Understanding Coronary Heart Disease


Coronary heart disease (CHD) is a condition when the blood vessels of the heart (coronary arteries) clogged by fat deposits. When fat accumulates, the more so the artery will be making narrows, and makes the blood flow to the heart is reduced.

The reduced blood flow to the heart will trigger symptoms such as angina, CHD, and shortness of breath. If the condition is not immediately addressed, the artery will be blocked completely, and trigger a heart attack.
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Coronary arteries are the blood vessels that drain the oxygen-rich blood to the heart. There are two types of coronary arteries, which are both branched out from the aorta or its major blood vessels, namely:

  • Left main coronary artery (left main coronary artery/LMCA) – these are functioning Artery flow of blood to the left of the porch and left Chambers of the heart. LMCA is divided into two parts, namely:
-The Left anterior descending (LAD) – functional blood flow to the front and left sides of the heart.
-Circumflex (LCX) – functional blood flow to the back and sides of the outside of the heart.
  • The right coronary artery (right coronary artery/RCA) – this Arterial blood flow to the right of the porch and the booth right. In addition, RCA also drains blood into the node and atrioventricular node, sinoatrial regulating heart rhythms. RCA is divided into acute and right posterior descending artery marginally. Along LAD, RCA also drains blood into the central part of the heart, and the septum (the wall of separation between the right and left chambers of the heart Chambers).
According to the WHO, coronary heart disease is one of the highest causes of death in the world. In the year 2015, recorded more than 7 million people died due to the CHD. Whereas in Indonesia alone, more than 2 million people affected by CHD in 2013. Of these, CHD occurs more frequently in the age range 45-54 years.

Symptoms Of Coronary Heart Disease

Intake of blood to the heart may not cause any symptoms at first. However, when fat accumulates in the arteries, the more it will begin to appear symptoms of coronary heart disease (CHD), such as:

Angina

Angina is chest pain due to the reduced blood supply to the heart muscle. Although it is generally not life-threatening, can increase the risk of angina someone had a heart attack or stroke.

Angina can last a few minutes, and usually appears because the triggered by physical activity or stress. Pain experienced due to angina is also diverse. Mild angina only causes discomfort such as stomach ulcers. But, the attack can inflict severe angina chest pain such as littlest toe. The sensation of the chest pain may spread to the arms, neck, Chin, stomach, and back.

Heart attack

A heart attack occurs when the arteries already clogged completely. This condition should be immediately addressed so that no permanent damage occurs on the heart muscle.

Due to a heart attack pain similar to angina. However, pain in the heart attack will be more severe and can occur even though the sufferer is resting.

The symptoms of a heart attack can be a pain that radiates from the chest to the arms, Chin, neck, abdomen, and back. The pain can last for more than 15 minutes. In addition to the above symptoms, sufferers can also experience dizziness, sweating, nausea, and body felt limp.
A heart attack can happen suddenly, especially in diabetics and the elderly.

Heart failure

Coronary heart disease sufferers can also experience heart failure when the heart is too weak to pump blood throughout the body. The condition causes the blood to accumulate in the lungs, so sufferers experiencing shortness of breath.

Heart failure can occur instantly (acute), or evolve gradually (chronic).

In some cases, sufferers CHD experience symptoms differently, such as palpitations (heart palpitations). Most sufferers don't even feel any symptoms until diagnosed with CHD.

Diagnosis Of Coronary Heart Disease

As a first step the diagnosis, the doctor will ask the symptoms being experienced, as well as examining the risk factors which belonged to the patient. When patients are at risk of developing coronary heart disease (CHD), the doctor will examine the patient's blood pressure.

The doctor will also run blood tests to measure cholesterol levels of patients. In order for an accurate result is obtained, the patient will be asked to fast 12 hours before the test is done.

