Coronary Heart Disease | قلب کی شریانوں کے امراض

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Coronary Heart Disease

Heart disease is the world's most deadly condition, causing more deaths each year than any other disease globally in all races and in both men and women. Coronary heart disease (CHD) occurs when the coronary arteries become narrowed or completely blocked. Coronary arteries are blood vessels which supply oxygen-rich blood to heart muscles.
Source: National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services
Source: National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services
Angina is the most common symptom of CHD in which the blood supply to heart muscles is reduced, it causes severe squeezing pain in chest. Heart Attack is the condition occurs when the blood supply to heart muscles is greatly reduced or completely stopped. It causes severe chest pain extending to left arm, jaws, neck and back accompanied with breathlessness and lightheadedness. Without oxygen-rich blood, the affected heart muscles can start to die in a short period of time.

This condition is usually the result of another condition called atherosclerosis – hardening of arteries due to fatty deposits and cholesterol build up (these are called plaque).  Plaque build-up occurs gradually in many years. The plaques can partially or fully block the coronary arteries which can reduce blood flow to the heart muscles. As a result of interruption in blood flow, the heart muscles do not get a constant supply of nutrients and oxygen required to work correctly. This increases the risk for many serious complications, such as chest pain and heart attack.

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There are not many signs and symptoms and the ones that do occur can come on suChest pain body-116585_640ddenly. 

  • Squeezing chest pain feels moving to left arm, shoulder, neck, back and jaws
  • Pain increases with movement and reduces when resting
  • Shortness of breath
  • Sweating
  • Indigestion, vomiting and nausea

The chest pain, also referred to as angina, is most often described as an intense tightness or pressure in the chest.  Many people think they are having a heart attack because the pain can also move to the left arm, as well as the back and abdomen.  Stress, both emotional and physical, usually bring it on and stopping the stress usually causes the pain to go away.

Shortness of breath can be coupled with extreme fatigue, especially when the patient is exercising or performing physical activity.

In most coronary artery patients, the plaque build-up is usually as a result of many years of unhealthy dieting habits  (consuming too much fats), inactive life-style and in some cases genetic reasons.

It is believed that this disease begins when the coronary artery's inner layer is damaged at some point in life.  This can occur at any time, including during childhood.  Many things can cause this damage, such as:

  • Smoking
  • High cholesterol
  • High blood pressure
  • Radiation in the chest area
  • Insulin resistance or diabetes
  • Not exercising regularly

After the damage is done, plaques made up of cellular waste products and cholesterol can start to build up, leading to atherosclerosis (a condition where the arteries harden).  If a plaque surface breaks, platelets (a type of blood cell) rush to the area to try and repair it, resulting in a clump that can block the artery and cause a heart attack.

Source: National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services.
Source: National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services.

Risk factors of coronary heart disease include:

A complete physical exam and taking a full medical history is the first thing the doctor will do when making a diagnosis. Routine blood work that examines complete blood count, cholesterol level and electrolyte status are commonly done because the doctor wants to get a full picture of the patient’s health.

An electrocardiogram (ECG) provides information about the electrical signals traveling through the heart. It can show whether or not someone is having a heart attack and it also can help to show if the person had a heart attack in the past.

An echocardiogram provides doctors with images of the patient’s heart through the use of sound waves. The doctor can examine the different heart wall parts to ensure proper pumping activity. Coronary heart disease may be the problem if there is a part moving weakly.

A stress test is done if the patient starts to notice symptoms when he/she is exercising or participating in physical activity. The patient may be on a treadmill or the doctor may use medications to stimulate the heart.

Cardiac catheterization (angiography) looks at the flow of blood through the heart. A dye is usually injected into the arteries via a catheter that is threaded up to the heart. The dye can show where blockages are when X-rays are taken. In some cases, blockages and narrowing can be repaired at the same time (Angioplasty or ballooning).

Treatment often begins with medications and the patient may need to take more than one.  Medications may include:

  • Cholesterol-modifying drugs: These works to decrease the bad cholesterol (LDL).  This helps to reduce plaques within the coronary arteries.  There are many different options, such as statins, fibrates, niacin and bile acid sequestrants.
  • Aspirin: Aspirin thins the blood and can decrease the risk of clots formation, which in turn, lowers the risk of coronary blockages.
  • Beta blockers:  This type of drug helps to maintain blood pressure and heart rate in normal range, reducing how much oxygen heart requires. This can reduce additional heart attacks in those who have had one in the past.
  • Nitroglycerin: This drug reduces how much blood the patient’s heart is demanding by opening up the coronary arteries.
  • Angiotensin II receptor blockers and Angiotensin-converting enzyme inhibitors: These drugs can decrease how quickly coronary heart disease progresses.  They also work to maintain blood pressure in the normal range.

In some cases, medications are not enough and more aggressive treatment is necessary.  These options often include:

  • Percutaneous coronary revascularization: This involves by inserting a thin thread-like wire (a catheter) into the narrowed area of an artery and using a balloon to push the plaques toward the walls so that the artery is more open.  A stent (metallic device) is usually placed to maintain this opening.
  • Coronary artery bypass surgery: This procedure uses blood vessels from elsewhere in the body to create a graft.  This allows the surgeon to bypass a severely narrowed or blocked artery to improve blood flow.

Heart attack, abnormal heart rhythm and heart failure are the possible complications of coronary heart disease. All of these can occur as a result of reduced blood flow due to narrowed or blocked arteries. This can starve the heart muscle of the nutrients and oxygen it needs to function properly.

Living with coronary heart disease requires some basic lifestyle changes and health maintenance to help lower risk of experiencing the potential complications.  These include:

  • Keep track and control of diabetes
  • Maintain healthy blood pressure numbers
  • Exercise regularly
  • Eat a well-balanced, healthy diet
  • Manage stress
  • Maintain a healthy weight
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