Definition: What is a coronary heart disease (CHD) and how does it arise? CHD is the most common heart disease of the entire world population. It is also referred to as ischemic heart disease. In Germany, approximately 6 million patients are affected. Scientists believe that the incidence of coronary heart disease will increase with increasing life expectancy.
CHD primarily affects people over the age of 50 and is one of the most frequently reported causes of death in all industrialized countries. It is a disease of the heart caused by occlusions and constrictions in the coronary arteries.
These arteries are among the blood vessels that supply the heart with energy-giving nutrients and oxygen-rich blood. Especially with physical stress, the blood transport through the body is reduced and there are typical symptoms of CHD.
How is the calcification of coronary arteries formed?
Calcification of coronary arteries is caused by deposition of arteriosclerotic plaques by :
- saturated fatty acids
- lime-like particles
In some cases, initial nutritional damage already exists due to :
- high blood pressure
- Diabetes mellitus
The human immune system does not recognize the plaques as endogenous. This is followed by inflammatory reactions and the plaques become increasingly unstable, since activated immune cells no longer fulfill their task and die in the same. Deposits begin to open by progressive increase. The contents enter the bloodstream and finally the coronary vessels, where it settles again.
Typical symptoms of CHD
Depending on the stage of development of CHD different symptoms occur. It is distinguished into three different forms of stages of coronary heart disease.
A latent coronary heart disease is characterized by mild to moderate constrictions of the coronary arteries. There is a coronary sclerosis.
Although this phase is asymptomatic, there is already a significant mismatch between oxygen supply and demand. Despite the absence of symptoms, it is possible to detect a reduced perfusion of the heart muscle. In diabetics often no typical symptoms are noticeable.
At this stage, sufferers notice typical CHD symptoms that occur under certain conditions. In most cases, they return alone or can be treated with medication (stable angina pectoris).
Angina Pectoris is the leading symptom of coronary heart disease. Affected notice a feeling of tightness as well as pain directly behind the breastbone. Primarily, the symptoms occur in cold, but also exercise. Other factors, such as mental stress or high-fat meals, can trigger these symptoms as well.
The resulting pain often spreads to the left arm or to other body regions such as upper abdomen, jaw or neck.
Other typical symptoms of CHD are:
- Shortness of breath (shortness of breath)
Occasionally affected people feel dread. As soon as the affected person comes to rest or stays warm again, these symptoms of angina pectoris return.
Typical symptoms of angina pectoris vary in their frequency, intensity and duration. They are closely related to the current progression of the CHD. In patients with renal insufficiency or diabetes mellitus, chest pain persists. This also applies to persons over 75 years and operated on. Here are breathlessness, dizziness, nausea and radiation of pain in the abdominal area as warning signs.
Unstable CHD and acute coronary syndrome
Similar symptoms of angina pectoris also occur here. However, they are significantly stronger and unpredictable (unstable angina pectoris). This expression can not always be adjusted to medication.
As a result, coronary heart disease leads to a reduced resilience of sufferers and causes a reduction in performance. Depending on the severity, this affects the quality of life. In individual cases, patients can no longer sufficiently fulfill everyday tasks.
At the same time, the clinical picture may continue to deteriorate and become a life-threatening stage of CHD. The so-called acute coronary syndrome is characterized by three manifestations :
- Unstable angina pectoris
- is characterized by a lack of elevations of the heart enzymes (creatine kinase MB, troponin) in the blood. ECG results show no changes that indicate a heart attack.
- Non-ST-elevation myocardial infarction (NSTEMI, acute myocardial infarction)
- shows no changes in the ECG, however, heart enzymes that point to possible heart disease and an infarction, detectable in the blood.
