Coronary Heart Disease (CHD), also known as coronary artery disease or ischemic heart disease, is a prevalent cardiovascular condition characterised by the narrowing or blockage of the coronary arteries that supply blood, oxygen, and nutrients to the heart muscle. This restriction of blood flow can lead to chest pain (angina), heart attacks, and other complications such as Acute Coronary Syndrome. ACS typically occurs when a plaque in a coronary artery ruptures, causing a blood clot to form. This blood clot can partially or completely block blood flow to the heart. Understanding its causes, diagnosis, treatment, and post-care is essential for managing this condition effectively and timely.
What is coronary circulation?
Coronary circulation refers to the movement of blood through the vessels of the heart, including the coronary arteries and veins. It is crucial for delivering oxygen and nutrients to the heart muscle and removing deoxygenated blood.
The coronary arteries, including the left coronary artery (LCA) and right coronary artery (RCA), play a vital role in supplying oxygenated blood to the heart muscle. The LCA branches into the left anterior descending artery (LAD) and the left circumflex artery, while the RCA supplies the right atrium, and right ventricle, branching into the posterior descending artery.
After this delivery of oxygenated blood, coronary veins, including the great cardiac vein, collect deoxygenated blood from the heart muscle and transport it back to the right atrium.
The ligaments surrounding the coronary arteries and veins provide structural support and stability, contributing greatly to this system. They play a role in securing these vessels in their anatomical positions within the heart.
What are the causes?
CHD develops gradually due to a buildup of cholesterol, fat, and other substances, forming plaques on the inner walls of coronary arteries. These plaques can then narrow the arteries, reducing blood flow. Contributing factors for CHD include:
High Blood Pressure: Increases strain on arteries and contributes to plaque formation.
High Cholesterol: Elevated levels of LDL (bad) cholesterol can lead to plaque buildup.
Smoking: Damages blood vessels and accelerates plaque formation.
Diabetes: Increases the risk of atherosclerosis and accelerates CHD progression.
Obesity:Excess weight strains the heart and is linked to other risk factors.
Sedentary Lifestyle: Lack of physical activity contributes to weight gain and worsens risk factors.
Family History: A genetic predisposition to heart disease.
Coronary Vasospasm: An additional phenomenon where the coronary arteries can experience temporary constriction or spasm, leading to a reduction in blood flow to the heart. While not a plaque-related blockage, it is an important aspect to consider in the comprehensive understanding of CHD.
Coronary Cameral Fistula: A rare condition where an abnormal connection (fistula) forms between a coronary artery and a cardiac chamber or a nearby blood vessel. This can disrupt normal blood flow and oxygen supply to the heart, potentially leading to complications.
How is it diagnosed?
CHD’s diagnosis involves a combination of symptoms assessment, medical history, and diagnostic tests:
Symptoms: Common symptoms include chest pain or discomfort (angina), shortness of breath, fatigue, and irregular heartbeats. Some cases might be asymptomatic until a heart attack occurs.
Electrocardiogram (ECG/EKG): Records the heart’s electrical activity, detecting abnormal rhythms and signs of reduced blood flow.
Stress Test: Measures heart performance during exertion, exposing inadequate blood flow under stress.
Coronary Angiography: Invasive procedure where dye is injected into arteries to visualise blockages using X-rays. A CT Coronary Angiography (CTCA) may also be used for diagnosis. It is a non-invasive imaging technique that uses computed tomography (CT) to create detailed images of the coronary arteries.
Echocardiogram: Ultrasound imaging assesses heart structure, function, and blood flow.
How is it treated?
Treatment approaches vary based on the severity of CHD:
Lifestyle Changes: Embracing a heart-healthy lifestyle through dietary improvements, regular exercise, weight management, stress reduction, and smoking cessation is foundational.
Medications: Prescribed medications may include statins to control cholesterol, blood thinners to reduce clot formation, beta-blockers to manage blood pressure, and nitroglycerin to alleviate chest pain.
Angioplasty and Stenting: A minimally invasive procedure might be performed to widen narrowed arteries using a balloon-like device and placing a stent, keeping the artery open.
Coronary Artery Bypass Surgery (CABG): For severe cases, a surgical approach involving the utilisation of blood vessels from other parts of the body to bypass blocked coronary arteries might be taken.
What are the precautions to be taken post-treatment?
Maintaining heart health following CHD diagnosis and treatment is paramount:
Medication Adherence: Strictly following prescribed medications is crucial to prevent further complications.
Heart-Healthy Lifestyle: Being mindful of what foods you eat or avoid after surgery, exercise routines, stress management, and other lifestyle adjustments optimise long-term heart health.
Regular Follow-Ups: Scheduled appointments with healthcare providers ensure treatment effectiveness and enable timely adjustments.
Monitoring Symptoms: Being attentive to any recurrence or new symptoms and reporting them promptly is vital.
Emotional Well-Being: Coping strategies, support groups, and stress management techniques promote emotional resilience.
By addressing risk factors, pursuing treatment, and prioritising post-care measures, individuals can effectively manage CHD and enhance their heart health, ensuring a higher quality of life and reducing the risk of complications.
