Coronary heart disease

The heart is a powerful pump responsible for delivering blood to all the vital organs through a complex network of arteries and veins. It is essential that your heart, veins, and arteries remain in good condition. Arteries have different names, depending on what part of the body they supply; those supplying the heart itself are called coronary arteries. When these arteries are affected, the result is coronary heart disease.

What is coronary heart disease?
Coronary heart disease results from the coronary arteries becoming narrowed with fatty deposits on the inside wall. This narrowing reduces flow of blood to the heart and increases the chances of a blood clot blocking the artery, resulting in a heart attack.

How does it affect people?
As the coronary arteries narrow, patients will often experience chest pain or tightness, known as angina. This pain may spread to the left shoulder or arm, or to the neck and jaw. The pain can occur at times of exercise, stress, or strain, particularly in cold weather.

What are the causes?
Certain factors are linked with the development of coronary heart disease. The main factors that increase the risk of developing coronary heart disease are listed below. They are divided into two categories, depending on whether you can change them.

Things you can change Things you cannot change
  • Cholesterol
  • Smoking
  • High blood pressure
  • Stress
  • Lack of exercise
  • Excessive alcohol intake
  • Diabetes
  • Being overweight
    •
  • Family history of coronary heart disease
  • Sex
  • Age
    •

 

Of the risk factors that you can control, high blood cholesterol, high blood pressure, and smoking are three of the most important.

 

Cholesterol

Cholesterol is an essential body fat. It is present in food but is also made by the liver. At any one time, some cholesterol is always present in the bloodstream. When people with heart disease have abnormally high amounts of cholesterol in their blood, however, the danger of a heart attack increases. This is because cholesterol becomes embedded in the blood-vessel walls, causing them to narrow.

What can be done?
If you have coronary heart disease, you should have your cholesterol levels checked. Not everyone with raised cholesterol will develop problems, but the chances of developing coronary heart disease increases with raised cholesterol, especially as the cholesterol level increases above 5.2 mmol/L.

If your cholesterol levels are high, the first step is to change your diet by reducing your intake of fat, especially saturated fat. Eating the right foods, like fresh fruit and vegetables, which contain a lot of fiber, will also help. Moderate exercise may also help (more about this later). If the doctor tells you that your cholesterol level is still too high, medicines may be prescribed to help reduce your cholesterol level further.

Smoking

Smoking has been shown to increase coronary heart disease risk two to threefold (compared with not smoking). In addition to coronary heart disease, other diseases are linked with smoking. These include diseases affecting blood vessels, lung cancer, and chest conditions. If you have had a heart attack or a coronary bypass graft operation or suffer from angina (chest pain), stopping smoking is one of the most important things you can do for yourself.

Smoking can be hard to give up, but help is available. Various information brochures, books, and videos are available that suggest ways in which you can win the battle against cigarettes.

Blood pressure

As the blood circulates around the body, it is under pressure. The blood pressure is a result of the pumping action of the heart and the resistance of the vessels through which the blood flows. When blood pressure remains high, it puts an unnecessary strain on the heart and blood vessels. High blood pressure is a common problem that causes few symptoms but is a major risk factor contributing to coronary heart disease.

The only way you can tell if your blood pressure is high is to have it measured by your doctor. It will have to be measured on several occasions over a period of time before it can be confirmed whether you have high blood pressure.

If your blood pressure is high, you can help to reduce it. Regular exercise, weight loss, and reducing salt intake can all help to lower your blood pressure. Some patients, however, also need drugs to lower their blood pressure.

Stress

Almost everyone at one time or another experiences stress. The effects of stress are the result of the hormone epinephrine (adrenaline), which is released into the blood, speeding up the heart and increasing the blood pressure. The release of epinephrine can be triggered by anything we are worried about at work, in our private lives, or when any excess physical or mental demands are made on us.

Being subjected to stress on an occasional basis is not usually harmful. Continual stress, however, will eventually have a detrimental effect on your health. Whether you suffer because of stress depends on your reaction to it. The following are some good tips on how to cope with stress:

Exercise

If you exercise regularly, you will soon find that you get less tired and will be able to do more. Exercise helps you to lose weight, lower your blood pressure, and improve your blood cholesterol levels.

Before starting an exercise program, consult your doctor. Choose activities that you enjoy, and increase your pace gradually. Make exercise part of your daily routine. Varying the type of exercise helps. If you are overweight or arthritic, you are likely to find that swimming and cycling put less pressure on your joints.

