Coronary Heart Disease: Heart problems

 

Coronary Heart Disease

Overview:

We often hear that the neighbour living next door had a heart attack last night. Some would say “He’s lucky: it was only a minor one, the doctor had informed to his relatives.” Such phrases are becoming more and more common. Earlier it was thought that heart attack comes in only aged or above fifty years person but now it is a totally different scenario, you could hear people saying, that young guy was only thirty years and he passed away due to heart attack. Or a forty year man has a history of many attacks and is being mentioned as a heart patient. The heart health has been deteriorating ever since and people need to be aware of heart-healthy habits and general education to prevent such heart related problems.

Coronary heart Disease also known as CHD in short is a medical condition involving the coronary arteries of the heart; the condition is characterised by the deposition of plagues in the major arteries supplying the heart which obstructs the blood flow to the heart.

 

Understanding Coronary Arteries:

Let’s recall some quick information about the coronary arteries.

What are coronary arteries?

 Coronary arteries are the major blood vessels supplying the heart muscles. They carry oxygen and nutrient rich blood in them.

Our heart is supplied by various coronary arteries and their branches; these are named based on their position or location in the heart. 

There are four main coronary arteries such as:

·         Right coronary artery

·         Left coronary artery

·         left circumflex artery

·         Left anterior descending artery

What is the major function of coronary artery?

The function of coronary arteries is to supply oxygen, nutrients and blood to the heart. The formation of plague forms over a long period and remains undiagnosed until the person has mild or major attack.

 Cholesterol is the main culprit causing Coronary artery disease. Hence adapting healthy lifestyle and developing healthy food habits play a major role in the prevention of the risk factors that share a contribution to coronary artery disease.

What affects the heart health? How are the coronary arteries involved?

When there is excess levels of fats, fatty acids and bad cholesterol in the body, it is not absorbed and metabolised. This leads to the accumulation in the blood vessels. 

Over a long period of time, depending upon the serum triglycerides and cholesterol level, the arteries start getting narrow and the deposits get accumulated on the arterial walls which turn into plague.

 The plague formation blocks the lumen of arteries and thus the normal blood flow to the heart gets obstructed. It is called as Atherosclerosis. This impacts the heart health and produces symptoms such as palpitations, chest pain and others.

Let’s understand: What is Plague?

Plague is the formation of hard lining inside the arteries due to the collection of fats, cholesterol, waste debris, residues of the clot forming substances, etc.  When the plague progresses to cover a larger portion of the arterial wall, it narrows the luminal passage of artery. It starts clogging the passage for blood flowing towards heart. This results in sudden chest pain. The condition of plague formation is known as Atherosclerosis.

In order to keep heart healthy, one should have healthy coronary arteries and it can be possible only by healthy lifestyle and good food habits

Whenever the heart receives less blood due to the blocked arteries, there is sudden feeling of chest pain which is known as angina. Depending on the blockages, a person may experience sudden or slow, mild to severe chest pain. Heart attacks are the consequences of blocked major arteries which are showed upon in a cardiac angiogram.

Because the coronary arteries are involved this condition can also be referred to as a coronary artery disease (CAD).

It is also termed as Ischemic Heart Disease (ISD) as the blood supply is reduced causing ischemia (reduced blood and oxygen perfusion in any tissue) in the heart.

Coronary artery disease has been evolving as a major health challenge nowadays due to faulty lifestyles and harmful or unhealthy food patterns of the people. Awareness regarding the heart health can play a vital role in reducing the number of cases and controlling the pre-diagnosed cases. Several cases of death are reported every year due to heart attacks worldwide.

Causes and Risk factors:

Atherosclerosis is the major cause of coronary artery disease. It is defined as the process of deposition of cholesterol based products into the arterial wall forming thickened substance called plague. 

Whenever these plagues breakdown or rupture, the platelets in the blood stream get active to heal the place and this leads to further narrowing of the arterial lumen. Thus it makes the arteries narrow which cannot carry enough nutrient-rich blood or oxygen.  The blood supply to the heart is interrupted or slowed down leading to the slow death of the cardiac cells and tissues. 

Heart which pumps blood to the whole body cannot continue its normal pumping function due to inadequate blood and oxygen supply. This causes heart attacks. Heart attacks are also medically termed as Myocardial Infarction. Severity of the heart attacks depend upon the arterial narrowing and cardiac damage.

