Coronary Heart Disease

One of the main reasons for deaths worldwide and the single leading cause of death (1 in 5) and illness in the US is coronary heart disease (CHD). Also referred to as coronary artery disease (CAD) and ischemic heart disease (IHD), approximately 14 million women and men are impacted by coronary heart disease in America. Costing about $156 billion annually, coronary heart disease is one of the most costly types of cardiovascular conditions in the US.

Causes

In general, coronary heart disease develops over time and occurs when the arteries or major blood vessels, which supply the heart with blood, become diseased or damaged. This is often the result of plaques or fatty deposits, which have built-up in the walls of the arteries.

The hardening of the arteries or atherosclerosis is the condition which causes coronary heart disease and this occurs when the arteries become narrow, restricting the flow of blood, resulting in chest pain or angina.

In addition, if the arteries are blocked because of plaque, it may cause a heart attack or sudden cardiac arrest.

Overall, if the heart does not received sufficient blood, which is rich in oxygen and nutrients, then you have a high chance of getting coronary heart disease.

Risk factors

There are several risk factors, which may contribute to coronary heart disease. However, some common ones may include:

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• Diabetes and persistent kidney disease
• Hypertension or high blood pressure
• Diet high in fat
• Age, especially for men in their 40s and women who have reached menopause
• Family genes or hereditary, in that if someone in your family has had coronary heart disease before age 55, your chances of being affected by this disease increases
• High or abnormal cholesterol levels, which results if your bad cholesterol or low density lipoproteins (LDLs) are high and your good cholesterol, or high-density lipoproteins (HDLs) are low
• Smoking and excessive tobacco use, including smoking cigarettes, pipes and cigars as well as chewing tobacco
• Lack of exercise and physical activity
• Obesity and being overweight
• Excessive use of alcohol
• Emotional stress

Symptoms

Often called the silent killer, coronary heart disease symptoms may occur quickly, sharply, and unexpectedly and may be destructive, as in a cardiac arrest or a heart attack. Some symptoms include feelings of discomfort especially during exercise or increased activity when your heart has an increased demand for nutrients and oxygen in the blood. However, if the arteries are blocked, the flow is decreased and they may trigger a cardiac arrest or extreme discomfort.

Sometimes symptoms may not occur even though you have coronary heart disease and in many cases, apart from having an electrocardiogram (ECG) test done, it would not be discovered that you have a heart problem. This condition is called silent ischemia when half or more of your arteries are blocked without showing any symptoms.

Other common symptoms for coronary artery disease occur because the heart is unable to pump enough blood in order to meet the demands of your body. These may include

• Tightness in the chest and chest pains, which is one of the most common symptoms
• Heart palpitations
• Shortness of breath resulting from strenuous activity or exercise
• Pain in the neck, arm, back, stomach or jaw in particular on the left side of the body, which may occur during rest or strenuous exercise
• Feeling weak or fatigued during rest or exertion
• Heartbeat that is irregular
• Feeling dizzy, faint or lightheaded

While you may not have all of the symptoms, you may experience a few. However, paying close attention and seeking timely medical help if the symptoms are persistent is important since they may lead to serious complications.

Complications

Some complications include a heart attack, which usually damages your heart muscles due to little or no blood flowing to the heart. The damage is often irreversible; however, with quick treatment it may be reduced. Some persons who have a heart attack may show symptoms such as spells of blackout, sweating excessively without an explanation, frequent chest pains, shortness of breath and pain in the jaws with exertion or during rest.

If you have experienced a heart attack before, you may develop heart failure. With heart failure, the heart is too weak to pump the flow of blood required for your heart to function properly.

Another complication arising from the symptoms of coronary heart disease is angina or chest pains which is usually experienced during strenuous activity such as exercise. In addition, you may experience arrhythmia or abnormal heartbeats resulting from damage to the tissues of the heart due to limited blood flow. The possibility of unexpected or sudden death may also arise from coronary artery disease.

Prevention and Diagnosis Considerations

In general, people usually seek to have tests done and to get a diagnosis for coronary heart disease if they exhibit some of the symptoms or complications such as a heart attack, an unexpected cardiac arrest or angina.

However, many of the symptoms that lead to heart disease might be caused by other conditions that are not related to the heart. Therefore, the process of diagnosis begins with getting information on your medical history, including symptoms, general and specific health issues and any medications that you are taking currently.

In order to determine whether you are having a heart attack or any other type of condition that may be life threatening, the doctor may order a few tests, before making a diagnosis. These may include a physical examination, an ECG, a blood test and other imaging tests such as an x-ray or Computerized Tomography (CT) scan.

Testing

Some of the most common diagnostic tests, which are used include:

Blood Test to check your blood chemical makeup, the blood cells as well as if there are any leakages from heart muscles that may be damaged. This may indicate that there has been a heart attack.

Electrocardiogram (ECG) is used to measure the electrical signals in your heart and helps to detect heart problems, including a previous or current heart attack, ischemia, and strain on the heart because of high blood pressure and rhythm disorders. The ECG helps to give indications as to the significant causes of the coronary heart symptoms.

With the ECG, electrodes are attached to your chest, arms and legs as you lie down on a table. The test is easy and takes just a few minutes to be completed. In some cases, another test, called Holter monitoring, is used with the ECG. This requires you to wear a portable monitor for 24 hours to test any abnormalities that may exist in your heart.

Echocardiogram

Echocardiogram is a stress test, which uses sound waves on the heart walls and valves to produce images of the heart as it beats. It checks to see if all parts of your heart are helping with pumping the blood flow. This helps to identify any form of coronary disease or if some parts of the heart are weak or have been damaged by a heart attack. With echocardiography, the test may involve the patient exercising on a treadmill or a drug may be administered.

