Coronary heart disease (CHD)

Coronary heart disease - symptoms, causes and treatment

As cardiovascular disease, coronary heart disease (CHD) is one of the most frequent causes of death in the industrialized nations. The chronic disease is one of the so-called "common diseases" in Germany and their occurrence increases with age. In most cases, a constriction of the coronary arteries is the cause. An ensuing oxygen deficiency of the heart leads to discomfort and heart damage, which can be life threatening. The disease persists for a lifetime, but with targeted treatment, a good long-term good condition can be achieved. Several risk factors favor the development of CHD. Early prevention plays an important role in this context.

contents

• Coronary heart disease - symptoms, causes and treatment
• A short overview
• definition
• symptoms
• causes
• diagnosis
• treatment
• Naturopathic treatment
• Current state of research

A short overview

Before the detailed description of the clinical picture, the most important symptoms and risk factors are listed in the following overview. Because knowing about the presence of the disease and proper behavior in an emergency can save lives.

The main symptom of coronary heart disease is angina pectoris, a seizure-like chestwash with chest pain that can also radiate. (Image: sasinparaksa / fotolia.com)

How to recognize a coronary heart disease?

Although it is a serious, chronic disease, it does not cause long-term discomfort and does not affect every individual. In the course of the disease, however, it can always come to different degrees of symptoms, usually in stressful and stressful situations.

Mainly angina pectoris occurs. It comes to seizure-like tightness and pain in the chest, which can also radiate in the neck, jaw, arms or upper abdomen and often cause fear of death. Furthermore, non-specific symptoms such as:

• Shortness of breath (dyspnoea),
• Drop in blood pressure (hypotension),
• Palpitations (tachycardia),
• Facial paleness and paleness,
• Sweats ("cold sweat"),
• nausea.

Risk Factors - How to Prevent?

For arteriosclerosis (arteriosclerosis), the main cause of coronary heart disease, several risk factors have been proven, some of which can be influenced by those affected:

• Age (increasing),
• Gender Male),
• heredity,
• Smoke,
• lack of exercise,
• Strong overweight (obesity),
• increased blood lipids (triglycerides),
• elevated cholesterol level (hypercholesterolemia),
• Diabetes mellitus,
• High blood pressure (hypertension),
• mental stress (stress, depression).

In prevention, a balanced and healthy diet and sufficient physical activity play a central role. Even abstaining from nicotine and alcohol reduces the risk of illness.

What to do in an emergency?

The severity of the disease depends on how strong the vascular constrictions are and which vessels or vascular sites are affected. In the course of the disease, there are risks of serious and life-threatening sequelae such as a heart attack (myocardial infarction). Contrary to the chronic underlying illness one speaks in life-threatening situations also of an acute coronary syndrome.

If the condition is known, medical advice should be sought on what to do in the event of an emergency. The relatives should also be informed and it is advisable to carry written information with them, so that even strangers in an emergency situation gain knowledge about the present illness.

An emergency is when the above symptoms are very severe and last longer or occur at rest. First choice is then a nitro-spray or a nitro-capsule as a fast-acting emergency drug. Furthermore, the rescue service should be called immediately.

In the course of the disease of the CHD can lead to emergencies and life-threatening sequelae, such as a heart attack. (Image: benjaminnolte / fotolia.com)

definition

Coronary artery disease is also referred to as ischemic heart disease because the disease is most often caused by reduced blood flow (ischemia) of the heart due to constricted coronary arteries. As the name implies, these vessels lie around the heart like a wreath, providing it with blood and the oxygen it carries. Fat and other deposits (plaques) on the inner walls of these arterial vessels lead to a narrowing, so that the blood supply to the heart is impaired. This is referred to as arteriosclerosis (atherosclerosis), the most common form of arteriosclerosis. According to this cause, CHD is defined as a manifestation of arteriosclerosis on the coronary arteries. There are also other definitions that relate to other possible causes.

symptoms

Complaints do not always occur and not with the same intensity. At onset of illness, symptoms often occur only under exercise and increased oxygen demand of the heart. With a progression of the disease or the vasoconstriction, the symptoms are then increasingly increased.

The main symptom, and usually the main complaint, is the angina pectoris caused by circulatory disturbance of the heart. This so-called "chest tightness" is usually accompanied by an episodic pain in the chest. The symptoms may also radiate to other areas (neck, jaw, arms and upper abdomen) and cause a feeling of tightness and dread.

The coronary arteries affected by illness are no longer able to supply the heart with sufficient blood and oxygen. (Image: Henrie / fotolia.com)

The symptoms of angina pectoris distinguish between a stable and unstable form. A stable angina pectoris exists when the patient's complaints are regularly caused by a specific physical or mental stress, last only briefly and improve again at rest or the drug nitroglycerine provides a rapid relief. According to the Canadian Cardiovascular Society, four different grades of stable angina pectoris are also differentiated depending on the individual exercise tolerance.

On the other hand, unstable angina pectoris is characterized by seizures that also occur at rest and become more frequent, longer, and more severe. This form is associated with an acute coronary syndrome and represents an immediate threat to life for the patients.

