In medical terms, CHD most commonly stands for coronary heart disease, a condition where the arteries supplying blood to the heart become narrowed by a buildup of fatty deposits called plaque. CHD can also stand for congenital heart disease, which refers to structural heart problems present from birth. Context usually makes the meaning clear: in adults, CHD nearly always means coronary heart disease; in pediatrics, it typically refers to congenital heart defects.
Coronary Heart Disease: The Most Common Meaning
Coronary heart disease occurs when the coronary arteries, the blood vessels that feed the heart muscle itself, can no longer deliver enough oxygen-rich blood. The underlying process is called atherosclerosis, and it develops over years or decades. You may also see it called coronary artery disease (CAD) or ischemic heart disease. These terms are essentially interchangeable in everyday medical use.
CHD is the most common type of heart disease in the United States and the leading cause of death for both men and women. In 2022 alone, it killed more than 371,000 Americans.
How Plaque Builds Up in the Arteries
Atherosclerosis starts with damage to the inner lining of an artery. Risk factors like high blood pressure, high cholesterol, smoking, and elevated blood sugar all irritate this lining in slightly different ways. Once the lining is irritated, white blood cells from the bloodstream stick to the damaged area and burrow into the artery wall. There they encounter cholesterol particles that have also lodged in the wall, and they begin absorbing those particles.
Over time, these fat-laden cells accumulate, die, and leave behind a soft, fatty core inside the artery wall. Smooth muscle cells migrate into the area and build a fibrous cap over this core, creating a structure known as plaque. For much of its life, plaque actually grows outward rather than inward, so a person can carry a significant amount of atherosclerosis without any obvious narrowing of the artery. By the time a plaque does start to block blood flow, the disease is usually widespread across multiple arteries.
Inflammation drives this process at every stage. It is not simply a matter of cholesterol accumulating like grease in a pipe. The interplay between immune cells, artery wall cells, and modified cholesterol particles creates a self-sustaining inflammatory cycle that can progress silently for years.
Symptoms of Coronary Heart Disease
The hallmark symptom is angina, a sensation of pressure, heaviness, or aching beneath the breastbone. Many people describe it as discomfort rather than outright pain. It can radiate to the shoulders, arms (especially the left), back, jaw, or teeth. In stable angina, this discomfort appears predictably during physical exertion or emotional stress and goes away with rest.
Unstable angina is a warning sign that something has changed. The episodes become more frequent, more severe, or start occurring at rest or with less activity than before. Unstable angina does not show the hallmark damage markers of a heart attack on blood tests, but it signals that a plaque may be on the verge of rupturing.
A heart attack occurs when a plaque ruptures and a blood clot forms on top of it, completely blocking the artery. Heart muscle downstream begins to die within minutes. The pain is often more intense and prolonged than angina, centered in the chest and sometimes spreading to the back, jaw, or left arm. It does not go away with rest. The symptoms of unstable angina and a heart attack can feel very similar, and it is often impossible to tell them apart without medical testing.
Major Risk Factors
Four modifiable risk factors account for most coronary heart disease. Smoking roughly doubles the risk. High blood pressure is the single largest contributor at the population level: if every case of elevated blood pressure (above 130 mm Hg systolic) were eliminated, an estimated 28% of all CHD cases would be prevented. High non-HDL cholesterol (the “bad” cholesterol fraction) accounts for about 17% of the overall disease burden. Diabetes contributes around 10%.
Other factors that raise risk include physical inactivity, obesity, a family history of early heart disease, and chronic stress. Age itself is a powerful risk factor since plaque accumulates over time, and men tend to develop CHD about a decade earlier than women on average.
How CHD Is Diagnosed
If your doctor suspects coronary heart disease, the first-line test for many patients is a stress test, where you walk on a treadmill or ride a stationary bike while your heart’s electrical activity is monitored with an ECG. The goal is to see whether your heart shows signs of inadequate blood flow when it is working harder than usual. This approach works well for people who can exercise and have a normal baseline ECG reading.
When a standard stress test is not practical (for example, if you cannot exercise or your resting ECG is already abnormal), imaging-based alternatives are used. These include stress echocardiography, which uses ultrasound to watch the heart pump under stress, and nuclear perfusion imaging, which tracks blood flow through the heart muscle using a small amount of radioactive tracer. Coronary CT angiography, a specialized scan that directly visualizes the arteries, has become increasingly common and performs comparably to stress-based approaches in clinical trials.
No single test is universally best. The choice depends on your symptoms, your overall likelihood of having CHD, and practical considerations like whether you can exercise.
Congenital Heart Disease: The Other CHD
When CHD appears in a pediatric or birth-defect context, it stands for congenital heart disease, meaning a structural problem with the heart that forms before birth. These defects are broadly divided into two categories based on whether they reduce oxygen levels enough to cause a bluish skin color (cyanotic defects) or not (non-cyanotic defects).
Common non-cyanotic defects include holes between heart chambers (atrial or ventricular septal defects), a narrowed aorta (coarctation), and valves that do not open fully (aortic or pulmonic stenosis). Cyanotic defects, which tend to be more complex, include conditions like tetralogy of Fallot (a combination of four structural problems) and transposition of the great arteries, where the two main vessels leaving the heart are switched.
Congenital heart defects range enormously in severity. A small hole between chambers may close on its own and never cause symptoms. A complex defect like hypoplastic left heart syndrome, where the left side of the heart is severely underdeveloped, requires surgical intervention shortly after birth. Many congenital heart conditions are now detected before birth through routine ultrasound, and surgical techniques have improved survival dramatically over the past several decades.
How to Tell Which CHD Is Meant
If you encounter CHD on a lab report, medical record, or health article without further context, look at the surrounding details. A reference to plaque, cholesterol, angina, or stenting points to coronary heart disease. A reference to birth defects, pediatric cardiology, or structural abnormalities points to congenital heart disease. In adult cardiology, the default meaning is almost always coronary heart disease. In neonatal or pediatric settings, it is almost always congenital heart disease.