coronary heart disease
Meaning of coronary heart disease: Narrowed heart arteries starve the muscle of blood, causing chest pain on effort and, when one blocks, a heart attack.
Definition of coronary heart disease
Coronary heart disease is narrowing of the arteries that supply the heart muscle with blood, almost always caused by fatty plaque building up inside their walls. When the supply falls short of what the muscle needs, chest pain or breathlessness follows, typically brought on by exertion. A plaque that ruptures can block the artery outright and cause a heart attack.
How does the narrowing develop?
Two coronary arteries branch off the aorta and run across the surface of the heart, sending smaller vessels down into the muscle. Damage to the smooth inner lining lets cholesterol-carrying particles enter the wall. White cells follow, swallow the fat and become trapped, and a plaque forms: a fatty core beneath a fibrous cap. This is atherosclerosis, and it builds silently over decades. A plaque narrows the channel gradually, but the dangerous event is abrupt. If the cap tears, the exposed contents set off a clot, and that clot can seal the artery within minutes.
What does it feel like?
The classic symptom is angina: a heavy, tight or squeezing discomfort behind the breastbone, sometimes spreading to the jaw, neck or left arm, brought on by exertion or emotion and easing with rest. Breathlessness may appear instead of pain, particularly in older people and in people with diabetes, whose nerves may not carry the signal normally. Pain that arrives at rest, lasts longer or is worse than usual signals that the situation has changed. Some people have no symptoms at all until a heart attack occurs.
What raises the risk?
| Risk factor | Can it be changed |
|---|---|
| Smoking | Yes |
| Raised blood pressure | Yes |
| Raised cholesterol | Yes |
| Diabetes and obesity | Yes |
| Physical inactivity | Yes |
| Age, sex and family history | No |
Raised cholesterol matters through the particles that carry it into the artery wall. Risk factors multiply rather than simply add, so several modest ones together weigh more heavily than one large one alone.
How is it treated?
Treatment works on three fronts: reducing the factors driving the disease, relieving symptoms, and restoring blood flow where a narrowing is severe. Medicines lower cholesterol and blood pressure, slow the heart so it needs less oxygen, and make clotting less likely. Flow can be restored by threading a balloon and a small metal scaffold into the narrowed segment, or by coronary artery bypass, which grafts a vessel from elsewhere around the blockage. Muscle already lost in a heart attack does not grow back, and losing enough of it leaves the heart pumping poorly.
Also known as
Used in a sentence
The referral cited exertional chest pain and a family history of coronary heart disease.
Good to know
Chest discomfort is the classic sign, but breathlessness alone or no symptom at all is common in older people and in those with diabetes, so absence of pain does not exclude the disease.
Word origin
Where “coronary heart disease” comes from
Coronary comes from the Latin corona, meaning crown, because the arteries encircle the heart in the manner of a crown.