Coronary heart disease (CHD), also known as coronary artery disease, is a condition where the small blood vessels supplying oxygen to the heart are narrowed.
CHD frequently leads to heart attacks and is the number one cause of death for males and females in the United States. Approximately 1.2 million people suffer from heart attacks annually in the United States and as many as 50% are fatal, so patient education is crucial.
Although these are good practices for any who want a healthy heart, patients who are at risk or who have experienced a heart attack are advised to do the following:
Doctors Who Treat CHD - Patient Education
The first physicians that will be caring for the patient are those that are intimately engaged in the individual's care and history already. These include:
- Family Practitioner (General practice) - This physician is involved in the daily general care of the patient, dealing with all organ systems of every age group in both preventive health and treatment of chronic medical conditions.
- Pediatrician - This doctor focuses on the health of infants, children and adolescents.
- Geriatrician - This physician specializes in the care of seniors and elders.
- Internist - Physician who deals with prevention and treatment of medical conditions among adults. In addition to helping diagnose and treat medical problems on a daily basis, the internist will refer patients
Once there is a suspicion of coronary heart disease, the following specialists may be recommended for your team:
- Interventional Cardiologist - This physician performs angiograms, catheter and stent insertions. One would be referred to this physician if a blood vessel leading to the heart or damage to the heart itself is suspected.
- Cardiologist - Physician in the branch of medicine dealing with the heart and vascular system. This doctor focuses on prevention and therapy of circulatory problems and blood vessel conditions along with the heart.
- Cardiothoracic Surgeon - Performs surgeries on heart, lungs, esophagus, diaphragm and blood vessels of the chest. Conditions include tumors, vessel repair or unblocking vessels, cancer, heart transplant, and valve repair.
- Endocrinologist - Focuses on the diagnosis and treatment of medical conditions involved with hormones and glands. Diabetes and thyroid dysfunction is associated with cardiac problems. The endocrinologist may monitor and control the level of cholesterol, which causes increased plaque formation in the blood vessels, or enlist the aid of a separate cholesterol specialist.
- Nutritionist - Dietician creates and manages the special diet plans as well as the appropriate vitamins and supplements to ensure the patient's health and prevent a progression of a medical condition.
- Physical Therapist - This is a healthcare provider that creates and executes exercises that help patients maintain and improve endurance, coordination, muscle strength and motor skills.
How to Prepare for Your Coronary Heart Disease Doctor Visit
When coronary heart disease is suspected in a patient, they will be sent for several tests and labs. An echocardiogram and a stress cardiogram are the common measures, however, for heart disease. To get the most accurate reading on the day of your exam, follow the patient education advice below.
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Echocardiogram |
Stress Echocardiogram |
| Preparatory Advice |
No special fasting required.
Wear loose, comfortable clothing from the waist up.
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Abstain from caffeine or non-prescribed drugs with caffeine for a full day.
Do not consume food or beverages for 4 hours prior to the exam.
Do not take the following medications for 24 hours prior to the test (clear with your physician):
- Beta Blockers
- Nitroglycerin
- Isosorbide dinitrate
- Isosorbide mononitrate
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If the patient wears a pacemaker, it is prudent to discuss this with the doctor prior to any exams for any specific advice.
Questions to Ask Your Doctor About Coronary Heart Disease
From your initial diagnosis throughout your treatment and care, you will have questions about your coronary heart disease. Our patient education guide lists important questions to discuss with your doctor so you can make informed decisions about your condition.
Questions About My Diagnosis
- What is causing my heart disease? Can I reverse it? Will it progress?
- What is my long-term prognosis?
- What symptoms should I be concerned about?
- Will my condition improve if I stop smoking and/or using alcohol?
Questions About My CHD Treatment
- Will I need surgery? What would happen if I didn't have it? What are the risks?
- What other treatment options are available?
- Can I be treated with a special diet and medications?
- What medications would treat me? What are their side effects?
- Can I take this medication with the drugs that I am currently on?
- Should I be taking a daily aspirin?
Questions About My Lifestyle and Family
- Is heart disease genetic?
- What can my family do to decrease the risk of CHD?
- What activities must I give up? Can I still have sex? Can I still work? Can I still drive?
- What diet should I be on?
- What exercise do you advise? Is there a rehabilitation program I should join?
Common Tests or Labs to Diagnose Coronary Heart Disease
There are several tests and labs used to diagnose coronary heart disease and monitor a patient's ongoing condition. Listed in this patient education guide are the most common tests and labs ordered, why patients need them, and what they can tell about your condition.
| Test Site |
Test Name |
What it Measures |
Normal Range |
| Chest/Torso |
Electrocardiogram (ECG, EKG) |
Records the heart's electrical activity.
Measuring:
- Rhythm
- Rate of beats
- Interval of beats and recovery
- Pattern of beats
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A normal EKG is a pattern with a P wave followed by a QRS wave, with an interval rest period whereupon the pattern recurs. P wave rate = 60-100 bpm
P height < 2.5 mm in lead II
P width < .11 in lead II
PR interval= .12-.20 s
QRS complex < .12 s
Normal ST segment= no elevation or depression
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| Torso/Legs |
Stress Test |
Follows the heart and lung reactions during exercise.
