Coronary heart disease

Heart disease, Coronary heart disease, Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD

Coronary heart disease is a narrowing of the small blood vessels that supply blood and oxygen to the heart. Coronary heart disease (CHD) is also called coronary artery disease.

Coronary Artery Disease Quiz

Coronary artery disease is …

	A. A buildup of plaque in the arteries that carry blood to the heart
	B. The same thing as coronary heart disease
	C. Sometimes called hardening of the heart’s arteries
	D. The leading cause of death in the U.S. for men and women
	E. All of the above

Correct Answer

The correct answer is all of the above. Coronary artery disease (CAD) and coronary heart disease describe the same condition: the buildup of plaque in the arteries that carry blood and oxygen to the heart. These are called the coronary arteries. Over time, they can become narrow, slowing or stopping blood flow to the heart.

What causes plaque to build up in the arteries?

	A. Smoking
	B. High blood pressure
	C. High cholesterol
	D. High blood sugar
	E. All of the above

Correct Answer

The correct answer is all of the above. Any of these factors cause damage to the inside walls of the coronary arteries. Cholesterol and other chemicals in the blood then build up on these injured areas as plaque. This process is called atherosclerosis.

You can have CAD and not have any symptoms.

A. True

B. False
Correct Answer
The correct answer is true. Plaque buildup occurs slowly over time, so you can have the disease and not have any symptoms. This is especially true in the early stages of heart disease. Sometimes, a heart attack is the first sign of CAD.

What are the noticeable symptoms of CAD?

	A. Chest pain or pressure, called angina
	B. Shortness of breath
	C. Fatigue
	D. Weakness
	E. All of the above

Correct Answer

The correct answer is all of the above. Angina (chest heaviness, pressure, or pain) is the most common symptom. It often occurs during activity or stress and goes away with rest or when you take an angina medicine (most often nitroglycerin under your tongue). You also may feel shortness of breath, fatigue, or weakness.

Angina is another name for a heart attack.

A. True

B. False
Correct Answer
The correct answer is false. Angina is a sign that your heart isn't getting enough oxygen. A heart attack occurs when heart muscle cells die due to a blocked artery. Having angina means you are at risk for a heart attack. If you have angina, and your chest pain doesn't go away minutes after rest or medicine, call 9-1-1.

Which heart problems can be caused by CAD?

	A. Heart failure
	B. Arrhythmia (abnormal heart rhythm)
	C. Heart attack
	D. All of the above

Correct Answer

The correct answer is all of the above. Reduced blood flow can damage the heart in different ways. Heart failure occurs when the weakened heart muscle can't pump enough blood to the rest of the body. CAD can damage the heart's electrical system, causing arrhythmias. A blocked artery can cause a heart attack.

If you have heart disease, you are at higher risk for depression.

A. True

B. False
Correct Answer
The correct answer is true. It's unclear why, but there is a link between depression and heart disease, angina, and heart attack. Being depressed may make it harder to follow your treatment plan, and treating depression can help you better manage heart disease. If you think you may be depressed, talk with your doctor.

How may CAD be treated?

	A. Healthy lifestyle changes
	B. Medicines
	C. Angioplasty, a procedure to open blocked arteries
	D. Heart bypass surgery
	E. All of the above

Correct Answer

The correct answer is all of the above. Your treatment depends on your symptoms and how much artery blockage you have. For some people, lifestyle changes alone can treat CAD. Others may need medicine, angioplasty, or surgery. Talk with your doctor about the best treatment for you.

Which lifestyle change WON'T help treat CAD?

	A. Quitting smoking
	B. Eating a healthy, low-fat, low-sodium, high-fiber diet
	C. Getting regular exercise
	D. Managing stress
	E. Maintaining a healthy weight
	F. Following a gluten-free diet

Correct Answer

The correct answer is following a gluten-free diet. Most people don't need to follow a gluten-free diet, and avoiding gluten certainly won't help treat CAD. Follow a plant-based diet low in sodium, cholesterol, and trans and saturated fats. Talk with your doctor about other changes that can help your heart.

Plaque buildup can begin in childhood.

A. True

B. False
Correct Answer
The correct answer is true. It may seem hard to believe, but plaque starts building up on artery walls in our childhood and teen years. That's why it's never too early to eat a healthy diet, get regular exercise, and manage stress. And if you never start smoking in the first place, you never have to quit!

Causes

CHD is the leading cause of death in the United States for men and women.

CHD is caused by the buildup of plaque in the arteries to your heart. This may also be called hardening of the arteries.

Hardening of the arteries

Atherosclerosis, sometimes called "hardening of the arteries," occurs when fat, cholesterol, and other substances build up in the walls of arteries. ...

