One may experience various types of emotional and behavioral distress. Depression and anxiety are problems which are very common. These conditions not only affect the individual’s emotional state but also have an impact on the symptoms of heart. Learning about heart disease is one of the life changing events as it educates us on the serious consequences of lifestyle habits. Heart disease prevention is a major health concern. It's vital that people learn to identify and manage heart disease causing risk factors such as health eating, regular exercise, regular doctor visit to measure blood pressure, and weight control.
There are different types of heart disease like irregular heartbeat conditions called arrhythmia, chronic inflammatory disease - Atherosclerosis, changes in heart muscle causing cardiomyopathy, abnormalities from birth such as congenital heart defects, and coronary heart disease or coronary artery disease.
Heart requires a regular supply of blood rich in oxygen. Coronary arteries are the blood vessels that transport oxygenated blood to the heart muscle for its normal function. Damage to these vessels (also known as atherosclerosis) lead to coronary heart disease.
Once upon a time, Coronary artery disease was considered as a man’s disease. On an average, males develop it about 10 years earlier than a women, because until menopause, women are protected by high levels of estrogen. Coronary artery disease occurs more often among women post their menopause.
Do you know what really happens during a myocardial infarction? A heart attack occurs when an artery supplying your heart with blood and oxygen becomes blocked. Watch this process in detail, with a 3D video.
Statistics of coronary heart disease
Coronary artery disease is the leading cause of death worldwide and its prevalence is expected to increase in the coming years.
In India, over the past 60 years, CHD prevalence has increased from 1% to 9-10% in urban areas and in rural areas it has shown increase from less than 1% to 5-6%.
In the U.S, CHD accounts for one-third of all deaths in subjects over age 35. An estimated 17.9 million people die of cardiovascular diseases every year. 80% of the deaths occur in low- and middle-income countries.
This disease affects people of all races, but the incidence is extremely high among African Americans and Southeast Asians.
There are many conditions that can proceed or accelerate the ongoing disease progression such as high cholesterol, obesity, hypertension, diabetes, sedentary lifestyle, smoking that ultimately lead to this disease development.
How does this disease develop?
The blockage of coronary arteries occurs as the cholesterol-rich-deposits, which are termed as plaques, build up inside the inner lining called as endothelium of larger coronary arteries in a condition like atherosclerosis. These deposits are called atheromatous plaque or atheroma. Once the inner lining is damaged, this leads to the inclusion of molecules of cholesterol, fats, lipoproteins, and other debris that accumulate inside the wall or intima of arteries. After the low density lipoproteins (LDL) penetrates through the damaged arterial walls, they undergo a chemical process called oxidation and become a beacon. This beacon then attracts the white blood cells and leukocytes. In response to these changes, the macrophages appear and engulf these beacons and become foam cells. This gives rise to the earliest form of an atheromatous lesion called the fatty streak.
These plaques cause a thickening of arterial walls and a narrowing of arterial space causing a partial or complete block to the blood flow in larger arteries of the heart.
This condition is referred to as atherosclerosis. Since the lumen of arteries are narrowed, the amount of blood reaching and supplying oxygen and nutrients to the heart muscles also reduces. Other causes of atherosclerosis could be a disease or injury affecting heart arteries.
Recent results have established the multiplicity of “high-risk” plaques and the widespread nature of inflammation in patients prone to develop acute coronary syndromes. A family history of coronary heart disease is also seen as predictive of individuals developing the disorder.
Causes of coronary heart disease
Spasm of coronary artery
1. Endothelial dysfunction
2. Birth defects (coronary artery abnormalities)
3. Systemic lupus erythematosus
4. Arterial inflammation
5. A loose blood clot that moves from a chamber of heart into one of the coronary arteries
6. Physical damage (injury or radiotherapy)
Risk factors of coronary heart disease
CHD is a silent disease as it may persist for decades before it starts showing its clinical symptoms. Most people develop heart disease from adolescence. From age 45-75 yrs, the onset of this disease causing an impact can be felt. Even in various developed countries this disease is causing a lot of disability and death in older people.
