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Coronary heart disease is caused by any problem with the coronary arteries that keeps the heart from getting enough oxygen- and nutrient-rich blood. The most common cause by far is atherosclerosis. Lack of sufficient blood is called ischemia, so coronary heart disease is sometimes called ischemic heart disease.

The cause of coronary heart disease is related to multiple risk factors. The following are the most common:

• Heredity: Coronary heart disease runs in the family.
• High cholesterol: Levels of cholesterol in the blood are above healthy levels. This usually involves high levels of low-density lipoprotein (LDL), the bad cholesterol, and low levels of high-density lipoprotein (HDL), the good cholesterol.
• Tobacco abuse: This includes not only smoking any form of tobacco (cigarettes, cigars, pipes), but also chewing tobacco.
• Obesity
• High blood pressure (hypertension)
• Diabetes
• Lack of regular exercise
• High-fat diet
• Emotional stress
• Type A personality (impatient, aggressive, competitive)

Coronary Heart Disease Symptoms

The most devastating sign of coronary heart disease is abrupt, unexpected cardiac arrest.

• Cardiac arrest commonly occurs in people who have had previous heart attacks, but it may occur as the first symptom of heart disease.
• Most people exhibit some symptom or discomfort.
• Symptoms usually occur during exercise or activity because the heart muscle's increased demand for nutrients and oxygen is not being met by the blocked coronary blood vessel.

More common symptoms of coronary heart disease include the following. No one person usually has all of these symptoms.

• Chest pain on exertion (angina pectoris), which may be relieved by rest
• Shortness of breath on exertion
• Jaw pain, back pain, or arm pain, especially on left side, either during exertion or at rest
• Palpitations (a sensation of rapid or very strong heart beats in your chest)
• Dizziness, light-headedness, or fainting
• Weakness on exertion or at rest
• Irregular heartbeat

Silent ischemia is a condition in which no symptoms occur even though an electrocardiogram (ECG, or heart tracing) and/or other tests show evidence of ischemia. Arteries may be blocked 50% or more without causing any symptoms.

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