According to the online journal MEDICAL NEWS TODAY coronary heart disease (CHD) is the narrowing of the coronary arteries that supply oxygen and blood to the heart. It is known that cardiovascular disease is the most common type of heart disease and is the leading cause of death worldwide. The leading cause of this modern day pandemic is the sedentary lifestyle and diets rich in calories with high amounts of saturated fats, salt and simple sugars.
There are a few types of CHD namely congestive heart failure, angina pectoris and myocardial infarction. The coronary arteries are blood vessels on the heart that supply blood and oxygen to the heart. The basic structure of artery is made up of tunica intima, tunica media and tunica adventitia. Tunica intima consists of endothelium cells that line the lumen of the vessel, tunica media consist of smooth muscle and elastic fibers and tunica adventitia consist of collagen fibers.
Figure 1: Basic structure of artery.
The narrowing or the coronary artery is known as atherosclerosis in which plaque or fatty substances build up inside the walls of the vessel. Plaque is a fatty material made up of cholesterol, calcium and other substances. When plaque builds up in the coronary arteries, the heart does not get sufficient amount of blood needed for it to work well. If a plaque tears the body tries to fix the tear by forming a blood clot around it. This causes the artery to narrow even more. Over time this can weaken or damage the heart.
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Figure 2: Formation of plaque in artery.
Congestive heart disease is a condition in which the heart can no longer pump enough blood to the rest of the body. The condition may affect just the right chamber or just the left chamber of the heart, more often both chambers are involved. When the heart’s pumping action is lost fluid starts to build up in the lungs, the liver, the gastrointestinal tract and the arms and the legs. As a result, there is lack of oxygen rich blood flow and nutrients to these organs, which damages them and reduces their ability to function properly.
Figure 3: Difference between a normal heart & a congested heart.
Some common symptoms of congestive heart disease include:
* Shortness of breath
* Swelling of feet
* Swelling of abdomen, etc…
There are several options of treatment for congestive heart failure; treatments depend on the severity of the condition. Treatments include:
* Surgery: Heart valve repair or replacement, Coronary bypass surgery, Heart transplant and Myectomy.
* Medical devices: Ventricular assist device (VAD), Cardiac resynchronization therapy (CRT) device, Internal cardiac defibrillator (ICD).
* Medications : Angiotensin – converting enzyme (ACE) inhibitors, Angiotensin 2 ( A-2) receptor blockers, Beta blockers, Digoxin, Diuretics, Nesiritide, Aldosterone antagonist, Inotropes.
Angina pectoris is a term used for chest pain caused by inadequate supply of blood and oxygen to the heart. It is often associated with the narrowed arteries found in coronary heart disease. With angina the affected person’s heart may get sufficient blood for daily activity but the arteries may not be able to respond appropriately to increased demands for oxygen during exercise, times of emotional and physical stress and with extremes of temperatures.
There are three main types of angina:
1. Stable angina is the most prevalent type and is usually predictable as it exhibits a definite pattern. It is commonly induced by exercise or any other physical exertion like running or walking. The pain usually last for 3 to 5 minutes, and medications help relieve the pain. The pain experienced in the chest may sometimes spread to other parts of the body such as arms, back and shoulders, etc. it can be responsible for increasing the risk of heart attacks.
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2. Unstable angina unlike stable angina is not triggered by physical activities. It is more severe than stable angina and can occur even while resting. The chest pain can last for 10 or 15 minutes and can’t be cured by rest or medications. It does not follow a regular pattern like stable angina, and can be an indication of an imminent heart attack.
3. Variant angina, or Prinzmetal’s angina, is a form of unstable angina, but the cause is different. In variant angina, the heart muscle contracts in spasm, causing nearby arteries to temporarily narrow or close off. This briefly reduced blood flow to the heart results in angina symptoms. Variant angina symptoms almost always occur at rest and are particularly common between midnight and morning.
Symptoms of angina include:
* Discomfort or pain n the chest
* Radiating pain in the neck, shoulder, arms, neck, jaw or back
* Shortness of breath
* Nausea a rapid irregular heartbeat
* A feeling of impending doom.
