According to 2005 statistics published by the American Heart Association (AHA), over 80,700,000 people in the U.S. have at least one type of cardiovascular disease.
Coronary heart disease (CHD), a type of cardiovascular disease, is the leading cause of death in the United States for men and women. According to the American Heart Association, more than 15 million people have some form of the condition.
This year an estimated 1.5 million Americans will have a new or recurrent coronary attack. About 400,000 people a year die of coronary attack in an Emergency Department or without being hospitalized. Most of these are sudden deaths caused by cardiac arrest, usually resulting from ventricular fibrillation.
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What Is Coronary Heart Disease (CHD)?
Coronary heart disease (CHD) is a narrowing of the small blood vessels that supply blood and oxygen to the heart. CHD is also called coronary artery disease.
What Causes CHD?
CHD is usually caused by a condition called atherosclerosis, which occurs when fatty material and a substance called plaque (raised patches) builds up on the inner walls of your arteries. These plaques consist of low-density lipoproteins, decaying muscle cells, fibrous tissue, clumps of blood platelets, cholesterol, and sometimes calcium.
Atherosclerosis is a disease affecting arterial blood vessels. It is a chronic inflammatory response in the walls of arteries. It is commonly referred to as a "hardening" or "furring" of the arteries. It is caused by the formation of multiple plaques within the arteries.
The plaques tend to form in regions of turbulent blood flow and are found most often in people with high concentrations of cholesterol in the bloodstream.
Atherosclerosis causes the arteries to narrow. As the coronary arteries narrow, blood flow becomes restricted, slows down and/or can stop. Atherosclerosis can occur in any area of the body, but is most important when it happens in the heart, brain or blood vessels leading to the brain. Atherosclerosis also causes a great deal of serious illness by reducing the flow of blood in other major arteries, such as to the kidneys, legs, and intestines.
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The number and thickness of plaques increases with age, causing loss of the smooth lining of the blood vessels and encouraging the formation of thrombi (blood clots). Sometimes fragments of thrombi break off and form emboli, which travel through the bloodstream and block smaller vessels.
While the symptoms and signs of CHD disease are noted in the advanced state of disease, most individuals with coronary heart disease show no evidence of disease for decades as the disease progresses before the first onset of symptoms, often a "sudden" heart attack, finally arise.
After decades of progression, some of these atheromatous plaques may rupture and (along with the activation of the blood clotting system) start limiting blood flow to the heart muscle. The disease is the most common cause of sudden death, and is also the most common reason for death of men and women over 20 years of age.
Show No Evidence Of Disease For Decades."
This condition can cause a variety of symptoms such as chest pain (stable angina), shortness of breath, heart attack, and other symptoms.
Chest pain or discomfort (angina) is the most common symptom. You feel this pain when the heart is not getting enough blood or oxygen. There are two main types of chest pain, atypical chest pain, and typical chest pain.
Atypical chest pain is often felt as a sharp pain in your left chest, abdomen, back, or arm that comes and goes. It is not associated with exercise or activity and is NOT relieved by rest or a medicine called nitroglycerin.
Nitroglycerin is used as a medicine for angina pectoris (ischaemic heart disease) in tablets, ointment, solution for intravenous use, transdermal patches.
The principal action of nitroglycerin is vasodilation??"widening of the blood vessels. Nitroglycerin will dilate veins more than arteries, decreasing cardiac preload.
Atypical chest pain is more common in women. The second type of CHD related chest pain is called typical chest pain. This type of chest pain feels heavy or like someone is squeezing you. It is typically felt under the sternum (breast bone) and often associated with activity or emotion, and goes away with rest or nitroglycerin.
Pain varies from person to person. Symptoms can be readily noticeable, and sometimes they may not be noticeable. When they are not noticeable, they can still be deadly. This is why education, and acceptance, rather then denial or avoidance is extremely important.
The Atherosclerosis - CHD Connection
Atherosclerotic heart disease, involving the coronary arteries (coronary heart disease), is the most common cause of death, accounting for one-third of all deaths. Atherosclerotic interference with blood supply to the brain (stroke) is the third most common cause of death after cancer.
According to present trends in the United States, half of healthy 40-year-old males will develop CHD in the future, and one in three healthy 40-year-old women. There are many factors can increase the risk for CHD.
- Heredity (genes) 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.
- Your risk goes up if you live a sedentary lifestyle.
- Many health conditions can also increase your risk of CHD, such as:
- Hyperglycemia (due to diabetes mellitus or otherwise)
- Hypertension (high systolic pressure)
- Hypercholesterolemia (specifically, serum LDL concentrations)
- Low HDL "good" cholesterol
- Not getting enough physical activity or exercise
- Higher-than-normal levels of inflammation-related substances such as C-reactive protein and fibrinogen.
- Increased homocysteine (an amino acid) levels
- Type A Behavioral Patterns (Studies indicate that Type A Behavioral patterns can double the risk of CHD)
Adults with typical chest pain have a higher risk of CHD than those with atypical chest pain.
