Coronary Heart Disease Causes, Symptoms, Diagnosis, Treatment, Prevention

Coronary Heart Disease Causes, Symptoms, Diagnosis, Treatment, Prevention

Some 7 million Americans suffer from coronary heart disease, the most common form of heart disease. This type of heart disease is caused by a narrowing of the coronary arteries that feed the heart.

Coronary Heart Disease is the number one killer of both men and women in the U.S. Each year, more than 500,000 Americans die of heart attacks caused by Coronary Heart Disease.

Many of these deaths could be prevented because Coronary Heart Disease is related to certain aspects of lifestyle. Risk factors for Coronary Heart Disease include high blood pressure, high blood cholesterol, smoking, obesity, and physical inactivity--all of which can be controlled. Although medical treatments for heart disease have come a long way, controlling risk factors remains the key to preventing illness and death from Coronary Heart Disease.

Risks for Coronary Heart Disease

Risk factors are conditions that increase your risk of developing heart disease. Some can be changed and some cannot. Although these factors each increase the risk of Coronary Heart Disease, they do not describe all the causes of coronary heart disease; even with none of these risk factors, you might still develop Coronary Heart Disease.


  • High blood pressure
  • High blood cholesterol
  • Smoking
  • Obesity
  • Physical inactivity
  • Diabetes
  • Stress*


  • Gender
  • Heredity (family history of Coronary Heart Disease)
  • Age

* Although stress may be a risk factor for Coronary Heart Disease, scientists still do not know exactly how stress might be involved in heart disease.

Read more: Creutzfeldt-Jakob Disease: Causes, Symptoms, Diagnosis, Treatment

What is Coronary Heart Disease?

Like any muscle, the heart needs a constant supply of oxygen and nutrients that are carried to it by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged and cannot supply enough blood to the heart, the result is Coronary Heart Disease. If not enough oxygen-carrying blood reaches the heart, the heart may respond with pain called angina. The pain is usually felt in the chest or sometimes in the left arm and shoulder. (However, the same inadequate blood supply may cause no symptoms, a condition called silent angina.)

When the blood supply is cut off completely, the result is a heart attack. The part of the heart that does not receive oxygen begins to die, and some of the heart muscle may be permanently damaged.

What causes Coronary Heart Disease?

Coronary Heart Disease is caused by a thickening of the inside walls of the coronary arteries. This thickening, called atherosclerosis, narrows the space through which blood can flow, decreasing and sometimes completely cutting off the supply of oxygen and nutrients to the heart.

Atherosclerosis usually occurs when a person has high levels of cholesterol, a fat-like substance, in the blood. Cholesterol and fat, circulating in the blood, build up on the walls of the arteries. The buildup narrows the arteries and can slow or block the flow of blood. When the level of cholesterol in the blood is high, there is a greater chance that it will be deposited onto the artery walls. This process begins in most people during childhood and the teenage years, and worsens as they get older.

In addition to high blood cholesterol, high blood pressure and smoking also contribute to Coronary Heart Disease. On the average, each of these doubles your chance of developing heart disease. Therefore, a person who has all three risk factors is eight times more likely to develop heart disease than someone who has none. Obesity and physical inactivity are other factors that can lead to Coronary Heart Disease. Overweight increases the likelihood of developing high blood cholesterol and high blood pressure, and physical inactivity increases the risk of heart attack. Regular exercise, good nutrition, and smoking cessation are key to controlling the risk factors for Coronary Heart Disease.

What are the symptoms of Coronary Heart Disease?

Chest pain (angina) or shortness of breath may be the earliest signs of Coronary Heart Disease. A person may feel heaviness, tightness, pain, burning, pressure, or squeezing, usually behind the breastbone but sometimes also in the arms, neck, or jaws. These signs usually bring the patient to a doctor for the first time. Nevertheless, some people have heart attacks without ever having any of these symptoms.

It is important to know that there is a wide range of severity for Coronary Heart Disease. Some people have no symptoms at all, some have mild intermittent chest pain, and some have more pronounced and steady pain. Still others have Coronary Heart Disease that is severe enough to make normal everyday activities difficult.

