Coronary Heart Disease: Causes, Symptoms, Risk factors, Diagnosis, Treatment.
Coronary Heart Disease: Causes, Symptoms, Risk factors, Diagnosis, Treatment.
What is Coronary Heart Disease?
Coronary heart disease (CHD) also called coronary artery disease and atherosclerotic heart disease, is a medical condition that develops when the coronary arteries become too narrow (atherosclerosis). The coronary arteries are the blood vessels that supply oxygen and blood to the heart.
CHD tends to develop when cholesterol builds up on the artery walls, creating plaques. These plaques cause the arteries to narrow, reducing blood flow to the heart. A clot can sometimes obstruct the blood flow, causing serious health problems.
Coronary arteries form the network of blood vessels on the surface of the heart that feed it oxygen. If these arteries narrow, the heart may not receive enough oxygen rich blood, especially during physical activity.
CHD can sometimes lead to heart attack. It is the “most common type of heart disease in the United States,” where it accounts for more than 370,000 deaths every year.
What causes coronary heart disease?
The most common cause of CHD is vascular injury with cholesterol plaque buildup in the arteries, known as atherosclerosis. Reduced blood flow occurs when one or more of these arteries becomes partially or completely blocked.
The four primary coronary arteries are located on the surface of the heart:
right main coronary artery
left main coronary artery
left circumflex artery
left anterior descending artery.
These arteries bring oxygen and nutrient-rich blood to your heart. Your heart is a muscle that’s responsible for pumping blood throughout your body. According to the Cleveland Clinic, a healthy heart moves approximately 3,000 gallons of blood through your body every day.
Like any other organ or muscle, your heart must receive an adequate, dependable supply of blood in order to carry out its work. Reduced blood flow to your heart can cause symptoms of CHD.
Other rare causes of damage or blockage to a coronary artery also limit blood flow to the heart.
Am I at risk for CHD?
Understanding the risk factors for CHD can help with your plan to prevent or decrease the likelihood of developing the disease.
These risk factors include:
Tobacco use
Diabetes Mellitus/Hyperglycemia
High blood pressure
High blood cholesterol levels
Obesity
Inactivity
Unhealthy eating habits
Obstructive sleep apnea
Emotional stress
Excessive alcohol consumption
History of preeclampsia during pregnancy.
The risk for CHD also increases with age. Based on age alone as a risk factor, men have a greater risk for the disease beginning at age 45 and women have a greater risk beginning at age 55. The risk for coronary heart disease is also higher if you have a family history of the disease.
Symptoms of coronary heart disease.
If your coronary arteries narrow, they can't supply enough oxygen-rich blood to your heart, especially when it's beating hard, such as during exercise. At first, the decreased blood flow may not cause any symptoms. As plaque continues to build up in your coronary arteries, however, you may develop the following coronary artery disease signs and symptoms:
Shortness of breath.
This occur when heart can not pump enough blood to meet the body's needs, you may develop shortness of breath or extreme fatigue with activity.
Chest pain (angina).
You may feel pressure or tightness in your chest, as if someone were standing on your chest. This pain, called angina, usually occurs on the middle or left side of the chest. Angina is generally triggered by physical or emotional stress. The pain usually goes away within minutes after stopping the stressful activity. In some people, especially women, the pain may be brief or sharp and felt in the neck, arm or back.
Heart attack.
The classic signs and symptoms of a heart attack include crushing pressure in your chest and pain in your shoulder or arm, sometimes with shortness of breath and sweating. A completely blocked coronary artery will cause a heart attack.
Women are somewhat more likely than men are to have less typical signs and symptoms of a heart attack, such as neck or jaw pain. And they may have other symptoms such as shortness of breath, fatigue and nausea.
Sometimes a heart attack occurs without any apparent signs or symptoms.
When to see a doctor
If you think you're having a heart attack, immediately call 911 or your local emergency number. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only as a last option.
How to diagnose CHD?
CHD diagnosis requires a review of medical history, a physical examination, and other medical testing. These tests include:
I. Electrocardiogram: This test monitors electrical signals that travel through your heart. It may help your doctor determine whether you’ve had a heart attack.
II. Echocardiogram: This imaging test uses ultrasound waves to create a picture of your heart. The results of this test reveal whether certain things in your heart are functioning properly.
