Coronary (Ischemic) Heart Disease

Coronary heart disease (CHD), also called coronary artery disease and atherosclerotic heart disease, may be caused by inflammation of the lining of the arteries which allows atheromatous plaques (caused by the buildup of cholesterol in the vessel wall) to form, limiting blood flow to the heart muscle.

Pathophysiology
Limitation of blood flow to the heart causes ischemia (cell starvation secondary to a lack of oxygen) of the myocardial cells. When myocardial cells die from lack of oxygen, this is called a myocardial infarction (commonly called a heart attack), and leads to heart muscle damage and later scarring. Myocardial infarction can result from the sudden occlusion of a coronary artery when a plaque ruptures and a blood clot fills the lumen of the artery. The events leading up to plaque rupture are not fully understood. Myocardial infarction is also caused, less commonly, by spasm of the artery wall occluding the lumen, a condition also associated with atheromatous plaque and CHD.

CHD is associated with smoking, obesity and hypertension. A family history of CHD is one of the strongest predictors of CHD. Screening for CHD includes evaluating homocysteine levels, high-density and low-density lipoprotein (cholesterol) levels and triglyceride levels.

Angina
The pain associated with CHD is known as angina, and may feature a sensation of pressure in the chest, arm pain, jaw pain, and other forms of discomfort. The word discomfort is preferred over the word pain for describing the sensation of angina, because it varies considerably among individuals in character and intensity. There is evidence that angina and CHD present differently in women and men.

Angina that occurs regularly with activity, upon awakening, or at other predictable times is termed stable angina. It is usually treated with nitrate preparations such as nitroglycerin, which come in short-acting and long-acting forms, and may be administered transdermally, sublingually or orally.

Angina that changes in intensity, character or frequency is termed unstable. Unstable angina may precede myocardial infarction, and requires urgent medical attention. It is treated with oxygen, intravenous nitroglycerin, and morphine. Interventional procedures such as Percutaneous Transluminal Coronary Angioplasty may be done.

Prevention
Coronary heart disease is the most common form of heart disease in the Western world. Prevention centers on the modifiable risk factors: obesity, hypertension, sedentary lifestyle, diet, and smoking.

Individuals with CHD are advised to eat a low-fat diet, limit sodium intake to control blood pressure, exercise and stop smoking. These measures both limit the progression of the disease and may help reverse it in some people.

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