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Fatty material and other substances form a plaque buildup on the walls of your coronary arteries. The coronary arteries bring blood and oxygen to your heart.
This buildup causes the arteries to get narrow.
As a result, blood flow to the heart can slow down or stop.

A risk factor for heart disease is something that increases your chance of getting it. You cannot change some risk factors for heart disease, but you can change others.

Risk factor for 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...

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Symptoms

In some cases, symptoms may be very noticeable. But, you can have the disease and not have any symptoms. This is more often true in the early stages of heart disease.

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

Chest pain

Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen.

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Angina

Angina is a type of chest discomfort or pain due to poor blood flow through the blood vessels (coronary vessels) of the heart muscle (myocardium). Th...

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It may feel heavy or like someone is squeezing your heart. You may feel it under your breast bone (sternum). You may also feel it in your neck, arms, stomach, or upper back.
The pain most often occurs with activity or emotion. It goes away with rest or a medicine called nitroglycerin.
Other symptoms include shortness of breath and fatigue with activity (exertion).

Some people have symptoms other than chest pain, such as:

Fatigue
Shortness of breath
General weakness

Exams and Tests

Your health care provider will examine you. You will often need more than one test before getting a diagnosis.

Tests to evaluate for CHD may include:

Coronary angiography -- an invasive test that evaluates the heart arteries under x-ray.
Coronary angiography
Coronary angiography is a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the arteries in your heart....
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Echocardiogram stress test.
Echocardiogram
An echocardiogram is a test that uses sound waves to create pictures of the heart. The picture and information it produces is more detailed than a s...
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Electrocardiogram (ECG).
Electrocardiogram (ECG)
An electrocardiogram (ECG) is a test that records the electrical activity of the heart.
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Electron-beam computed tomography (EBCT) to look for calcium in the lining of the arteries. The more calcium, the higher your chance for CHD.
Exercise stress test.
Exercise stress test
An exercise stress test is used to measure the effect of exercise on your heart.
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Heart CT scan.
Heart CT scan
A computed tomography (CT) scan of the heart is an imaging method that uses x-rays to create detailed pictures of the heart and its blood vessels. Th...
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Nuclear stress test.
Nuclear stress test
Nuclear stress test is an imaging method that uses radioactive material to show how well blood flows into the heart muscle, both at rest and during a...
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Treatment

You may be asked to take one or more medicines to treat blood pressure, diabetes, or high cholesterol levels. Follow your provider's directions closely to help prevent CHD from getting worse.

Diabetes

Diabetes is a long-term (chronic) disease in which the body cannot regulate the amount of sugar in the blood.

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High cholesterol levels

Cholesterol is a fat (also called a lipid) that your body needs to work properly. Too much bad cholesterol can increase your chance of getting heart...

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Goals for treating these conditions in people who have CHD:

The most commonly used blood pressure target for people with heart disease is less than 130/80, but your provider may recommend a different blood pressure target.
If you have diabetes, your HbA1c levels will be monitored and brought down to the level your provider recommends.
HbA1c
A1C is a lab test that shows the average level of blood sugar (glucose) over the previous 3 months. It shows how well you are controlling your blood...
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Your LDL cholesterol level will be lowered with statin drugs.

Treatment depends on your symptoms and how severe the disease is. You should know about:

Other medicines used to treat angina.
Other medicines used to treat angina
Stable angina is chest pain or discomfort that most often occurs with activity or emotional stress. Angina is due to poor blood flow through the blo...
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What to do when you have chest pain.
What to do when you have chest pain
Angina is a type of chest discomfort due to poor blood flow through the blood vessels of the heart muscle. This article discusses how to care for yo...

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Being active when you have heart disease.
Being active when you have heart diseas...
Getting regular exercise when you have heart disease is important. Physical activity can strengthen your heart muscle and help you manage blood pres...
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Eating a heart-healthy diet.
Eating a heart-healthy diet
A healthy diet is a major factor in reducing your risk for heart disease.
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Never stop taking your medicines without first talking to your provider. Stopping heart medicines suddenly can make your angina worse or cause a heart attack.

You may be referred to a cardiac rehabilitation program to help improve your heart's fitness.

Procedures and surgeries used to treat CHD include:

Angioplasty and stent placement, called percutaneous coronary interventions (PCIs)
Angioplasty and stent placement
Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart. These blood vessels are called the coronary art...
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Coronary artery bypass surgery
Coronary artery bypass surgery
Heart bypass surgery creates a new route, called a bypass, for blood and oxygen to go around a blockage to reach your heart.
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Minimally invasive heart surgery
Minimally invasive heart surgery
Heart bypass surgery creates a new route, called a bypass, for blood and oxygen to reach your heart. Minimally invasive coronary (heart) artery bypas...
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Outlook (Prognosis)

Everyone recovers differently. Some people can stay healthy by changing their diet, stopping smoking, and taking their medicines as prescribed. Others may need medical procedures such as angioplasty or surgery.