Many tests help diagnose CHD. Usually, your doctor will order more than one test before making a definite diagnosis.
Tests may include:
- Coronary angiography/arteriography
- Coronary CT angiography
- Electrocardiogram (ECG)
- Electron-beam computed tomography (EBCT)
- Exercise stress test
- Magnetic resonance angiography
- Nuclear scan
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Treatment will depend on the symptoms and how severe the disease is. Procedures to treat and diagnose CHD are called percutaneous coronary interventions, or PCIs. Types of PCIs 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 a stent-related problems. Angioplasty and stenting are types of PCIs.
Angioplasty is a procedure where a tiny balloon is passed into a blocked area of an artery. When the balloon is inflated, it presses the plaque that is causing the blockage against the blood vessel wall, freeing blood flow.
Angioplasty is the mechanical widening of a narrowed or totally obstructed blood vessel. These obstructions are often caused by atherosclerosis
Coronary atherectomy is a procedure where the blockage within the coronary artery is removed by using a cutting device to shave, cut, or drill through the blockage in the artery in order to widen it.
Coronary angiography is an x-ray procedure in which a catheter is threaded through the blood vessels leading to the heart and special x-ray dye is injected. It enabling the cardiologist to see whether the arteries in the heart are narrowed or blocked by plaque build-up or a blood clot and how severe the problem is.
Stenting is an artificial reinforcement/sheath inserted into a blood vessel (or other body channel) to prevent the blood vessel from closing.
Typically 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.
Treatment - Medications
Medication is unsatisfactory for treating CHD since the damage has already been done. However, there are medicines prescribed that are helpful in providing symptom relief, and reduce additional strain on the heart, but they are of no curative value. Medications used to treat CHD include:
- ACE inhibitors (to lower blood pressure)
- Blood thinners (anti-platelet drugs) to reduce your risk of blood clots and embolus formation
- Beta-blockers (to lower heart rate, blood pressure, and oxygen use by the heart)
- Calcium channel blockers (to relax arteries, lower blood pressure and reduce 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)
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Surgeries Used To Treat CHD
Surgeries used to treat CHD include:
- Coronary artery bypass surgery
- Minimally invasive heart surgery
Coronary artery bypass surgery involves taking a portion of a blood vessel from another part of the body, usually the leg or chest, and surgically attaching it across a severely narrowed or blocked coronary artery, thus 'bypassing' the blockage to improve blood supply to the heart muscle.
It is also known as coronary artery bypass grafting (CABG-pronounced CABBAGE). Coronary bypass surgery is a common procedure used to divert blood around blocked arteries in the heart. Coronary bypass surgery remains one of the gold standard surgical treatments for coronary artery disease.
What Does CABG Mean?
Coronary artery bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease.
Arteries or veins from elsewhere in the patient's body are grafted to the coronary arteries to bypass atherosclerotic narrowings and improve the blood supply to the coronary circulation supplying the myocardium (heart muscle).
Minimally invasive heart surgery refers to surgery performed on the beating heart to provide coronary artery bypass grafting. This technique is often referred to as MIDCAB, minimally invasive direct coronary artery bypass; or OPCAB, off-pump CABG.
Minimally invasive heart surgery is performed on the diseased heart to reroute blood around clogged arteries and improve the blood and oxygen supply to the heart. This approach provides patients some benefit in that cardiopulmonary bypass (use of a heart-lung machine) may be avoided, and smaller incisions can be used instead of the standard sternotomy (incision through the sternum, or breast bone) approach. Faster recovery time, decreased procedure costs, and reduced morbidity and mortality are the goals of this technique.
Surgery doesn't cure the underlying disease process called atherosclerosis or coronary artery disease. Even if you have bypass surgery, lifestyle changes are still necessary and an integral part of treatment after surgery.
Lifestyle Changes To Reduce Risk & Improve Quality Of Life
Lifestyle changes are crucial to reduce risk, and/or reduce the chance of future blockages and heart attacks - even after successful bypass surgery.
- Smoking Cessation if you smoke
- Eating a heart healthy diet -- one that is low in saturated fats, cholesterol, and trans fat; increasing consumption of fruits and vegetables (Note: the consumption of trans fat (commonly found in hydrogenated products such as margarine) has been shown to cause the development of endothelial dysfunction, a precursor to atherosclerosis)
- Reducing sodium in your diet
- Increase anti-oxidants (through diet or supplementation)
- Increasing physical activity
- 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
- Maintaining a healthy bodyweight
- Controlling high blood pressure, cholesterol levels, diabetes and other risk factors for heart disease
- Reducing stress in your life
Dr. David Ryan
Note: recent studies suggest that moderate amounts of alcohol (1 glass a day for women, 2 for men) and taking aspirin (in doses of less than 75 to 81 mg/day) has shown to reduce the incidence of cardiovascular events.