Since it is becoming a common medical malady, it is important to be aware of the risk factors for coronary heart disease. There are a number of irregular conditions that affect the heart and the vessels supplying the heart with blood. Coronary heart disease is the most widespread kind of heart problem. It is also the most common cause of heart attacks.
Damage that occurs to the heart when the supply of blood is reduced is referred to as coronary heart disease. What normally happens is, deposits that are fatty in nature, build up within the lining of blood vessels whose job it is to supply blood to the heart muscles. This causes narrowing of the blood vessels and the resulting factor is a reduction in the blood supply to the heart muscles. This causes symptoms of pain known as angina.
Causes of Coronary Heart Disease
There are risk factors for coronary heart disease that are considered to be responsible for this disease. The biggest and most well known culprit is high cholesterol. Worldwide cholesterol levels in different populations vary quite dramatically. The Japanese population for instance, has much lower blood cholesterol levels and the rate of heart problem is lower. But in other populations that have similar incidences of blood cholesterol levels often have very varied disease rates.
Smoking tobacco is often quoted as one of the major risk factors for coronary heart disease. The smoker has a twice greater chance of developing heart problem than a nonsmoker. Studies indicate that after having given up smoking for five years, the risk factor of developing heart problem lowers to that of a person who has never smoked.
There is a medically proven relationship between smoking tobacco products and coronary heart disease. While smoking is legal and remains a personal choice, it is a dangerous practice and it is necessary for individuals to know that smoking habits play a role in the causes of serious disease for the heart. Many individuals may be in denial regarding the connection between smoking and heart disease. This denial is often based upon a need to mollify criticism towards smoking and may also stem from those companies who profit from the sale of tobacco products.
Pop Cultural Influences
When watching old episodes of the TONIGHT SHOW with Johnny Carson, it is surprising to see that he casually smokes cigarettes during the greater part of the program. In the classic films made in the 1930's and 40's, many actors puff away on cigarettes during the duration of the film. In one of the most bizarre scenes in the 1973 film THE EXORCIST portrays doctors smoking whilst acting in the examination scene. Fans of classic motion pictures and television programs will notice that the number of people portrayed smoking while acting out their roles as very high by today's standards. It is no wonder that the incidences of coronary heart disease were so high only a few decades ago.
At one time, smoking was so routinely shown in film and television productions worldwide that it acquired a foothold in pop culture. The result of this is that much of the public, close to 50%, was profoundly addicted to tobacco products. This addiction has not been without consequences as coronary heart disease and lung cancer incidences increased to correspond with the huge amount of individuals who enjoyed smoking cigarettes.
How Smoking Contributes To Coronary Heart Disease
Despite various attempts by stakeholders in the tobacco industry to deny the link between smoking tobacco products and coronary heart disease, medical technologists have confirmed the link between the two after numerous research programs over the last two decades. The continuous inhalation of smoke into the lungs over an extended period of time constricts the arteries and leads to heart problem. This limits the blood flow throughout the arteries and the potential for a heart attack becomes very significant. This is a very dangerous situation to be in. Besides this, the smoking of tobacco products can cause various other ravaging effects on the human body. This can include breathing problems and the stunting of growth.
Diagnosis Of Coronary Heart Disease
The only sure way that coronary heart disease can be diagnosed is with a special procedure known as a coronary angiography. An x-ray sensitive dye is introduced to the blood flow to the heart. X-rays are then taken to examine how well the blood is flowing through the heart. This procedure is undertaken in conjunction with cardiac catherization when the patient is under sedation.
Prevention
The best possible way to prevent risk factors of coronary heart disease is to avoid them as much as possible. The most important thing to do is to maintain a healthy lifestyle. This includes eating healthily and ensuring the correct amount of daily physical activity. Only by living as healthily as possible will you be able to protect yourself from any of the risk factors.
What are the causes of coronary heart disease? This is a condition where a fatty deposits and cell proliferation build up in the arteries supplying the heart muscle and is often called "coronary artery disease". This is the most common form of heart problems. The question is who are at risk in having this disease? What are the predisposing factors?
Coronary artery disease is much more common in older people and in males, but however, women tend to be older and sicker when they are first treated for a heart attack. What causes coronary artery disease? It occurs when some of the arteries that carry blood to the heart muscle become narrowed with fatty deposits which are also called as plaque. This plaque is composed of cholesterol and fats that is built up on the inner wall of the coronary arteries. If the arteries become narrowed the heart is not fully supplied with the oxygen and the other nutrients in needs. If it happens completely heart attack may occurs. Artery disease is the leading cause of death in the United States. The tendency to develop this disease can be genetic. The other contributing factors like diet, smoking and stress make a big difference in whether or not a person will develop heart disease.