Then, to make sure the diagnosis, the doctor will perform some inspection methods that include:

Electrocardiography (ECG)

ECG aims to record the electrical activity of heart patients. Through ECG, a doctor can find out whether the patient ever had or is having a heart attack. ECG may also help doctors know the beat and rhythm of the patient's heart belongs to normal or not.

In some cases, the doctor will recommend that patients undergo a Holter monitoring. Just like ECG, this examination aims to record the electrical activity of the heart. The difference is, the patient will wear a small device called a Holter monitor. Such a device would be worn on the chest of the patient, as long as the patient activity within 24 hours.

X-rays

X-rays in the chest may be done to look at the conditions the heart, lungs, and blood vessels. Through chest x-rays, the doctor can tell if the size of the heart is enlarged or there are disorders of the lungs.

CT scans and MRI scans

Two Imaging tests can be done to see the heart condition with more details, which cannot be seen on x-rays examination. This examination also can show if there is a buildup of calcium in the blood vessels, which can trigger coronary heart disease.

Test pressure (stress test)

When the symptoms experienced by the patients more often appear while activity, the doctor will suggest the test pressure. This test aims to measure a patient's heart when working activity.

In the test pressure, the patient will be asked to walk on a treadmill or pedaling bikes, static, while undergoing an examination of ECG at the same time. At a time when patients are unable to move, the doctor will give the drug to increase the heart rate while running the tests MRI.

Echocardiography

Echocardiography is the examination by using sound waves (such as ultrasound), to display the image of the patient's heart monitor. During echocardiography was performed, the doctor can check whether all parts of the walls of the heart to function well in pumping blood.

The wall of the heart that moves are weak, can be caused by lack of oxygen, or the existence of damage from a heart attack. It could be a sign of CHD.

Examination of cardiac enzymes

Examination of cardiac enzymes is done by taking blood samples of the patient, to be examined in the laboratory. Through this inspection, the doctor can determine the levels of troponin T in patients ' blood.

Troponin is a protein produced from heart cells are damaged. To someone who had a heart attack, troponin levels will increase in 3-12 hours later. Troponin levels will reach its peak in the 1-2 days, and returned to normal after 5-14 day.

Troponin levels are associated directly with the level of damage to the heart muscle. In other words, the higher the levels of troponin in the blood, the more severe heart damage anyway.

Examination radionuclide

A radionuclide examination is used to help measure blood flow to the heart muscle while resting and while activity. This test is almost the same as the test pressure, i.e. by asking the patient to walk on a treadmill or pedaling a bike static. The difference is, these tests can show more complete information by displaying a picture of a heart patient.

Before the test is done, the patient will be injected with a radioactive substance called isotopes. When patients are unable to walk on a treadmill or using a static bicycle, the doctor will provide the drug to increase the patient's heartbeat. Then, the camera will be directed to the patient's chest and captures images when the isotopes flowing to the heart.

Cardiac catheterization and coronary angiography

Katerisasi heart aims to see the condition of the heart, by inserting a catheter through a blood vessel in the arm or thigh to be directed to the heart. Then, the doctor will run coronary angiography procedures. This procedure is performed by injecting a contrast fluid and using x-rays to see the flow of blood toward the heart. Through the coronary angiography, doctors can find out if there is a blockage in the blood vessels.

