Pathophysiology:
· Limitation of blood flow to the heart causes ischemia of the myocardial cells.
·
Myocardial
cells may die from lack of oxygen (myocardial infarction)
·
It
leads to heart muscle damage, heart muscle death and later myocardial
scarring without heart muscle regrowth.
·
Chronic
high-grade stenosis of the coronary arteries can induce transient ischemia which
leads to the induction of a ventricular arrhythmia, which may terminate
into ventricular fibrillation leading to death.
Risk Factors
The following factor are responsible to develop Coronary Heart Disease:
1.
Age: In older age great the chance of CHD.
2. Sex: usually man have greater risk for
Coronary Heart Disease.
3. Family history: A family history of heart
disease is associated with a higher risk of coronary artery disease, especially
if a close relative developed heart disease at an early age. Your risk is
highest if your father or a brother was diagnosed with heart disease before age
55 or your mother or a sister developed it before age 65
4.
Smoking: The incidence of heart attack
in women who smoke at least 20 cigarettes a day is six times that of women
who've never smoked. For men who smoke, the incidence is triple that of non-smokers.
5.
High blood pressure: Uncontrolled high blood
pressure can result in hardening and thickening of your arteries, narrowing the
channel through which blood can flow.
6.
High blood cholesterol levels: High levels of cholesterol can
increase the risk of formation of plaques and atherosclerosis. High cholesterol
can be caused by a high level of low-density lipoprotein (LDL), known as the
"bad" cholesterol. A low level of high-density lipoprotein (HDL),
known as the "good" cholesterol, also can promote atherosclerosis.
7.
Diabetes: Diabetes
is associated with an increased risk of coronary artery disease. Both conditions
share similar risk factors, such as obesity and high blood pressure.
8.
Obesity: Excess weight typically worsens
other risk factors.
9.
Physical inactivity: Lack of exercise also is
associated with coronary artery disease and some of its risk factors, as well.
10. High stress: Unrelieved
stress in your life may damage your arteries as well as worsen other risk
factors for coronary artery disease.
Cause:
Coronary artery
disease is thought to begin with damage or injury to the inner layer of a coronary artery, sometimes as early as childhood. The damage may be caused by
various factors, including:- Smoking
- High blood pressure
- High cholesterol
- Diabetes or insulin resistance
- Radiation therapy to the chest, as used for certain types of cancer
- Sedentary lifestyle
Clinical presentation
Patient with CHD may
present with the following feature:
1. Chest pain (angina). Feeling of chest tightness as someone sit above chest. The pain, similar
to as angina, may increase by physical or emotional stress
2. Shortness of breath: If the heart can’t pump the blood the body requirements are increased
than breathing is too fast to maintain body requirements.
3.
Heart attack: A completely blocked coronary artery may cause a heart attack. The
classic signs and symptoms of a heart attack include crushing pressure in your
chest and pain radiating to shoulder or arm, sometimes with shortness of breath
and sweating.
Investigation:
1. ECG
2.
Echocardiogram.
3.
Magnetic resonance angiography (MRA).
Treatment:
There are a number of treatment options for coronary artery
disease:
A. Lifestyle changes
Making a commitment to the following
healthy lifestyle changes can go a long way toward promoting healthier
arteries: Quit smoking, Eat healthy foods, Exercise regularly, Lose excess
weight, Reduce stress.
B. Drugs
Various
drugs can be used to treat coronary artery disease, including:
1.
Cholesterol-modifying medications. By decreasing the amount of
cholesterol in the blood, these drugs decrease the primary material that
deposits on the coronary arteries. Such as statins, niacin, fibrates and bile
acid sequestrants.
2.
Aspirin. This can reduce the tendency
of your blood to clot, which may help prevent obstruction of your coronary
arteries. Aspirin help to prevent future heart attacks.
3.
Beta blockers. These drugs slow heart rate
and decrease blood pressure, which decreases heart's demand for oxygen.
4.
Nitroglycerin. Nitroglycerin control chest
pain by opening up your coronary arteries
5.
Angiotensin-converting enzyme (ACE)
inhibitors and angiotensin II receptor blockers (ARBs). These similar drugs decrease
blood pressure and may help prevent progression of coronary artery disease.
Prevention
The same lifestyle
habits that can help treat coronary artery disease can also help prevent it
from developing in the first place. Leading a healthy lifestyle can help keep
your arteries strong and clear of plaques. To improve your heart health, you
can:
- Quit smoking
- Control conditions such as high blood pressure, high cholesterol and diabetes
- Stay physically active
- Eat a low-fat, low-salt diet that's rich in fruits, vegetables and whole grains
- Maintain a healthy weight
- Reduce and manage stress
Reference:
1. Davidsons Principal and practice of Medicine 21th Ed.
2. Medline plus
4. Wikipedia
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