Because Coronary Heart Disease varies so much from one person to another, the way a doctor diagnoses and treats Coronary Heart Disease will also vary a lot. The following descriptions are general guidelines to some tests and treatments that may or may not be used, depending on the individual case.

Are there tests for Coronary Heart Disease?

There is no one simple test--some or all of the following procedures may be needed. These diagnostic procedures are used to establish Coronary Heart Disease, to determine its extent and severity, and to rule out other possible causes of the symptoms.

After taking a careful medical history and doing a physical examination, the doctor may use some tests to see how advanced the Coronary Heart Disease is. The only certain way to diagnose and assess the extent of Coronary Heart Disease is coronary angiography (see below); other tests can indicate a problem but do not show exactly where it is.

An examination for Coronary Heart Disease may include the following tests:

An electrocardiogram

An electrocardiogram (ECG or EKG) is a graphic record of the electrical activity of the heart as it contracts and rests. Abnormal heartbeats and some areas of damage, inadequate blood flow, and heart enlargement can be detected on the records.

A stress test

A stress test (also called a treadmill test or exercise ECG) is used to record the heartbeat during exercise. This is done because some heart problems only show up when the heart is working hard. In the test, an ECG is done before, during, and after exercising on a treadmill; breathing rate and blood pressure may be measured as well. Exercise tests are useful but are not completely reliable; false positives (showing a problem where none exists) and false negatives (showing no problem when something is wrong) are fairly common.

Nuclear scanning

Nuclear scanning is sometimes used to show damaged areas of the heart and expose problems with the heart's pumping action. A small amount of radioactive material is injected into a vein, usually in the arm. A scanning camera records the nuclear material that is taken up by heart muscle (healthy areas) or not taken up (damaged areas).

Coronary angiography (or arteriography)

Coronary angiography (or arteriography) is a test used to explore the coronary arteries. A fine tube (catheter) is put into an artery of an arm or leg and passed through the tube into the arteries of the heart. The heart and blood vessels are then filmed while the heart pumps. The picture that is seen, called an angiogram or arteriogram, will show problems such as a blockage caused by atherosclerosis.

Coronary Heart Disease Treatment

Coronary Heart Disease is treated in a number of ways, depending on the seriousness of the disease. For many people, Coronary Heart Disease is managed with lifestyle changes and medications. Others with severe Coronary Heart Disease may need surgery. In any case, once Coronary Heart Disease develops, it requires lifelong management.

What kind of lifestyle changes can help a person with Coronary Heart Disease?

Although great advances have been made in treating Coronary Heart Disease, changing one's habits remains the single most effective way to stop the disease from progressing.

If you know that you have Coronary Heart Disease, changing your diet to one low in fat, especially saturated fat, and cholesterol will help reduce high blood cholesterol, a primary cause of atherosclerosis. In fact, it is even more important to keep your cholesterol low after a heart attack to help lower your risk of having another one. 

Eating less fat should also help you lose weight. If you are overweight, losing weight can help lower blood cholesterol and is the most effective lifestyle way to reduce high blood pressure, another risk factor for atherosclerosis and heart disease.

People with Coronary Heart Disease can also benefit from exercise. Recent research has shown that even moderate amounts of physical activity are associated with lower death rates from Coronary Heart Disease. However, people with severe Coronary Heart Disease may have to restrict their exercise somewhat. If you have Coronary Heart Disease, check with your doctor to find out what kinds of exercise are best for you.

Smoking is one of the three major risk factors for Coronary Heart Disease. Quitting smoking dramatically lowers the risk of a heart attack and also reduces the risk of a second heart attack in people who have already had one.

What medications are used to treat coronary heart disease?