Disease symptoms may also be completely absent (asymptomatic CHD) or it may show rather nonspecific complaints, such as:

• Shortness of breath (dyspnoea),
• Drop in blood pressure (hypotension),
• Palpitations (tachycardia),
• Facial and skin blotches,
• Sweats ("cold sweat"),
• nausea.

Cardiac arrhythmias and gradual cardiac insufficiency (heart failure) are known to be serious sequelae of coronary heart disease leading to deficient supply of blood to the whole organism. Signs include shortness of breath, decreased exercise capacity, water retention in the arms and legs and frequent nocturnal urination (nocturia). It can also cause a heart attack (myocardial infarction) or sudden cardiac death.

In arteriosclerosis (arteriosclerosis), the main cause of CHD, deposits (plaques) form on the inner arterial walls, which lead to narrowing and thus to reduced blood flow. (Image: Axel Kock / fotolia.com)

causes

In most cases, several causes are responsible for the development of CHD. The main cause of coronary heart disease is atherosclerosis or arteriosclerosis, although other causes usually occur in combination with arteriosclerosis. The dangerous constriction of blood vessels in arteriosclerosis is caused by inflammatory processes that leave scarring on the damaged vessel walls with deposits of proteins, blood lipids and calcium particles. This process also takes place in other parts of the body, but the heart is often affected at an early stage.

risk factors

For atherosclerosis, there are a number of risk factors that differ in whether they are influenced or not.
Factors that can not be influenced are increasing age, gender and heredity. In Germany, about 7 percent of women and about 10 percent of men fall ill with CHD during their lifetime. Hereditary risk refers to the occurrence of vasoconstriction in first-degree relatives (male before age 55, female before age 65).

However, the following factors that increase the risk of CHD can be influenced or treated:

• Smoke,
• lack of exercise,
• severe overweight (obesity) due to wrong and unhealthy diet,
• increased blood lipids (triglycerides) due to a disorder of lipid metabolism (hyperlipidemia),
• elevated cholesterol level (hypercholesterolemia),
• Diabetes mellitus,
• High blood pressure (hypertension),
• mental stress (stress, depression),
• elevated levels of homocysteine ​​or lipoprotein (rare and still unclear).

Risk factors of an unhealthy lifestyle, such as smoking, obesity and lack of exercise, favor the development of coronary heart disease. (Image: Vadym / fotolia.com)

Preventing the above risks and their consequences is very important for disease prevention. Preventive measures for a CHD are therefore closely linked to the clinical picture of arteriosclerosis.

diagnosis

Important information for medical diagnostics is provided first by the patient survey (anamnesis). This should include possible pre-existing conditions (especially diabetes mellitus), drug intake, lifestyle habits (diet, nicotine and alcohol consumption, exercise, stress and other stressful situations), risk factors and the exact symptoms.

This is followed by a general physical examination (including height, weight, blood pressure, heart sound) and usually a blood test to rule out other causes of a present chest pain. If the laboratory results of the blood sample detect specific enzymes (for example, troponin), cardiac perfusion of the heart and cardiac muscle cells are likely to be suspected.

In the primary care examination, the personal risk of coronary heart disease should be recorded as precisely as possible. Following the principle of the "Marburg Heart Score", five characteristics are queried according to a simple point system. The score from zero to five indicates the probability of having a CHD, where a high score is equivalent to a high probability.

Using the points system of the so-called "Marburg Heart Score", physicians can determine the probability of a present CHD. (Image: bsd555 / fotolia.com, own editing heilpraxis.de)

If the initial suspicion of coronary heart disease is close, additional cardiological examinations are usually initiated.

Electrocardiogram (ECG)

By means of an electrocardiogram, the activity of the heart is recorded via electrodes. Results of the so-called ECG curve provide information about cardiac rhythm and heart rate, and it is possible to make indirect statements about the present heart structure and its changes. There are three forms in this study: the resting ECG, the exercise ECG, and the long-term ECG. For the diagnosis of coronary heart disease, a resting ECG is especially important. However, a KHK does not rule out a normal result.

Heart ultrasound (echocardiography)

The ultrasound exam focuses on the nature and function of the heart. The heart chambers, the left heart muscle wall and possible disturbances in structure and function can be easily recognized. With this examination, in rest or stress condition, the heart and possible circulatory disturbances can be accurately evaluated. Other heart diseases, which are often in addition to coronary heart disease, can be detected.

If the results of this study indicate a high probability of CHD, ie the personal risk is greater than 85 percent, treatment should be started immediately. If the estimated risk is lower (15 to 85 percent), further examinations should be performed for a final diagnosis. Possible methods used here include myocardial scintigraphy (visualization of the cardiac perfusion), magnetic resonance imaging (MRI) and computed tomography (CT coronary angiography). The latter method is an equivalent and less risky alternative to the invasive cardiac catheter in diagnostics, but is not always used.

When making the diagnosis cardiological examinations such as the electrocardiogram usually take place. Important statements on heart rhythm and heart rate help to determine the exact causes. (Photo: Evgeniy Kalinovskiy / fotolia.com)

Is a heart catheter necessary?

