and depression can lead to coronary artery disease.

The combination of several of these factors increases the risk of developing CHD significantly. For example, anyone who is overweight, smokes and has high blood pressure can put a lot of strain on and weaken their heart.

Coronary artery disease: forms

Doctors classify coronary heart disease into different degrees of severity depending on the extent of the vasoconstriction in the three main branches of the coronary arteries :

• Single-vessel disease: One or more constrictions (stenoses) are present in a main branch of the coronary arteries.
• Two-vessel disease : One or more constrictions have developed in two of the three main branches.
• Three-vessel disease : One or more constrictions have arisen in the blood vessels in all three main branches.

Coronary artery disease: diagnosis

In order to determine a coronary heart disease, a detailed examination is first carried out (anamnesis). The doctor (a general practitioner or a cardiologist is responsible for this) will ask when and in what situation the symptoms first appeared (e.g. when climbing stairs, while running), whether the patient has a previous or existing disease (e.g. high blood pressure , Diabetes, depression) and regularly takes medication, whether he smokes, does sports, eats a healthy diet, whether he frequently experiences periods of stress and whether his family has already had heart diseases.

This is followed by the physical examination, during which the doctor measures the pulse and blood pressure, listens to heart and lungs with the stethoscope for unusual noises and has a blood analysis carried out. The blood count can be used, for example, to determine whether the cholesterol levels are increased.

To make the diagnosis, he will conduct further examinations:

• EKG : This involves attaching small electrodes to the patient's upper body that record the electrical activity of the heart. They show how often the heart is beating (heart rate) and whether the heart rhythm is normal. Noticeable changes can usually already be recognized. A stress ECG is often carried out, in which the patient sits on a bicycle ergometer and vigorously pedals, and a resting ECG that records the heart's activity without physical stress.
• Heart ultrasound : With a sonography of the heart (also called echocardiography ) the doctor can view and assess the size of the heart chambers, the movement of the heart muscle and the pumping function of the heart.
• Myocardial scintigraphy : A weakly radioactive substance is injected into the vein. It accumulates in the coronary arteries and makes existing constrictions and circulatory disorders visible there.
• Imaging procedures : A three-dimensional image of the coronary arteries is produced with the help of a computed tomography.
• Heart catheter examination : It is one of the most important examination methods to diagnose and treat coronary artery disease. The doctor inserts a thin probe (catheter) into the body (usually in the groin area) and pushes it through a large blood vessel to the heart. If the catheter tip is in the correct position, the doctor releases a contrast medium and then takes an X-ray image. The individual coronary vessels and the bottlenecks there are recognizable on this.

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