Measures:
- Abnormal change in rhythm, rate, pattern
- Abnormal blood pressure
- Chest Pain
- Shortness of Breath
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Normal blood pressure is 120/80 with a high reading of 140/90.
Normal EKG readings as above.
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| Chest/Torso |
Chest X-Ray |
Visualizes the lungs, heart and blood vessels, looking for masses, obstructions, abnormal sizes.
Heart failure can be detected.
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No narrowing or obstruction of blood vessels.
No tumors/masses
Consistent blood flow
Proper filling of atria and ventricles
Clear lungs with proper inflation
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| Chest/Torso |
Electron-Beam Computed Tomography (EBCT) |
Measures calcium deposits and plaque inside cardiac arteries.
- Test not routinely done
- Accuracy unknown
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No plaque formation in blood vessels with normal flow |
| Blood |
Screening and Diagnostic Blood tests |
(CRP) C-Reactive Protein is a good predictor of: heart attack, Stroke, Sudden death
Low risk= 1-3 mg/L
High risk= > 3 mg/L
Homocysteine (used to make protein)
Cholesterol Panel: Low-density lipoprotein (the "bad" cholesterol)
(HDL) High-density lipoprotein (the good type)
Triglycerides
Fibrinogen
(CBC) complete blood count
Hemoglobin
Hematocrit
WBC
RBC
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CRP C-Reactive Protein
Normal =<1 mg/L
Homocysteine:
Normal = 4.4-10.8
micromoles/L
Cholesterol Panel:
Total Cholesterol=<200 mg/dL
LDL<130 mg/dL
HDL>60 mg/dL
Triglycerides<150 mg/dL
Fibrinogen= 200-400 mg/L
CBC (complete blood count)
Hemoglobin
Men: 13-18 gm/dL
Women: 12-17 gm/dL
Hematocrit
Men: 45-52
Women: 37-48
WBC= 4300-10,800 cmm
RBC= 4.2-5.9 million cells/cubic millimeter
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| Blood/Chest |
Angiogram, Cardiac Catheterization |
Dye is injected through a tube (catheter) into your blood stream after being threaded into the coronary arteries.
X-rays are then taken to visualize the inside of the cardiac arteries.
Obstructions are diagnosed or ruled out.
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No obstruction or narrowing seen in the blood vessels visualized
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Common Medications and Treatments - Coronary Heart Disease
Lifestyle changes are recommended to any patient who has coronary heart disease, but sometimes medications and/or surgery is also necessary to prevent heart attacks or further heart damage. Read more in this patient education guide.
Medications
| Drug Category |
What it does |
| Diuretics (Water pill) |
- Lowers blood pressure
- Treats Congestive Heart Failure
- Rids body of excess fluids
- Rids excess salt through urination
|
| Aspirin |
- Inhibits arterial blood clots
- Decreases heart attack and stroke risk
|
| Statins |
Lowers cholesterol |
| Nitrates |
- Enhances blood to the heart
- Stops Chest Pain
|
| Beta-Blockers |
Decreases:
- Heart rate
- Blood Pressure
- Oxygen demands
- Arrhythmia risk (abnormal rhythm)
|
|
Calcium channel Blockers
|
- Relaxes arteries
- Lowers blood pressure
- Decreases heart strain
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| ACE inhibitors |
Lowers blood pressure by inhibiting the enzyme causing blood vessel narrowing
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Surgical Procedures
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What Is It |
Benefits |
Risks |
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Angioplasty/Stent Insertion
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Procedure that opens narrowed or blocked coronary arteries by feeding a balloon catheter into the blockage and then inflating the balloon to open the blood vessel and allow for proper blood flow. This is followed by placing a small tube (usually metal mesh) inside to prevent the vessels from closing again. There are stents with embedded medicine that aids to prevent the artery from closing.
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Markedly improves blood flow to the heart
May prevent the need for coronary artery bypass surgery
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Blood Clots
Valve or vessel damage
Heart attack Stroke (rare)
Kidney failure (for those who have kidney problems)
Allergic reaction to stents, drugs within the stent or dyes
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Coronary Artery Bypass
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Surgical procedure where arteries and veins (usually the legs) are grafted to the coronary arteries, bypassing the plaques or narrowing segments to increase blood flow to the heart muscle.
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Alleviates chest pain
Rescues someone having a heart attack
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Brain damage
Heart attack
Stroke
Arrhythmia (abnormal heart rhythm)
Blood clots
Infection (of chest, lungs, urinary tract, site of vessel retrieval)
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Minimally Invasive Heart Bypass
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Procedure designed for those suffering from angina (chest pain) due to blockage in one or two coronary arteries in the front of the heart. In this procedure, the chest incision is smaller and the vessel for use comes from the chest itself. Unlike the coronary artery bypass above, it is not necessary to place a person on a heart-lung machine.
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Alleviates chest pain
Less risk to individual than coronary artery bypass
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Heart attack
Stroke
Blood loss
Blood clots
Infection of chest incision and surgery site
Low-grade fever
Chest pain from surgery
Memory loss
Arrhythmia (abnormal heart rhythms)
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