Understanding coronary heart disease

Coronary heart disease: what's behind itCoronary heart disease, or CHD for short, is one of the most common heart diseases. It leads to circulatory disorders of the heart.


In Germany, around 5.5 million men and women are affected by. Prof. Dr. Michael Niehaus, head physician of the Medical Clinic I Cardiology and Rhythmology at the Helios Klinikum Gifhorn, explains what coronary heart disease is and which symptoms point to it.

What is coronary artery disease?

"Coronary artery disease is a serious disease of the heart that can lead to
Circulatory disorders of the heart muscle leads", says the chief physician. In CHD, there is vascular calcification (arteriosclerosis) in the coronary arteries, causing them to narrow. "Coronary arteries are arteries that supply oxygenated and nutrient-rich blood to the heart. 'They extend in a wreath shape around the heart,' says prof. Niehaus. Risk of atherosclerosis increases with age. This also increases the risk of coronary heart disease. Men are affected more often and earlier, Often from the age of 45. Year of life. Women are initially better protected by the female sex hormone estrogen. Only after menopause does this protection become weaker, so that women from the age of 55. The dentist must be aware of the fact that patients can develop coronary heart disease before they reach the age of 18. Coronary heart disease is widespread, especially in Western countries. Represents the most frequent cause of death there. The tricky thing: a CHD can remain asymptomatic for a long time proceed. If the symptoms of angina pectoris (chest tightness) then occur for the first time, for the first time at rest or more intensely than before, the risk of a heart attack has increased significantly.

Understanding coronary heart disease

Coronary heart disease is a serious disease of the heart that leads to circulatory disorders of the heart muscle.

How coronary heart disease arises?

The cause of a CHD is the Vascular calcification (arteriosclerosis) of the coronary vessels. It is mainly caused by increased blood fats – especially cholesterol crystals – and inflammatory cells deposited in the inner walls of blood vessels. This leads to chronic inflammation, which forms excess connective tie. There is less and less room for blood flow in the artery and the risk of the inner wall rupturing increases. If the inner wall ruptures, a clot forms that stops blood flow and causes a heart attack. The dangerous complication of coronary heart disease.

Symptoms of CHD

The symptoms of coronary artery disease can be as follows very different drop out. If there is only mild to moderate narrowing of the coronary arteries, patients are almost always symptom-free.

The The leading symptom of coronary heart disease is angina pectoris. This describes a feeling of tightness in the chest.

Other typical symptoms include seizure-like burning, pressing or tearing pain in the heart area. In addition to a feeling of tightness in the chest, pain can also spread to the back, upper arms and, most importantly in women also in shoulder-neck, upper abdomen and the jaws radiate.

In addition to the angina pectoris symptoms, there are often vegetative symptoms such as sweating, nausea, dizziness, shortness of breath to shortness of breath, restlessness and even fear of death. Whereas in the early stages angina pectoris only occurs under heavy and prolonged exertion, as the disease progresses the symptoms can already occur during normal walking or climbing stairs. Stable angina pectoris one speaks, if the complaints are recurring under similar loads.

Causes and risk factors of coronary heart disease

pathological deposits in the walls of the coronary arteries: The coronary arteries become increasingly narrowed by deposits. Hereditary predispositionIf mother, father or siblings have suffered a heart attack at a young age, their own risk of CHD is significantly increased. Smoking: Substances from tobacco smoke promote deposits in the vessels DiabetesJuvenile diabetes, in particular, can damage the blood vessels and thus the coronary arteries, even with well-controlled blood sugar levels. Elevated blood lipids: Especially high LDL cholesterol and highly elevated triglycerides promote deposition in the vessels. Being overweight (obesity): Often, blood lipids and blood sugar are elevated in overweight people; in addition, inflammatory messengers are formed in the abdominal fat that damage vessel walls. High blood prere: damages directly the vessel walls. Lack of exercise: increases blood prere, worsens blood lipid levels, and decreases insulin sensitivity in muscle cells

"Almost always not only a factor, which is responsible for the development of a CHD. Often, there are several factors that multiply in their damaging effect," says, says the chief physician.

CHD diagnosis: these examinations take place

Medical history

Taking a detailed medical history is very important in the diagnostic process. In addition the cardiologist clarifies with the patient among other things:

– When the pain usually occurs? – What accompanying symptoms are present? – Whether there are concomitant diseases? – Whether the patient smokes? – Whether heart diseases are known in the family?

Physical examination

During the physical examination, the abdominal circumference and blood prere are measured, among other things. In addition, a blood sample is taken to determine various values such as blood glucose, long-term blood glucose, blood lipids and kidney values.