In general, early detection of CHD generally leads to a better outcome.

When to Contact a Medical Professional

If you have any risk factors for CHD, talk to your provider about prevention and possible treatment steps.

Call your provider, call the local emergency number (such as 911), or go to the emergency room right away if you have:

Angina or chest pain
Shortness of breath
Symptoms of a heart attack
Symptoms of a heart attack
Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. The coronary arteries bring blood and oxygen to the heart. ...
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Prevention

Take these steps to help prevent heart disease.

If you smoke, stop. There are many resources available to help you stop smoking.
Stop smoking
There are many ways to quit smoking. There are also resources to help you. Family members, friends, and co-workers may be supportive. But to be su...
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Learn how to eat a heart-healthy diet by making simple substitutions. For example, choose heart-healthy fats over butter and other saturated fats.
Simple substitutions
A heart-healthy diet is low in saturated fat. Saturated fat can increase your bad cholesterol and clog your arteries. A heart-healthy diet also lim...

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Heart-healthy fats
Some types of fat are healthier for your heart than others. Butter and other animal fats and solid margarine may not be the best choices. Alternati...
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Get regular exercise, ideally at least 30 minutes most days. If you have heart disease, talk with your provider about starting an exercise routine.
Starting an exercise routine
Getting regular exercise when you have heart disease is important. Physical activity can strengthen your heart muscle and help you manage blood pres...
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Maintain a healthy body weight.
Lower high cholesterol with lifestyle changes, and if needed, statin medicines.
Lifestyle changes
Your body needs cholesterol to work well. But cholesterol levels that are too high can harm you. Cholesterol is measured in milligrams per deciliter...
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Statin medicines
Statins are medicines that help lower the amount of cholesterol and other fats in your blood. Statins work by:Lowering LDL (bad) cholesterolRaising ...

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Lower high blood pressure using diet and medicines.
Lower high blood pressure
Hypertension is another term used to describe high blood pressure. High blood pressure can lead to: StrokeHeart attackHeart failureKidney diseaseEar...
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Talk with your provider about aspirin therapy.
Aspirin therapy
Current guidelines recommend that people with coronary artery disease (CAD) receive antiplatelet therapy with either aspirin or clopidogrel. Aspirin ...
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If you have diabetes, keep it well-managed to help prevent heart attack and stroke.
Prevent heart attack and stroke
People with diabetes have a higher chance of having heart attacks and strokes than those without diabetes. Smoking and having high blood pressure an...
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Even if you already have heart disease, taking these steps will help protect your heart and prevent further damage.

Open References

References

Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease. Circulation. 2019 [Epub ahead of print]. PMID: 30879355 pubmed.ncbi.nlm.nih.gov/30879355/.

Boden WE. Angina pectoris and stable ischemic heart disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 62.

Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2014;130(19):1749-1767.PMID: 25070666 pubmed.ncbi.nlm.nih.gov/25070666/.

Marks AR. Cardiac and circulatory function. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 47.

Morrow DA, de Lemos J. Stable ischemic heart disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 40.

Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;72(3):e33. PMID: 29133354 pubmed.ncbi.nlm.nih.gov/29133354/.

All
Video
Images
Tog

Heart - section through the middle - illustration
The interior of the heart is composed of valves, chambers, and associated vessels.
Heart - section through the middle
illustration
Heart - front view - illustration
The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.
Heart - front view
illustration
Anterior heart arteries - illustration
The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.
Anterior heart arteries
illustration
Posterior heart arteries - illustration
The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.
Posterior heart arteries
illustration
Acute MI - illustration
A heart attack or acute myocardial infarction (MI) occurs when one of the arteries that supplies the heart muscle becomes blocked. Blockage may be caused by spasm of the artery or by atherosclerosis with acute clot formation. The blockage results in damaged tissue and a permanent loss of contraction of this portion of the heart muscle.
Acute MI
illustration
Cholesterol producers - illustration
Cholesterol is a waxy, fat-like material that is found in all parts of the body. It comes from two sources: our liver produces it, and we consume it in animal products.
Cholesterol producers
illustration
Atherosclerosis - illustration
Atherosclerosis is a disease of the arteries in which fatty material is deposited in the vessel wall, resulting in narrowing and eventual impairment of blood flow. Severely restricted blood flow in the arteries to the heart muscle leads to symptoms such as chest pain. Atherosclerosis shows no symptoms until a complication occurs.
Atherosclerosis
illustration

