CONTENTS3 Introduction4 The Human Heart5 Symptoms of Coronary Heart Disease5 Heart Attack5 Sudden Death5 Angina6 Angina Pectoris6 Signs and Symptoms7 Different Forms of Angina8 Causes of Angina9 Atherosclerosis9 Plaque10 Lipoproteins10 Lipoproteins and Atheroma11 Risk Factors11 Family History11 Diabetes11 Hypertension11 Cholesterol12 Smoking12 Multiple Risk Factors13 Diagnosis14 Drug Treatment14 Nitrates14 Beta-blockers15 Calcium antagonists15 Other Medications16 Surgery16 Coronary Bypass Surgery17 Angioplasty18 Self-Help20 Type-A Behaviour Pattern21 Cardiac Rehab Program22 Conclusion23 Diagrams and Charts26 BibliographyINTRODUCTIONIn today’s society, people are gaining medical knowledge atquite a fast pace.
Treatments, cures, and vaccines for variousdiseases and disorders are being developed constantly, and yet,coronary heart disease remains the number one killer in theworld.
The media today concentrates intensely on drug and alcoholabuse, homicides, AIDS and so on. What a lot of people are notrealizing is that coronary heart disease actually accounts forabout 80% of all sudden deaths. In fact, the number of deathsfrom heart disease approximately equals to the number of deathsfrom cancer, accidents, chronic lung disease, pneumonia andinfluenza, and others, COMBINED.
One of the symptoms of coronary heart disease is anginapectoris. Unfortunately, a lot of people do not take itseriously, and thus not realizing that it may lead to othercomplications, and even death.
THE HUMAN HEARTIn order to understand angina, one must know about our ownheart. The human heart is a powerful muscle in the body which isworked the hardest. A double pump system, the heart consists oftwo pumps side by side, which pump blood to all parts of thebody. Its steady beating maintains the flow of blood through thebody day and night, year after year, non-stop from birth untildeath.
The heart is a hollow, muscular organ slightly bigger than aperson’s clenched fist. It is located in the centre of the chest,under the breastbone above the sternum, but it is slantedslightly to the left, giving people the impression that theirheart is on the left side of their chest.
The heart is divided into two halves, which are furtherdivided into four chambers: the left atrium and ventricle, andthe right atrium and ventricle. Each chamber on one side isseparated from the other by a valve, and it is the closure ofthese valves that produce the “lubb-dubb” sound so familiar tous. (see Fig. 1 – The Structure of the Heart)Like any other organs in our body, the heart needs a supplyof blood and oxygen, and coronary arteries supply them. There aretwo main coronary arteries, the left coronary artery, and theright coronary artery. They branch off the main artery of thebody, the aorta. The right coronary artery circles the right sideand goes to the back of the heart. The left coronary arteryfurther divides into the left circumflex and the left anteriordescending artery. These two left arteries feed the front and theleft side of the heart. The division of the left coronary arteryis the reason why doctors usually refer to three main coronaryarteries. (Fig. 2 – Coronary Arteries)SYMPTOMS OF CORONARY HEART DISEASEThere are three main symptoms of coronary heart disease:Heart Attack, Sudden Death, and Angina.
Heart AttackHeart attack occurs when a blood clot suddenly andcompletely blocks a diseased coronary artery, resulting in thedeath of the heart muscle cells supplied by that artery.
Coronary and Coronary Thrombosis2 are terms that can refer to aheart attack. Another term, Acute myocardial infarction2, meansdeath of heart muscle due to an inadequate blood supply.
Sudden DeathSudden death occurs due to cardiac arrest. Cardiac arrestmay be the first symptom of coronary artery disease and may occurwithout any symptoms or warning signs. Other causes of suddendeaths include drowning, suffocation, electrocution, drugoverdose, trauma (such as automobile accidents), and stroke.
Drowning, suffocation, and drug overdose usually causerespiratory arrest which in turn cause cardiac arrest. Trauma maycause sudden death by severe injury to the heart or brain, or bysevere blood loss. Stroke causes damage to the brain which cancause respiratory arrest and/or cardiac arrest.
