Coronary heart disease

Coronary heart disease (CHD) or ischemic heart disease (IHD) occurs when plaques are deposited inside the coronary arteries: in arteries and veins.

These vessels carry oxygenated blood and other nutrients to the heart.
A plaque is a hardened tissue composed of fats, cholesterol, lime and other substances present in the blood.

The disease caused by the plaques accumulated in the arteries is called atherosclerosis and often occurs in the elderly.
The plaque narrows and closes the blood vessels (stenosis), so the heart receives insufficient blood and has to provide more pumping power.

One variant is dilated (or hypertrophic) ischemic heart disease, which is characterized by an increase in the size of the heart muscle, especially the left ventricle of the heart.
This cardiomyopathy can be caused by a heart attack or ischemia.

The decreased blood supply causes chest pain; if the blood flow is completely blocked, it can lead to heart attack or sudden cardiac death.
It is imperative to identify the cause of CHD and maintain a healthier lifestyle to avoid complications.


Causes of ischemic heart disease

  • Hereditary: Genetic transmission from father to son is thought to be one of the main causes of ischemic heart disease.
  • Hypertension: If there is a rapid increase in blood pressure in the cardiovascular system, the blood flow acts on the walls of veins and arteries with a force that results in hypertension.
  • High cholesterol: Cholesterol is a waxy and fatty substance that occurs naturally in the body. Excess cholesterol in the blood forms deposits on the walls of the coronary arteries, which thereby narrow and cause obstructive ischemic cardiopathy.
    Pronounced familial hypercholesterolemia can lead to juvenile ischemic cardiopathy.
  • Tobacco: If the nicotine present in tobacco passes into the blood, this causes blood vessel narrowing.
    If blood circulation decreases, the heart needs strong pressure for its pumping power.
    Often this constant effort of the heart leads to ischemia.
    Smoking cigarettes or pipes, as well as eating chewing tobacco, can cause various damage to the heart.
    Patients suffering from COPD have smoked a lot, so it’s easily possible that they both have diseases.
  • Diabetes: It occurs when the body is unable to regulate the amount of glucose in the blood. Because glucose is not trapped in cells, it remains in the blood, causing the unused sugar to accumulate.
    Diabetes accelerates the formation of arterial plaques and vascular occlusions.
  • Obesity: This is a metabolic disease in which excess fat accumulates in the body and increases blood cholesterol and triglyceride levels, as well as blood pressure.
    Obesity is a chronic disease and has many serious consequences.
  • Stress: It does not directly cause CHD, but it accelerates the narrowing of blood vessels. It leads to an increase in blood pressure and a faster heart rate.
    If the stress becomes chronic, it damages the coronary arteries.
  • Diet and exercise: A high-fat and low-fiber diet increases the risk of plaque buildup in the coronary arteries. A healthy diet low in fat helps to combat many causes of disease and ensures proper blood circulation for the functions of the heart.
    Those who do not do physical training contribute to the accumulation of fat in the body, resulting in obesity and the problems associated with it.
    Regular exercise prevents obesity and diabetes, and also lowers blood pressure and cholesterol.
    Competitive sports are contraindicated in ischemic heart disease, because the increased arterial blood requirement can trigger a heart attack.
  • Menopause. Coronary heart disease mainly affects postmenopausal women. Before this time, women are protected by elevated estrogen levels.

The fact that this disease has been the cause of increased deaths is a cause for serious concern. Lifestyle changes help fight ischemic heart disease.

Risk factors include physical exertion, temperature fluctuations, stress and diet.

Symptoms can also occur at rest and last up to five minutes. If this time limit is exceeded, a heart attack may develop.

Symptoms of coronary heart disease

The arteries narrow when plaques form inside them.
This condition is called atherosclerosis or atherosclerosis, it is a chronic ischemic heart disease.

Blocked arteries can develop new vessels for blood supply to the heart. However, under stress, these small blood vessels cannot carry the necessary amount of blood.
Sometimes rupture of a plaque causes the formation of blood clots, which increase the extent of constipation or completely prevent blood flow.
The consequence of this situation is ischemia, that is, insufficient blood flow to the heart muscle.
An ischemic heart muscle cannot function properly.
If ischemia affects an important part of the heart muscle, it can lead to tissue damage.
This can be reversible if the blood flow to the heart increases again. But ischemia can also lead to irreversible tissue death due to lack of blood flow.
This disease is then called myocardial infarction.
So, coronary occlusion causes ischemia, which can lead to angina pectoris or a heart attack.

