Coronary Artery DiseaseHeart DiseaseHeart disease can take many forms. The form of heart disease I am focusing on is coronary disease. Different arteries supply different areas of the heart with oxygenated blood. If one or more of these arteries become narrowed or clogged as a result of coronary artery disease, or atherscelorosis the artery cannot fully supply the part of the heart it is responsible for. The heart is an effective pump only when good blood supply is maintained to all heart muscles. If an artery becomes so clogged that blood cannot flow through it, the result is chest pain which could progress to a heart attack, or myocardial infarction (MI). “Myocardial” is a medical term that means “having to do with the heart” or “heart muscle”. “Infarct” is a medical term for tissue death. During a myocardial infarction, the portion of the heart that is supposed to get blood from the diseased artery dies. However, cardiologists are trained to recognize symptoms like chest pain, shortness of breath, and fatigue of coronary artery disease in patients before the symptoms becomes severe. A cardiologist is often able to treat coronary disease before it causes an MI. http://myweb.com/contents/dmk_article396168Coronary Artery Disease Healthy arteries are flexible, strong, and elastic. Their inner layer is smooth and blood flows freely. As you get older, your arteries become thicker, less elastic, and deposits build in them. This leads to a general hardening of the arteries, which is also called atherosclerosis. Atherosclerosis or arteriosclerosis is the main cause of coronary artery disease. Atherosclerosis or arteriosclerosis is the gradual buildup of cholesterol inside the artery. When this happens in a coronary artery, the space inside the artery where blood flows becomes narrow, making it difficult for blood to flow freely. The result is less blood flow through the artery and less blood supply to heart tissue. Symptoms can include chest pain, shortness of breath, and fatigue that can be mild, or abrupt and severe, such as a heart attack. http://www.heartpoint.comSymptoms of Coronary Disease More than 6 million Americans have symptoms due to coronary artery disease (CAD). As many as 1.5 million Americans will have a heart attack this year. As a result, almost one-third will die. The most dramatic symptom of CAD is sudden death. But CAD produces other, sometimes less dramatic symptoms (chest pain). http:www.heartpoint.comChest Pain (Angina) Angina, or chest pain, occurs when your heart tissue doesn’t receive enough oxygen and nutrients because of a blockage in the arteries. When a blockage occurs, heart cells use stored energy for pumping. By-products, such as lactic acid, build up and are not removed efficiently because of the blocked blood flow that caused the problem initially. Waste product build up is thought to be the cause of pain. The pain may be similar to the pain experienced when you overwork your muscles, which is also due to lactic acid buildup. The heart cells can rely on stored energy only for a short time before the cells become damaged permanently. This temporary injury is called ischemia. Permanent damage is called infarction or tissue death. AnginaThere are two types of angina associated with coronary artery disease: stable and unstable. Whereas stable angina has a predictable pattern that occurs over time, unstable angina is different from the patient’s usual pattern of chest pain. Typical symptoms of angina include a variety of sensations. For example, angina may involve only mild, vague discomfort that is not really perceived as pain but as more an ache. Or it may be a severe, intense, crushing pain in the center of the chest. The location of pain may differ, however, pain is usually felt beneath the breastbone. In addition to chest pain, there may be associated pain that radiates to the arms, shoulders, neck, jaw, or back. Patients are often pale, sweaty, and short of breath. Their blood pressure and heart rate may be higher than normal. They may have some abnormal heart rhythms. If the pain includes sharp, shooting, knifelike pain, it is probably not angina.-http://www.heartpoint.comStages in Coronary Artery Disease Development You may have heard the term lesion before. If not, a lesion in a coronary artery refers to an abnormal change in the structure of the vessel. Lesion development within an artery follow these stages: Different substances, such as lipids, or fat; cells; tissue; calcium, accumulate within the layers of the arterial wall over time, causing trauma and narrowing the blood flow passageAs a result, one of three types of lesions may occur:- Fatty streak: buildup of lipids(fats) within the arterial wall that enlarges and invades the deeper layers of the wall, causing scarring and calcium deposits- Fibrous plaque: advanced buildup of substances, including lipids, that may partially block the inner part of the artery (lumen) and compromise blood supply to surrounding tissueAdvanced lesion: soft cholesterol core increases in size and has a hard shell that may crack and lead to blood clot formation and additional blockage within the vesselLesion growth triggers symptoms of coronary disease that require medical attentionTreatment of Coronary Artery Disease Treatment of coronary artery disease (CAD) is focused on balancing the supply of blood flow to the parts of the heart that need it. Methods used to treat CAD depend on the underlying problem, severity of symptoms, and the future risk. The decision as to the best course of treatment can take time (days, weeks, or months) or it can be immediate (emergency). The different ways of treating stable angina, unstable angina, and acute myocardial infarction (MI) include: Medications- Choleterol lowering drugs- Warfarm- Nitrates-Beta blockers-Calcium Channel Blockers-Anti-Clotting Agents-Aspirin-HeparinOf course with every medication you take, there is a side effect:-severe mouth sores-major bleeding-gastriontestinal ulcer, bleeding-stroke-high blood pressure-dizzinessAngioplasty: This is a surgery that involves a balloon like form that is placed inside anArtery and is blown up to open the clogged artery. Coronary artery bypass graft surgery: A surgery that removes a vien from another part of the body and is connected to the vein in the heart so that the clogged vein is bypassed and the heart can receive the nutrients it needs.