Increasing age is one of the major risks of coronary artery disease. About 80% of the people are dying because of coronary heart disease most of them are age 65 or older. Hereditary is also a factor, if children with parents who have heart disease are more likely to develop it themselves. Another thing is being a cigarette and tobacco smoker. Smokers' risk of developing heart disease is twice that of non smokers. High blood pressure increases the workload of the heart causing it to enlarge and weaken over time. As the blood cholesterol increase, a person is more at risk in having coronary heart disease.
How can we diagnose coronary Artery disease? The only certain way to diagnose and measure the extent of coronary artery disease is through the use of coronary angiography. If the doctor suspects a person of having the coronary heart disease, the procedure will be ordered.
When the damage occurs, the body will start a healing process. Excess fatty tissues release compounds that promote this process. This healing causes plaque to build up where the arteries are damaged. This build up of plaque in the coronary arteries may start in childhood. Overtime, plaque can narrow or completely block some of your coronary arteries. This reduces the flow of oxygen-rich blood to the heart muscles.
Knowing the causes of coronary heart disease is very important; it will serve as the guidelines in having a healthy lifestyle. Early detection is very important. Seeking the advice of the doctor is the best thing that we can do to avoid one of the causes of heart attacks.
"You have coronary heart disease." When your doctor says those words to you or to someone you love, it's frightening and confusing. You probably have dozens of questions: What is coronary heart disease? Do I need to change my lifestyle?
Coronary heart disease (CHD), also called coronary artery disease (CAD) or ischemic heart disease, is a form of heart disease that's caused by narrowing of the coronary arteries that feed the heart. If you or someone you love has been diagnosed with CHD, it may help to know that you are not alone. In fact, CHD is the most common form of heart disease, affecting at least 12 million Americans. It is the single largest killer of both men and women in the United States, responsible for nearly a half million deaths each year, or about 1 out of every 5 deaths. CHD causes nearly all heart attacks (myocardial infarctions). Every 29 seconds, an American suffers a coronary event (a heart attack or fatal CHD), and every minute one of us will die from one. The american Heart Association estimates that this year alone, more than a million Americans will suffer from a new or recurrent coronary event, and nearly 40 percent of those will die from it.
Coronary heart disease isn't just an American problem. CHD is very common in other Westernized countries, too, such as many in Europe. Diseases of the heart and circulation such as heart attacks and stroke (a "brain attack") kill more people worldwide than any other cause. The World Health Organization estimates that as many as 30 percent of all deaths are caused by heart and circulation diseases like CHD.
The good news is that you don't have to become another CHD statistic. There is a lot you can do to reduce your risk of having a heart attack or dying from CHD. Sometimes just changing your lifestyle - following a heart-healthy diet, exercising regularly, and reducing the stress in your life-can prevent a heart attack or even reverse the narrowing in your arteries. There are a number of medications-and new ones being developed every day-that can help lower your heart attack risk. Surgical procedures such as angioplasty and stenting or bypass surgery can help compensate for blockages in your arteries and help keep your heart supplied with the blood it needs. By educating yourself about your treatment options, and working closely with your doctor you and your doctor can choose the best treatments that will enable you to live a long and healthy life.
The Circulatory System
The first step in taking charge of your CHD is to learn all you can about the disease. To understand what CHD is and how it affects your heart, you need to understand a little about your heart and how it works.
Your circulatory system, also called your cardiovascular system, is made up of the heart, the lungs, and blood vessels called arteries and veins. This system carries blood, food, and oxygen to every cell in the body. It also carries waste products away from the cells and out of the body. (A cell is a building block of every tissue and organ in the body.) Think of your circulatory system as a busy highway system composed of massive freeways and large streets that feed into smaller and smaller streets, and finally into tiny lanes and alleyways. This system is made up entirely of one-way streets. In our imaginary highway system, cars, or in this case, blood, can flow in only one direction. The one-way streets called arteries and arterioles (small arteries) carry blood enriched with oxygen and nutrients away from the heart to the cells in the body. The one-way street called veins and venules (small veins) carry blood loaded with waste products from the cells back to the heart.
Between these two one-way street systems are tiny blood vessels called capillaries. Almost too tiny to see and often thinner than a strand of hair, capillaries connect the smallest arteries with the smallest veins. They are the brides that connect our two systems of one-way streets. The walls of these tiny capillaries are so thin that food and oxygen in the blood pass through them into the surrounding cells. These thin walls also allow waste products from the cells to pass into the capillaries. This enables the blood to carry waste from the cell to be removed by the kidneys, liver, and lungs.
If you can imagine a single drop of blood flowing through this system, it might look something like this. The blood droplet, full of oxygen and nutrients, (fuel), is pumped out of the left side of the heart into the largest arteries. There is flows into progressively smaller arteries and finally into the capillaries, where it delivers its load of oxygen and food for the cells. At the same time, the blood picks up waste products from the cells and flows into tiny veins, then into larger and larger veins. Finally, the blood droplet arrives back at the right side of the heart, where it's pumped into the lungs and unload carbon dioxide, pick up a fresh supply of oxygen, and begin its circular journey again.