Symptoms of coronary artery disease

A person suffering from this disease has plaques in the coronary arteries, which can cause angina pectoris (chest pain) or a heart attack.

Some symptoms of this condition may include:
A heart attack, which is characterized by severe and sudden chest pain.
Severe or mild chest pain that can spread to the arm (especially the left arm), shoulder, back, neck, jaw, or stomach. You may also experience shortness of breath, an irregular heartbeat, sweating and nausea.

Other symptoms:

  1. Vertigo
  2. Skin pallor
  3. Vomit
  4. Erectile dysfunction
  5. Ohmacht

Symptoms do not always occur before a heart attack. The infarction can also occur without symptoms, in this case it is a silent ischemia.
Symptoms may be different in women and men.
In post-menopause, some women suffer from microvascular dysfunction, which is a dysfunction of the smaller arteries in the heart (the large arteries are inconspicuous). This dysfunction is caused by many factors, including changes in estrogen levels (female hormones), smoking, and hypertension.
The more accurate name of this phenomenon is cardiac syndrome X or angina pectoris syndrome: patients suffer from the symptoms of coronary heart disease caused by dysfunction of the small arteries, even if there are no occlusions in the larger coronary vessels.
So, the main cause of cardiac syndrome X is microvascular dysfunction.

Risks and complications of coronary artery disease

The heart pumps oxygen-rich blood from the lungs to the different parts of the body. The oxygen-rich blood is pumped through the coronary arteries. In coronary heart disease, blood flow to the heart is reduced due to plaque build-up within the artery walls. Atherosclerosis can cause frequent angina pectoris and myocardial infarction.
This disease is dangerous and can significantly change life.
Ischemic heart disease can progress and lead to cardiac decompensation.

Diagnosis of ischemic heart disease

Ischemic heart disease can be diagnosed based on its main symptomatology.

A chest X-ray and blood tests may be required.

Angina pectoris is clinically diagnosed on the basis of the symptoms in the chest under stress, which decreases again at rest.
To confirm angina, ischemic reversible changes during an attack are observed on the ECG or a small dose of nitroglycerin is administered sublingually, which relieves pain within 3 minutes.
The severity of ischemia, the presence and extent of heart disease are determined by some tests.

The diagnostic examinations include:

  1. To detect stable angina pectoris and acute coronary syndrome, an electrocardiogram (ECG) can be created (measurement of electrical cardiac activity)
  2. Cardiac stress test
  3. Myocardial scintigraphy
  4. Echocardiogram (sound wave measurement)
  5. Blood test (measurement of total fat, cholesterol and lipoproteins)
  6. Chest X-ray
  7. Coronary angiogram (cardiac catheterization)

Treatment of ischemic heart disease

Treatment options include:

  • Prescription of oral medications
  • Changes in diet
  • coronary bypass surgery
  • Minimally invasive surgical procedure on the heart
  • Myocardial revascularization by Percutaneous Transluminal Coronary Angioplasty (PTCA)
  • Physical exercises for postoperative cardiac rehabilitation

Prevention of CHD

In order to counter the disease and to avoid a heart attack, it is important that people over the age of 40 undergo quarterly routine checks to identify the following problems:

  • Diabetes
  • familial accumulation of the disease
  • high blood pressure
  • increased cholesterol levels
  • low cholesterol levels
  • Increase in C-reactive protein
  • Overweight

The diagnosis of ischemic heart disease is always clinical and provides:

  • Angio-MRI
  • Angio-CT
  • cardiac arteriography
  • Echocardiogram
  • Electrocardiogram or ECG
  • Electron beam tomography or EBCT
  • Cardiac stress test
  • Scintigraphy

What is the life expectancy? Prognosis

The prognosis depends on the number of coronary vessels affected, the location and the severity of the stenosis.
Ischemic coronary three-vessel disease is very serious, so surgical intervention often needs to be performed.
It is not possible to estimate life expectancy in patients with ischemic heart disease.

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