Coronary Heart Disease (CHD), also known as Coronary Artery Disease (CAD), remains the leading cause of death in the United States. According to the Centers for Disease Control and Prevention (CDC), over 20 million adults in the U.S. are currently living with CHD, with thousands of new diagnoses recorded annually. For nursing students, understanding the etiology and core characteristics of CHD is critical to providing safe and evidence-based patient care. This article explains the seven most common causes and the five defining characteristics of CHD, written in a clear and comprehensive format tailored for nursing education.
This article is also designed to be SEO-friendly for educational blogs and nursing resource websites. With over 1500 words, it provides a complete overview of CHD that student nurses in the United States can easily use for study, coursework, and clinical preparation.
What Is Coronary Heart Disease?
Coronary Heart Disease occurs when the coronary arteries—the vessels supplying oxygen-rich blood to the heart—become narrowed or blocked. The underlying cause is typically atherosclerosis, a condition where plaque builds up inside arterial walls. Reduced blood flow results in ischemia, angina, myocardial infarction (MI), arrhythmias, left ventricular dysfunction, and even sudden cardiac death.
Nurses play a key role in CHD prevention, identification, education, and ongoing management. Therefore, understanding the risk factors and pathophysiological characteristics is essential.
7 Common Causes of Coronary Heart Disease
Although CHD results from multiple interacting variables, research consistently identifies seven primary causes. These are the most common, evidence-supported contributors that nursing students must understand.
1. Atherosclerosis (Plaque Buildup)
Atherosclerosis is the most common and direct cause of CHD. It occurs when lipids, cholesterol, calcium, and cellular debris accumulate inside arterial walls. Over time, plaque hardens and narrows the arteries, reducing blood flow. Endothelial injury—triggered by smoking, hypertension, or inflammation—starts the atherosclerotic process.
In advanced stages, plaque rupture creates a blood clot that can completely obstruct the coronary artery, leading to myocardial infarction. Nurses must be familiar with this pathology because early interventions such as statin therapy, lifestyle management, and risk-factor education can slow or prevent progression.
2. Hypertension (High Blood Pressure)
Hypertension damages the endothelium, accelerates plaque formation, and increases myocardial oxygen demand. Chronically elevated blood pressure forces the heart to work harder, causing left ventricular hypertrophy and further reducing coronary perfusion. For these reasons, hypertension is considered both a cause and a major risk factor for CHD.
Nursing implications include regular blood pressure monitoring, teaching the DASH diet, and ensuring adherence to antihypertensive medication schedules.
3. Elevated LDL Cholesterol and Dyslipidemia
Lipid abnormalities, especially high LDL (low-density lipoprotein) cholesterol and low HDL cholesterol, directly contribute to plaque formation. LDL infiltrates damaged arterial walls and oxidizes, triggering inflammatory responses that accelerate atherosclerosis. HDL, conversely, helps remove cholesterol from circulation; therefore, low HDL levels further increase risk.
Patient teaching should emphasize heart-healthy diets, medication adherence (such as statins), and lifestyle modifications.
4. Cigarette Smoking
Smoking is one of the strongest modifiable risk factors for CHD. Nicotine increases heart rate and blood pressure, while carbon monoxide reduces oxygen delivery to tissues. Smoking also promotes endothelial damage, enhances platelet aggregation, and accelerates atherosclerosis. Even secondhand smoke significantly increases CHD risk.
Nursing interventions should include smoking cessation counseling, referral to cessation programs, and ongoing motivational support.
5. Diabetes Mellitus and Insulin Resistance
Individuals with diabetes have a significantly higher risk of CHD due to chronic hyperglycemia, systemic inflammation, and accelerated plaque formation. Diabetes also contributes to dyslipidemia, endothelial dysfunction, and increased platelet reactivity.
Nurses must focus on patient education related to blood glucose control, diet, medication management, and monitoring complications.
6. Sedentary Lifestyle and Obesity
Physical inactivity and excessive body weight contribute to hypertension, dyslipidemia, insulin resistance, and chronic inflammation—all major drivers of CHD. Obesity, especially central obesity, increases the metabolic demands on the heart and worsens atherosclerotic progression. A sedentary lifestyle also reduces cardiac conditioning and vascular elasticity.
Nursing education should include exercise recommendations, weight management strategies, and individualized goal-setting.