- ST segment elevation myocardial infarction (STEMI, acute myocardial infarction)
- manifests itself by typical changes in the ECG and detectable cardiac enzyme levels in the blood
As a consequence of these features occur :
- Heart failure due to a heart attack
- Heart arrhythmia due to a myocardial scar or coronary circulatory disorders
- Sudden cardiac death
Risk factors for the development of CHD
The training of CHD is favored by numerous risk factors. Women over the age of 55 and men over the age of 45 are at particular risk. The previous lifestyle plays a particularly important role here. Unhealthy, high-fat diet, lack of exercise and smoking increase the risk of diseases such as high blood pressure, high cholesterol, lipid metabolism and glucose tolerance disorders. As a consequence of this, in turn, a CHD can arise.
Not to be ignored is the family disposition. Special caution is advised when cases of CHD to heart attack have already occurred in the family environment, if possible risk factors should be largely avoided and a special focus on a healthy, balanced lifestyle should be laid.
The diagnosis of CHD
Due to the risk factors for coronary heart disease described above, the diagnosis begins with an intensive discussion. Besides the risks, complaints are also documented. In addition, an assessment of the physical capacity of the patient.
This is followed by a physical check focusing on the legs, lungs and heart. Possible signs of CHD include :
- Cardiac malformations such as aortic valve stenosis
- rattling breathing due to pulmonary congestion
- heart failure
Weight, heart rate, blood pressure and vascular status are also determined in order to make a correct diagnosis. If the patient reports symptoms suggestive of possible angina pectoris, the physician also measures the heart rate.
Which laboratory values are suitable for the diagnosis of CHD?
The following values are recorded in case of suspected coronary heart disease during the initial examination :
- blood count
- Cholesterol levels (HDL, LDL)
- total cholesterol
- Urinary findings (because of possible albuminuria)
- Fasting blood sugar
What exactly does a further diagnosis of CHC include?
In individual cases further investigations follow, for example :
- Stress echocardiogram
- Computed tomography (CT)
- Echocardiogram (ultrasound of the heart)
- Ergometry (ECG during exercise and rest)
- coronary angiography
Basically, the choice of possible advanced diagnostic methods depends on the likelihood of coronary heart disease. This results from various factors such as gender, age, risks as well as symptoms.
The treatment of CHD
Therapeutic measures in diagnosed CHD are based primarily on two basic elements. On the one hand, medications can support the treatment. On the other hand, specific non-pharmacological measures, especially on the part of the patient, are necessary.
Drug treatment of CHD
The primary goals of a drug therapy of CHD are the alleviation of the symptoms and the positive influence on the further course of the disease. For this purpose different groups of active ingredients are available :
- ACE inhibitors
- Beta-blocker (beta-receptor blocker)
- Cholesterol-lowering drugs (e.g., statins)
- Platelet aggregation inhibitor (clopidogrel, acetylsalicylic acid)
Typical symptoms of angina pectoris can be alleviated with nitrates or calcium channel blockers (calcium antagonists). In addition, the flu vaccine is recommended for affected patients. In acute cases, bypass surgery may improve the CHD. Sometimes a percutaneous coronary intervention (PCI) is necessary.
Treat CHD without medication
Secondary preventive measures aim to prevent further complications as well as alleviate the current symptoms of CHD. The focus is on a healthy lifestyle. The individual components are similar to the primary preventive approach, which prevents the development of coronary heart disease.
Can a CHD be prevented?
In order to prevent a possible development of CHD, primary preventive measures can be taken to improve general heart health. A healthy lifestyle, sufficient exercise and a balanced diet are the basic requirements for this.
Sports that have a positive effect on heart health include swimming, running or cycling. Ideally, stress should be avoided, which is not completely possible for most people, so stress should be adequately processed or broken down through yoga, relaxation exercises or autogenic training.
In case of overweight, a weight reduction should be targeted. In addition, smoking cessation is recommended, which can minimize or even prevent numerous health problems. In addition, persons over the age of 35 should take the health check at the family doctor every two years. Here, typical risks, such as Diabetes mellitus, high blood pressure or elevated cholesterol, to be diagnosed for CHD.