AnginaPeople with coronary artery disease, whether or not theyhave had a heart attack, may experience intermittent chest pain,pressure, or discomforts. This situation is known as anginapectoris. It occurs when the narrowing of the coronary arteriestemporarily prevents an adequate supply of blood and oxygen tomeet the demands of working heart muscles.
ANGINA PECTORISAngina Pectoris (from angina meaning strangling, andpectoris meaning breast) is commonly known simply as angina andmeans pain in the chest. The term “angina” was first used duringa lecture in 1768 by Dr. William Heberden. The word was notintended to indicate “pain,” but rather “strangling,” with asecondary sensation of fear.
Victims suffering from angina may experience pressure,discomfort, or a squeezing sensation in the centre of the chestbehind the breastbone. The pain may radiate to the arms, theneck, even the upper back, and the pain may come and go. Itoccurs when the heart is not receiving enough oxygen to meet anincreased demand.
Angina, as mentioned before, is only temporarily, and itdoes not cause any permanent damage to the heart muscle. Theunderlying coronary heart disease, however, continues to progressunless actions are taken to prevent it from becoming worse.
Signs and SymptomsAngina does not necessarily involve pain. The feeling variesfrom individuals. In fact, some people described it as “chestpressure,” “chest distress,” “heaviness,” “burning feeling,””constriction,” “tightness,” and many more. A person with anginamay feel discomforts that fit one or several of the followingdescriptions:-Mild, vague discomfort in the centre of the chest, whichmay radiate to the left shoulder or arm-Dull ache, pins and needles, heaviness or pains in thearms, usually more severe in the left arm-Pain that feels like severe indigestion-Heaviness, tightness, fullness, dull ache, intensepressure, a burning, vice-like, constriction, squeezingsensation in the chest, throat or upper abdomen-Extreme tiredness, exhaustion of a feeling of collapse-Shortness of breath, choking sensation-A sense of foreboding or impending death accompanyingchest discomfort-Pains in the jaw, gums, teeth, throat or ear lobe-Pains in the back or between the shoulder bladesAngina can be so severe that a person may feel frightened,or so mild that it might be ignored. Angina attacks are usuallyshort, from one or two minutes to a maximum of about four tofive. It usually goes away with rest, within a couple of minutes,or ten minutes at the most.
Different Forms of AnginaThere are several known forms of angina. Brief pain thatcomes on exertion and leave fairly quickly on rest is known asstable angina. When angina pain occurs during rest, it is calledunstable angina. The symptoms are usually severe and the coronaryarteries are badly narrowed. If a person suffers from unstableangina, there is a higher risk for that person to develop heartattacks. The pain may come up to 20 times a day, and it can wakea person up, especially after a disturbing dream.
Another type of angina is called atypical or variant angina.
In this type of angina, pain occurs only when a person is restingor asleep rather than from exertion. It is thought to be theresult of coronary artery spasm, a sort of cramp that narrows thearteries.
Causes of AnginaThe main cause of angina is the narrowing of the coronaryarteries. In a normal person, the inner walls of the coronaryarteries are smooth and elastic, allowing them to constrict andexpand. This flexibility permits varying amounts of oxygenatedblood, appropriate to the demand at the time, to flow through thecoronary arteries. As a person grows older, fatty deposits willaccumulate on the artery walls, especially if the linings of thearteries are damaged due to cigarette smoking or high bloodpressure.
As more and more fatty materials build up, they form plaqueswhich causes the arteries to narrow and thus restricting the flowof blood. This process is known as atherosclerosis. However,angina usually does not occur until about two-thirds of theartery’s diameter is blocked. Besides atherosclerosis, there areother heart conditions resulting in the starvation of oxygen ofthe heart, which also causes angina.
The nerve factor – The arteries are supplied with nerves,which allow them to be controlled directly by the brain,especially the hypothalamus – an area at the centre of the brainwhich regulates the emotions. The brain controls the expandingand narrowing of the arteries when necessary. The pressures ofmodern life: aggression, hostility, never-ending deadlines,remorseless, competition, unrest, insecurity and so on, cantrigger this control mechanism.
