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Written by Ramaz Mitaishvili   
Monday, 27 August 2007
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Guideline for nurse in Coronary Heart Disease (CHD) Clinic
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Dr. Ramaz MitaishviliBy Dr. Ramaz Mitaishvili

Definition of Coronary Heart Disease 
Coronary heart disease (CHD) is a narrowing of the small blood vessels that supply blood and oxygen to the heart. CHD is also called coronary artery disease.
Alternative names    
Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD

Causes, incidence, and risk factors   

Coronary heart disease is usually caused by a condition called atherosclerosis, which occurs when fatty material and a substance called plaque builds up on the walls of your arteries. This causes them to get narrow. As the coronary arteries narrow, blood flow to the heart can slow down or stop, causing chest pain (stable angina), shortness of breath, heart attack, and other symptoms.

Coronary heart disease (CHD) is the leading cause of death in the United States for men and women. According to the American Heart Association, more than 15 million people have some form of the condition.

Men in their 40s have a higher risk of CHD than women. But, as women get older, their risk increases so that it is almost equal to a man's risk. See: Heart disease and women

Many things increase your risk for CHD. Bad genes (heredity) can increase your risk. You're more likely to develop the condition if someone in your family has had it -- especially if they had it before age 50. Your risk for CHD goes up the older you get.

The following factors also increase your risk of CHD:

    * Diabetes
    * High blood pressure
    * High LDL "bad" cholesterol
    * Low HDL "good" cholesterol
    * Menopause
    * Not getting enough physical activity or exercise
    * Obesity
    * Smoking

Higher-than-normal levels of inflammation-related substances may also increase your risk for a heart attack. Such substances include C-reactive protein and fibrinogen. Increased levels of a chemical called homocysteine, an amino acid, are also linked to an increased risk of a heart attack.

Symptoms    

Symptoms may be very noticeable, but sometimes you can have the disease and not have any symptoms.

Chest pain or discomfort (angina) is the most common symptom. You feel this pain when the heart is not getting enough blood or oxygen. How bad the pain is varies from person to person.

There are two main types of chest pain:

  •     Atypical chest pain -- often sharp and comes and goes. You can feel it in your left chest, abdomen, back, or arm. It is unrelated to exercise and not relieved by rest or a medicine called nitroglycerin. Atypical chest pain is more common in women.
  •     Typical chest pain -- feels heavy or like someone is squeezing you. You feel it under your breast bone (sternum). The pain usually occurs with activity or emotion, and goes away with rest or a medicine called nitroglycerin.

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

Other symptoms include:

  •     Shortness of breath
  •     Heart attack -- in some cases, the first sign of CHD is a heart attack

Signs and tests   

Many tests help diagnose CHD. Usually, your doctor will order more than one test before making a definite diagnosis.

Tests may include:

  •     Electrocardiogram (ECG)
  •     Exercise stress test
  •     Echocardiogram
  •     Nuclear scan
  •     Coronary angiography/arteriography
  •     Electron-beam computed tomography (EBCT) to look for calcium in the lining of the arteries -- the more calcium, the higher your chance for CHD
  •     Coronary CT angiography
  •     Magnetic resonance angiography


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