CARE GUIDE Coronary Heart Disease

Coronary Heart Disease

Coronary heart disease (CHD), also known as coronary artery disease, is a condition where the blood vessels supplying oxygen to your heart become narrow. The cause of the narrowing is a buildup of a waxy substance made inside the arteries, called plaque. Plaque is a combination of cholesterol and fatty deposits. The buildup of plaque—called atherosclerosis or hardening of the arteries—is a gradual process that occurs over many years.

Narrowing of coronary arteries can cause chest pain (angina). If a plaque breaks open, a blood clot may form over the plaque and completely block blood flow. This can cause a heart attack. CHD frequently leads to heart attacks and is the No. 1 cause of death for males and females in the United States. About 790,000 people have a heart attack each year in the United States, and about 114,000 attacks are fatal.

CHD can cause your heartbeat to become irregular, a condition known as arrhythmia. It can also cause a gradual weakening of your heart, called heart failure. Heart failure means your heart can’t pump enough blood to your body. Symptoms include swelling in your legs, fatigue, and shortness of breath.

Men develop CHD more often than women. Other factors that increase your risk for CHD include being older than 65 or having a family history of the disease. You can't control these risk factors, but there are others that you can control. You should:

  • Stop smoking
  • Avoid excess salt in your diet
  • Maintain a normal blood sugar level (if you are diabetic)
  • Follow a heart-healthy diet—one that is low in cholesterol and saturated fat
  • Avoid trans fats
  • Exercise regularly
  • Strive to maintain a healthy weight

Doctors and Specialists

Care and treatment for CHD usually starts with your primary care doctor. Depending on your age and medical condition, this doctor may be a:

  • Family or general practitioner: This physician sees patients of all ages for both preventive health and treatment of chronic medical conditions.
  • Pediatrician: This doctor focuses on the health of infants, children and teens.
  • Geriatrician: This physician specializes in the care of seniors and the elderly.
  • Internist: This doctor handles prevention and treatment of medical conditions in adults.

You also may be referred to one or more specialists for further treatment, such as a:

  • Cardiologist: This doctor specializes in conditions of the heart and vascular system, including prevention and treatment of circulatory problems, blood vessel conditions and heart disease.
  • Interventional cardiologist: You may be referred to this doctor if there’s suspected damage to a blood vessel leading to your heart or to the heart itself. Procedures this physician may do include angiograms and catheter and stent insertions.
  • Cardiothoracic surgeon: This surgeon operates on the heart, lungs, esophagus, diaphragm and blood vessels of the chest. Cardiothoracic surgeons see patients with tumors or cancer and those who need vessel and valve repair or a heart transplant.
  • Endocrinologist: This doctor focuses on the diagnosis and treatment of medical conditions affecting your hormones and glands. Diabetes and thyroid dysfunction are endocrine problems often associated with cardiac problems. An endocrinologist may monitor and control your cholesterol levels, which can cause increased plaque formation in your blood vessels, or enlist the aid of a separate cholesterol specialist.
  • Nutritionist: This provider creates and manages specialized diet plans and supplement recommendations to help you make any needed changes to help protect the health of your heart.
  • Physical therapist: This provider creates specialized exercise plans to help you maintain and improve endurance, coordination, muscle strength and motor skills.

Preparing for Your Appointment

If your doctor thinks you may have CHD, you will probably have several diagnostic tests. An echocardiogram and a stress cardiogram are the most common ones. Here’s how to prepare for them:

Echocardiogram: Wear loose, comfortable clothing from the waist up.

Stress cardiogram:

  • Abstain from caffeine for a full day before your appointment.
  • Do not consume food or beverages for four hours before the exam.
  • Do not take the following medications for 24 hours before the test: beta blockers, nitroglycerin, isosorbide dinitrate, isosorbide mononitrate.
  • If you wear a pacemaker, ask your doctor if there are any precautions you should take.

Whether your appointment is before or after a heart attack, you’ll probably have questions for your doctor. Review this list of common concerns before your visit, or print it out to take with you.

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 or using alcohol?

Post-heart attack:

  • What symptoms warrant contacting emergency services?
  • How severe was the heart attack?
  • What complications am I at risk for?
  • What are the chances of a repeat attack?