When you become emotional, the chemicals that are released,such as adrenaline, noradrenaline, and serotonin, can cause afurther constriction of the coronary arteries. The pituitarygland, a small gland at the base of the brain, under the controlof the hypothalamus, can signal the adrenal glands to increasethe production of stress hormones such as cortisol and adrenalineeven further.
Coronary spasm – Sudden constrictions of the muscle layer inan artery can cause platelets to stick together, temporarilyrestricting the flow of flow. This is known as coronary spasm.
Platelets are minute particles in the blood, which play anessential role both in the clotting process and in repairing anydamaged arterial walls. They tend to clump together more easilywhen the blood is full of chemicals released during arousal, suchas cortisol and others.
Coronary spasm causes the platelets to stick together and tothe wall of the artery, while substances released by theplatelets as they stick together further constrict the bloodvessels. If the artery is already narrowed, this can have adevastating effect as it drastically reduces the blood flow.
(Fig. 3 – Spasm in a coronary artery)When people are very tense, they usually overbreathe or holdtheir breath altogether. Shallow, irregular but rapid breathingwashes out carbon dioxide from the system and the blood willbecome over-oxygenated. One might think that the more oxygen inthe blood the better, but overloaded blood actually does not giveup oxygen as easily, therefore the amount of oxygen available tothe heart is reduced. Carbon dioxide is present in the blood inthe form of carbonic acid, when there is a loss in carbonic acid,the blood becomes more basic, or alkaline, which leads to spasmof blood vessels, almost certainly in the brain but also in theheart.
ATHEROSCLEROSISThe coronary arteries may be clogged with atheroscleroticplaques, thus narrowing the diameter. Plaques are usuallycollections of connection tissue, fats, and smooth muscle cells.
The plaque project into the lumen, the passageway of the artery,and interfere with the flow of blood. In a normal artery, thesmooth muscle cells are in the middle layer of the arterial wall;in atherosclerosis they migrate into the inner layer. The reasonbehind their migration could hold the answers to explain theexistence of atherosclerosis. Two theories have been developedfor the cause of atherosclerosis.
The first theory was suggested by German pathologist RudolfVirchow over 100 years ago. He proposed that the passage of fattymaterial into the arterial wall is the initial cause ofatherosclerosis. The fatty material, especially cholesterol, actsas an irritant, and the arterial wall respond with an outpouringof cells, creating atherosclerotic plaque.
The second theory was developed by Austrian pathologist Karlvon Rokitansky in 1852. He suggested that atherosclerotic plaquesare aftereffects of blood-clot organization (thrombosis). Theclot adheres to the intima and is gradually converted to a massof tissue, which evolves into a plaque.
There are evidences to support the latter theory. It hasbeen found that platelets and fibrin (a protein, the finalproduct in thrombosis) are often found in atheroscleroticplaques, also found are cholesterol crystals and cells which arerich in lipid. The evidence suggests that thrombosis may play arole in atherosclerosis, and in the development of the morecomplicated atherosclerotic plaque. Though thrombosis may beimportant in initiating the plaque, an elevated blood lipid levelmay accelerate arterial narrowing.
PlaqueInside the plaque is a yellow, porridge-like substance,consisting of blood lipids, cholesterol and triglycerides. Theselipids are found in the bloodstream, they combine with specificproteins to form lipoproteins. All lipoprotein particles containcholesterol, triglycerides, phospholipids, and proteins, but theproportion varies in different particles.
LipoproteinsLipoproteins all vary in size. The largest lipoproteins arecalled Chylomicra, and consist mostly of triglycerides. The nextin size are the pre-beta-lipoproteins, then the betalipoproteins. As their size decreases, so do their concentrationof triglycerides, but the smaller they are, the more cholesterolthey contain. Pre-beta-lipoproteins are also known as low densitylipoproteins (LDL), and beta lipoproteins are also called verylow density lipoproteins (VLDL). They are most significant in thedevelopment of atheroma. The smallest lipoprotein particles, thealpha lipoproteins, contain a low concentration of cholesteroland triglycerides, but a high level of proteins, and are alsoknown as high density lipoproteins (HDL). They are thought to beprotective against the development of atherosclerotic plaque. Infact, they are transported to the liver rather than to the bloodvessels.