Heart - section through the middle - illustration
The interior of the heart is composed of valves, chambers, and associated vessels.
Heart - section through the middle
illustration
Heart - front view - illustration
The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.
Heart - front view
illustration
Anterior heart arteries - illustration
The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.
Anterior heart arteries
illustration
Posterior heart arteries - illustration
The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.
Posterior heart arteries
illustration
Acute MI - illustration
A heart attack or acute myocardial infarction (MI) occurs when one of the arteries that supplies the heart muscle becomes blocked. Blockage may be caused by spasm of the artery or by atherosclerosis with acute clot formation. The blockage results in damaged tissue and a permanent loss of contraction of this portion of the heart muscle.
Acute MI
illustration
Cholesterol producers - illustration
Cholesterol is a waxy, fat-like material that is found in all parts of the body. It comes from two sources: our liver produces it, and we consume it in animal products.
Cholesterol producers
illustration
Atherosclerosis - illustration
Atherosclerosis is a disease of the arteries in which fatty material is deposited in the vessel wall, resulting in narrowing and eventual impairment of blood flow. Severely restricted blood flow in the arteries to the heart muscle leads to symptoms such as chest pain. Atherosclerosis shows no symptoms until a complication occurs.
Atherosclerosis
illustration

A Closer Look

Myocardial infarction
Heart failure
Coronary artery disease
Heart attack and acute coronary syndrome
Heart failure
Atherosclerosis
Angina
Cholesterol
Heart-healthy diet

Talking to your MD

Angina - what to ask your doctor
Heart attack - what to ask your doctor

Self Care

Cholesterol and lifestyle
Being active when you have heart disease
Cardiac rehabilitation
Heart disease - risk factors
Cholesterol testing and results
Living with heart disease and angina
Diabetes - preventing heart attack and stroke
Angina - when you have chest pain
Simple, heart-smart substitutions
Being active after your heart attack

Tests for Coronary heart disease

Exercise stress test
Heart CT scan
Cardiac catheterization
Coronary angiography
Stress echocardiography
Nuclear stress test
Left heart catheterization
Left heart ventricular angiography
Nuclear ventriculography
Heart PET scan

Related Information

Atherosclerosis
Stable angina
Heart attack
Heart disease and women
Unstable angina
Magnetic resonance angiography
Ventricular assist device
Cardiac intravascular ultrasound
Metabolic syndrome
Obesity
Coronary artery disease
Heart attack and acute coronary syndrome

Review Date: 2/23/2022

Reviewed By: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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Health Library

Coronary heart disease

Coronary artery disease is …

What causes plaque to build up in the arteries?

You can have CAD and not have any symptoms.

What are the noticeable symptoms of CAD?

Angina is another name for a heart attack.

Which heart problems can be caused by CAD?

If you have heart disease, you are at higher risk for depression.

How may CAD be treated?

Which lifestyle change WON'T help treat CAD?

Plaque buildup can begin in childhood.

Causes

Hardening of the arteries

Risk factor for heart disease

Symptoms

Chest pain

Angina

Exams and Tests

Coronary angiography

Echocardiogram

Electrocardiogram (ECG)

Exercise stress test

Heart CT scan

Nuclear stress test

Treatment

Diabetes

High cholesterol levels

HbA1c

Other medicines used to treat angina

What to do when you have chest pain

Being active when you have heart diseas...

Eating a heart-healthy diet

Angioplasty and stent placement

Coronary artery bypass surgery

Minimally invasive heart surgery

Outlook (Prognosis)

When to Contact a Medical Professional

Symptoms of a heart attack

Prevention

Stop smoking

Simple substitutions

Heart-healthy fats

Starting an exercise routine

Lifestyle changes

Statin medicines

Lower high blood pressure

Aspirin therapy

Prevent heart attack and stroke

References

Heart - section through the middle - illustration

Heart - section through the middle

Heart - front view - illustration

Heart - front view

Anterior heart arteries - illustration

Anterior heart arteries

Posterior heart arteries - illustration

Posterior heart arteries

Acute MI - illustration

Acute MI

Cholesterol producers - illustration

Cholesterol producers

Atherosclerosis - illustration

Atherosclerosis

Heart - section through the middle - illustration

Heart - section through the middle

Heart - front view - illustration

Heart - front view

Anterior heart arteries - illustration

Anterior heart arteries

Posterior heart arteries - illustration

Posterior heart arteries

Acute MI - illustration

Acute MI

Cholesterol producers - illustration

Cholesterol producers

Atherosclerosis - illustration

Atherosclerosis

A Closer Look

Talking to your MD