Treatment of angina pectoris aims at relieving the symptoms and stopping or slowing down the advancement of the risk of heart attack. Treatment also depends on the type and the severity of the angina. The common medicines include aspirin, beta blockers, nitroglycerine, calcium channel blockers, isosorbibe mononitrate and nicorandil.
People with diabetes, high blood pressure and high cholesterol have a higher risk of suffering from angina. Besides that, smoking can also be an important contributory factor. So, efficient supervision and regulation of these factors can be effective in preventing angina and thereby lowering the risk of heart attack.
... judgment by physician and patient. Angina is a manifestation of coronary artery disease, the same disease leading to heart attacks. Coronary artery disease refers to those ... reversible in most cases. Risk also increases with age. Elevated blood cholesterol levels (both total and low density types) are risks, whereas ...
Myocardial infarction (also known as heart attack) is the death of a portion of heart muscle in an area where there is a sudden loss of blood supply. The orderly movement of electrical signals in the heart is important for the regular beating of the heart. Death of the heart often causes chest pain and may cause electrical instability of the heart muscle tissue, resulting in a rapid and a disorganized heart beat (ventricular fibrillation).
A heart that undergoes fibrillation simply quivers and cannot pump or deliver oxygenated blood to the brain. Permanent brain damage and death can occur unless oxygenated blood flow is quickly resumed. Muscle continues to die at which time the heart attack usually is “complete”. The dead heart muscle is eventually replaced by scar tissue.
Treatment options for myocardial infarction include medications such as:
* Anti platelets
* Beta blockers
* Calcium channel blockers
* ACE Inhibitor
Medical procedures used to help treat myocardial infarction include;
* Coronary angioplasty: involves placing a catheter with a small balloon on its tip into the patient’s narrowed artery. When properly positioned, the balloon is inflated and deflated, moving plaque build-up further against the artery wall and thereby improving the flow of blood. Coronary angioplasty may be followed by stinting, a procedure in which a stent (expandable wire mesh tube) is permanently inserted into the artery to keep it open and restore normal blood flow.
Figure 4: Coronary angioplasty & stenting.
* Coronary artery bypass graft: Involves grafting the end of a healthy blood vessel (often taken from the chest or leg) above and below a narrowed artery, bypassing the flow of blood around the narrowed artery. Bypass surgery can relieve the symptoms of coronary heart diseases such as angina and dyspnea (shortness of breath) and may be used to prevent or treat myocardial infarction.
Figure 5: Coronary artery bypass graft.
There are a number of ways you can prevent coronary heart disease. The main strategy for prevention of CHD is to control your cholesterol level. Generally, one should have a low level of Low Density Lipoprotein and a high level of High Density Lipoprotein. There are a number of ways you can achieve this, such as:
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Eating a healthy, balanced diet. Your diet should low in saturated fat, sugar and salt and should contain at least five servings of fruits and vegetables. Eat plenty of fish as it contains oils that can reduce the risk of thrombosis. Many vegetable, fruit and cereal contain antioxidant vitamins (beta-carotene and vitamins C and E) that prevent saturated fats from being changed into cholesterol. Other foods that may help lower your cholesterol level are that which contain soluble fiber.
Be sure to get regular aerobic exercise, for a minimum of 30 minutes a day, at least three to four times a week. Exercise is known lower LDL level and increase HDL level, as exercise burn calories, it can help to control your weight and reduce stress.
Give up smoking; it will reduce the risk of developing CHD. Smoking is a major risk factor for developing atherosclerosis. It also causes the majority of cases of coronary thrombosis in people under the age of 50.
Keep your blood pressure under control, by eating a healthy diet, exercising regularly, and if required taking appropriate blood pressure lowering medication. Your target blood pressure should be below 140/85mmHg.
Keep your diabetic under control, you can reduce your chances of developing diabetes by being physically active, controlling your weight, and keeping your pressure under control, your target blood pressure level should be below 130/80mmHg.