Heart disease 2: Coronary Heart Disease (#1 killer of women in the United States).

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          Coronary Heart Disease

CHD is a disease in which plaque (usually made up fat, cholesterol, calcium, and other substances found in the blood) builds up on the inner walls of your coronary arteries. Over time, this plaque can harden or rupture. Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina. 


If the plaque ruptures, a blood clot can form on its surface. A large blood clot can partially or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries. 

When plaque builds up in the arteries, the condition is called atherosclerosis.CHD may lead to heart failure, irregular heartbeats called arrhythmias, and sudden cardiac arrest (SCA).

click to see the risk factors and causes of CHD

How Is Coronary Heart Disease Diagnosed?

No single test can diagnose CHD. If your doctor thinks you have CHD, he or she may recommend one or more of the following tests.

      I.            EKG (Electrocardiogram)

An EKG is a simple, painless test that detects and records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through the heart.
An EKG can show signs of heart damage due to CHD and signs of a previous or current heart attack.

   II.            Stress Testing

During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can't exercise, you may be given medicine to raise your heart rate.
When your heart is working hard and beating fast, it needs more blood and oxygen. Plaque-narrowed arteries can't supply enough oxygen-rich blood to meet your heart's needs.
A stress test can show possible signs and symptoms of CHD, such as:

• Abnormal changes in your heart rate or blood pressure
• Shortness of breath or chest pain
• Abnormal changes in your heart rhythm or your heart's electrical activity

If you can't exercise for as long as what is considered normal for someone your age, your heart may not be getting enough oxygen-rich blood. However, other factors also can prevent you from exercising long enough (for example, lung diseases, anemia, or poor general fitness).
As part of some stress tests, pictures are taken of your heart while you exercise and while you rest. These imaging stress tests can show how well blood is flowing in your heart and how well your heart pumps blood when it beats.

III.            Echocardiography

Echocardiography (echo) uses sound waves to create a moving picture of your heart. The picture shows the size and shape of your heart and how well your heart chambers and valves are working.
Echo also can show areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.

IV.            Chest X Ray

A chest x ray takes pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels.
A chest x ray can reveal signs of heart failure, as well as lung disorders and other causes of symptoms not related to CHD.

   V.            Blood Tests

Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels might be a sign that you're at risk for CHD.

VI.            Coronary Angiography and Cardiac Catheterization

Your doctor may recommend coronary angiography if other tests or factors show that you're likely to have CHD. This test uses dye and special x rays to show the insides of your coronary arteries.
To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization.
A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream.
Special x rays are taken while the dye is flowing through your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels.
Cardiac catheterization usually is done in a hospital. You're awake during the procedure. It usually causes little or no pain, although you may feel some soreness in the blood vessel where your doctor inserts the catheter.

How Is Coronary Heart Disease Treated?

Treatments for coronary heart disease (CHD) include lifestyle changes, medicines, and medical procedures.

       I.            Lifestyle Changes

Making lifestyle changes often can help prevent or treat CHD. Lifestyle changes might be the only treatment that some people need.

·         Follow a Healthy Diet

A healthy diet includes some types of fish, such as salmon, tuna (canned or fresh), and mackerel. These fish are a good source of omega-3 fatty acids. These acids may help protect the heart from blood clots and inflammation and reduce the risk of heart attack. Try to have about two fish meals every week. A diet rich in fruits and vegetables can increase important cholesterol-lowering compounds in your diet.
You also should try to limit the amount of sodium (salt) that you eat. This means choosing low-salt and "no added salt" foods and seasonings at the table or while cooking. The Nutrition Facts label on food packaging shows the amount of sodium in the item.
Try to limit drinks that contain alcohol. Too much alcohol will raise your blood pressure and triglyceride level. (Triglycerides are a type of fat found in the blood.) Alcohol also adds extra calories, which will cause weight gain.
Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is a glass of wine, beer, or a small amount of hard liquor.