Lipoproteins and AtheromaThe theory is that lipoproteins pass between the liningcells of the arteries and some of them accumulate underneath. Allexcept the chylomicra, which are too big, have a chance toaccumulate. The protein in the lipoproteins are broken down byenzymes, leaving behind the cholesterol and triglycerides. Thesefats are trapped and set up a small inflammatory reaction. Thealpha particles do not react with the enzymes are returned to thecirculation.
RISK FACTORSThere are several risk factors that contribute to thedevelopment of atherosclerosis and angina: Family history,Diabetes, Hypertension, Cholesterol, and Smoking.
Family HistoryWe all carry approximately 50 genes that affect the functionand structure of the heart and blood vessels. Genetics candetermine one’s risk of having heart disease. There are manycases today where heart disease runs in a family, for manygenerations.
DiabetesDiabetics are at least twice as likely to develop anginathan nondiabetics, and the risk is higher in women than in men.
Diabetes causes metabolic injury to the lining of arteries, as aresult, the tiny blood vessels that nourish the walls of medium-size arteries throughout the body, including the coronaryarteries, become defective. These microscopic vessels becomeblocked, impeding the delivery of blood to the lining of thelarger arteries, causing them to deteriorate, andartherosclerosis results.
HypertensionHigh blood pressure directly injures the artery lining byseveral mechanisms. The increased pressure compresses the tinyvessels that feed the artery wall, causing structural changes inthese tiny arteries. Microscopic fracture lines then develop inthe arterial wall. The cells lining the arteries are compressedand injured, and can no longer act as an adequate barrier tocholesterol and other substances collecting in the inner walls ofthe blood vessels.
CholesterolCholesterol has become one of the most important issues inthe last decade. Reducing cholesterol intake can directlydecrease one’s risk of developing heart disease, and people todayare more conscious of what they eat, and how much cholesteroltheir foods contain.
Cholesterol causes atherosclerosis by progressivelynarrowing the arteries and reduces blood flow. The building up offatty deposits actually begins at an early age, and the processprogresses slowly. By the time the person reaches middle-age, ahigh cholesterol level can be expected.
SmokingIt has been proven that about the only thing smoking do isshorten a person’s life. Despite all the warnings by the surgeongeneral, people still manage to find an excuse to quit smoking.
Cigarette smoke contains carbon monoxide, radioactivepolonium, nicotine, arsenious oxide, benzopyrene, and levels ofradon and molybdenum that are TWENTY times the allowable limitfor ambient factory air. The two agents that have the mostsignificant effect on the cardiovascular system are carbonmonoxide and nicotine.
Nicotine has no direct effect on the heart or the bloodvessels, but it stimulates the nerves on these structures tocause the secretion of adrenaline. The increase of adrenaline andnoradrenaline increases blood pressure and heart rate by about10% for an hour per cigarette. In simpler words, nicotine causesthe heart to beat more vigorously. Carbon monoxide, on the otherhand, poisons the normal transport systems of cell membraneslining the coronary arteries. This protective lining breaks down,exposing the undersurface to the ravages of the passing blood,with all its clotting factors as well as cholesterol.
Multiple Risk FactorsThe five major risk factors described above do more thanjust add to one another. There is a virtual multiplication effectin victims with more than one risk factor. (Chart: Risk Factors)DIAGNOSISIt is very important for patients to tell their doctors ofthe symptoms as honestly and accurately as possible. The doctorwill need to know about other symptoms that may distinguishangina from other conditions, such as esophagitis, pleurisy,costochondritis, pericarditis, a broken rib, a pinched nerve, aruptured aorta, a lung tumour, gallstones, ulcers, pancreatitis,a collapsed lung or just be nervous. Each of the above mentionedis capable of causing chest pain.
A patient may take a physical examination, which includestaking the pulse and blood pressure, listening to the heart andlung with a stethoscope, and checking weight. Usually anexperienced cardiologist can distinguish it as a cardiac ornoncardiac situation within minutes.