There are several risk factors that can predispose a person to coronary artery disease. They are as below:

• High cholesterol levels. High level of serum cholesterol and triglycerides are the factors causing atherosclerosis in people.
• High blood pressure: People who have consistent high blood pressure levels are at risk of developing coronary heart disease.
• History of Diabetes Mellitus: Diabetes patients can have weak vascular system which can be a risk factor.
• Obesity or overweight is one of main reason behind many major diseases such as hypertension, heart disease, diabetes and liver disorders.
• Sedentary life styles: prolonged sitting, lower activity levels. Heart related problems are more common in people who are engaged in less or almost inactive type of work. Siting for a long time for work or studies can also pose a risk in long run. Though exercising twice a week can help out a lot in case there are desk-jobs in this fast moving age.
• Faulty or unhealthy food habits: eating more of junk and fast foods, heavy fat diets, etc. Increased intake of fatty foods build up cholesterol quickly in the body. There are different types of cholesterol depending on the density of the triglycerides such as high density (Good), low density (Bad) and very low density cholesterol. Of them, Bad Cholesterol is the main culprit.
• Stress or emotional breakdown: Stress is also known to be a major cause of heart related problems. Extra burden due to stress or emotional factors in life may pressurise your mind and this may lead to the damage of coronary arteries. Emotional stress breaks down the plague too often, which activates the blood platelets which get collected in between the arterial walls blocking the lumen of the arteries.
• Addictions: Overconsumption of alcohol, tobacco smoking can also aggravate the condition.
• Previous history of heart attacks

Signs and symptoms of Coronary Artery Disease:

·         Sudden chest pain. The pain radiates from the left side of chest to the shoulders to arms pointing towards the little finger.

·         Squeezing, burning or sharp needle pricking pain or a dull ache may be one of any types of pain a person may describe as.

·         Chest tightness

·         Shortness of breath

·         Sudden weakness

Diagnosis of coronary artery disease:

Any heart related problem can be diagnosed using the below mentioned diagnostic procedures:

ECG or Electro-cardiogram: It is the visual graphic representation of the cardiac rhythm of the patient. It measures the electrical activity and heart rate. It also rules out any dysrrhythmias.

Chest X-Rays: chest x-rays are advised to visualise the organs such as heart and lungs that are located in the chest cavity of the patient. Size of lungs, any consolidation of the lobes or fluid effusion can be diagnosed by chest x-rays. It also helps in noting any changes in the heart size of the patient.

Echocardiogram: It is an ultrasound procedure that scans the heart for checking any abnormalities or dysfunction.

Cardiac Profile tests: Many doctors advise a thorough blood laboratory tests to rule out the cause of the problem. The profile may include test such as Hemogram, CPKMB, Troponin, Lipid profile tests such as cholesterol, triglycerides, Etc. Liver function and kidney function tests can also be done if the person has other co-morbidities.

Cardiac catheterization: It is an invasive procedure in which a cardiac thin catheter is introduced through brachial or femoral artery to check the patency of the coronary arteries and learn the intensity of the blockages. The inside of the heart can be visualised properly including the heart chambers and the blood vessels.

CT angiography: It is a non-invasive type of angiography which is done using CT scan procedures.  It also helps to check the blockages in the arteries, ejection capacity of heart and the pumping ability of heart. It detects the calcium deposition level in the heart.

Treadmill test: In this test a treadmill is used to check the heart rate and rhythm while walking on the treadmill with varied speeds. The ECG of the person is recorded and diagnosis is made.

Nuclear tests: In nuclear stress tests, ECG is recorded and the inside pictures of heart chambers and arteries are taken using a specific injected tracer. It identifies the areas of heart that receive low blood supply.

 

Treatment:

Coronary artery disease can be managed with medications and healthy changes in daily routine. Only in few cases, the people know that they have blocked arteries. Otherwise most of the cases show the history of diagnosis as post-attack or post-angina scenarios. Once the person arrives at the hospital, the vital signs are recorded, medicines to relieve the chest pain, reduce hypertension are then administered. Patient is hospitalised, if needed for few days until he becomes stable. All the necessary investigations are carried out for diagnosing the condition.

The treatment involves multi-faceted approach towards further care and prevention by changing the lifestyle and dietary patterns to ensure heart health. Severe cases may require cardiac surgery.

