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Coronary Heart Disease (CHD)

A Summary

by: George Pararas-Carayannis, Ph.D.*

A brief summary prepared under contract for the Regenesis Medical Center

* Disclaimer - I am not a medical doctor. All material provided at this website is for informational purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. I will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising therefrom.

What is Coronary Heart Disease (CHD)?

Like any muscle, the heart needs a constant supply of oxygen and nutrients that are carried to it by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged and cannot supply enough blood to the heart, the result is Coronary Heart Disese (CHD). If not enough oxygen-carrying blood reaches the heart, the heart may respond with pain called angina. The pain is usually felt in the chest or sometimes in the left arm and shoulder. However, the same inadequate blood supply may cause no symptoms, a condition called silent angina.

When the blood supply is cut off completely, the result is a heart attack. The part of the heart that does not receive oxygen begins to die, and some of the heart muscle may be permanently damaged.

What causes CHD?

CHD is caused by a thickening of the inside walls of the coronary arteries. This thickening, called atherosclerosis, narrows the space through which blood can flow, decreasing and sometimes completely cutting off the supply of oxygen and nutrients to the heart.

Atherosclerosis usually occurs when a person has high levels of cholesterol, a fat-like substance, in the blood. Cholesterol and fat, circulating in the blood, build up on the walls of the arteries. The buildup narrows the arteries and can slow or block the flow of blood. When the level of cholesterol in the blood is high, there is a greater chance that it will be deposited onto the artery walls. This process begins in most people during childhood and the teenage
years, and worsens as they get older.

In addition to high blood cholesterol, high blood pressure and smoking also contribute to CHD. On the average, each of these doubles your chance of developing heart disease. Therefore, a person who has all three risk factors is eight times more likely to develop heart disease than someone who has none. Obesity and physical inactivity are other factors that can lead to CHD. Overweight increases the likelihood of developing high blood cholesterol and high blood pressure, and physical inactivity increases the risk of heart attack. Regular exercise, good nutrition, and smoking cessation are key to controlling the risk factors for CHD.

What are the symptoms of CHD?

Chest pain (angina) or shortness of breath may be the earliest signs of CHD. A person may feel heaviness, tightness, pain, burning, pressure, or squeezing, usually behind the breastbone but sometimes also in the arms, neck, or jaws. These signs usually bring the patient to a doctor for the first time. Nevertheless, some people have heart attacks without ever having any of these symptoms.

It is important to know that there is a wide range of severity for CHD. Some people have no symptoms at all, some have mild intermittent chest pain, and some have more pronounced and steady pain. Still others have CHD that is severe enough to make normal everyday activities difficult.

Because CHD varies so much from one person to another, the way a doctor diagnoses and treats CHD will also vary a lot. The following descriptions are general guidelines to some tests and treatments that may or may not be used, depending on the individual case.

 

What is Congestive Heart Failure?

Heart failure occurs when the heart loses its ability to pump enough blood through the body. Usually, the loss in pumping action is a symptom of an underlying heart problem, such as coronary artery disease.

The term heart failure suggests a sudden and complete stop of heart activity. But, actually, the heart does not suddenly stop. Rather, heart failure usually develops slowly, often over years, as the heart gradually loses its pumping ability and works less efficiently. Some people may not become aware of their condition until symptoms appear years after their heart began its decline.

How serious the condition is depends on how much pumping capacity the heart has lost. Nearly everyone loses some pumping capacity as he or she ages. But the loss is significantly more in heart failure and often results from a heart attack or other disease that damages the heart.

The severity of the condition determines the impact it has on a person's life. At one end of the spectrum, the mild form of heart failure may have little effect on a person's life; at the other end, severe heart failure can interfere with even simple activities and prove fatal. Between those extremes, treatment often helps people lead full lives.

But all forms of heart failure, even the mildest, are a serious health problem, which must be treated. To improve their chance of living longer, patients must take care of themselves, see their physician regularly, and closely follow treatments.

The Basics of Angina

Angina Pectoris ("Angina") is a recurring pain or discomfort in the chest that happens when some part of the heart does not receive enough blood. It is a common symptom of coronary heart disease (CHD), which occurs when vessels that carry blood to the heart become narrowed and blocked due to atherosclerosis.

Angina feels like a pressing or squeezing pain, usually in the chest under the breast bone, but sometimes in the shoulders, arms, neck, jaws, or back. Angina is usually precipitated by exertion. It is usually relieved within a few minutes by resting or by taking prescribed angina medicine.

What brings on angina?

Episodes of angina occur when the heart's need for oxygen increases beyond the oxygen available from the blood nourishing the heart. Physical exertion is the most common trigger for angina. Other triggers can be emotional stress, extreme cold or heat, heavy meals, alcohol, and cigarette smoking.

Does angina mean a heart attack is about to happen?

An episode of angina is not a heart attack. Angina pain means that some of the heart muscle in not getting enough blood temporarily--for example, during exercise, when the heart has to work harder. The pain does NOT mean that the heart muscle is suffering irreversible, permanent damage. Episodes of angina seldom cause permanent damage to heart muscle.

In contrast, a heart attack occurs when the blood flow to a part of the heart is suddenly and permanently cut off. This causes permanent damage to the heart muscle. Typically, the chest pain is more severe, lasts longer, and does not go away with rest or with medicine that was previously effective. It may be accompanied by indigestion, nausea, weakness, and sweating. However, the symptoms of a heart attack are varied and may be considerably milder.

When someone has a repeating but stable pattern of angina, an episode of angina does not mean that a heart attack is about to happen. Angina means that there is underlying coronary heart disease. Patients with angina are at an increased risk of heart attack compared with those who have no symptoms of cardiovascular disease, but the episode of angina is not a signal that a heart attack is about to happen. In contrast, when the pattern of angina changes--if episodes become more frequent, last longer, or occur without exercise--the risk of heart attack in subsequent days or weeks is much higher.

A person who has angina should learn the pattern of his or her angina--what cause an angina attack, what it feels like, how long episodes usually last, and whether medication relieves the attack. If the pattern changes sharply or if the symptoms are those of a heart attack, one should get medical help immediately, perhaps best done by seeking an evaluation at a nearby hospital emergency room.

Is all chest pain "angina"?

No, not at all. Not all chest pain is from the heart, and not all pain from the heart is angina. For example, if the pain lasts for less that 30 seconds or if it goes away during a deep breath, after drinking a glass of water, or by changing position, it almost certainly is NOT angina and should not cause concern. But prolonged pain, unrelieved by rest and accompanied by other symptoms may signal a heart attack.

Can a person with angina exercise?

Yes. It is important to work with the doctor to develop an exercise plan. Exercise may increase the level of pain-free activity, relieve stress, improve the heart's blood supply, and help control weight. A person with angina should start an exercise program only with the doctor's advice. Many doctors tell angina patients to gradually build up their fitness level--for example, start with a 5-minute walk and increase over weeks or months to 30 minutes or 1 hour. The idea is to gradually increase stamina by working at a steady pace, but avoiding sudden bursts of effort.

Miscellaneous Summaries on Chronic Illnesses

heart disease | | stroke | diabetes | | high blood pressure | | high cholesterol | | Alzheimer's | | Parkinson's | | arthritis | | chronic fatigue | | poor circulation | | brain injury | | multiple sclerosis | | cerebral palsy | | life extension | | memory loss |

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