There are also routine tests, such as urine and blood tests,which can be used to determine body fat level. Blood test canalso tests for:Anemia – where the level of haemogoblin is too low, and canrestrict the supply of blood to the heart.
Kidney function – levels of various salts, and wasteproducts, mainly urea and creatinine in the blood. Normally theselevels should be quite low.
There are other factors which can be tested such as saltlevel, blood fat and sugar levels.
A chest x-ray provides the doctor with information about thesize of the heart. Like any other muscles in the body, if theheart works too hard for a period of time, it develops, orenlarges.
An electrocardiogram (ECG) is the tracing of the electricalactivity of the heart. As the heart beats and relaxes, thesignals of the heart’s electrical activities are picked up andthe pattern is recorded. The pattern consists of a series ofalternating plateaus and sharp peaks. ECG can indicate if highblood pressure has produced any strain on the heart. It can tellif the heart is beating regularly or irregularly, fast or slow.
It can also pick up unnoticed heart attacks. A variation of theECG is the veterocardiogram (VCG). It performs exactly like theECG except the electrical activity is shown in the form of loops,or vectors, which can be watched on a screen, printed on paper,or photographed. What makes VCG superior to ECG is that VCGprovides a three-dimensional view of a single heart beat.
DRUG TREATMENTAngina patients are usually prescribed at least one drug.
Some of the drugs prescribed improve blood flow, while othersreduce the strain on the heart. Commonly prescribed drugs arenitrates, beta-blockers, and Calcium antagonists. It should benoted that drugs for angina only relief the pain, it does nothingto correct the underlying disorder.
NitratesNitroglycerine, which is the basis of dynamite, relaxes thesmooth fibres of the blood vessels, allowing the arteries todilate. They have a tendency to produce flushing and headachesbecause the arteries in the head and other parts of the body willalso dilate.
Glyceryl trinitrate is a short-acting drug in the form ofsmall tablets. It is taken under the tongue for maximum and rapidabsorption since that area is lined with capillaries. It usuallyrelieves the pain within a minute or two. One of the drawbacks oftrinitrates is that they can be exposed too long as theydeteriorate in sunlight. Trinitrates also come in the form ofointment or “transdermal” sticky patch which can be applied totheskin.
Dinitrates and mononitrates are used for the prevention ofangina attacks rather than as pain relievers. They are sloweracting than trinitrates, but they have a more prolonged effect.
They have to be taken regularly, usually three to four times aday. Dinitrates are more common than trinitrates ortetranitrates.
Beta-blockersBeta-blockers are used to prevent angina attacks. Theyreduce the work of the heart by regulating the heart beat, aswell as blood pressure; the amount of oxygen required is therebyreduced. These drugs can block the effects of the stress hormonesadrenaline and noradrenaline at sites called beta receptors inthe heart and blood vessels. These hormones increase both bloodpressure and heart rate. Other sites affected by these hormonesare known as alpha receptors.
There are side effects, however, for using beta-blockers.
Further reduction in the pumping action may drive to a heartfailure if the heart is strained by heart disease. Hands and feetget cold due to the constriction of peripheral vessels. Beta-blockers can sometimes pass into the brain fluids, and causesvivid dreams, sleep disturbance, and depression. There is also apossibility of developing skin rashes and dry eyes. Some beta-blockers raise the level of blood cholesterol and triglycerides.
Calcium antagonistsThese drugs help prevent angina by moping up calcium in theartery walls. The arteries then become relaxed and dilated, soreducing the resistance to blood flow, and the heart receivesmore blood and oxygen. They also help the heart muscle to use theoxygen and nutrients in the blood more efficiently. In largerdose they also help lower the blood pressure. The drawback forcalcium antagonists is that they tend to cause dizziness andfluid retention, resulting in swollen ankles.
Other MedicationsThere are new drugs being developed constantly. Pexid, forexample, is useful if other drugs fail in severe angina attacks.
However, it produces more side effects than others, such as pinsand needles and numbness in limbs, muscle weakness, and liverdamage. It may also precipitate diabetes, and damages to theretina.
