Like any muscle, the heart must have a continuous source of oxygen and nutrients that are carried to it by the blood in the coronary arteries. When the coronary arteries become narrowed or blocked and are unable to give adequate blood to the heart, the result is CHD. If not enough oxygen-carrying blood reaches the heart, the heart may respond with suffering called angina. The pain is usually felt in the chest or occasionally in the left arm and shoulder. (However, the very same insufficient blood supply may cause no signs or symptoms, a affliction called silent angina.)

When the blood supply is cut off totally, the consequence is a heart attack. The portion of the heart that does not receive oxygen will begin to expire, and a few of the heart muscle may be forever injured.

So what brings about CHD? CHD is caused by a thickening of the inside walls of the coronary arteries. This thickening, known as atherosclerosis, narrows the space through which blood can move, lowering and in some cases entirely cutting off the source of oxygen and nutrients to the heart.

Atherosclerosis generally occurs when a person has substantial amounts of cholesterol, a fat-like substance, in the blood. Cholesterol and fat, going around in the blood, build up on the walls of the arteries. The buildup narrows the arteries and may slow or obstruct the movement of blood. When the amount of cholesterol in the blood is excessive, there is a higher probability that it will be transferred onto the artery walls. This progression begins in most people during childhood and the teenage years, and gets worse as they get older.

In addition to high blood cholesterol, high blood pressure and smoking also play a role to CHD. On the average, each of these doubles your probability of developing heart disease. For these reasons, a person who has all three risk factors is eight times more likely to manifest heart disease than someone who has none. Weight problems and physical inactivity are other factors that can lead to CHD. Being obese increases the possibility of acquiring high blood cholesterol and high blood pressure, and a sedentary lifestyle raises the probability of heart attack. Frequent workout, good nutrition, and smoking cessation are key to managing the risk variables for CHD.

Among its signs are chest pain (angina) or shortness of breath, which may be the very first signs of CHD. A person may feel heaviness, tightness, pain, burning, pressure, or squeezing, usually behind the breastbone but sometimes also in the arms, neck, or jaws. These signs commonly bring the patient to a doctor for the first time. Nevertheless, some people have heart attacks without ever acquiring any of these symptoms.

It is important to know that there is a wide range of severity for CHD. Some people have no signs at all, some have moderate intermittent chest pain, and some have more pronounced and steady ache. Still others have CHD that is serious enough to make normal everyday routines challenging.

Because CHD can vary so considerably from one person to another, the way a doctor determines and treats CHD will also vary a lot. The following types are general guidelines to some tests and remedies that may or may not be employed, depending on the individual circumstance.

There is no one straightforward test--some or all of the following types of treatments may be required. These diagnostic processes are used to identify CHD, to figure out its degree and seriousness, and to rule out other likely causes of the symptoms.

After taking a careful medical history and undergoing a physical examination, the doctor may use some tests to see how advanced the CHD is. The only certain approach to analyze and assess the degree of CHD is coronary angiography (see below); other tests can indicate a problem but do not show exactly where it is.

An examination for CHD may include the following tests:

An electrocardiogram (ECG or EKG) is a graphic record of the electrical activity of the heart as it contracts and rests. Unnatural heartbeats and some areas of deterioration, insufficient blood flow, and heart enlargement can be found on the records.

A stress test (also called a treadmill test or exercise ECG) is used to document the heartbeat during exercise. This is performed since several heart problems only show up when the heart is working hard. In the test, an ECG is done before, during, and after exercising on a treadmill; breathing rate and blood pressure may be measured as well. Exercise tests are useful but are not completely reliable; false positives (showing a problem where none exists) and false negatives (showing no problem when something is wrong) are fairly common.

Nuclear scanning is sometimes used to show damaged areas of the heart and reveal problems with the heart's pumping action. A small amount of radioactive material is injected into a vein, usually in the arm. A scanning camera tracks the nuclear material that is taken up by heart muscle (healthy areas) or not taken up (damaged areas).

Coronary angiography (or arteriography) is a test used to check out the coronary arteries. A fine tube (catheter) is put into an artery of an arm or leg and passed through the tube into the arteries of the heart. The heart and blood vessels are then filmed while the heart pumps. The picture that is seen, called an angiogram or arteriogram, will display problems such as a blockage caused by atherosclerosis.

CHD is treated in a number of ways, depending on the severity of the disease. For many people, CHD is handled with lifestyle changes and medications. Others with serious CHD may need surgery. In any case, once CHD develops, it demands lifelong management.