Coronary heart disease (CHD), also known as coronary artery disease and arteriosclerotic heart disease, is a narrowing of the small blood vessels that supply blood and oxygen to the heart.
CAUSES
Coronary heart disease is usually caused by a condition called atherosclerosis, which occurs when fatty material and a substance called plaque builds up on the walls of your arteries. This causes them to get narrow. As the coronary arteries narrow, blood flow to the heart can slow down or stop, causing chest pain (stable angina), shortness of breath, heart attack, and other symptoms.
Men in their 40s have a higher risk of CHD than women. But, as women get older, their risk increases so that it is almost equal to a man's risk.
Many things increase your risk for CHD. Bad genes (heredity) can increase your risk. You're more likely to develop the condition if someone in your family has had it -- especially if they had it before age 50. Your risk for CHD goes up the older you get.
The following factors also increase your risk of CHD:
· Diabetes
· High blood pressure High LDL "bad" cholesterol
· Low HDL "good" cholesterol
· Menopause
· Not getting enough physical activity or exercise
· Obesity
· Smoking
· Emotional stress
Higher-than-normal levels of inflammation-related substances may also increase your risk for a heart attack. Such substances include C-reactive protein and fibrinogen. Increased levels of a chemical called homocysteine, an amino acid, are also linked to an increased risk of a heart attack.
SYMPTOMS
The most devastating sign of coronary heart disease is abrupt, unexpected cardiac arrest.
Cardiac arrest commonly occurs in people who have had previous heart attacks, but it may occur as the first symptom of heart disease.
Most people exhibit some symptom or discomfort.
Symptoms usually occur during exercise or activity because the heart muscle's increased demand for nutrients and oxygen is not being met by the blocked coronary blood vessel.
Chest pain or discomfort (angina) is the most common symptom. You feel this pain when the heart is not getting enough blood or oxygen. How bad the pain is varies from person to person.
There are two main types of chest pain:
· Atypical chest pain -- often sharp and comes and goes. You can feel it in your left chest, abdomen, back, or arm. It is unrelated to exercise and not relieved by rest or a medicine called nitroglycerin. Atypical chest pain is more common in women.
· Typical chest pain -- feels heavy or like someone is squeezing you. You feel it under your breast bone (sternum). The pain usually occurs with activity or emotion, and goes away with rest or a medicine called nitroglycerin. Adults with typical chest pain have a higher risk of CHD than those with atypical chest pain.
More common symptoms of coronary heart disease include the following. No one person usually has all of these symptoms.
· Shortness of breath on exertion
· Jaw pain, back pain, or arm pain, especially on left side, either during exertion or at rest
· Palpitations (a sensation of rapid or very strong heart beats in your chest)
· Dizziness, light-headedness, or fainting
· Weakness on exertion or at rest
· Irregular heartbeat
Silent ischemia is a condition in which no symptoms occur even though an electrocardiogram (ECG, or heart tracing) and/or other tests show evidence of ischemia. Arteries may be blocked 50% or more without causing any symptoms.
TREATMENT
Treatment depends on your symptoms and how severe the disease is.
If you have coronary artery disease that does not cause symptoms, you can be treated with either medicine or angioplasty with stenting. Recent studies show that medicine and angioplasty with stenting have equal benefits. Angioplasty with stenting does not help you live longer, but it can reduce angina or other symptoms of CHD.
Angioplasty with stenting, however, can be a life-saving procedure if you are having a heart attack.
Medications used to treat CHD include:
ACE inhibitors to lower blood pressure Blood thinners (antiplatelet drugs) to reduce your risk of blood clots Beta-blockers to lower heart rate, blood pressure, and oxygen use by the heart Calcium channel blockers to relax arteries, lowering blood pressure and reducing strain on the heart Diuretics to lower blood pressure Nitrates (such as nitroglycerin) to stop chest pain and improve blood supply to the heart Statins to lower cholesterol Procedures to treat and diagnose CHD are called percutaneous coronary interventions, or PCIs. Angioplasty and stenting are types of PCIs.
Other types include:
Coronary atherectomy Coronary radiation implant or coronary brachytherapy Coronary brachytherapy delivers radiation into the coronary arteries. This treatment is only for patients who have had stent-related problems.
Surgeries used to treat CHD include:
· Coronary artery bypass surgery
· Minimally invasive heart surgery
Lifestyle changes are very important. Your doctor may tell you to:
· Avoid or reduce the amount of salt (sodium) you eat
· Eat a heart healthy diet -- one that is low in saturated fats, cholesterol, and trans fat
· Get regular exercise and maintain a healthy weight
· Keep your blood sugar strictly under control if you have diabetes
· Stop smoking
PREVENTION
See your health care provider regularly. Tips for preventing CHD or lowering your risk of the disease:
· Avoid or reduce stress as best as you can.
· Don't smoke. Eat well-balanced meals that are low in fat and cholesterol and include several daily servings of fruits and vegetables.
· Get regular exercise. If your weight is considered normal, get at least 30 minutes of exercise every day. If you are overweight or obese, experts say you should get 60 to 90 minutes of exercise every day.
· Keep your blood pressure, blood sugar, and cholesterol under control.
Moderate amounts of alcohol (1 glass a day for women, 2 for men) may reduce your risk of cardiovascular problems. However, drinking larger amounts does more harm than good.
If you have one or more risk factors for coronary heart disease, talk to your doctor about possibly taking an aspirin a day to help prevent a heart attack or stroke. Low-dose aspirin therapy may be prescribed if the benefit is likely to outweigh the risk of gastrointestinal side effects.
New guidelines no longer recommend hormone replacement therapy, vitamins E or C, antioxidants, or folic acid to prevent heart disease.
