Weight and physical activity play a role in risk of
coronary heart disease. Being overweight makes the
heart work harder to do its everyday job of pumping
blood to the body. Even when people have no other
risk factors, obesity greatly increases risk of heart
disease, particularly if weight is concentrated at the
waist. Excess weight also raises blood pressure and
affects cholesterol and triglyceride levels. Losing as
little as 10 pounds can decrease risk for coronary
heart disease, though maintaining a healthy weight is
best. Being inactive contributes to weight gain and all
of the associated conditions that then lead to coronary
heart disease.
Stress also may play a role in coronary heart
disease risk. However, the real problem is how people
react to stress. For instance, overeating in response to
stress leads to risk factors listed above. Drinking too
much alcohol can cause some of the conditions listed
above and lead to heart failure. However, studies
have shown that moderate amounts of alcohol,
described as about 1.5 fluid oz. of 80-proof spirits, 1
fluid oz. of 100-proof spirits, 4 fluid oz. of wine, or 12
fluid oz. of beer per day, may be good for the heart.
The American Heart Association does not recom-
mend that people who do not drink begin drinking
or that anyone increase alcohol intake to meet these
amounts, however.Symptoms
The restricted blood flow to the heart caused by
narrowing arteries may not produce any symptoms at
first and many people are completely unaware that
they have coronary heart disease. As the plaque builds
up, symptoms begin to develop. One of the first signs
may be chest pain that is triggered by physical oremotional stress. This pain often is referred to as
angina. The pain feels much like pressure or tightening
in the chest or it may be felt in the arm, neck, jaw,
shoulder, or back. Sometimes the pain is confused
with indigestion. Women may notice pain more often
in the back or arm than in the chest and the pain may
be brief and pass quickly.
Shortness of breath also is a symptom of coronary
heart disease. This results from the heart’s decreasing
ability to pump enough blood to the body to meet its
needs. The person with shortness of breath also may
feel very tired.
The most serious symptom of coronary heart dis-
ease is heart attack. Although some heart attacks start
suddenly and are clearly occurring, most start slowly
with uncertain symptoms. Discomfort in the center of
the chest that lasts for several minutes that feels like
squeezing, fullness, or pain is a sign that a heart attack
is occurring or about to occur. The pain also may go
away and come back. The pain may occur in one or
both upper arms, the back, neck, jaw, or stomach. A
person may experience shortness of breath with or
without chest pain. Some people break out in a sweat
or experience nausea or lightheadedness.Diagnosis
A physician will ask questions about edical his-
tory, symptoms, and relatives with heart disease, as
well as diet and lifestyle. A physical examination and
routine blood tests also may be ordered as part of the
evaluation. In addition, several examinations can be
done to diagnose and evaluate coronary heart disease.
These include:
Resting electrocardiogram (ECG or EKG). This
records electrical signals as they travel through the
heart and usually is performed in a physician’s office.
It is noninvasive and involves placing electrodes on
the body.
Holter monitoring. Also called ambulatory electro-
cardiography, this involves wearing a portable EKG
unit for 24 hours to monitor inadequate blood flow
to the heart as a person goes about everyday
activities.
Exercise stress test. This test takes an EKG reading
while a person is walking on a treadmill or riding a
stationary bicycle. It often is used to evaluate people
who experience symptoms when exercising. A
nuclear stress test may be used as well. In this exami-
nation, the patient exercises and the flow of blood to
the heart while at rest and during exercise is meas-
ured by injecting minor amounts of a radioactive
material into the bloodstream. A special cameraKEY TERMS
Angina pectoris—Chest pain or discomfort. Angina
pectoris is the more common and stable form of
angina. Stable angina has a pattern and is more
predictable in nature, usually occurring when the
heart is working harder than normal.
Atherosclerosis—The hardening and narrowing of
the arteries caused by the slow build-up of fatty
deposits, or plaque, on the artery walls.
Triglyceride—A fat that comes from food or is made
up of other energy sources in the body. Elevated
triglyceride levels contribute to the development of
atherosclerosis.Coronary heart disease