Symptoms and life expectancy of CHD

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What is Coronary Artery Disease?

The heart pumps blood throughout the body to supply oxygen and nutrients to the various organs. Its powerful heart muscle cells require a lot of energy and oxygen: blood circulation is ensured by the so-called coronary arteries.

In coronary heart disease, or CHD for short, arteriosclerosis (hardening of the arteries) leads to an increasing narrowing of the coronary arteries. As a result, the heart no longer receives sufficient blood flow, especially during exertion. The circulatory disorder of the heart is also known as ischemic heart disease (IHD).

Frequency of CHD

CHD is the most common heart disease worldwide. Around six percent of women and twelve percent of men will develop the disease during their lifetime. The risk increases with increasing age.

However, the number of deaths from the disease – mostly due to a resulting heart attack – has been falling steadily for several years. This is likely due to improvements in lifestyle following diagnosis and advanced medical care.

Coronary heart disease: symptoms of CHD

In the early stages, CHD has no symptoms. Only when the arteriosclerotic vascular changes have progressed to such an extent that blood flow is reduced by 50 percent can the first symptoms appear during heavy exertion, which is accompanied by increased oxygen requirements of the heart.

The main symptom of coronary heart disease is angina pectoris: This refers to a feeling of tightness in the chest or severe pain on the left side of the chest. The chest pain can radiate to the left arm, the neck, the lower jaw or the upper abdomen and is usually accompanied by shortness of breath, a feeling of pressure or oppression and even fear of death.

The symptoms usually last for seconds to minutes. They usually subside as soon as the exertion is over and the body calms down again.

If angina pectoris only occurs under stress, it is called stable angina pectoris. However, if the symptoms occur suddenly without a trigger or at rest, experts speak of unstable angina pectoris. It is a medical emergency and can herald a heart attack. Together with this, unstable chest tightness is part of the acute coronary syndrome.

Other possible symptoms of CHD include:

Degree of complaint depending on the stage of the disease

Depending on when the symptoms appear, the disease is classified into different levels of severity:

• Grade 1: No symptoms
• Grade 2: Symptoms associated with greater physical exertion
• Grade 3: Symptoms during mild physical exertion
• Grade 4: Symptoms at rest

CHD can be asymptomatic

The disease can also progress with no or atypical symptoms. As with heart attacks, this is often the case in women. Shortness of breath during exertion or just a slight feeling of oppression can be the only indications of CHD. Coronary heart disease can occur without any other symptoms, especially in people with diabetes mellitus. There is a risk that CHD will only be diagnosed when severe cardiac arrhythmias or a heart attack have already occurred.

Causes: How does coronary heart disease develop?

Coronary heart disease is caused by arteriosclerotic deposits in the coronary arteries, which supply the heart muscle with oxygen. Deposits, so-called plaques, settle in the inner walls of the vessels, causing the vessels to narrow and their elasticity to decrease. As a result, blood circulation decreases.

The risk of arteriosclerosis in the heart increases with age. In addition, heart problems such as CHD, heart attacks and strokes run in families: genetic factors play a role.

There are also a number of other factors that can promote the occurrence of the disease:

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Diagnosis: How is coronary heart disease diagnosed?

Those affected often come to their GP practice because of chest pain. If coronary heart disease is suspected, a thorough medical history is first taken. Previous illnesses and possible risk factors are asked. Diagnosis also includes psychosocial diagnostics to identify depression or other mental illnesses that can influence the course and willingness to participate in therapy.

This is usually followed by a physical examination in which weight and blood pressure are measured and the heart and lungs are listened to (auscultation). The vascular status can be determined by palpating the pulse in various parts of the body such as the feet.

Most doctors order a blood test in the laboratory if CHD is suspected. The blood is examined for markers of inflammation and heart attack. Blood lipids and blood sugar levels can also be determined.

The guidelines also provide for the following examinations if CHD is suspected:

The cardiac catheter examination can take place while you are awake or under anesthesia. During angiography, a thin wire is passed over the groin area through an artery to the heart. The blocked vessels can be made visible using X-rays and contrast media. In some cases, the bottlenecks can be addressed directly.

Therapy of coronary heart disease

Coronary heart disease, like the underlying arteriosclerosis, cannot be cured. However, it can be easily treated so that a life expectancy and quality of life comparable to that of healthy people can be achieved. The therapy always depends on the stage of the disease.

Patients should primarily avoid possible risk factors and adapt their lifestyle. In this way, progression of the disease can be contained and serious consequences can be prevented. The important things are:

• Quit smoking
• regular exercise
• low-salt and low-fat diet
• Losing excess weight

There are also special heart sports groups to begin moderate exercise training under heart control. Information about cardiac sports groups can be found at German Society for the Prevention and Rehabilitation of Cardiovascular Diseases e. v. of the respective federal states.

Which medications for CHD?

Medication can also be prescribed. Several groups of active ingredients are combined for therapy:

• Platelet inhibitorsfor example acetylsalicylic acid (ASS)
• Statins (positive effect on blood lipid levels)
• Beta blockers (to lower blood pressure and slow the heartbeat to protect the heart)

Scientific studies have proven that these medications significantly reduce mortality and the risk of a heart attack or stroke.

The symptoms of an angina pectoris attack can be treated with so-called nitrates, which temporarily dilate the blood vessels and relieve the pain.

Surgery for CHD

In around a third of those affected, drug treatment does not improve the symptoms. Then surgery may make sense. In order to find out which therapy option is most suitable, a cardiac catheter examination is recommended beforehand. The following are possible:

• Stent implantation: A stent is a fine metal structure that can hold a narrowed vessel wide. To use the vascular support, a catheter – a fine plastic tube – is pushed from the groin or arm through the arteries to the narrowed area. There is a tiny balloon in a stent at the tip of the catheter. The balloon is inflated at the constriction and the constriction is widened. The stent expands and is inserted into the artery to prevent the dilated area in the artery from contracting again.

• Bypass surgery: If narrowings in a coronary artery can no longer be widened or if several coronary arteries are affected by such stenosis, bypass surgery is a treatment option. The narrowed cardiac vessels are artificially bridged and bypassed. To bridge the gap, the affected person’s own vessels, for example lower leg veins or plastic vessels, are used. The procedure can be minimally invasive, but sometimes major open heart surgery is necessary.

Course, prognosis and life expectancy in CHD

Various factors are crucial for the course and prognosis of life expectancy in coronary heart disease. On the one hand, it is crucial when the disease was diagnosed and treatment measures were initiated. On the other hand, it is relevant how the therapeutic measures are adhered to, i.e. whether lifestyle adjustments are made and medications such as ASA are taken regularly. The general health of the person affected also plays an important role.

Without therapy and lifestyle changes, there is a high probability that the CHD will worsen over time due to progressive arteriosclerosis and become one

• heart failure (heart failure),
• a heart attack,
• serious cardiac arrhythmias or
• sudden cardiac death

comes. Cardiological check-ups should therefore be carried out regularly.

Those affected who take their medication as prescribed, adjust their eating habits and ensure sufficient exercise can usually expect a good quality of life and a normal life expectancy despite CHD.

Coronary heart disease: How to prevent it

The risk of developing coronary heart disease can be reduced through simple measures. This includes a healthy lifestyle with a balanced diet and enough exercise. Avoiding nicotine is also recommended.

Those insured by statutory health insurance companies are entitled to a free preventive examination every three years from the age of 35. The aim of these examinations is to identify common diseases and risk factors at an early stage.

If coronary heart disease or its risk factors are recognized early, harmful consequences for health can be reduced or averted.

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