CORONARY HEART DISEASE


Definition

CHD is narrowing of small blood vessels which supply blood and oxygen to the heart. CHD is also known as the disease of the coronary arteries.

Alternative names: the disease of coronary arteries, arteriosclerotic heart disease, CHD.



Causes

Usually, CHD is the reason of atherosclerosis resulting from the buildup of deposits of fatty substances (the so-called plaques) on the walls of arteries that leads to their narrowing thus reducing or blocking the blood flow to the heart. This can cause chest pain (angina), shortness of breath, heart attack and other symptoms.

CHD is the leading cause of death in the USA for men and women.

There are many factors increasing the risk of cardiovascular diseases:

  • Men older than 40 have a greater risk of CHD than women. However, once a woman becomes older (especially after menopause) her CHD risk is equated to that of a man.
  • Genetic predisposition (heredity) may increase your risk. You are more susceptible to development of this condition if anyone in your family suffered from CHD – especially at the age younger than 50. The older you are, the greater the CHD risk is.
  • Diabetes is a major factor of CHD risk.
  • High blood pressure increases the risk of HCD and heart failure.
  • Abnormal cholesterol levels: LDL (‘bad’) should be as low as possible, while HDL (‘good’) should be as high as possible.
  • Metabolic syndrome leads to the high triglyceride level, high blood pressure, excess fat around your waist and a high insulin level. People from the group with such issues have great chances of CHD.
  • Smokers have much higher risk of disease that non-smokers.
  • Chronic renal insufficiency may increase the risk.
  • Atherosclerosis of arteries in other parts of your body (e.g., aneurysm of abdominal artery or atherosclerosis of carotid artery) increases CHD risk.
  • Other risk factors include alcohol abuse, hypodynamia and frequent stress.
Increased level of inflammatory substances such as C-reactive protein and fibrinogen are considered as the possible indicator of a high risk of the disease. High level of chemical substances such as the so called homocysteines and amino acids are also associated with the high CHD risk.



Symptoms

The symptoms may be very noticeable. But you can have the disease and not have any symptoms.

Chest pain, or angina, is the most common symptom. You feel this pain when the heart gets insufficient amount of blood or oxygen. You may feel tightness in your chest or like anyone is squeezing your heart. You may feel pain under your breast bone and also in the neck, arms, stomach or upper back. The pain is usually triggered by the physical or emotional stress and goes away when having a rest or taking nitroglycerine. Other symptoms include dyspnea and fatigability during excercise.



Diagnostic Techniques

There are many methods of CHD diagnostics. Usually, the physician performs more than one test before getting a diagnosis.

The following tests may be performed:

  • Electrocardiography (ECG)
  • Exercise stress test
  • Echocardiography (cardiac US)
  • Magnetic resonance imaging (IMR)
  • Multi-slice spiral computed tomography (MSCT) for visualization of cardiac vessels and assessment of calcification degree in the walls of arteries – the more calcium, the higher CHD risk.
  • Coronary angiography — an invasive procedure for evaluation of the coronary artery condition with obtaining x-ray pictures.



Treatment

You may be suggested one or a few medicines to treat your blood pressure, diabetes or high cholesterol levels. Follow your physician’s directions strictly to prevent CHD from getting worse. Treatment of patients with CHD is aimed at:

  • LDL level of no more than 100 mg/dL
  • Glycated hemoglobin level of no more than 7%
  • Blood pressure within 120/80 mm Hg
Taking Aspirin with or without clopidogrel (Plavix) prevents clot formation in your arteries and reduces the risk of a heart attack. Ask your physician whether you should take these medicines.

The treatment depends on symptoms and severity of the disease. Your physician may prescribe one or more medicines for CHD, including:
  • ACE inhibitors to reduce your blood pressure and protect your heart;
  • beta blockers to slow your heart rates, BP and heart’s demand for oxygen;
  • calcium channel blockers to relax arteries, thus lowering BP and reducing the heart workload;
  • diuretics for lowering BP and treatment of congestive heart failure;
  • nitrates (such as nitroglycerine) to control the chest pain and improve blood supply to the heart;
  • statins to reduce the cholesterol level.
Never abruptly stop taking these medicines. Consult your physician first. Abrupt cancellation will worsen angina or trigger a heart attack.

Procedures and surgeries used in CHD treatment include:
  • angioplasty and stent implantation called percutaneous coronary intervention;
  • coronary artery bypass grafting (CABG);
  • minimally invasive heart surgery.
Lifestyle change is of great importance. Your physician may recommend you to:
  • exclude or reduce salt intake;
  • keep a ‘heart diet’: with low content of saturated fats, cholesterol or trans fats;
  • exercise regularly and maintain a healthy weight;
  • if you have diabetes, keep the blood sugar level under control;
  • do not smoke.



Prognosis

Every person recovers differently. Some people stay healthy by changing their diet and giving up smoking, and strictly follow the doctor’s recommendations. Others require surgical manipulations, like angioplasty or CABG.

Early CHD detection leads to a better outcome.

Possible complications:

  • heart attack;
  • heart failure;
  • unstable angina;
  • sudden death.



When to Seek Medical Attention

If you have CHD risk factors contact your physician to discuss the disease prevention and possible treatment.

Immediately call the local emergency unit or go to the emergency room if you have:

  • angina
  • shortness of breath
  • symptoms of a heart attack.



Prevention

Regularly see your doctor. There are some recommendations to prevent CHD or reduce the risk of its development:

  • Avoid or reduce stress;
  • Do not smoke;
  • Eat balanced low-fat and low-cholesterol food including plenty of fruit and vegetables every day;
  • Regularly exercise. If your weight is normal, exercise at least for 30 minutes every day. In case of excessive weight or obesity, you should exercise for 60-90 minutes daily according to the researches;
  • Keep your BP under control within at least 130/80 mm Hg if you have diabetes or chronic renal insufficiency, and no higher than 140/90 mm Hg in other cases;
  • Keep your cholesterol level and blood sugar.
Moderate amount of alcohol (one glass of wine for women and two for men) may decrease a risk of cardiovascular problems. However, in great amounts alcohol does more harm than good.

In case you have one or more CHD risk factors, talk to your physician as to the daily intake of aspirin to prevent a heart attack. In case of a risk of intestinal side effects, you may be given low doses of aspirin.

According to the new regulations, hormone replacement, vitamin E or C , antioxidant or folic acid supplements are not recommended for CHD prevention. Use of hormonal replacement therapy in women (menopausal) before or after menopause is currently controversial.

The information is provided by the site: www.sibheart.ru