What is coronary heart disease?
Coronary heart disease (CHD) or coronary artery disease is the
narrowing of the small blood vessels (coronary arteries) that
supply blood and oxygen to the heart. Coronary disease usually
results from the build up of fatty material and plaque
(atherosclerosis). As the coronary arteries narrow, the flow of
blood to the heart can slow or stop. This results in chest pain
(angina), shortness of breath, heart attack, or other symptoms.
What are the causes?
CHD can run in the family. It might develop as one gets older or
if one is overweight, has high blood pressure, high cholesterol or
diabetes. Unhealthy habits, like smoking, eating a diet high in
fat and not exercising enough, can also cause CHD.
Risk factors for CHD include the following:
Family history of coronary heart disease (especially before age
50)
Male gender
Age (65 and greater)
Tobacco smoking
High blood pressure
Diabetes
High cholesterol levels (specifically high LDL cholesterol and low
HDL cholesterol)
Lack of physical activity or exercise
Obesity
High blood homocysteine levels
Menopause in women
What are the symptoms?
The symptoms associated with coronary heart disease may be
pronounced, but it can also be present without any noticeable
symptoms.
(Chest pain (angina)) - This is the most common symptom, and it
results from the heart not getting enough blood or oxygen. The
intensity of the pain varies from person to person. Chest pain may
be typical or atypical. Typical chest pain is felt under the
sternum (breast bone) and is characterised by a heavy or squeezing
feeling. It is precipitated by exertion or emotion, and it is
relieved by rest or nitroglycerin. Atypical chest pain can be
located in the left chest, abdomen, back, or arm and is fleeting
or sharp. Atypical chest pain is unrelated to exercise and is not
relieved by rest or nitroglycerin. Atypical chest pain is more
common in women.
Other symptoms include:
(Shortness of breath) - This is usually a symptom of congestive
heart failure. The heart at this point is weak because of the
long-term lack of blood and oxygen, or sometimes from a recent or
past heart attack. If the heart is not pumping enough blood to
circulate in the body, shortness of breath may be accompanied by
swollen feet and ankles.
(Heart attack) - In some cases, the first sign of CHD is a heart
attack. This occurs when atherosclerotic plaque or a blood clot
blocks the blood flow of the coronary artery to the heart. The
coronary artery was likely already narrowed from CHD. The pain
associated with a heart attack is usually severe, lasts longer
than the chest pain described above, and is not relieved by
resting or nitroglycerin.
How is it diagnosed?
There are many tests that may help to diagnose CHD. Usually, more
than one test will be done before a definitive diagnosis can be
made. Some of the tests include:
* Electrocardiogram (ECG)
* Exercise stress test
* Echocardiogram
* Nuclear scan
* Coronary angiography
* Electron-beam computed tomography (EBCT) - the purpose of this
test is to identify calcium within the plaque found in the
arteries. The more calcium seen, the higher the likelihood for CHD.
What is the treatment?
The treatment for CHD varies depending on the symptoms and how
much the disease has progressed. General treatments include
lifestyle changes, medications, and sometimes surgery.
Lifestyle changes may include:
* A weight reduction programme
* A low saturated fat, low cholesterol diet to help reduce
cholesterol
* Reducing sodium (i.e. salt) ingestion to keep high blood
pressure under control
* A routine exercise regimen
* Permanently discontinuing cigarette smoking
Medications may include:
* Cholesterol-lowering medication
* Antiplatelet agents such as aspirin, ticlopidine, or clopidogrel
to reduce the risk of blood clots
* Glycoprotein inhibitors to reduce the risk of blood clots
* Antithrombin agents such as blood-thinners (low-molecular
heparin, unfractionated heparin), to reduce the risk of blood
clots
* Beta-blockers to decrease heart rate and to lower oxygen
consumption by the heart
* Nitrates such as nitroglycerin to dilate the coronary arteries
and improve blood supply to the heart
* Calcium-channel blockers to relax the coronary arteries and all
systemic arteries and, thus, reduce the workload for the heart
* ACE inhibitors, diuretics, or other medications to lower blood
pressure
Interventions may include:
Percutaneous Coronary Interventions (PCI's):
* Coronary angioplasty
* Coronary atherectomy
* Catheter-based thrombolysis
* Coronary radiation implant
* Coronary stenting (placing a tube in the artery to keep it
open).
Surgical Interventions:
* Coronary artery bypass surgery
* Minimally invasive heart surgery
What is the prognosis?
The outcome is variable. Some people can maintain a healthy life
by changing diet, stopping smoking, and taking medications as long
as they are closely monitored. Others may require more drastic
measures, such as surgery. It is necessary to detect CHD early and
treat it appropriately.
What can one do to lower the risk of CHD?
Do not smoke
Lower cholesterol levels by eating a low-fat diet
Eat well-balanced meals that include several daily servings of
fruits and vegetables
Control blood pressure
Develop a routine exercise regimen. Short, frequent sessions of
exercise are preferable to a complete sedentary lifestyle. Walking
instead of driving, taking the stairs instead of the elevator, are
all measures that most people can incorporate into their busy
routines
Keep blood pressure under control
Maintain weight appropriate to the frame and build
Doctor should be consulted about vitamins. Vitamin E has been
shown to lower the risk of a heart attack. Vitamin B may also
protect against CHD.
Surgery
Healthcare Provider
Surgical treatment for
coronary
heart disease
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