Coronary heart disease

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Acute MI	Anterior heart arteries	Cholesterol producers	Heart, front view
Heart, section through the middle	Posterior heart arteries

Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD

The symptoms associated with coronary heart disease may be pronounced, but the disease can also exist without noticeable symptoms.

Chest pain (angina) is the most common symptom. It results from the heart not getting enough blood or oxygen. The intensity of the pain varies from person to person.

Chest pain may be typical or atypical.

Typical chest pain is felt under the sternum (breast bone) and feels heavy or squeezing. It usually occurs with activity (exertion) or emotion, and it goes away with rest or nitroglycerin.

Atypical chest pain can be felt in the left chest, abdomen, back, or arm. It is often fleeting or sharp. Atypical chest pain is unrelated to exercise and is not relieved by rest or nitroglycerin. Atypical chest pain is more common in women.

Adults with typical chest pain have a higher risk of CHD than those with atypical chest pain.

Other symptoms include:

• Shortness of breath. This may be a symptom of congestive heart failure. The heart is weak because of a long-term lack of blood and oxygen or because of a recent or past heart attack. If the heart is not pumping enough blood to the body, shortness of breath may be accompanied by swollen feet and ankles.
• Heart attack . In some cases, the first sign of CHD is a heart attack. The heart attack occurs when atherosclerotic plaque or a blood clot blocks the blood flow of the coronary artery to the heart. The coronary artery was likely already narrowed from CHD. The pain associated with a heart attack is usually severe, lasts longer than the chest pain described above, and is not relieved with rest or nitroglycerin.

There are many tests that help diagnose CHD. Usually, more than one test will be done before a definitive diagnosis is made. Some of the tests include:

• Electrocardiogram (ECG)
• Exercise stress test
• Echocardiogram
• Nuclear scan
• Coronary angiography/arteriography
• Electron-beam computed tomography (EBCT) -- the purpose of this test is to identify calcium within the plaque found in the arteries. The more calcium seen, the higher the likelihood for CHD.
• Coronary CT Angiography

Review Date: 08/28/2006
Reviewed By: Steven Kang, MD, Division of Cardiac Pacing and Electrophysiology, East Bay Arrhythmia, Cardiovascular Consultants Medical Group, Oakland, CA. Review provided by VeriMed Healthcare Network.