EBCT

CT scan and Electron Bean CT (EBCT) Scan use technology, which helps your doctor to see whether there are any plaques or calcium rich fatty deposits in your arteries. It also helps to detect blockages in your arteries up to 20%, which may be overlooked in other tests. The EBCT scans are most helpful in screening young people who may have many risk factors for heart disease and generally, minor blockages may be treated with medication and some lifestyle changes.

Coronary Angiogram or Coronary Catheterization

Coronary Angiogram or Coronary Catheterization is a surgery, which uses a catheter, a long, thin, flexible tube, filled with an iodine dye, which is injected intravenously into your arteries.

The catheter is often threaded through the opening of your arteries from a blood vessel usually in your leg or arm or groin. The arteries are made visible on an x-ray screen and images of the arteries are taken and recorded for further review. The images may show the size of the arteries and any blockages that may be occurring.

The coronary angiogram is one of the most accurate tests, which are used to determine the type of treatment you will require for your heart condition.

Possible treatments may include a heart bypass surgery, an angioplasty, stent placement or medications.

The diagnosis test using the coronary angiogram is usually a one-day invasive surgery at a hospital or a special catheterization lab and the complication risks are extremely limited especially with an experienced doctor.

CT Angiography and MRA’s

CT angiography is another method used to perform the coronary angiogram, which is non-invasive.

Magnetic Resonance Angiogram (MRA) is combined with an injected dye, which is used to detect if the arteries are narrow or blocked. However, the results are not as effective as with the coronary angiogram.

Nuclear Scan

Nuclear Scan is often used as a stress test and involves the injection of a small dose of radioactive tracer such as thallium into a vein. With the help of a special camera, the amount of blood flow reaching the areas of the heart muscles is identified.

You will be required to do two tests, one with stress or exercise on a treadmill and the other when you are at rest. If you are unable to exercise, you will be given a drug, such as Adenocard, Persantine or Dobutrex to help stress your heart on a temporary basis. The nuclear scan is a non-invasive and very accurate test, and is often very expensive.

Stress Tests

Stress Tests are used to determine when coronary heart disease symptoms occur, whether during exertion or at rest. It may involve walking on a treadmill or riding a stationary bike during an ECG. In cases where you are unable to exercise, a drug may be used to stimulate your heart.

Treatment options

The treatment for coronary heart disease involves home, pharmaceutical and medical applications. Following your doctor directions is very important to reducing or preventing this disease as well as other related ones such as hypertension and diabetes.

Home remedies or treatments

Most of the control for treatment lies in the hands of the individual with heart problems. With changes to your lifestyle, you are able to help prevent or slow the progression of the disease. These changes include

Eating a diet that is heart-healthy, which should include fruits, vegetables, whole grains and fish and reduce your fat intake.

• Maintaining a healthy weight by exercising on a regular basis or 30 to 60 minutes for 3 to 5 days weekly.
• Controlling high blood pressure and diabetes by taking measurements and getting the appropriate treatment.
• Quitting smoking so that you may reduce your risk for heart disease after 3 years of quitting.
• Keeping your cholesterol in check with acceptable levels of LDL.
• Managing your stress or reducing it by using muscle relaxation and deep breathing techniques.

Pharmaceutical treatment

There are many drugs, which are used for treating coronary heart disease. Aspirin is a popular medication and taking a low-dose type daily may help to reduce your risk of a heart attack and the possibility of a clot forming. However, always consult your doctor before taking this medication as some people may experience side effects such as bleeding problems or ulcers. You doctor may also recommend a blood thinner.

Beta Blockers help to slow your heart rate and your blood pressure by decreasing your heart demand for oxygen. However, asthma patients should avoid this treatment as it may trigger an asthma attack. Statins are drugs, which are used to reduce the amounts of lipids such as cholesterol and fats in your blood.

They also help to slow or prevent the succession of heart disease and the repeat of heart attacks. Other medications may include calcium channel blockers, nitroglycerin, cholesterol-modifying drugs and angiotensin-converting enzyme inhibitors. Some side effects from the calcium blockers may include constipation and leg swelling.

Medical Treatment

The medical treatment for coronary heart disease may involve some invasive procedures and more complicated measures such as surgery, which may have some risks such as a stroke, heart attack or even death.

Some invasive procedures include coronary angioplasty, which provides both therapeutic and diagnostic treatment and involves a tube, which is inserted in your artery. Another method is using a stent to keep the blocked arteries open so that the blood can flow freely.

It is a small coil-like tube, which is placed over an inflated balloon at the blocked area. Other invasive treatments include brachytherapy, which uses radiation to clear the blocked arteries, and atherectomy helps to cut away the plaque build-up in small areas or self-contained parts of an artery.

Other Options

However, when medication and invasive procedures fail to help the person with coronary heart disease or if the disease is severe, then surgery is often recommended. If several coronary arteries are blocked or if the major left artery is significantly blocked, a coronary artery bypass operation is usually performed. With this operation, you are connected to a bypass pump machine while the heart is stopped briefly. In rare cases, the operation is done without using a bypass pump.

Other surgical treatments include minimally invasive coronary bypass, usually for your front or right coronary arteries. Some patients who are unable to have either a bypass surgery or angioplasty, the transmyocardial laser revascularization (TMR) procedure is offered. This surgery, which may be done by itself or with a bypass surgery, uses a laser catheter to make several holes in your heart™s muscle so that new vessels will grow into the diseased heart muscles.

Stem Cells

A relatively new treatment option uses stem cell; however, this is not approved by the US FDA and is done on a limited basis in a few countries. It involves screening by stem cell cardiologists and the cells are taken, isolated, multiplied and injected into one or more of coronary arteries. This procedure is similar to the standard angioplasty or minimal invasive heart surgery.