Coronary heart disease Coronary heart disease (CHD), also known as atherosclerotic heart disease, is a type of ischemic heart disease. The coronary arteries (coronary arteries) supply blood to the heart. When the coronary arteries undergo atherosclerosis, causing narrowing or blockage of the lumen, it leads to myocardial ischemia, hypoxia, or necrosis, resulting in discomfort such as chest pain and tightness. This condition is known as coronary heart disease.

Coronary heart disease is a condition caused by narrowing or blockage of the coronary arteries, leading to chest pain, tightness, and worsening symptoms after physical activity. It is more prevalent in individuals over 40 years old, with a higher incidence in males than females. Treatment includes lifestyle changes, medication, and surgical interventions.

Coronary atherosclerotic heart disease, also known as coronary heart disease (CHD), is a type of ischemic heart disease. The coronary arteries (coronary arteries) supply blood to the heart. When atherosclerosis occurs in the coronary arteries, leading to narrowing or blockage of the lumen, it results in myocardial ischemia, hypoxia, or necrosis, causing symptoms such as chest pain and tightness, characteristic of coronary heart disease.

Based on different characteristics and treatment principles, coronary heart disease is mainly divided into two major categories:

Chronic coronary artery disease

Chronic coronary artery disease (CAD), also known as chronic myocardial ischemia syndrome (CIS), includes stable angina pectoris, ischemic cardiomyopathy, and silent coronary heart disease, among others.

Acute coronary syndrome

Acute coronary syndrome (ACS) includes unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI), and some scholars also include sudden cardiac death in this category.

Coronary heart disease is caused by the accumulation of plaques on the walls of the coronary arteries. These plaques are composed of cholesterol and other substances deposited in the arteries. The accumulation of plaques leads to the continuous narrowing of the arterial lumen, which may partially or completely obstruct blood flow. This process is known as atherosclerosis.

In addition, over time, coronary heart disease can weaken the myocardium, causing the heart to pump inadequately, leading to heart failure. It can also cause irregular heartbeats, known as arrhythmias.

Chest pain (angina pectoris)

Temporary narrowing or blockage of the coronary arteries can cause chest pain, known as angina pectoris. Patients may feel pressure or tightness in the chest, as if someone is pressing on it, typically occurring in the middle or left side of the chest.

Chest pressure

Complete blockage of the coronary arteries can lead to a heart attack, or myocardial infarction. Typical symptoms of a heart attack include compressive pressure in the chest and pain in the shoulders or arms, sometimes accompanied by shortness of breath and profuse sweating. Women are more likely than men to experience atypical symptoms of a heart attack, such as pain in the neck or jaw.

Shortness of breath

If the heart is unable to pump enough blood to meet the body's needs, exertion may lead to shortness of breath and extreme fatigue.

Based on the typical symptoms of angina pectoris in patients, along with their age and risk factors for coronary heart disease, and by ruling out other causes of angina, a preliminary diagnosis can be made.

Imaging tests such as coronary CT angiography (CTA) and coronary angiography can provide direct evidence of coronary artery narrowing, leading to a definitive diagnosis.

Blood tests

Evaluating cholesterol, triglycerides, blood sugar, lipoproteins, and various inflammatory markers can help identify risk factors for coronary heart disease.

Electrocardiogram (ECG)

This test is used to determine whether the heart's rhythm is stable or irregular, and can record the strength and timing of electrical signals passing through the heart. An ECG can provide evidence of past or ongoing heart attacks. Ambulatory ECG monitoring can help detect evidence and severity of myocardial ischemia during daily activities.

Echocardiography

This test can detect abnormal movement of the infarcted or ischemic areas of the ventricular wall, and can also assess left ventricular function. Diminished ventricular wall motion may be due to damage during a heart attack or as a result of hypoxia. Echocardiography can be used not only to diagnose coronary heart disease, but also to rule out other heart conditions.

Exercise stress test

If symptoms and signs occur frequently during physical activity, a doctor may request walking on a specialized treadmill or using a stationary bike while monitoring changes in the ECG during exercise, known as an exercise stress test. In some cases, such as for individuals who cannot exercise, the heart may be stimulated with medication, known as a pharmacological stress test.

Some stress tests utilize echocardiography for monitoring. The physician may perform an ultrasound examination before and after exercise, or may use medication to stimulate the heart during the ultrasound examination, or may use medication during magnetic resonance imaging (MRI) to stimulate the heart.

Nuclear imaging tests

This test can observe changes in myocardial metabolism and is currently the only imaging technique that can directly assess myocardial viability. Combining pharmacological stress tests with nuclear imaging can help evaluate myocardial blood supply during rest and stress.

Coronary CT angiography

Coronary CT angiography (CTA) displays three-dimensional images of the coronary arteries after injecting a contrast agent intravenously and using spiral CT scanning followed by computer reconstruction, which can directly assess coronary artery lesions and stenosis.

Coronary angiography

This test involves injecting a contrast agent to visualize the heart's blood vessels, providing clear and accurate identification of narrowed vessels and their locations, leading to a definitive diagnosis, guiding treatment, and assessing prognosis. It is an invasive procedure with high costs, but is considered the most accurate method for diagnosing coronary heart disease, often referred to as the "gold standard" for diagnosing coronary heart disease. After non-invasive tests, if there is a need to determine whether revascularization should be performed, coronary angiography should be performed.

Patients with stable angina can travel by air. However, it should be noted that at higher altitudes, due to thin air, the oxygen content in the blood may decrease, potentially exacerbating symptoms of coronary heart disease. If symptoms such as shortness of breath occur, it may indicate unstable conditions, so it is important to carry medications for relieving angina in case of need.

Patients with unstable angina should not travel by air until their condition is under control. For heart attack patients without complications, it is not recommended to fly within 2 weeks of the event. For patients with implanted stents, it is recommended to wait at least 1 week after the procedure before flying, to reduce the risk of thrombosis formation.