Medications are prescribed according to the nature of the patient's Coronary Heart Disease and other problems. The symptoms of angina can generally be controlled by "beta-blocker" drugs that decrease the workload on the heart, by nitroglycerine and other "nitrates" and by "calcium-channel blockers" that relax the arteries, and by other classes of drugs. The tendency to form clots is reduced by aspirin or by other platelet inhibitory and anticoagulant drugs. Beta-blockers are given to decrease the recurrence of heart attack. For those with elevated blood cholesterol that is unresponsive to dietary and weight loss measures, cholesterol-lowering drugs may be prescribed, such as lovastatin, colestipol, cholestyramine, gemfibrozil, and niacin. Impaired pumping function of the heart may be treated with digitalis drugs or ACE inhibitors. If there is high blood pressure or fluid retention, these conditions are also treated.

Ask your doctor which medication you are taking, what it does, and whether there are any side effects. Knowing more about this will help you stick to the schedule that has been prescribed for you.

How To Prevent and Control Coronary Heart Disease Risk Factors

You can prevent and control many coronary heart disease risk factors with lifestyle changes and medicines. Examples of these controllable risk factors include high blood cholesterol, high blood pressure, and overweight and obesity. Only a few risk factors—such as age, gender, and family history—can't be controlled.

To reduce your risk of Coronary Heart Disease and heart attack, try to control each risk factor you can. The good news is that many lifestyle changes help control several Coronary Heart Disease risk factors at the same time. For example, physical activity may lower your blood pressure, help control diabetes and prediabetesexternal link icon, reduce stress, and help control your weight.

Eat a healthy, balanced diet

A low-fat, high-fibre diet is recommended, including plenty of fresh fruit and vegetables (five portions a day) and whole grains. You should limit the amount of salt you eat to no more than 6g (0.2oz) a day as too much salt will increase your blood pressure. Six grams of salt is about one teaspoonful.

There are two types of fat: saturated and unsaturated. You should avoid food containing saturated fats because these will increase your cholesterol levels.

Foods high in saturated fat include:
  • meat pies 
  • sausages and fatty cuts of meat 
  • butter 
  • ghee, a type of butter often used in Indian cooking 
  • lard 
  • cream 
  • hard cheese 
  • cakes and biscuits 
  • foods that contain coconut or palm oil
However, a balanced diet should include a small amount of unsaturated fat, which will help reduce your cholesterol levels.

Foods high in unsaturated fat include:
  • oily fish 
  • avocados 
  • nuts and seeds 
  • sunflower, rapeseed, olive and vegetable oils
You should also try to avoid too much sugar in your diet as this can increase your chances of developing diabetes, which is proven to dramatically increase your chances of developing Coronary Heart Disease.

Maintaining a Healthy Weight

Following a healthy diet and being physically active can help you maintain a healthy weight. Controlling your weight helps you control Coronary Heart Disease risk factors.

If you're overweight or obese, try to lose weight. A loss of just 5 to 10 percent of your current weight can lower your risk of Coronary Heart Disease.

To lose weight, cut back your calorie intake and do more physical activity. Eat smaller portions and choose lower calorie foods. Don't feel that you have to finish the entrees served at restaurants. Many restaurant portions are oversized and have too many calories for the average person.

For overweight children and teens, slowing the rate of weight gain is important. However, reduced-calorie diets aren't advised, unless approved by a doctor.

Quitting Smoking

If you smoke, quit. Smoking can raise your risk of Coronary Heart Disease and heart attack and worsen other Coronary Heart Disease risk factors. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.

If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.

You can help your children avoid smoking or quit smoking. Talk with them about the health effects of smoking. Teach them how to handle peer pressure to smoke.

Teens who have parents who smoke are more likely to smoke themselves. Set a good example by not smoking or quitting smoking. Set firm rules about no tobacco use in your home.

If you have a child who smokes, help him or her create a plan to quit. Offer your child information and resources on how to quit. Stress the natural rewards that come with quitting, such as freedom from addiction, better fitness and sports performance, and improved appearance. Reinforce the decision to quit with praise.

Reduce your alcohol consumption

If you drink, stick to the recommended guidelines. The recommended daily amount of alcohol for men is three to four units a day and two to three units for women. Always avoid binge drinking.

Keep your blood pressure under control

You can keep your blood pressure under control by eating a healthy diet low in saturated fat, exercising regularly, and, if required, taking the appropriate medication to lower your blood pressure. Your target blood pressure should be below 140/85mmHg. If you have high blood pressure, ask your GP to check your blood pressure regularly.