In order to determine the risk of coronary heart disease, further examinations take place. These include such things as:

Resting ECG: Records the electrical activity of the heart muscle and can provide information about whether the chest pain experienced is due to an acute myocardial infarction or a circulatory disorder. Likewise cardiac arrhythmias are recognizable. Cardiac echo (heart ultrasound) at rest: Imaging technique that allows the size, structure, and function of the heart chambers to be assessed and movement abnormalities of the heart wall to be identified as an indication of CHD.

Exercise testing

Stress tests can also be used as part of the examinations, as pathological changes are only visible under stress, especially in the early stages. These include:

Stress ECGThe electrical potentials of the heart are recorded during physical exertion on a bicycle ergometer and provide information about possible damage to the heart. Stress echocardiography: Can provide direct evidence of impaired blood flow to the coronary arteries. Nuclear medical examination (myocardial scintigraphy)Isotope injected into the arm vein to see blood flow in the heart muscle cells. If an area of the heart muscle is not sufficiently supplied with blood under physical stress, the isotope is not absorbed in this area. Stress MRI (Magnetic Resonance Imaging): Used to differentiate between other heart diseases and CHD. During stress MRI, patients are given a drug that dilates blood vessels. A contrast medium is also administered. If the coronary artery responds weakly to the drug on examination, this is an indication of narrowing.

Acute coronary syndrome

In acute coronary syndrome, the symptoms occur suddenly or when the personal stress threshold changes. This can be already with smaller physical load than before. This is called unstable angina pectoris. "Unstable angina pectoris can thus indicate an acute circulatory disorder of the heart, which almost always represents a medical emergency situation. This is because there is a risk of occlusion of a coronary artery. So a heart attack", says Prof. Dr. Michael Niehaus.

Chronic coronary syndrome

The symptoms of chronic coronary syndrome occur in stressful situations in which the heart muscle needs more oxygen. For example, during sports, physical activity, stress or even sumptuous meals. Patients experience the symptoms in an attack-like manner with physical exertion. They subside again by resting or taking medication. In a chronic coronary syndrome, the stress threshold at which symptoms occur remains the same over a longer period of time.

Consequential diseases of coronary heart disease

Heart attack: If a coronary artery suddenly closes, the heart muscle is no longer supplied with enough oxygen and begins to die off. It is always an acute life-threatening event, because regardless of the extent of the infarct area, the risk of malignant cardiac arrhythmias is greatly increased by the infarct.

Heart failureOccurs mainly as a result of a heart attack, since the heart muscle destroyed by the infarction is replaced by connective tie and can no longer cooperate. As a result, the pumping capacity decreases.

Sudden cardiac deathUnrecognized CHD is often found in patients who die unexpectedly.

CHD therapy

Prof. Dr. Michael Niehaus: "The treatment of coronary heart disease consists of several measures. This includes, for example, an adapted lifestyle, medication and possibly also invasive interventions."

Most important – adjust lifestyle: Stop smoking, reduce weight, exercise regularly and moderately, avoid stress.

Drugs against concomitant diseasesInhibition of platelet aggregation, cholesterol-lowering drugs, beta-blockers, ACE inhibitors, if necessary. Nitrates. These must be taken after consultation. May not be discontinued arbitrarily. These must be taken in consultation with the patient. Must not be discontinued on one's own authority. Possible interactions with other medications (sexual enhancers) must be discussed with the physician.

Invasive measures: A cardiac catheter examination can be used to identify constrictions. The examination is now almost always performed from the wrist, sometimes also from the groin. For this purpose, the cardiologist guides a thin tube, the catheter, to the coronary arteries and visualizes them with contrast medium. Constrictions in need of treatment can usually be treated directly during the examination. To do this, the constriction is first widened with a small balloon. A stent is then placed. In certain cases, a bypass operation must be performed by a cardiac surgeon to ensure blood flow to the heart. The small vascular bridges that are inserted during bypass surgery guide blood past the narrowing of the coronary arteries. In this way, the blood flow is still ensured and the heart muscle receives sufficient blood and oxygen again.

Course of the disease and prognosis

The earlier CHD is diagnosed, the more effectively it can often be treated and stopped with appropriate therapies. The goal is always to prevent a heart attack. Since the side effect rate with the drugs is rather low, it is well-cared-for CHD patients can go about their daily lives without any restrictions.

However CHD not curable. Therefore, it is all the more important that the patients themselves actively and sustainably change their lifestyle somewhat.

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