SURGERYWhen medications or any other means of treatment are unableto control the pain of angina attacks, surgery is considered.
There are two types of surgical operation available: Coronarybypass and Angioplasty. The bypass surgery is the more common,while angioplasty is relatively new and is also a minoroperation. Surgery is only a “last resort” to provide relief andshould not be viewed as a permanent cure for the underlyingdisease, which can only be controlled by changing one’slifestyle.
Coronary Bypass SurgeryThe bypass surgery involves extracting a vein from anotherpart of the body, usually the leg, and uses it to construct adetour around the diseased coronary artery. This procedurerestores the blood flow to the heart muscle.
Although this may sound risky, the death rate is actuallybelow 3 per cent. This risk is higher, however, if the disease iswidespread and if the heart muscle is already weakened. If thegrafted artery becomes blocked, a heart attack may occur afterthe operation.
The number of bypasses depends on the number of coronaryarteries affected. Coronary artery disease may affect one, two,or all three arteries. If more than one artery is affected, thenseveral grafts will have to be carried out during the operation.
About 20 per cent of the patients considered for surgery haveonly one diseased vessel. In 50 per cent of the patients, thereare two affected arteries, and in 30 per cent the disease strikesall three arteries. These patients are known to be suffering fromtriple vessel disease and require a triple-bypass. Triple vesseldisease and disease of the left main coronary artery before itdivides into two branches are the most serious conditions.
The operation itself incorporates making an incision downthe length of the breastbone in order to expose the heart. Thepatient is connected to a heart-lung machine, which takes overthe function of the heart and lungs during the operation and alsokeeps the patient alive. At the same time, a small incision ismade on the leg to remove a section of the vein.
Once the section of vein has been removed, it is attached tothe heart. One end of the vein is sewn to the aorta, while theother end is sewn into the affected coronary artery just beyondthe diseased segment. The grafted vein now becomes the new arterythrough which the blood can flow freely beyond the obstruction.
The original artery is thus bypassed. The whole operationrequires about four to five hours, and may be longer if there ismore than one bypass involved. After the operation, the patientis sent to the Intensive Care Unit (ICU) for recovery.
The angina pain is usually relieved or controlled, partiallyor completely, by the operation. However, the operation does notcure the underlying disease, so the effects may begin to diminishafter a while, which may be anywhere from a few months to severalyears. The only way patients can avoid this from happening is tochange their lifestyles.
AngioplastyThis operation is a relatively new procedure, and it isknown in full as transluminal balloon coronary angioplasty. Itentails “squashing” the atherosclerotic plaque with balloons. Avery thin balloon catheter is inserted into the artery in the armor the leg of a patient under general anaesthetic. The ballooncatheter is guided under x-ray just beyond the narrowed coronaryartery. Once there, the balloon is inflated with fluid and thefatty deposits are squashed against the artery walls. The balloonis then deflated and drawn out of the body.
This technique is a much simpler and more economicalalternative to the bypass surgery. The procedure itself requiresless time and the patient only remains in the hospital for a fewdays afterward. Exactly how long the operation takes depends onwhere and in how many places the artery is narrowed. It is mostsuitable when the disease is limited to the left anteriordescending artery, but sometimes the plaques are simply too hard,making them impossible to be squashed, in which case a bypassmight be necessary.
SELF-HELPThe only way patients can prevent the condition of theirheart from deteriorating any further is to change theirlifestyles. Although drugs and surgery exist, if the heart isexposed to pressure continuously and it strains any further,there will come one day when nothing works, and all that remainis a one-way ticket to heaven.
The following are some advices on how people can change theway they live, and enjoy a lifetime with a healthy heart oncemore.
WorkA person should limit the amount of exertions to the pointwhere angina might occur. This varies from person to person, somepeople can do just as much work as they did before developingangina, but only at a slower pace. Try to delegate more, reassessyour priorities, and learn to pace yourself. If the rate of workis uncontrollable, think about changing the job.
ExerciseEveryone should exercise regularly to one’s limits. This maysound contradictory that, on the one hand, you are told to limityour exertion and, on the other, you are told to exercise. It isactually better if one exercise regularly within his or herlimits.