III. Stress test: This particular test measures the stress on your heart during physical activity and while at rest. The test monitors your heart’s electrical activity while you walk on a treadmill or ride a stationary bike. Nuclear imaging may also be performed for a portion of this test. For those unable to perform physical exercise, certain medications can be used instead for stress testing.
IV. Cardiac catheterization (left heart catheterization): During this procedure, your doctor injects a special dye into your coronary arteries through a catheter inserted through an artery in your groin or forearm. The dye helps enhance the radiographic image of your coronary arteries to identify any blockages.
V. Heart CT scan: Your doctor may use this imaging test to check for calcium deposits in your arteries.
What are the complications of coronary heart disease?
I. Arrhythmia
An abnormal heartbeat is called an arrhythmia. When a person is at rest, the heart normally beats about 60 to 80 times per minute in a predictable, steady rhythm and with consistent force. Arrhythmias that can develop in people with CHD include, but are not limited to, the following:
slow heart rate (bradicardia)
fast heart rate (tachycardia
atrial fibrillation, a chaotic, irregular rhythm in the top chambers of the heart (atria).
Atrial fibrillation causes your heart to be ineffective at pumping blood out of the atria to the lower chambers of the heart (ventricles) and into other parts of your body for circulation. Over time, atrial fibrillation can lead to an ischemic stroke or heart failure.
Certain types of cardiac arrhythmias, such as ventricular fibrillation, can cause your heart to lose its pumping ability without warning. This kind of cardiac emergency causes sudden death if an external defibrillator device or an implantable cardioverter defibrillator doesn’t restore your heart’s normal rhythm immediately.
Chest pain
Reduced blood flow in your coronary arteries can mean that your heart doesn’t receive enough blood, especially when you exert yourself. This can cause a type of pain called angina.
Angina may cause chest numbness or the following sensations in your chest:
.tightness
.heaviness
.pressure
.aching
.burning
.squeezing
.fullness
Besides your chest, you may feel angina radiating to your:
.back
.jaw
.neck
.arms
.shoulders
For example, the discomfort may extend into your right shoulder and arm, down to your fingers, and into your upper abdomen. Anginal pain is typically not felt above the ears or below the belly button.
Heart failure
Over time, CHD can lead to heart failure. Heart failure means that your heart isn’t able to pump enough blood to the rest of your body. This can cause fluid buildup in the lungs, difficulty breathing, and swelling of the legs, liver, or abdomen.
Heart attack
If the fatty plaque in one of your coronary arteries ruptures, a blood clot can form. This can greatly block and decrease needed blood flow to your heart, causing a heart attack. The severe lack of oxygenated blood flow can damage your heart. Part of your heart tissue may die.
Sudden death
If coronary artery blood flow to your heart is severely blocked and not restored, it can cause sudden death.
Related arterial diseases
The process that causes injury and plaque to accumulate in the coronary arteries can affect all of the arteries in the body.
The carotid arteries in the neck supply blood to the brain. Atherosclerotic plaques in these arteries can lead to ischemic strokes.
Plaques elsewhere can impede blood flow within the arteries that supply the legs, arms, or other vital organs, and accumulation of these plaques can lead to aneurysm formation with life-threatening rupture, such as an aneurysm and rupture of the abdominal aorta or a cerebral artery.
What is the treatment for CHD?
It’s important to reduce or control your risk factors and seek treatment to lower the chance of a heart attack or stroke, if you’re diagnosed with CHD. Treatment also depends on your current health condition, risk factors, and overall wellbeing. For example, your doctor may prescribe medication therapy to treat high cholesterol or high blood pressure, or you may receive medication to control blood sugar if you have diabetes.
Lifestyle changes can also reduce your risk of heart disease and stroke. For example:
quit tobacco use
stop your consumption of alcohol
exercise regularly
lose weight to a healthy level
eat a healthy diet (low in fat, low in sodium).
If your condition doesn’t improve with lifestyle changes and medication, your doctor may recommend a procedure to increase blood flow to your heart. These procedures may be:
1. balloon angioplasty: to widen blocked arteries and smoosh down the plaque buildup, usually performed with insertion of a stent to help keep the lumen open after the procedure.
2. coronary artery bypass graft surgery: to restore blood flow to the heart in open chest surgery.
3. enhanced external counterpulsation: to stimulate the formation of new small blood vessels to naturally bypass clogged arteries in a noninvasive procedure.
What is the outlook for CHD?
