CORONARY HEART DISEASE

You can have the disease and not have any symptoms. However, symptoms may be very noticeable in some cases. 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. 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.
• shortness of breath
• fatigue with activity (exertion).
• General weakness

DIAGNOSIS

Your doctor will diagnose coronary heart disease (CHD) based on your

• medical and family histories
•  risk factors for CHD
• physical exam
• and the results from tests and procedures.

No single test can diagnose CHD. If your doctor thinks you have CHD, he or she may recommend one or more of the following tests.

EKG (Electrocardiogram)

An EKG is a simple and painless test that detects and records the heart’s electrical activity. It shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through the heart.

An EKG can show signs of heart damage due to CHD and signs of a previous or current heart attack.

Stress Testing

You exercise during stress testing. This makes your heart work hard and beat fast while heart tests are done. You may be given medicine to raise your heart rate if you can’t exercise. As part of some stress tests, pictures are taken of your heart while you exercise and while you rest.These imaging stress tests can show how well blood is flowing in your heart and how well your heart pumps blood when it beats.

A stress test can show possible signs and symptoms of CHD, such as:

• Abnormal changes in your heart rate or blood pressure
• Shortness of breath or chest pain
• Abnormal changes in your heart rhythm or your heart’s electrical activity

Echocardiography

Echocardiography (echo) uses sound waves to create a moving picture of your heart. The picture shows the size and shape of your heart and how well your heart chambers and valves are working. Echo also can show areas of poor blood flow to the heart, areas of heart muscle that aren’t contracting normally, and previous injury to the heart muscle caused by poor blood flow.

Chest X Ray

A chest x ray takes pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels. A chest x ray can reveal signs of heart failure, as well as lung disorders and other causes of symptoms not related to CHD.

Blood Tests

Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels might be a sign that you’re at risk for CHD.

Coronary Angiography and Cardiac Catheterization

Your doctor may recommend coronary angiography (an-jee-OG-rah-fee) if other tests or factors show that you’re likely to have CHD. This test uses dye and special x rays to show the insides of your coronary arteries. Special x rays are taken while the dye is flowing through your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels.

To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization. A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream.

TREATMENT

You may be asked to take one or more medicines to treat blood pressure, diabetes, or high cholesterol levels. Follow your health care provider’s directions closely to help prevent coronary artery disease from getting worse.

• The most commonly used blood pressure target for people with heart disease is below 140/90 mm Hg, but sometimes less than 130/80. If you have diabetes, your HbA1c levels will be monitored and brought down to the level your provider recommends.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 or what to do when you have chest pain. You should be active when you have heart disease and eating a heart-healthy diet
• 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)
• Coronary artery bypass surgery
• Minimally invasive heart surgery