Questions About My CHD Treatment

  • Will I need surgery? What would happen if I didn’t have it? What are the risks?
  • Are other treatment options available?
  • Can I be treated with a special diet and medications?
  • What medications will I need to take? What are their side effects?
  • Can I take this medication with the drugs that I am currently on?
  • Should I be taking a daily low-dose aspirin?

Post-heart attack:

  • What can I do to prevent having another heart attack?
  • What medications will I need to take? Will I need to take these for the rest of my life?
  • What are the side effects of the medications?
  • Should I be taking a daily low-dose aspirin along with other medications?

Questions About My Lifestyle and Family

  • Is heart disease genetic?
  • What can my family do to decrease their chances of developing CHD?
  • Should I give up certain activities? 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?

Post-heart attack:

  • When can I resume daily activities? When can I go back to work?
  • Do I need an alert button system to contact emergency services?
  • What exercises do you recommend?
  • Should the exercises be done in a cardiac rehabilitation gym and monitored? Can I go to a regular gym for exercise?
  • Is it safe for me to exercise on my own?
  • Are there exercises and activities I should not do? Can I have sex?
  • Are there dietary restrictions? Can I drink alcohol?
  • How often will I need to be evaluated?

Tests and Diagnosis

Diagnosing CHD starts with a physical exam and a review of your symptoms and risk factors. Your doctor will use several tests to diagnose and monitor your condition. These are the most common ones:

  • Electrocardiogram (ECG, EKG): Records your heart’s electrical activity, including rhythm, rate of beats, interval of beats and recovery, and pattern of beats.
  • Stress test: Measures how your heart and lungs respond to exercise, including abnormal changes in your heart's rhythm, rate and pattern; abnormal blood pressure; chest pain; and shortness of breath.
  • Chest X-ray: Looks for abnormalities and obstructions in the lungs, heart and blood vessels. Can detect heart failure.
  • Echocardiogram: Uses sound waves to create a moving image of your heart. Can tell the size of your heart and how well it is pumping.
  • Blood tests: Measure factors that can contribute to your risk for CHD, such as: C-reactive protein, which indicates inflammation; blood sugar, which tells if diabetes may be contributing to your CHD risk; and blood lipids, which are fatty substances in blood that can lead to atherosclerosis.
  • Angiogram and cardiac catheterization: Can identify obstructions or narrowing in your arteries. A dye is injected into your coronary arteries through a thin, flexible tube (called a catheter). X-rays then can reveal any narrowing or blockage.

Medications and Treatment

Lifestyle changes are recommended to anyone who has heart disease, but sometimes medication and surgery are necessary to prevent a heart attack or further heart damage.

Suggested lifestyle changes may include:

  • Eating a more heart-healthy diet.
  • Limiting alcohol.
  • Maintaining a healthy weight.
  • Getting regular exercise.
  • Reducing stress.
  • Not smoking.

If you have angina, had a recent heart attack or have had a procedure or surgery for CHD, your treatment may include cardiac rehabilitation. This involves education and training about lifestyle factors to reduce your risk for CHD. You would work with a team of health care providers in a cardiac rehabilitation program designed for you.

Medications you may be prescribed include:


  • Lower blood pressure
  • Treat congestive heart failure
  • Rid your body of excess fluids
  • Rid your body of excess salt through urination


  • Reduces the risk of arterial blood clots
  • Decreases heart attack and stroke risk


  • Lowers cholesterol


  • Increases blood flow to the heart
  • Stops chest pain

Beta blockers


  • Heart rate
  • Blood pressure
  • Oxygen demands
  • Arrhythmia risk

Calcium channel blockers

  • Relaxes arteries
  • Lowers blood pressure
  • Decreases heart strain

ACE inhibitors and angiotensin receptor blockers (ARBs)

  • Lowers blood pressure by inhibiting blood vessel narrowing

Angioplasty With Stent Insertion

  • What it is: Procedure that opens narrowed or blocked coronary arteries by feeding a balloon into the blockage and then inflating it to open the blood vessel and allow for proper blood flow. This is followed by placing a small tube (stent) inside the blood vessel to keep it from closing again. Some stents contain medicine that helps keep the artery from closing.
  • Benefits: Improves blood flow to the heart; may prevent the need for coronary artery bypass surgery.
  • Risks: Blood clots, valve or vessel damage, heart attack, stroke (rare), kidney failure in those with kidney problems and allergic reaction to the stent, to drugs in the stent or to X-ray dye.