Exercises can be grouped into two categories: isotonic andisometric. People suffering from angina should limit themselvesto only isotonic exercises. This means one group of muscle isrelaxed while another group is contracted. Examples of this typeof exercise include walking, swimming leisurely, and yoga; someharder exercises are cycling and jogging.
Weight LossThe more weight there is on the body, the more work theheart has to do. Reducing unnecessary weight will reduce theamount of strain on the heart, and likely lower blood pressure aswell. One can lose weight by simply eating less than their normalintake, but keep in mind that the major goal is to cut down onfatty and sugar foods, which are low in nutrients and high incalories.
DietWhat you eat can have a direct effect on the kind ofcondition you are in. To stay fit and healthy, eat fewer animalfats, and foods that are high in cholesterol. They include fattymeat, lard, suet, butter, cream and hard cheese, eggs, prawns,offal and so on. Also, the amount of salt intake should bereduced. Eat more food containing a high amount of fibre, such aswholegrain cereal products, pulses, wholemeal bread, as well asfresh fruits and vegetables.
Alcohol, tea and coffeeAlcohol in moderation does no harm to the body, but it doescontain calories and may slow the weight loss progress. Peoplecan drink as much mineral water, fruit juice and ordinary or herbtea as they wish, but no more than two cups of coffee per day.
CigarettesIt has been medically proven that cigarettes do the body nogood at all. It makes the heart beat faster, constricts the bloodvessels, and generally increases the amount of work the heart hasto do. The only right thing to do is to quit smoking, it will notbe easy, but it is worth the effort.
StressStress can actually be classified as a major risk factor,and it is one neglected by most people. Try to avoid those heatedarguments and emotional situations that increase blood pressure,as well as stimulate the release of stress hormones. If they areunavoidable, try to anticipate them and prevent the attack bysucking an angina tablet beforehand.
RelaxationHelp your body to relax when feeling tense by sitting orlying down quietly. Close your eyes, breathe slowly and deeplythrough the nose, make each exhalation long, soft and steady. Anadequate amount of sleep each night is always important.
Sexual activityIt is true that sexual intercourse may bring on an anginaattack, but the chronic frustration of abstinence may cause moretension. If intercourse precipitates angina, either suck on anangina tablet a few minutes beforehand or let your partner assumethe more active role.
TYPE-A BEHAVIOUR PATTERNThere is a marked increase of coronary heart disease in mostindustrialized societies in the twentieth century. This may haveresulted, in part, because these societies reward those whoperformed more quickly, aggressively, and competitively.
Type-A individuals of both sexes were considered to have thefollowing characteristics: (1) an intense, sustained drive to achieve self-selected but often poorly defined goals.
(2) a profound inclination and eagerness to compete.
(3) a persistent desire for recognition andadvancement.
(4) a continuous involvement in multiple and diversefunctions subject to time restrictions.
(5) habitual propensity to accelerate the rate ofexecution of most physical and mental functions.
(6) extraordinary mental and physical alertness.
(7) aggressive and hostile feelings.
The enhanced competitiveness of type-A persons leads to anaggressive and ambitious achievement orientation, increasedmental and physical alertness, muscular tension, and an explosiveand rapid style of speech. A sense of time urgency leads torestlessness, impatience, and acceleration of most activities.
This in turn may result in irritability and the enhancedpotential for type-A hostility and anger. Type-A individuals arethus at an increased risk of developing coronary heart disease.
The type-A behaviour pattern is defined as an action-emotioncomplex involving10: (1) behavioural dispositions (e.g., ambitiousness,aggressiveness, competitiveness, and impatience).
(2) specific behaviours (e.g., muscle tenseness,alertness, rapid and emphatic speech stylistics,and accelerated pace of most activities).
(3) emotional responses (e.g., irritation, hostility,and anger).
Comparatively, type-A persons are more risky to developcoronary heart disease than type-B individuals, whose manners andbehaviours are relaxed. The risk, however, is independent of therisk factors. Not all physicians are convinced that type-Abehaviour pattern is a risk factor, and thousands of studies andresearches are currently being done by experts on this topic.
