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Coronary Heart Disease

Coronary heart disease or coronary artery disease is a condition in which the coronary arteries that  supply oxygen rich blood to the heart muscles, narrow down. The narrowed arteries hinder the blood flow, causing damage to the heart and resulting in coronary heart disease.

Symptoms
Coronary heart disease may not display any symptoms, initially. However, as the disease progresses, the symptoms start to appear. A person suffering from coronary heart disease may experience the following symptoms:

  • Chest pain due to exertion – (this condition can also be called as angina or heart attack)
  • There may be abnormality in the rate of heart beats, causing palpitations – (this condition is called arrhythmia)
  • You may feel light headed and lose consciousness
  • If the heart rate is severely affected, it can also cause a cardiac arrest, which may even be fatal
  • Elderly individuals may suffer from chronic heart failure. In this the heart may gradually become weak, hindering the supply of blood to the body.
  • This may further lead to accumulation of fluids in lungs and tissues, causing swelling in the ankles and shortness of breath.

Causes

  • Coronary heart disease is often linked to poor lifestyle choices, high fat diet, smoking, obesity and  lack of exercise. Illnesses such as diabetes, high blood pressure and atherosclerosis can also lead to coronary heart disease.
  • Atherosclerosis is one of the prime reasons that leads to coronary heart disease. In this condition, plaque gets deposited in the coronary artery. This causes narrowing down of the artery and blockage blood flow. A person is more likely to suffer from atherosclerosis if his cholesterol levels are high. If a blood clot forms in the narrowed arteries, it might completely block the passage of blood and thus worsen the condition.
  • In pre-menopausal phase the levels of oestrogen are high in women, possibly because of this, they are less likely to be affected by the disease. The oestrogen levels fall in women post menopausal stage. Hence, post menopause, women are at equal risk of suffering from coronary heart disease as men.
  • Narrowing down of arteries due to inflammation is a very rare occurrence. This can happen due to auto-immune diseases like polyartritis nodasa or kawasaki disease that affects children.
  • The coronary artery can also temporarily narrow down to cause coronary heart disease due to spasms in the artery wall. In very rare cases this can even lead to a heart attack.

Diagnosis
As coronary heart disease shows no symptoms initially, it is difficult to diagnose it at that stage. It can be detected and diagnosed only when you start experiencing the symptoms. If you experience chest pain, you might be advised to undergo a series of tests to determine the problem and its severity. The tests include:

ECG – Electrocardiography
ECG records electrical and muscular functions of the heart. Electrodes are attached to the chest, wrist, and ankles, and the signals received from the electrodes show the electrical activity in different areas of the heart during the rest. The abnormal heart rhythms are supervised, and the extent of damage is gauged.
ECG is also taken by making the patient to do some exercise in order to determine how the heart functions under stress.

MRI and CT scanning
These techniques are being increasingly used to detect coronary heart disease and heart abnormalities. These tests determine whether the blood supply to your heart is adequate or not. In case an inadequate blood supply is detected, a coronary angiography becomes a must.

Coronary angiography
In coronary angiography a dye is infused into the blood stream, this enables a clear X-ray image of the arteries and makes it easy to determine the blockages. The reports of coronary angiography provide enough information to enable the doctor to decide whether a surgical treatment is required or not.

Treatment
The treatment of coronary heart disease involves three main categories:

Lifestyle changes
Adopt a healthy and active lifestyle, exercise regularly, and consciously include healthier foods in your diet. Smoking will not only worsen your condition but also cause several other health issues and complications. Regular exercise is also a great remedy for heart diseases and blockages. Start with light exercises like walking, as they do not exert your heart too much.

Drug treatments
Your doctor will advice treatment and drugs based on the severity of the coronary heart disease. Lipid lowering drugs are usually prescribed to patients with high cholesterol levels. These drugs slow down the progress of the coronary heart disease, thus reducing the risk of heart attacks. Nitrate drugs and beta blocker drugs improve the flow of blood through arteries. These drugs are often prescribed in case of angina or heart attack to help the heart pump effectively. Calcium channel blockers are also prescribed, as they relax the arteries and improve the blood flow. Ivabadine is a drug that slows down the heart rate, thus reducing the requirement of oxygen and energy. If the heart does not function in rhythm, the arrhythmia can be rectified using anti arrhythmic drugs.

Surgical procedures
If all other treatments fail to improve the condition, and if there is extensive narrowing down of arteries, the patient has to undergo surgical procedures to remove the blockages and revive the blood flow. If the blockages are in small segments, angioplasty and stenting can be done. In these procedures a balloon is inflated in the narrowed area of the artery, which opens up, and then a stent is inserted in the artery to keep it open. In case the damage is too severe to be repaired through angioplasty and stenting, a coronary artery bypass graft is performed.

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