Examination with a cardiac catheter involves risks. In certain cases, a cardiac catheterization study may be important to plan further treatment steps or, if appropriate, to perform a treatment at the same time. It is not necessary in every case. A detailed explanation of the individual treatment options should be given before the decision for or against a cardiac catheterization is made. In general, a heart catheter is not necessary if surgery is ruled out or an exclusively drug treatment is sought.

treatment

A chronic coronary heart disease can not be cured. But it is possible to alleviate the symptoms with appropriate treatment, to prevent complications and to extend life. The primary goal is to relieve the heart and improve blood circulation. Every treatment should be based on a healthy lifestyle. A balanced and low-fat diet, sufficient exercise, abstinence from smoking and the least possible stress prevent not only arteriosclerosis and thus a CHD, but provide the basis for a good treatment success and alleviation of discomfort.

In addition, medications are an integral part of the treatment, either alone or in combination with so-called stents or a bypass operation.

drugs

Regardless of whether complaints are present or not usually two drugs are used. So-called platelet inhibitors (platelet aggregation inhibitors) prevent deposits of platelets in the coronary vessels and cholesterol-lowering drugs (statins) have a favorable effect on the blood lipid levels and thus reduce the formation of plaques in the vessels. The use of these drugs has been shown to lower the risk of heart attack or cardiac death in CHD. In addition, some patients use antihypertensive agents such as beta-blockers, sartans or ACE inhibitors.

If medication is not sufficient for the treatment, stents may be used to keep the blood vessels open. (Image: crevis / fotolia.com)

There are also medications (nitrates) that immediately relieve acute discomfort by dilating blood vessels and thereby improving the blood supply to the heart. These are usually available in the form of nitro-spray or as a nitro-capsule and should be used immediately in case of an anginal attack.

If the symptoms persist despite taking these medications, stents or a bypass operation may be appropriate. Which approach is more appropriate depends mainly on comorbidities and the extent of vasoconstriction.

stents

Stents are thin wire mesh support tubes designed to keep narrowed blood vessels open for better blood flow. A guiding catheter is used to advance a stent into the coronary artery and place it at the narrowed site. In any case, stents should be associated with the use of appropriate medication to reduce the risk of heart attack and increase life expectancy. Should an emergency occur, such as a heart attack, stents are often used in this situation.

Bypass surgery

The word "bypass" in English means "bypassing" and describes how in open heart surgery narrowed blood vessels are bridged with the body's own tissue (veins or arteries). It has been proven that a bypass operation usually relieves the symptoms more persistently than stents. However, surgery is associated with higher risks and the recovery time needed is longer in most cases. After the operation, medication must be taken permanently.

Naturopathic treatment

In addition to the classic treatment of coronary heart disease mentioned above, natural remedies can also be used to support and support them. Alternative therapies focus primarily on the treatment of arteriosclerosis. Since the disease usually causes symptoms only at an advanced stage, prevention is of particular importance. If one or more of the risk factors listed above are known, the affected persons (independently or under naturopathic guidance) should adjust their diet and lifestyle accordingly. Naturopathy offers nutritional concepts and exercise therapies.

Depending on the risk factors, preventive measures play an important role in preventing illness. A healthy lifestyle with lots of exercise and balanced nutrition is essential. (Image: Kzenon / fotolia.com)

In the naturopathic practice, the face, eye or dark field diagnostics can provide additional information about the state of health and be taken into account in the treatment. Numerous possibilities of naturopathy are also available, for example, to achieve a general strengthening of the constitution and to regulate the cardiovascular function. These methods can not replace the conventional drug treatment, but effectively support.

In the case of medicinal plants, garlic is used in the prevention because it lowers the fat level and leads to vascular dilation. Also hawthorn (Crataegi folia) is often used in alternative therapy to expand the coronary vessels and improve cardiac output. In homeopathy, mostly constitutional and complex remedies are administered to relieve pain and cramps. In angina pectoris and coronary cramps, bishop's cabbage (Ammi visnaga), also called Khella, a component.

Also Schüßler salts are repeatedly used for complementary therapy in the KHK. In addition, relaxation methods can help relieve stress and can help anxiety-relieving heart patients.

Current state of research

To date, the understanding of the complex emergence of atherosclerosis is inadequate and also the defined risk factors are not comprehensive enough. In addition to the already known risks, there are, together with certain genetic conditions, other disease-causing factors. Also, for example, infections and pathogenic environmental toxins have not been sufficiently considered in the cause research.

According to a new theory, the previous doctrine of atherosclerosis is called into question. Professor Haverich, Director of the Clinic for Cardiac, Thoracic, Transplantation and Vascular Surgery of the Hannover Medical School (MHH), is convinced that the fatty deposits are not from the blood, but are remnants of dead cells of the vessel wall. In an article in the journal "Circulation", he shares his view and states that artery wall disorders lead to deposits in the inner wall of the vessel and trigger arteriosclerosis, which in most cases is the cause of coronary heart disease. (jvs, cs; Updated on 08/10/2018)

To read more:
Patient Guide to the National Care Guideline (NVL) Chronic Coronary Artery Disease: KHK (2017)