You should try to exercise four or five times a week, allowing your body to recover between sessions. Gradually increase your exercise until you can manage 30 minutes continuously, which should make you sweat or breathe hard.

Will diet and exercise lower my high cholesterol?

Yes. These are important steps. Talk with your doctor about exercise and a weight-loss program. Regular exercise should be an important part of any cholesterol-lowering treatment plan. Exercise not only helps reduce high cholesterol, it may also help reduce other risk factors for heart disease, such as high blood pressure and obesity. Remember - food (especially red meat and dairy products) is a major source of the excess fat and cholesterol in your body. That is why diet is an important part of all treatment plans to lower high cholesterol.

Does diet and exercise work for everyone?

No. Even the strictest low-fat diet and exercise program may not lower your high cholesterol enough. It may be genes or body chemistry. No one knows for sure. That is why doctors usually monitor patients on a low-fat diet for a specific length of time. 

Alcohol intake

It has been shown that people who drink a lot of alcohol have a high coronary heart disease risk. Excessive alcohol intake makes risk factors like high blood pressure and being overweight more likely. Drinking alcoholic beverages should therefore be done only in moderation.

Diabetes

Diabetic people have problems with controlling the level of sugar in their blood. If not properly controlled, diabetes can lead to a range of diseases, including coronary heart disease. Good control of blood sugar, combined with a low-fat/high-fiber diet, should help.

Being overweight

Being overweight is likely to increase both your blood pressure and cholesterol. By losing weight, your risk of coronary heart disease will be considerably reduced.

Here is an outline of the foods you should eat and those
you should avoid:

 

Choose these foods

Limit these foods

Vegetables, especially green leafy
types (kale, collard greens)

Fried foods

Fruits (grapes, melons, apples)

Avocado, coconut

Poultry without skin (chicken,
turkey), well-trimmed meats

Fatty cuts of beef, lamb, or veal

Fish, baked or broiled

Shrimp and other shellfish

Whole grains, beans, pasta,
breads, potatoes

Eggs

Vegetable oils (olive, corn, canola)

Whole milk, ice cream
 

Cakes, cookies, pastries, butter,
shortening, mayonnaise

About angioplasty and bypass surgery...
As you have learned, coronary heart disease is caused by the buildup of fatty matter in the walls of the coronary (heart) arteries. Over time, this buildup causes the inside of the coronary arteries to become rough and narrowed, limiting the supply of oxygen-rich blood to the heart muscle. This can cause chest pain (angina) or increase your risk of having a heart attack. If you develop this amount of fatty buildup in your coronary arteries, your doctor may recommend that you have either coronary angioplasty or coronary bypass surgery, to remove the fatty deposit or replace the damaged arteries.

Angioplasty
In coronary angioplasty (also called percutaneous transluminal coronary angioplasty, or PTCA), a tube called an inducer catheter, or sheath, is inserted into the femoral artery in your groin. A dye is used so that the narrowed artery can be viewed on a TV screen, or monitor. Through the sheath, a thin tube with a balloon at the tip is carefully threaded to the area of narrowing in your coronary artery. Once it is in place, the balloon is inflated for several seconds. As the balloon fills, it splits and compresses the fatty material in the artery wall. The opening of the artery is enlarged to allow blood to flow more easily through it. The balloon catheter is then removed. The procedure usually lasts about three hours.

Coronary bypass surgery
Two types of blood vessels are commonly used for the coronary artery bypass graft: the saphenous veins in the legs, or the left or right internal mammary artery (also called thoracic arteries), which lies in the chest wall. Both types of blood vessels can be used for bypasses because there are other pathways that circulate blood to and from the tissues of the chest wall and legs. The surgeon determines which graft(s) to use depending on the location and amount of blockage in the coronary arteries.

If the saphenous vein is used, it is surgically removed from the leg. The vein graft is then sewn from the aorta (the large artery leaving the heart) to the coronary artery below the site of blockage. Oxygen-rich blood flows from the aorta, through the saphenous vein graft, past the site of blockage to the coronary artery to nourish the heart muscle. If a mammary artery is used, it is kept intact at its origin because it carries oxygen-rich blood originally coursing through the aorta, and it is sewn to the coronary artery beyond the blockage site. Prior to admission to the hospital, your doctor will discuss the specific bypass procedure with you.