THE CARDIAC REHAB PROGRAMThis program at the Credit Valley Hospital is designed tohelp patients with coronary artery disease lower their overallrisk, and to prevent any further attacks. It providesrehabilitation for patients who are likely to have heart attacks,have had heart attacks, or had a recent surgery.
Most patients come to this one-hour class two nights a week,which takes place outside the physiotherapy department. The classis ran by volunteers, and is usually supervised by akinesiologist. The patients come in a little before 6:00 pm, andhave their blood pressure taken. At six o’clock, volunteers willtake the patients through a fifteen-minute warm-up. After thewarm-up, the patients will go on with their exercise for half anhour. The patients can choose from walking, rowing machines,stationary bicycles, and arm ergometer, or a combination of twoor more as their exercise.
Each patient is reassessed once a month, in order to keeptrack of their progress. Volunteers will ask the patient beingreassessed a series of questions, which includes frequency ofexercise, type of exercise program, problems with exercise, etc.
About 6:30, when the patients are near the peak of theirexercise, the ones being reassessed will have to have their pulseand blood pressure measured; to see if they have reached their”target heart rate”, and to see if their blood pressure goes upas expected.
At about 6:45, the patients end their exercise and cool-downbegins. Cool-down is in a way similar to warm-up, only this helpsthe patients to relax their hearts, as well as their body after ahalf-hour workout. After cool-down most patients have their bloodpressure taken again just to make sure nothing unusual occurs.
CONCLUSIONAngina pectoris is not a disease which affect a person’sheart permanently, but to encounter angina pain means somethingis wrong. The pain is the heart’s distress signal, a built-inwarning device indicating that the heart has reached its maximumworkload. Upon experiencing angina, precautions should be taken.
A person’s lifestyle plays a major role in determining thechance of developing heart diseases. If people do not learn howto prevent it themselves, coronary artery disease will remain asthe single biggest killer in the world, by far.
Fig. 3 Spasm in a coronary arteryRISK FACTORSAverage Risk = 100U UA3 3 3 3 33NONE3 3 3 7733 3 3 3 3AU AAUU UA3 3 3333CIGARETTES3 33 120 33 3 333AU AAUU UA3CIGARETTES3 3333AND CHOLESTEROL3 33 236 33 3 333AU AAUU UA3CIGARETTES, 3 3 3 33CHOLESTEROL, AND3 3 3 38433HIGH BLOOD PRESSURE3 3 3 3AU AAAAAAAU100200300400500For purpose of illustration, this chart uses as abnormal ablood pressure level of 180 systolic and a very high cholesterollevel of 310 in a 45-year-old man.
CORONARY HEART DISEASE AND MULTIPLE FACTORSU3HIGH BLOOD PRESSURE, HIGH CHOLESTEROL AND CIGARETTES3AUU3HIGH CHOLESTEROL AND CIGARETTES3AUU3CIGARETTES 3AUU3NONE3AUUAAA3LOW3 1 1/2 times 33 times3 5 times 3AAAAUBIBLIOGRAPHY1.Amsterdam, Ezra A. and Ann M. Holms. TAKE CARE OF YOUR HEART, New York, Facts on File, 1984.
2.Houston, B. Kent and C.R. Snyder. TYPE A BEHAVIOUR PATTERN, John Wiley ; Sons, Inc., 1988.
3.Pantano, James A. LIVING WITH ANGINA, New York, Harper ; Row, 1990.
4.Patel, Chandra. FIGHTING HEART DISEASE, Toronto, Macmillan, 1988.
5.Shillingford, J.P. CORONARY HEART DISEASE: THE FACTS, Oxford, Oxford University Press, 1982.
6.The Heart and Stroke Foundation of Canada. CARDIOPULMONARY RESUSCITATION – BASIC RESCUER MANUAL, Canada, 1987.
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Cite this Heart Diseases: Symptomes, Effects and Treatment
Heart Diseases: Symptomes, Effects and Treatment. (2019, Apr 18). Retrieved from https://graduateway.com/angina-pectoris-2/