The Heart: An Amazing Pump
The heart is the pump that keeps the blood flowing around and around in an endless circle throughout the body. Think of it as the traffic cop that coordinates the flow of traffic throughout our highway system. The heart is a hollow muscle that weighs less than a pound and is about the size of a man's fist. Despite its small size, this amazing organ an average of 100,000 times a day, pumping about 2,000 gallons of blood every day. If you live to be 70, your heart will beat more than 2.5 billion times.
Located in the center of the chest and protected by the breastbone and rib cage, the heart is actually a double pump thats divided into four chambers, two upper ones and two lower ones. A thin wall of muscle separates the left and right sides of the heart. The top chamber (atriums or atria) and lower chambers (ventricles) are connected by valves that act like one-way doors. These valves make sure blood flows only in one direction. In the heart, the blood is pumped from the left and right atriums to the left and right ventricles. The right side of the heart sends blood to the lungs. The left side of the heart pumps blood out to the cells in the body.
Coronary Arteries
Just like other muscles in the body, the heart needs its own supply of blood and oxygen to work properly. Even though the heart pumps blood through its chambers, the heart itself receives no significant nourishment from this blood. There is a separate set of arteries that branch off the aorta (the main artery that receives blood from the left ventricle) that provide the heart's blood supply. These are called coronary arteries. The coronary arteries encircle the top and sides of the heart bringing plenty of oxygen-rich blood to the heart. The two major coronary arteries are the left coronary artery and the right coronary artery. These vessels divide into many smaller coronary arteries that feed the heart.
What Is Coronary Heart Disease?
Healthy coronary arteries have smooth, flexible walls that provide plenty of blood to the heart. However, over many years, these flexible walls can become progressively irritated and damaged by such substance as fats, cholesterol, calcium, cellular debris, and platelets (tiny cells responsible for blood clotting). When the walls of the arteries are damaged, these substances are able to "stick" to them. Coronary heart disease (CHD) occurs when these coronary arteries become narrowed and clogged.
This buildup inside the artery walls is a process called atherosclerosis, which produces a substance known as plaque. As it builds, plaque is a lot like the dirt, fat, and minerals that build up inside your home's plumbing. As the buildup becomes thicker, the flow through the pipes becomes less and less and may even completely stop. Similarly, when your heart doesn't get enough oxygen due to narrowed arteries, you may feel chest pressure or pain called angina. If the blood supply to part of the heart is completely cut off, the result is often a heart attack.
Everyone has a certain amount of atherosclerosis as they age. For many of us, atherosclerosis begins in childhood. Some people have a rapid increase in the buildup of atherosclerotic plaque after age 30. For others, plaque buildup does not become a problem until we're in our 50s or 60s.
What Causes CHD
We don't know for sure why atherosclerosis occurs or even how it begins, but there are several theories. Some medical experts believe the atherosclerotic buildup in the inner layer of the arteries may be caused by several conditions, including:*Elevated levels of LDL cholesterol (low-density lipoprotein) and triglycerides in the blood*Low levels of HDL CHOLESTEROL (high-density lipoprotein)*High blood pressure*Tobacco smoke*High blood sugar levels (diabetes mellitus)*Inflammation.
It's likely that more than one process is involved in the buildup of plaque. Many researchers believe that when excess fat combine with oxygen, they become trapped in the arterial wall. This attracts white blood cells which help prevent infection when tissue is damaged. Then substances call prostaglandins, which are involved in blood clotting and altering tone (firmness) within arteries, become active. Any injury to the artery wall, such as damage caused by smoking, can activate prostaglandins. The activated prostaglandins stimulate more plaque growth and narrow arteries and/or cause blood clots to form.
Regardless of how plaque forms, advanced plaque is made up mostly of living cells. In fact, about 85 percent of advanced plaque consists of cell debris, calcium, smooth muscle cells, connective tissue, and foam cells (white blood cells that have digested fat). About 15 percent of advanced plaque is made up fatty deposits.
Once the plaque develops, plaque containing cells can be easily damaged. This can lead to blood clots forming on the outside of the plaque. Small clots can further damage other layers of the blood vessel wall and stimulate more plaque growth. Larger blood clots can partially or totally block the artery.
In addition to interfering with or totally blocking blood flow, plaque can hinder the arteries ability to dilate and contract. In order to respond to the bodies ever-changing need for blood, the arteries need to be strong and elastic. For instance, when you exercise, your body needs more blood. The heart responds by pumping faster, and the arteries respond by expanding to accommodate the increased volume of blood expanding to accommodate the increased volume of blood coming from the heart. As the artery becomes narrowed and hard, that elasticity is lost. Arteries that have atherosclerotic plaque are more apt to spasm (temporarily narrow), causing even less blood to flow to the heart and possible causing chest pain or heart attack.