Managing Stress

Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Having supportive people in your life with whom you can share your feelings or concerns can help relieve stress.

Physical activity, medicine, and relaxation therapy also can help relieve stress. You may want to consider taking part in a stress management program.

Being Physically Active

You don't have to be an athlete to lower your risk of Coronary Heart Disease. You can benefit from as little as 60 minutes of moderate-intensity aerobic activity per week.

For major health benefits, adults should do at least 150 minutes (2.5 hours) of moderate-intensity aerobic activity or 75 minutes (1 hour and 15 minutes) of vigorous-intensity aerobic activity each week.

Another option is to do a combination of both. A general rule is that 2 minutes of moderate-intensity activity counts the same as 1 minute of vigorous-intensity activity.

The more active you are, the more you'll benefit. If you're obese, or if you haven't been active in the past, start physical activity slowly and build up the intensity over time.

Children and youth should do 60 minutes or more of physical activity every day. A great way to encourage physical activity is to do it as a family. You also may want to limit your children's TV, video, and computer time to encourage them to be more active.

If you have Coronary Heart Disease or symptoms such as chest pain and dizziness, talk with your doctor before you start a new exercise plan. Find out how much and what kinds of physical activity are safe for you. Avoid exercising outdoors when air pollution levels are high or the temperature is very hot or cold.

Keep your diabetes under control

If you are diabetic, you have a greater risk of developing Coronary Heart Disease. If you have diabetes, being physically active and controlling your weight and blood pressure will help manage your blood sugar level. If you are diabetic, your target blood pressure level should be below 130/80mmHg.


Sometimes lifestyle changes aren't enough to control your blood pressure, cholesterol levels, or other Coronary Heart Disease risk factors. Your doctor also may prescribe medicines. For example, you may need medicines to:

  • Lower your LDL cholesterol
  • Lower your blood pressure
  • Lower your blood sugar level
  • Prevent blood clots and/or inflammation
Take your medicines as prescribed. Don't cut back on the dosage unless your doctor tells you to. If you have side effects or other problems related to your medicines, talk with your doctor. He or she may be able to provide other options.

You should still follow a heart healthy lifestyle, even if you take medicines to control your Coronary Heart Disease risk factors.

What types of surgery are used to treat Coronary Heart Disease?

Many patients can control Coronary Heart Disease with lifestyle changes and medication. Surgery may be recommended for patients who continue to have frequent or disabling angina despite the use of medications, or people who are found to have severe blockages in their coronary arteries.

Coronary angioplasty or balloon angioplasty

Coronary angioplasty or balloon angioplasty begins with a procedure similar to that described under angiography. However, the catheter positioned in the narrowed coronary artery has a tiny balloon at its tip. The balloon is inflated and deflated to stretch or break open the narrowing and improve the passage for blood flow. The balloon-tipped catheter is then removed.

Strictly speaking, angioplasty is not surgery. It is done while the patient is awake and may last 1 to 2 hours. If angioplasty does not widen the artery or if complications occur, bypass surgery may be needed.

Coronary artery bypass operation

In a coronary artery bypass operation, a blood vessel, usually taken from the leg or chest, is grafted onto the blocked artery, bypassing the blocked area. If more than one artery is blocked, a bypass can be done on each. The blood can then go around the obstruction to supply the heart with enough blood to relieve chest pain.

Bypass surgery relieves symptoms of heart disease but does not cure it. Usually you will need to make a number of changes in your lifestyle after the operation. If your normal lifestyle includes smoking, a high-fat diet, or no exercise, changes are advised.

Several experimental catheter-surgical procedures for unblocking coronary arteries are under study; their safety and effectiveness have not yet been established. They include:

  • Atherectomy, a procedure in which surgeons shave off thin strips of the plaque blocking the artery and remove these strips.
  • Laser angioplasty; instead of using a balloon to open up the blocked artery, doctors insert a catheter with a laser tip that burns or breaks down the plaque.
  • Insertion of a stent, a metal coil that can be permanently implanted in a narrowed part of an artery to keep it propped open.