7. Genetic and Family History Factors
Genetic predisposition plays a vital role in CHD development. Individuals with a family history of early-onset CHD (before age 55 in men and age 65 in women) are at significantly higher risk. Genetic factors influence lipid metabolism, endothelial function, and susceptibility to hypertension and diabetes.
Nurses must be able to assess family history accurately and identify patients who require early screening and preventative interventions.
5 Key Characteristics of Coronary Heart Disease
The characteristics of CHD describe how the disease manifests clinically and pathophysiologically. Understanding these characteristics helps nursing students recognize early signs, perform accurate assessments, and communicate effectively using standardized terminology.
1. Angina Pectoris (Chest Pain)
Angina is the hallmark symptom of CHD. It occurs when the myocardium receives inadequate oxygen, resulting in discomfort or pain. Typical angina is described as pressure, tightness, heaviness, or squeezing in the chest and may radiate to the left arm, jaw, or back. Stable angina occurs during exertion and resolves with rest, while unstable angina indicates worsening ischemia and is a medical emergency.
2. Reduced Coronary Blood Flow
The central characteristic of CHD is impaired blood flow due to plaque narrowing or arterial blockage. Reduced blood flow leads to myocardial ischemia, resulting in oxygen insufficiency. This characteristic forms the foundation of CHD’s pathophysiology and explains most clinical symptoms, including fatigue, dyspnea, and chest discomfort.
3. Myocardial Ischemia
Ischemia occurs when oxygen demand exceeds supply. This may be due to activity, emotional stress, tachycardia, or coronary spasm. Prolonged ischemia leads to cellular injury, and if uncorrected, myocardial infarction. Nursing students must be able to differentiate ischemia from infarction, interpret ECG changes, and recognize high-risk symptoms.
4. Inflammation and Endothelial Dysfunction
Chronic inflammation is a defining characteristic of CHD. Elevated inflammatory markers such as C-reactive protein (CRP) indicate endothelial damage and ongoing plaque instability. Endothelial dysfunction impairs vasodilation, promotes thrombosis, and accelerates atherosclerotic progression.
Understanding inflammatory mechanisms helps students grasp why statins and anti-inflammatory lifestyle changes are effective treatments.
5. Plaque Formation and Potential Rupture
Another major characteristic is the development of atherosclerotic plaques composed of cholesterol, lipids, fibrous tissue, and calcification. Plaque stability is a key determinant of risk: stable plaques cause predictable symptoms such as stable angina, while unstable plaques may rupture, causing thrombosis and acute coronary syndrome.
Nurses must recognize signs of plaque instability and the pathophysiological reason behind emergency interventions such as antiplatelet therapy.
Why Nursing Students Must Understand Causes and Characteristics of CHD
Nursing assessment, diagnosis, and intervention depend heavily on understanding CHD’s underlying mechanisms. These principles underpin clinical decision-making in emergency departments, telemetry units, cardiac surgery units, and community health settings. U.S. nursing curricula emphasize CHD because nurses frequently encounter these patients in both acute and chronic care environments.
Key skills for nursing students include:
- Identifying early symptoms of ischemia or MI
- Understanding diagnostic tests such as ECG, troponin, and lipid profiles
- Educating patients on modifiable risk factors
- Monitoring cardiac medications like beta-blockers and nitrates
- Providing safe and effective discharge teaching
Conclusion
Coronary Heart Disease is a complex and progressive condition influenced by multiple causes and marked by several defining characteristics. For nursing students, understanding these factors is essential to delivering effective assessment, intervention, and patient education. The seven major causes—atherosclerosis, hypertension, dyslipidemia, smoking, diabetes, sedentary lifestyle, and genetic predisposition—provide a framework for prevention and early management. Meanwhile, the five primary characteristics—angina, reduced blood flow, ischemia, inflammation, and plaque formation—explain how CHD manifests clinically.
By mastering these concepts, nursing students can improve clinical reasoning and contribute meaningfully to patient outcomes in a variety of healthcare settings.
References
- American Heart Association. (2024). Coronary Artery Disease.
- Centers for Disease Control and Prevention. (2024). Heart Disease Facts.
- Lewis, S. L., et al. (2023). Medical-Surgical Nursing, 11th ed.
- Ignatavicius, D., & Workman, M. (2024). Medical-Surgical Nursing: Patient-Centered Collaborative Care.
- National Heart, Lung, and Blood Institute (NHLBI). (2024). Coronary Heart Disease.