Clinical symptoms of coronary heart disease
1. Clinical symptoms of CHD include
2. Chest pain or discomfort (angina)
5. Nausea, or a cold sweat
6. Discomfort in arms and shoulders
7. Shortness of breath
8. Jaw pain
9. Back pain
Diagnosis of Coronary heart disease
1. ECG or EKG (electrocardiogram): Measures the electrical activity, rate, and regularity of your heartbeat.
2. Echocardiogram: Ultrasound of heart
3. Exercise Stress Test: Patients are made to walk on treadmill to determine how well heart is working when it has to pump more blood
4. Chest X ray
5. Cardiac catheterization: to check inside the arteries for blockage by inserting a thin, flexible tube through an artery in the groin, arm, or neck to reach the heart.
6. Coronary angiogram: This system can monitor the blockage and blood flow in the coronary arteries.
7. Coronary artery calcium scan: A computed tomography (CT) scan that looks in the coronary arteries for calcium buildup and plaque.
Management of a person living with coronary heart disease
Education is a common element of care for people with CHD aiming to decrease mortality and morbidity as well as improving quality of life. Making a commitment to healthy lifestyle changes like quit smoking, eating healthy, regular exercising, stress management can go a long way towards promoting healthier arteries.
Common drugs used for treatment of coronary heart disease
1. Cholesterol modifying medications (decrease cholesterol deposits)
2. Aspirin (blood thinners)
3. Beta-blockers (reduces oxygen demand in the heart)
4. Calcium channel blockers (if beta-blockers alone are not effective)
5. Ranolazine (for chest pain- angina)
6. Nitroglycerin (temporarily dilates the coronary arteries and reduces heart demand for blood)
7. Angiotensin-converting enzyme (ACE) inhibitors that decrease blood pressure and prevent progression.
The antiplatelet treatment should be started early and must be in accordance with the patient risk of bleeding and thrombotic factors during the hospital phase. For patients who are not responsive to Prasugrel or Ticagrelor, Clopidogrel is a preferred choice of medication. From very day one, Statin therapy should be initiated, irrespective of the initial cholesterol level. Atorvastatin 80mg is preferred statin. Medicines like Angiotensin-converting enzyme inhibitors and beta-blockers should also be given both in-hospital and in the long term management.
In patients with acute coronary syndrome (ACS), early management is very important.
The presence of a physician as the first responder ensures good quality treatment in case of cardiac arrest, and allows recording of a first ECG, which can be very informative. The treatment at this stage is limited to sublingual Nitroglycerin and Aspirin.
Patients should be immediately positioned for reperfusion if the first ECG presents the ST segment elevation. Usually a percutaneous coronary intervention is performed at this stage. A thin tube called catheter is inserted into the narrowed part of the artery and a wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is inflated that compresses the deposits against artery walls and a stent is inserted for slow medication release to help keep arteries open.
In the absence of ST segment elevation, the diagnosis of ACS remains unconfirmed. Such a condition does not indicate or infer that the risk is low, but rather the risk cannot be evaluated accurately in the pre-hospital phase..
The use of risk scores can guide the choice of management towards an invasive strategy, including coronary angiography (immediately, or within 24-72 hours).
Procedures like angioplasty and stent placement (percutaneous coronary revascularization) and coronary artery bypass surgery are performed to surgically restore and improve blood flow to ischemic areas.
The coronary artery bypass is an open-heart surgery where a graft is created to bypass the blocked coronary arteries using a vessel from another body part allowing blood flow around the blocked or narrowed coronary artery to restore. This surgery is performed for people with multiple narrowed coronary arteries.
An invasive strategy is performed for patients with low risk; however, presence of ischemia should be indicated by non-invasive tests.
Surgical management is an aggressive management. Modifying risk factors reduces the cardiovascular events. The treatment of coronary heart disease is very important
It's important to reduce or control your risk factors and seek treatment to lower the chance of heart attack or stroke if you're diagnosed with coronary heart diseases. Treatment also depends on your current health condition, risk factors, and overall well being.
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- 1. Clinical journal of the American Society of Nephrology- https://cjasn.asnjournals.org/
- 3. The American Heart Association/ American Stroke Association Journals
- 4. The American Journal of Cardiology