Words such as coronary microvascular disease, coronary syndrome X, ischemic heart disease, nonobstructive coronary heart disease, and obstructive coronary artery disease may be used interchangeably with coronary heart disease.
Heart disease is a general term for various conditions that affect the heart’s ability to pump blood. Coronary heart disease emerges when the arteries of the heart are unable to deliver enough oxygen to the heart muscle. In the USA and Australia, it is one of the leading causes of death.
Classically, coronary heart disease occurs when fat plaques grow inside coronary arteries over time and result in partial or complete obstruction of blood supply to the heart. However, there are other types of the same conditions that start after a disease or injury that change the structure and function of arteries in the heart. For instance, the coronary microvascular disease is a type of heart disease that results when tiny vasculature in the heart function abnormally.
What are the types of CHD?
Many factors determine the type of CHD, i.e., cardiac oxygen deficiency, duration of onset, and how fast the disease progresses. The primary forms of ischemic heart disease are:
- Asymptomatic, or “silent” CHD – which can progress without showing any signs and symptoms.
- Exertional angina, a chronic disease, may go unnoticed, only showing signs of illness during exertion or physical exercise.
- Unstable angina (stenocardia) is an indication of worsening heart health. Typically, there’s more than one attack, and the next attack having more devastating signs and symptoms.
- Arrhythmic type or atrial fibrillation: can be acute or chronic and is a disorder of heart rhythm.
- Myocardial infarction is an acute disease after a section of your heart is deprived of oxygen and gradually dies. Occasionally a plaque is dislodged and gets trapped in narrow vessels and blocks circulation.
- Sudden cardiac death can occur as the supply of oxygen-rich blood to the heart rapidly drops as a result of blocked arteries causing a cardiac arrest.
Sometimes these classes of diseases can simultaneously take place or overlap—for instance, arrhythmias with angina.
Before conducting blood and other lab tests, your doctor will inquire about your medical history and do a physical exam to find a baseline. Tests that may assist your doctor in reaching a definitive diagnosis include:
- Electrocardiogram (ECG). An ECG records electrical activity from your heart and can be used to detect ongoing or previous heart attacks.
- Echocardiogram. By using sound waves to map the structure of the heart, your doctor can tell if all parts of the heart have a normal form and can meet the body’s oxygen demands. Coronary artery disease may be detected when parts of the heart start to lose their structure and move weakly because they have been receiving an insufficient oxygen supply.
- Exercise stress test. When your symptoms get worse during exercise, your doctor will do additional tests such as an ECG on a treadmill or stationary bike. At times an echo will be done while you are active. This is known as stress echo. Medicine to increase heart activity may also be used instead of exercise.
- Nuclear stress test. This test uses the same principle as the exercise stress test, but the only difference is that it adds pictures to the ECG recordings. It gets readings of your heart during rest and in an active state. A tracer is injected into your bloodstream, and dedicated cameras are used to find areas that get insufficient blood flow.
- Cardiac catheterization and angiogram. Cardiac catheterization is a precise procedure where a doctor inserts a catheter into a large artery in the groin, neck, or arm and guide it to your heart. An X-ray is used to guide and place it in the best position properly. A contrast dye gives an outline of vessels and shows detailed images and any detectable blockages.
When there is a blockage that requires treatment, a balloon can be passed through the catheter and inflated to improve blood flow through coronary arteries. A stent or mesh keeps the dilated artery open.
- Cardiac CT scan. A CT scan detects calcium deposits that can cause narrowing in arteries. If a higher amount is detected, then coronary artery disease is likely.
More detailed images can be captured using a coronary angiogram with the help of a contrast dye before a CT scan.
Women and Heart Disease
Women are disproportionately affected by CHD than men. Between the age of 60-80, about 80% of women will have multiple risk factors for the development of coronary artery disease and may lead to mortality.
Because of the different hormonal and anatomical differences, women sometimes have an “atypical” disease compared with men.
- Hormonal changes affect a woman’s risk of coronary heart disease. Before menopause, estrogen protects women from the premature development of CHD. The hormone elevates levels of HDL cholesterol (good cholesterol). It keeps arteries elastic and flexible so that they can accommodate more blood and increase oxygen demand in response to different stimuli.
- The size and structure of the heart are different for women and men. Women have a smaller heart and vessels than men, and their heart muscle is slightly thinner.
- Women are more likely to have nonobstructive coronary heart disease or coronary microvascular disease. These types are among the hardest to diagnose, and delays in treatment worsen the prognosis.
Can symptoms differ for women?
Although the disease is the same in both men and women, sometimes the disease can silently progress and have very different signs and symptoms from men.
- Men tend to have angina at rest while women are likely to get bouts even at rest or in routine daily activities such as cooking and shopping, and is more painful.
- Women experience different anginal pain to men. The location is on the left side of the chest, and some report the pain to be crushing or squeezing or tightness and may radiate to the neck, back, or left arm.
- Mental stress is likely to initiate angina pain in women than men
- It is not unusual to find additional symptoms such as nausea, vomiting, abdominal pain, sleep problems, shortness of breath, loss of energy, and fatigue.