Lifestyle changes:

Walking is the best exercise and it must be done regularly. Walk as tolerated. Don’t try harsh or rapid walking. It may prove to be harmful.

Reduce the sitting periods and adapt an active life routine.

Stay away from alcohol and smoking

Try to reduce the excess weight. Exercise at least twice a week. Do aerobics as tolerated.
Practice slow deep breathing exercise.

Meditate regularly to keep stress on bay. Use relaxation therapies.

Laughing exercises are often seen in elder persons during their park visit for walking.

Acupressure therapy can also aid in providing relief. Consult an acupressure specialist if you believe in its magic.

Control Blood pressure by continuing the medications as prescribed by your doctor. Do not stop any medications without medical consultation.

Dietary Changes:

Photo by Abet Llacer from Pexels

Diagnosis of heart problem and advise of the doctor for diet almost comes as a sudden shock. It is unbelievably the most terrible plight and you now start feeling as patient now rather than being a normal individual. These are the general concerns of the patients diagnosed for the first time for coronary artery disease. 

I have known this with nearness to the condition and emotions of the person. My Dad was diagnosed as a CHD patient a year ago after he had a mild heart attack. I have keenly observed his concerns and feelings as never before. He totally behaved as a patient; and being a paramedic I had to ensure him, he can lead normal life by stopping overthinking and following the doctor's advice properly.

    Sometimes it becomes too difficult to switch to new food habits all of a sudden. Nobody likes to give up his or her favourite foods, no matter how oily it is or how much cholesterol it contains. It almost feels like "caught in a trap" feel where your desires no longer matter and you are left with no choices up to satisfy your food cravings. 

First think and plan your diet slowly and gradually. Make it a good man's choice and try to be faithful to yourself . Cut down the fats from your foods slowly and gradually, there's no need to stop everything in one single day. Take a few days time to adjust to your new heart-healthy diet regimen. Don't let it be enforced on you by others. Instead try to be the one to actively participate in maintaining heart health.

The sudden news of having a heart problem is extremely painful and devastating. It can make you lose your senses. You might start fearing death as never ever before and that adds up to the existing problem. Don't lose patience and be practical. For every problem there's a solution in the universe and always hope better things to come your way. 

Few tips may help you:

1. Eat a balanced diet. Cut off the intake of fatty foods.
2. Eat fresh fruits and include clear juices in your diet.
3. Warm soups also are good for heart health.
4. Eat less amounts of salt and sugar.
5. Avoid intake of any deep fried items.

Medical treatment:

The medical treatment includes the following types of medicines:

Anti-platelet medication: Aspirin is indicated in patients with arterial blockages. Aspirin inhibits the aggregation of the platelets inside the arterial wall and thus helps reducing the thickness of blood. It is described as a blood thinner which helps to decrease the clot formation in the blood vessels. It should be used with caution in patients with bleeding disorders as it can be dangerous.

Aspirin is a drug of choice in coronary artery disease as it may prevent further sudden heart attacks.

Beta-blockers:

Beta blockers are the drug of choice in hypertension as they lower down the heart rate. It helps to lower down the blood pressure. This has effect on the heart as the hearts workload is reduced and the oxygen demand is also decreased.

Use of Nitro-glycerine pellets: Nitro-glycerine gives short term relief from angina (chest pain). It is given after diagnosis of heart attack. Its effect is vasodilation which means the blood vessels are expanded to allow blood flow. This reduces the hearts workload.

Calcium channel blockers: these are medicines used to treat high blood pressure. They relax the heart muscles and arteries.

Cholesterol lowering drugs: Statins are the drugs which reduce the level of bad cholesterol from the blood. It decreases the risk of further heart attacks and death. It is continued for long as per doctor’s recommendation or advice.

Angiotensin converting Enzyme inhibitors or ACE inhibitors: these medicines also help to bring down the blood pressure.

The drugs are to be continued and follow-up medical check-ups are also important for the treatment of coronary artery disease to prevent further damages.

Along with healthy lifestyles and medications, a person with heart problems can lead a normal life.

In case of severe blockages doctor may advise to perform some of the procedures such as coronary angioplasty, balloon angioplasty, stent placement or even cardiac by-pass surgery to treat the blockages or save the life of the patient.