Coronary Artery Bypass

  • What it is: Surgical procedure that involves grafting arteries and veins (usually in the legs) to coronary arteries to increase blood flow to the heart muscle.
  • Benefits: Alleviates chest pain; rescues someone having a heart attack.
  • Risks: Brain damage, heart attack, stroke, arrhythmia, blood clots and infection of the chest, lungs or urinary tract.

Minimally Invasive Heart Bypass

  • What it is: Procedure designed for those with angina (chest pain) caused by blockage in one or two coronary arteries in the front of the heart. The procedure requires only a small chest incision. Also, unlike a coronary artery bypass, the patient does not need to be placed on a heart-lung machine.
  • Benefits: Alleviates chest pain; less risk than standard coronary artery bypass.
  • Risks: Heart attack, stroke, blood loss, blood clots, infection at chest incision site, low-grade fever, chest pain from surgery, memory loss and arrhythmia

CHD can lead to heart failure. Two medications approved in 2015 for certain types of heart failure are:

  • Corlanor (ivabradine), an oral drug taken twice a day, works by slowing down the heart. This reduces the amount of blood the heart needs. Corlanor may be added to a beta-blocker to reduce the risk of hospitalization in patients with a certain type of heart failure who do not have an arrhythmia and have a resting heart rate of 70 beats a minute or greater.
  • Entresto (sacubitril/valsartan), an oral drug taken twice a day, works by relaxing blood vessels, increasing blood flow and decreasing stress on the heart. It may be used in place of an ACE inhibitor or ARB for a certain type of heart failure.

To further lower high cholesterol in some people with CHD:

Statin drugs are an important treatment for lowering low-density lipoprotein (LDL) cholesterol—the bad type—and for reducing the risk for heart attack in people who have CHD. However, some people with CHD cannot adequately lower their LDL cholesterol with a statin.

Two drugs were approved in 2015 for people with CHD who require additional lowering of their LDL cholesterol despite being on the maximum tolerated dosage of a statin. Both are man-made antibodies that clear LDL cholesterol from your blood.

  • Praluent (alirocumab) is given by injection under the skin once every two weeks.
  • Repatha (evolocumab) is given by injection under the skin once every two weeks or once a month.

10 Things to Know About CHD

  1. Coronary heart disease goes by other names, too: coronary artery disease and hardening of the arteries. It's the No. 1 cause of death for both men and women.
  2. Atherosclerosis, the cause of CHD, is itself caused by the slow accumulation of plaque inside coronary arteries. Plaque is made from cholesterol and fatty substances. It hardens and over time narrows your arteries.
  3. Chest pain can be a sign of atherosclerosis. As plaque begins to block blood flow through an artery, the heart doesn't get the supply of blood that it needs. You feel that pain. Over time, a decreased blood supply may cause arrhythmias and heart failure.
  4. If a plaque breaks open, a blood clot may form over the plaque and cut off all blood flow through the artery. This may cause a heart attack.
  5. Anyone can develop CHD, and at any age. Plaque buildup can start in childhood or teen years but not be detected or cause problems until much later. CHD is more common in men than women. People older than 65 and those with a family history of CHD also have a higher risk.
  6. You can reduce your risk for CHD by eating a heart-healthy diet, getting regular exercise, maintaining a healthy weight and not smoking.
  7. Chest pain, called angina, is the most common symptom of CHD. It usually feels like pressure or squeezing in your chest. Sometimes it's mistaken for indigestion. Shortness of breath is another common symptom. Some people, though, have no symptoms and discover they have CHD only after a heart attack or a diagnosis of heart failure or arrhythmia.
  8. There are many treatment options for CHD. The best treatment for you will depend on your symptoms and the severity of your condition. Options include lifestyle changes to lower your risk factors, medications, medical procedures, and surgery.
  9. A treatment program known as cardiac rehabilitation is often prescribed for people who have angina and those who've had a heart attack, or a recent procedure or surgery for CHD. Cardiac rehabilitation includes teaching and training on diet, exercise, and stress reduction.
  10. Adapting a heart-healthy lifestyle and working with your doctor to find the best treatment for CHD can lower your risk for a heart attack and other complications from CHD.