Coronary heart disease, is a narrowing of the coronary artery: a large blood vessel that supplies blood to the heart. This narrowing is caused by fatty deposits in the artery itself and is the leading cause of heart attacks in the developed world. Cardiac disease of all types is, indirectly, the leading cause of maternal death in the UK. The risk of developing coronary heart disease increases significantly with age beyond 35 years and more significantly still in those over 50 years.
Large scale social changes have led to the increase in the number of pregnant women who suffer with coronary heart disease. The age at which women are able to conceive and sustain a pregnancy has, on average, increased with many factors driving this, not least, increases in health care and fertility medicine. Career and financial pressures also mean women are delaying having their first child and fluidity of family structures also have contributed to older women wishing to conceive with their second or third partners/spouse.
Lifestyle changes have, without doubt, contributed to the rise in younger women developing coronary heart disease. The huge rise in obesity is an obvious starting point and, according to current statistics, the number of young women who smoke far exceeds the number of young men who partake in this unhealthy habit.
Working and leisure patterns have also played their part with more and more jobs being sedentary and desk based in their nature and women far less likely than men to take part in organised sports but increasingly likely to drink more alcohol than is recommended on a regular basis.
Should women with coronary heart disease risk pregnancy at all?
This is a rather vexing question. It is only in recent times that the number of women with coronary heart disease has reached any significant level. The greatest risk posed by embarking upon a pregnancy with coronary heart disease is the risk of heart attack particularly during labour. Other diseases and conditions associated with coronary heart disease such as hypertension (high blood pressure) and diabetes serve only to increase the risk to mother and child. It is also possible that some medications you are taking to control your heart condition may not be suitable for use during pregnancy. Stopping or changing them may further increase the risk of heart attack.
Pregnancy itself may worsen symptoms of coronary heart disease. This exacerbated form of the disease is known as acute coronary syndrome and is three to four times more common in pregnant women compared to non-pregnant women of the same age. It is estimated that acute coronary syndrome affects one in every ten thousand pregnancies in the USA. The rates are assumed to be lower in the UK but large scale studies have yet to be conducted. This is likely the result of a host of factors common in pregnancy: mobility may become restricted in later stages, drug absorption may be affected particularly in mothers who suffer morning sickness and blood pressure may increase to dangerous levels.
Choosing to conceive if you have coronary heart disease is not a decision that should be taken lightly and certainly not without consultation with your doctor and cardiologist.
Risks of coronary heart disease during pregnancy
As already indicated, the greatest risk is that of heart attack. This could, of course be fatal or leave your baby starved of oxygen (hypoxia) which, in turn, can lead to permanent brain damage. The risk of heart attack is increased during labour and you may be advised to have a caesarian delivery.
Hypertension (high blood pressure) is a predisposing factor for coronary heart disease and a condition that develops in the last twenty weeks of pregnancy, pre-eclampsia can increase the risk of heart attack many-fold. Indeed, pre-eclampsia alone has the potential to be fatal. Pre-eclampsia superimposed on (chronic) hypertension has been seen to develop in as many as one quarter of women with pre-existing hypertension. Early detection is important to ensure a good outcome in this scenario so frequent and regular blood pressure monitoring is essential for pregnant women with hypertension and coronary heart disease.
Reducing the risks
Should you choose, on balance of risk, to try to conceive then you should prepare for pregnancy by taking folic acid supplements for at least three months before conception and throughout pregnancy, try to keep weight within a healthy range, eat a healthy and balanced diet, take exercise and avoid alcohol, caffeine and tobacco products - these are sensible steps for any woman wishing to conceive and have a healthy pregnancy but are especially important for women with coronary heart disease.
Consult with your cardiologist to establish which drugs will be safest for you during pregnancy. For those who are prescribed it Aspirin is, generally safe to use. It may be that your doctor will not change your medication so it is important to discuss the risk and rates of potential side effects for your baby if these drugs are generally not recommended during pregnancy. Discuss whether or not you should attempt to breast feed your baby. Do not stop taking medication you have been prescribed without consulting your cardiologist.
Birth choices for women with coronary heart disease are limited in the extreme and you should be under the care of a consultant obstetrician led (as opposed to midwife led) team. You should plan to give birth in a maternity unit within a hospital. Under no circumstances should you attempt a home birth or even birth at a birthing centre though, for most women with coronary heart disease vaginal delivery is possible. Wear medical alert jewellery and carry a medical alert card in case of an emergency and ensure those who you spend most time with are educated in how to properly conduct CPR.