Everyone’s outlook for CHD is different. You have better chances of preventing extensive damage to your heart the earlier you can start your treatment or implement lifestyle changes.
It is important to follow your doctor’s instructions. Take medications as directed and make the recommended lifestyle changes. If you have a higher risk for CHD, you can help to prevent the disease by reducing your risk factors.
What is cardiac rehabilitation and recovery?
Cardiac rehabilitation (rehab) is an important program for anyone recovering from a heart attack, heart failure, or other heart problem that required surgery or medical care. In these people, cardiac rehab can help improve quality of life and can help prevent another cardiac event. Cardiac rehab is a supervised program that includes
Physical activity
Education about healthy living, including healthy eating, taking medicine as prescribed, and ways to help you quit smoking
Counseling to find ways to relieve stress and improve mental health
A team of people may help you through cardiac rehab, including your health care team, exercise and nutrition specialists, physical therapists, and counselors or mental health professionals.
How can I be healthier if I have coronary artery disease?
If you have CHD, your health care team may suggest the following steps to help lower your risk for heart attack or worsening heart disease:
Lifestyle changes, such as eating a healthier (lower sodium, lower fat) diet, increasing physical activity, reaching a healthy weight, and quitting smoking
Medicines to treat risk factors for CHD, such as high cholesterol, high blood pressure, or an irregular heartbeat
Surgical procedures to help restore blood flow to the heart.
How to prevent CHD?
Up to 90% of cardiovascular disease may be preventable if established risk factors are avoided. Prevention of CHD involves the following:
Eating a healthy diet
Adequate physical exercise
Decreasing obesity
Treating high blood pressure
Decreasing cholesterol levels
Quit smoking.
Medications and exercise are roughly equally effective. High levels of physical activity reduce the risk of coronary artery disease by about 25%.
Most guidelines recommend combining these preventive strategies. A 2015 Cochrane Review found some evidence that counselling and education in an effort to bring about behavioral change might help in high-risk groups. However, there was insufficient evidence to show an effect on mortality or actual cardiovascular events.
In diabetes mellitus , there is little evidence that very tight blood sugar control improves cardiac risk although improved sugar control appears to decrease other problems such as kidney failure and blindnes.
World Health Organization (WHO) recommends "low to moderate alcohol intake" to reduce risk of coronary artery disease while high intake increases the risk.
Diet and heart disease
A diet high in fruits and vegetables decreases the risk of cardiovascular disease and death. Vegetarians have a lower risk of heart disease, possibly due to their greater consumption of fruits and vegetables. Evidence also suggests that the Mediterranean diet and a high fiber diet lower the risk.
The consumption of trans fat (commonly found in hydrogenated products such as margarine ) has been shown to cause a precursor to atherosclerosis and increase the risk of coronary artery disease.
Evidence does not support a beneficial role for omega-3 fatty acid supplementation in preventing cardiovascular disease (including
myocardial infarction and sudden cardiac death ). There is tentative evidence that intake of menaquinone ( Vitamin K 2 ), but not phylloquinone ( Vitamin K 1 ), may reduce the risk of CHD mortality.
Secondary prevention
Secondary prevention is preventing further sequelae of already established disease. Effective lifestyle changes include:
Weight control
Smoking cessation
Avoiding the consumption of trans fats (in partially hydrogenated oils)
Decreasing psychosocial stress.
Exercise
Aerobic exercise , like walking, jogging, or swimming, can reduce the risk of mortality from coronary artery disease. [90] Aerobic exercise can help decrease blood pressure and the amount of blood cholesterol (LDL) over time. It also increases HDL cholesterol which is considered "good cholesterol".
Although exercise is beneficial, it is unclear whether doctors should spend time counseling patients to exercise.
The U.S. Preventive Services Task Force found "insufficient evidence" to recommend that doctors counsel patients on exercise but "it did not review the evidence for the effectiveness of physical activity to reduce chronic disease, morbidity and mortality", only the effectiveness of counseling itself.
The American Heart Association , based on a non-systematic review, recommends that doctors counsel patients on exercise.
Psychological symptoms are common in people with CHD, and while many psychological treatments may be offered following cardiac events, there is no evidence that they change mortality, the risk of revascularization procedures, or the rate of non-fatal myocardial infarction.
Sources:
Wikipedia
www.mayoclinic.org
www.healthline.com
www.medicalnewstoday.com
www.clevelandclinic.org
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