Wilu's paper: chapter 3, coronary heart disease

CHAPTER 3 CORONARY HEART DISEASE 3.1 Definition Coronary Heart Disease (CHD), also known as Coronary Artery Disease, develops when fat, calcium, and plaque (or scar tissue) build up in the arteries that lead to the heart. Coronary arteries allow the heart to receive oxygen and other nutrients that are required for pumping blood to the rest of the body. CHD, however, causes the arteries to harden and constrict, impeding both blood flow and delivery of these vital nutrients. Coronary heart disease is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart) with oxygen and nutrients. While the symptoms and signs of coronary heart 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. 3.2 Etiology Coronary heart disease (CHD) 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. In West Jakarta, more than 100 case of coronary heart disease caused death in 2006. 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. 3.3 Epidemiology Coronary heart disease is the most common cause of morbidity and mortality in the developed world. More than 50,000 deaths a year are attributed to coronary heart disease in Indonesia. At least a third of the individuals that die of coronary heart disease are younger than 55 years of age. This disease costs much per year in medical treatment and lost income. 3.4 Signs and symptoms The classic symptom of Coronary Heart Disease is angina, the direct result of inadequate flow of oxygen to the myocardium. It’s usually described as a burning, squeezing, or tight feeling in the substernal or precordial chest that may radiate to the left arm, neck, jaw, or shoulder blade. Approximately 50% of women don’t present with the typical symptoms of angina. These women experience vague symptoms such as fatigue, shortness of breath, abdominal pain, nausea, or vomiting. Symptoms are less visible in females, the elderly, and people with diabetes. Other symptoms include: pressure,fullness or a squeezing pain in chest for more than a few minutes,pain going from chest to shoulders and arms,more chest pain,pain in upper abdomen,shortness of breath,sweating,impending sense of doom, lightheadedness, fainting, nausea and vomiting, choking feeling, lightheadedness, dizziness, weakness 3.5 Causes and Risk Factors Heart disease is caused by narrowing of the coronary arteries that feed the heart. Like any muscle, the heart needs a constant supply of oxygen and nutrients, which are carried to it by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, the result is coronary heart disease. If not enough oxygen-carrying blood reaches the heart, you may experience chest pain called angina. If the blood supply to a portion of the heart is completely cut off by total blockage of a coronary artery, the result is a heart attack. This is usually due to a sudden closure from a blood clot forming on top of a previous narrowing. The following are confirmed independent risk factors for the development of Coronary Heart Disease, in order of decreasing importance: Hypercholesterolemia (specifically, serum LDL concentrations) Smoking Hypertension (High systolic pressure seems to be most significant in this regard) Hyperglycemia (due to diabetes mellitus or otherwise) Type A behavioural Patterns, TAPB. Added in 1981 as an independent risk factor after a majority or research into the field discovered that TAPB’s were twice as likely to cause CHD than any other personality type. Hereditary differences in such diverse aspects as lipoprotein structure and that of their associated receptors, homocysteine processing/metabolism. The significant but indirect risk factors, include : Lack of exercise, Stress, Diet rich in saturated fats, Diet low in antioxidants, Obesity and Men over 50. 3.6 Complications When your coronary arteries narrow, your heart may not receive enough blood when demand is greatest - particularly during physical activity. This can cause chest pain or shortness of breath. If a cholesterol plaque ruptures, complete blockage of your heart artery may trigger a heart attack. The lack of blood flow to your heart during a heart attack leads to irreversible damage to your heart muscle. The amount of damage depends in part on how quickly you receive treatment. If your heart has been damaged and can't pump enough blood to meet your body's needs, you may experience heart failure 3.7 Screening and diagnosis Many tests help diagnose CHD. Usually, your doctor will order more than one test before making a definite diagnosis.Tests may include: Electrocardiogram (ECG), Exercise stress test, Echocardiogram, Nuclear scan, Coronary angiography/arteriography, Electron-beam computed tomography (EBCT) to look for calcium in the lining of the arteries -- the more calcium, the higher your chance for CHD, Coronary CT angiography, and Magnetic resonance angiography 3.8 Treatments Coronary Heart Disease can be treated with a variety of drugs that help reduce the effects that the disease has on its host body. One of the most commonly used drugs to treat Coronary Heart Disease is aspirin, which reduces the tendency of blood to form clots over a rupturing artery (a common cause of heart attacks). Another type of medication, beta-blockers, decreases the heart rate and blood pressure so that the heart's demand for oxygen lowers. Statins drugs, also a popular means of treating Coronary Heart Disease, reduce the amount of fats and cholesterol in your blood so that plaques are less likely to form or increase in size in the blood vessels.For extreme cases of Coronary Heart Disease the only option is often bypass surgery. 3.9 Preventions Coronary heart disease is the most common form of heart disease. Prevention centers on the modifieable risk factors, which include decreasing cholesterol levels, addressing obesity and hypertension, avoiding a sedentary lifestyle, making healthy dietary choices, and stopping smoking. It has been suggested that coronary heart disease is partially reversible using an intense dietary regime coupled with regular cardio exercise. 3.10 Prognosis Everyone recovers differently. Some people can maintain a healthy life by changing their diet, stopping smoking, and taking medications exactly as the doctor prescribes. Others may need medical procedures such as angioplasty or surgery. Although everyone is different, early detection of Coronary Heart Disease generally results in a better outcome.

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