Some other treatments include cholesterol watchingWhat is cholesterol?Cholesterol is a substance present in all of us. Our bodies make cholesterol. It’s also present in meat and dairy foods. Plant foods don’t have cholesterol. There are several types of cholesterol, including low-density lipoproteins (LDL) and high-density lipoproteins (HDL). LDL cholesterol is called “bad” cholesterol because it can build up on the inside of your arteries, causing them to become narrow from plaque. HDL is called “good” cholesterol because it protects your arteries from plaque buildup. How does lowering LDL cholesterol help?Lowering your LDL cholesterol level will help keep plaque from building up in your arteries. This makes it easier for your heart to get the blood and nutrients it needs. If you already have coronary artery disease, your doctor will probably want you to lower your LDL level by at least 30 to 35% through diet, exercise and, possibly, medicines. Another way to help is to increase your HDL level. If you can reduce your LDL level to less than 130 and increase your HDL level to at least 50, you’re on the right track. http://www.coronary_artery.comWhat foods should I add to my diet?When trying to lower your LDL cholesterol, you should add foods to your diet that are low in cholesterol and saturated fats, because your body turns saturated fats into cholesterol. To do this, eat foods that are high in soluble fiber (see the box below).
Author: Cathereine M.Otto MD-Book: Coronary Artery Disease In Woman: What All Physicians need toKnow Eat less of these foods:Instead, eat more of these foods:Potato chips, french fries and other “junk” foodsWhole-grain breads and pasta, brown rice, bagelsVegetables cooked in butter, cheese or cream saucesFresh, frozen, baked or steamed fruits and vegetablesFried foodsSteamed, baked or fresh foodsWhole milk1% or fat-free milkBacon, sausage and organ meats (like liver) and dried beansFish, skinless poultry, lean cuts of meat (with fat trimmed away), soy products Egg yolksEgg whites, egg substitutesCheesecake, pastries, doughnuts, ice creamAngel food cake, fig bars, animal crackers, graham crackers, air-popped popcorn, low-fat frozen desserts (yogurt, sherbet, ice milk)Butter and margarineOlive oil or canola oil (in small amounts)There are lots of ways to add healthy foods to your diet. Follow the tips and the serving-size guidelines below: Start your day out right. Have some form of grain (like whole-grain bread or whole-grain cereal) and fruit for breakfast. Think of grains and vegetables as your main dish in lunches and dinners. If you’re serving meat or poultry as a main dish, add a tossed salad or vegetable to the plate. Add beans to leafy salads, pasta salads and stews–chick peas, kidney beans and navy beans have been shown to reduce LDL cholesterol levels. Drink fat-free or 1% milk, not whole milk or 2% milk. Look for low-fat yogurt and cheese, too. Try soy products. Soy has come a long way in the last few years. Today, you can find soy products in many grocery and health food stores. Try veggie-soy burgers, soy pepperoni, tofu or soy milk. Serve raw or cooked fruits with low-fat yogurt for dessert. Eat only a little oil. If you want to use oil for cooking, try olive oil or canola oil instead of oils high in polyunsaturated fats, such as corn oil, peanut oil and many margarines. Both olive oil and canola oil are high in monounsaturated fat, which decreases LDL and total cholesterol levels. Eat only small amounts of sweets. Eat 1 to 2 servings of fish or seafood each week if you have coronary artery disease. People with coronary artery disease seem to benefit from eating fish and seafood. Cook with garlic. Several studies have shown that garlic reduces LDL cholesterol and lowers blood pressure. Eat moderate amounts of nuts that are rich in monounsaturated fat, like hazelnuts, almonds, pecans, cashews, walnuts and macadamia nuts. These nuts have been shown to improve cholesterol levels. Avoid eating nuts by the handful. Instead, garnish food with one tablespoon of chopped nuts per person. What else can I do if I have coronary artery disease?Besides changing your diet, you should talk to your doctor about an exercise program that’s right for you. If you smoke, quit. If you’re overweight, try to lose weight (changing your diet and exercising will help you lose weight). Talk with your doctor about reducing other risk factors, such as high blood pressure or diabetes. Dr. Donnely; Cody Family Practice Center