·         Be Physically Active

Routine physical activity can lower many CHD risk factors, including LDL ("bad") cholesterol, high blood pressure, and excess weight. Physical activity also can lower your risk for diabetes and raise your HDL cholesterol level. HDL is the "good" cholesterol that helps prevent CHD.

·         Maintain a Healthy Weight

Maintaining a healthy weight can lower your risk for CHD. A general goal to aim for is a body mass index (BMI) of less than 25. BMI measures your weight in relation to your height and gives an estimate of your total body fat. A BMI between 25 and 29.9 is considered overweight. A BMI of 30 or more is considered obese. A BMI of less than 25 is the goal for preventing and treating CHD. Your doctor or other health care provider can help you set an appropriate BMI goal.

·         Quit Smoking

If you smoke, quit. Smoking can raise your risk for CHD and heart attack and worsen other CHD risk factors. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.

·         Manage Stress

Research shows that the most commonly reported "trigger" for a heart attack is an emotionally upsetting event—particularly one involving anger. Also, some of the ways people cope with stress—such as drinking, smoking, or overeating—aren't healthy. Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Having supportive people in your life with whom you can share your feelings or concerns can help relieve stress. Physical activity, medicine, and relaxation therapy also can help relieve stress.

   II.            Medicines

You may need medicines to treat CHD if lifestyle changes aren't enough. Medicines can:

• Reduce your heart’s workload and relieve CHD symptoms
• Decrease your chance of having a heart attack or dying suddenly
• Lower your cholesterol and blood pressure
• Prevent blood clots
• Prevent or delay the need for a procedure or surgery (for example, angioplasty or coronary artery bypass grafting (CABG))

Medicines used to treat CHD include anticoagulants, also called blood thinners; aspirin and other anticlotting medicines; ACE inhibitors; beta blockers; calcium channel blockers; nitroglycerin; glycoprotein IIb-IIIa; statins; and fish oil and other supplements high in omega-3 fatty acids.

III.            Procedures and Surgery

You may need a procedure or surgery to treat CHD. Both angioplasty and CABG are used to treat blocked coronary arteries. You and your doctor can discuss which treatment is right for you.

·         Angioplasty

Angioplasty is a nonsurgical procedure that opens blocked or narrowed coronary arteries. This procedure also is called percutaneous coronary intervention, or PCI.
A thin, flexible tube with a balloon or other device on the end is threaded through a blood vessel to the narrowed or blocked coronary artery. Once in place, the balloon is inflated to compress the plaque against the wall of the artery. This restores blood flow through the artery. During the procedure, the doctor may put a small mesh tube called a stent in the artery. The stent helps prevent blockages in the artery in the months or years after angioplasty.

·         Coronary Artery Bypass Grafting

CABG is a type of surgery. In CABG, arteries or veins from other areas in your body are used to bypass (that is, go around) your narrowed coronary arteries. CABG can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack.

Cardiac Rehabilitation

Cardiac rehab is a medically supervised program that may help improve the health and well-being of people who have heart problems. Your doctor may prescribe cardiac rehabilitation (rehab) for angina or after CABG, angioplasty, or a heart attack. Almost everyone who has CHD can benefit from cardiac rehab.
Rehab has two parts:

• Exercise training. This part helps you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your personal abilities, needs, and interests.
• Education, counseling, and training. This part of rehab helps you understand your heart condition and find ways to reduce your risk for future heart problems. The rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and deal with your fears about the future.

How Can Coronary Heart Disease Be Prevented or Delayed?

One step you can take is to adopt a healthy lifestyle. Following a healthy diet is an important part of a healthy lifestyle.
Be as physically active as you can. Physical activity can improve your fitness level and your health. Talk with your doctor about what types of activity are safe for you.
If you smoke, quit. Smoking can damage and tighten blood vessels and raise your risk for CHD. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke.
Know your family history of health problems related to CHD. If you or someone in your family has CHD, be sure to tell your doctor.
If lifestyle changes aren't enough, you also may need medicines to control your CHD risk factors. Take all of your medicines as prescribed.












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