The Treatment Of Coronary Heart Disease

Handling of coronary heart disease (CHD) generally involves a change in the pattern of life which can be combined with drugs or medical procedures. Live healthy life patterns can improve heart health. An example is:
  • Stop smoking.
  • Reduce or stop consuming alcohol.
  • Consuming foods with nutritional balance.
  • Reduce stress.
  • Maintain ideal body weight.
  • Exercise regularly.
  • The doctor will also prescribe some type of medication to treat coronary heart disease, among other things:
  • Blood-thinning – doctors can prescribe blood-thinning antiplatelet types, except in patients with disorders of blood clotting. Antiplatelet may help prevent blood clotting and lowers the risk of angina and heart attack. Examples of these drugs are aspirin and clopidogrel.
  • Statins – cholesterol lowering Statins high-functioning, by removing LDL from the blood, thereby slowing the progression of heart disease. An example of commonly prescribed statin drugs is atorvastatin and simvastatin.
  • Angiotensin inhibitor drugs modifier enzyme (ACE PIs) – this type of medication is used to treat hypertension, including captopril and enalapril.
  • Angiotensin II receptor blockers (ARB) – drug Function is the same as ACE PIs, namely addressing hypertension. An example is valsartan and telmisartan.
  • Inhibitor of beta (beta blockers) – this remedy serves to prevent angina and overcome hypertension. An example is bisoprolol and metoprolol.
  • Nitrate – Nitric function dilates the blood vessels, so blood flow to the heart increases and the heart does not pump blood harder. One type of nitrates is nitroglycerine.
  • Calcium antagonists – these drugs work dilates the blood vessels, so blood pressure decreases. Examples are verapamil and diltiazem.
  • The diuretic drug is working – type reduces the levels of water and salt in the blood through urine, and dilates the blood vessels so that blood pressure declines.

When the drug was not effective to overcome the symptoms being experienced, the patient will be advised to undergo surgery. The doctor also will run the operations if the narrowing is caused by a buildup of aroma. A number of actions undertaken, among other things:

Attach the ring heart

Attach the ring of the heart or coronary angioplasty is performed by inserting a catheter into the artery is narrowed. Then, the doctor will develop a small balloon through the catheter to dilate the narrowed artery. Thus, blood flow can back smoothly. Ring (stent) will be installed in order to prevent arteries narrowing again.

This procedure can be done programmatically in patients with symptoms of angina, or as an emergency action to someone who had a heart attack.

Heart bypass

This procedure is done by taking a blood vessel from another part of the body, for pasting to the section between the large blood vessels (aorta) and arteries, by passing through the narrows area. In doing so, blood will flow smoothly through the new routes.

A heart bypass is performed with the patient's chest cut open. Therefore, this procedure is generally only done when there are more than one blocked arteries.

Heart transplant

This action is performed if cardiac damage has been very severe, and it can no longer be resolved by medication. Transplants heart is done by replacing the damaged heart, with a healthy heart of donors.

Prevention Of Coronary Heart Disease

Coronary heart disease can be prevented by living healthy life patterns, such as quitting smoking and limiting alcohol consumption. In addition, manage stress well, for example by doing muscle relaxation or deep breathing exercises.

Another precaution is to undergo a routine blood sugar and cholesterol checks every two years. More routine checkups will be advised, in patients with a history of hypertension and heart disease.
Some other steps to prevent coronary heart disease are:

A balanced nutritious food consumption

More consuming foods high in fiber, such as vegetables and fruit. In addition, limit the levels of salt in food, not more than 1 teaspoon a day. Avoid foods with high cholesterol levels, especially if Your LDL levels are high enough. Some types of foods high in cholesterol include:

  • Fried foods.
  • Egg yolk
  • Butter
  • Cow brains and offal of animals
  • Shrimp
  • Fast food
Other types of foods that should be avoided are the foods high in sweets because it can increase the risk of developing diabetes, one of the risk factors of coronary heart disease.

On the contrary, increase the levels of good cholesterol or HDL with high consumption of food multiply unsaturated fats, such as fish oil, avocado, nuts, and olive oil and vegetable oil.

Do regular gym

A healthy diet combined with regular exercise can maintain ideal weight. In addition, regular exercise can lower cholesterol levels and keeping blood pressure remained normal.

Take time at least 150 minutes a week, to work out. For example, by jogging 30 minutes every day. In addition to jogging, gymnastics, or swimming can also maintain heart health.

Consumption of the drug correctly

It is very important to follow the doctor's instructions in taking any medication. It is important to remember that do not stop treatment without first consulting with your doctor, as it may lead to a worsening of symptoms.

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