Coronary heart disease history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arzu Kalayci, M.D. [2]

Overview

Coronary heart disease may be asymptomatic, or have symptoms such as chest pain, shortness of breath, fatigue, weakness and lightheadedness.

History and Symptoms

  • Coronary heart disease may be asymptomatic.

Symptoms can include:

  • Chest pain or discomfort (angina) is the most common symptom. The pain is felt when the heart is not getting enough blood or oxygen. How bad the pain is varies from person to person.
  • It may feel heavy or like someone is squeezing the heart.
  • It is felt under the breast bone (sternum), but also in the neck, arms, stomach, or upper back.
  • The pain usually occurs with activity or emotion, and goes away with rest or a medicine called nitroglycerin.
  • Other symptoms include:
  • Women, elderly people, and people with diabetes are more likely to have symptoms other than chest pain, such as:

2017 ESC/EACTS Guidelines for the management of valvular heart disease [1]

Management of Coronary Artery Disease (CAD) in patients with Valvular Heart Disease (VHD)

Recommendations Class Level
Diagnosis of Coronary Artery Disease
Coronary angiography is recommended before valve surgery in patients with severe VHD and any of the following:

• history of cardiovascular disease

• suspected myocardial ischaemia

• LV systolic dysfunction • in men >40 years of age and postmenopausal women

• one or more cardiovascular risk factors.

I C
Coronary angiography is recommended in the evaluation of moderate to severe secondary mitral regurgitation. I C
CT angiography should be considered as an alternative to coronary angiography before valve surgery in patients with severe VHD and low probability of CAD or in whom conven- tional coronary angiography is technically not feasible or associated with a high risk. II A
CT angiography should be considered as an alternative to coronary angiography before valve surgery in patients with severe VHD and low probability of CAD or in whom conven- tional coronary angiography is technically not feasible or associated with a high risk. IIa C

References

  1. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Muñoz DR, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL (2017). "2017 ESC/EACTS Guidelines for the management of valvular heart disease". Eur. Heart J. 38 (36): 2739–2791. doi:10.1093/eurheartj/ehx391. PMID 28886619.

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