Understanding Coronary Heart Disease

8/13/2019 Understanding Coronary Heart Disease

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Understanding coronary heart disease

Coronary heart disease (CHD) develops when the artery supplying blood to the heart becomes partially orwholly blocked. Its often caused by fatty deposits building up on the inside lining of the arteries. hiscauses symptoms of chest pain! which is temporary and treatable. CHD can result in a heart attack if theblood supply to the heart is stopped for long enough to cause damage.

Heart disease is a concern for everyone. "esearch suggests there are #ust over $.% million people livingwith the condition in the &'. he older you are! the more likely you are to have heart disease. It affectsabout one in four men and one in five women aged and over.

he good news is that heart disease is largely preventable. here are small changes you can make toyour diet and lifestyle which significantly reduce your risk of developing CHD in the future! or havinganother heart attack. 'eeping your heart healthy will also have other health benefits! reducing your risk ofstrokeanddementia.

Avoiding coronary heart disease

Coronary heart disease (CHD) is largely preventable and often caused by fatty deposits forming on the

inside lining of the arteries. *ind out who+s at risk of CHD and how to reduce your chances of developingit.

,hos at risk of coronary heart disease-

ou+re more likely to develop coronary heart disease if/

you smoke!

you havehigh blood pressure!

you+ve had a high blood cholesterol level!

you do littlephysical activity!

you havediabetes!

you+re overweight or obese!

a close relative has had a heart attack before the age of for a man and % for a woman! or

you+re of 0outh 1sian descent.

he good news is that you can make changes to your lifestyle that will cut your risk of developing CHD inthe future.

Knowing the Symptoms

CHD occurs when the artery supplying blood to the heart becomes partially or wholly blocked. he mainsymptom is chest pain that is temporary and treatable. Heart disease can result in a heart attack if theblood supply to the heart is stopped for long enough to cause damage.

When should I see a doctor?

he signs and symptoms that make people go to their doctor with concerns about heart disease vary.
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hey can include! for e2ample! palpitations and unusual breathlessness. If you suspect you have heartdisease! the earlier you see a healthcare professional the better! because treatment and lifestyle changescan slow down the rate the disease progresses at.

Being Diagnosed

Doctors usually diagnose CHD from a mi2ture of information! including test results and symptoms such asangina. 3arly diagnosis! and intervention with lifestyle changes and treatment! can significantly slow theprogression of the disease and keep you living life to the full.

Treatment

What is good coronary heart disease care?

3ffective treatment of CHD saves lives. 0ince $444! there has been a 546 reduction in deaths from heartdisease in people under . 1 national reviewof heart disease services set out standards which definegood heart disease care/

7 ackling the factors which increase the risk of heart disease! such as smoking! poor diet! and littlephysical e2ercise.7 8reventing CHD in high risk patients and where patients have CHD avoiding complications and tacklingthe progression of the disease.7 "apid treatment for heart attack! including the choice of angioplasty in a specialist cardiac centre.7 "apid diagnosis of heart disease and access to diagnostic tests.7 "apid access and choice of treatment centre for specialised cardiac care.

Living with oronary !eart Disease

1fter your coronary heart disease (CHD) has been diagnosed and treated! particularly if you stayed inhospital! you will need a period of rehabilitation. 9y focusing on e2ercise! rela2ation and lifestyle!rehabilitation will help you get back to a normal life and keep you healthy. his is important! as CHD can

be treated and managed but not cured.

0ource/ http/::www.nhs.uk:8athways:coronaryheartdisease:8ages:;anding.asp2

"isk *actors and Coronary Heart Disease

A!A Scienti"ic #osition

32tensive clinical and statistical studies have identified several factors that increase the risk of coronaryheart disease and heart attack. 44 mg:d; has a greater risk than someone with a totalcholesterol of $5 mg:d;! even though everyone with a total cholesterol greater than $54 is consideredhigh?risk.

What are the ma$or ris% "actors that can&t 'e changed?
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_083060http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_083060http://www.nhs.uk/Pathways/coronaryheartdisease/Pages/Landing.aspxhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_083060http://www.nhs.uk/Pathways/coronaryheartdisease/Pages/Landing.aspx


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Increasing age@ =ver A> percent of people who die of coronary heart disease are % or older.

1t older ages! women who have heart attacks are more likely than men are to die from themwithin a few weeks.

(ale se) *gender+@


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you have diabetes! it+s e2tremely important to work with your healthcare provider to manage itand control any other risk factors you can.

What other "actors contri'ute to heart disease ris%?

Individual response to stress may be a contributing factor. 0ome scientists have noted a

relationship between coronary heart disease risk and stress in a person+s life! their health

behaviors and socioeconomic status. hese factors may affect established risk factors. *ore2ample! people under stress may overeat! start smoking or smoke more than they otherwise

would.

Drinking too much alcoholcan raise blood pressure! cause heart failure and lead to stroke. It

can contribute to high triglycerides! cancer and other diseases! and produce irregular heartbeats.It contributes to obesity! alcoholism! suicide and accidents.

he risk of heart disease in people who drink moderateamounts of alcohol (an average of onedrink for women or two drinks for men per day) is lower than in nondrinkers. =ne drink is definedas F?F:$ fluid ounces (fl o) of A4?proof spirits (such as bourbon! 0cotch! vodka! gin! etc.)! F fl oof F44?proof spirits! 5 fl o of wine or F$ fl o of beer. It+s notrecommended that nondrinkers startusing alcohol or that drinkers increase the amount they drink.

Source/ 1merican Heart 1ssociation http/::www.americanheart.org:presenter.#html-identifier5$%

Alternative 0ames

Coronary artery disease 1rteriosclerotic heart disease CHD C1D

auses

Coronary heart disease is usually caused by a condition called atherosclerosis!which occurs when fattymaterial and a substance called plaGue builds up on the walls of your arteries. his causes them to getnarrow. 1s the coronary arteries narrow! blood flow to the heart can slow down or stop! causing chest

pain (stable angina)! shortness of breath! heart attack! and other symptoms.

Coronary heart disease (CHD) is the leading cause of death in the &nited 0tates for men and women.1ccording to the 1merican Heart 1ssociation! more than F million people have some form of thecondition.


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Stable Angina(which is predictable)

Unstable Angina(which is less predictable and a sign of a more serious situation)

he intensity of the pain does not always relate to the severity of the medical problem. 0ome people mayfeel a crushing pain from mild ischemia! while others might e2perience only mild discomfort from severeischemia.

1ngina itself is not a disease.


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1ngina pain or discomfort is typically described by patients as fullness or tingling! sGueeing!

pressure! heavy! suffocating! or griplike. It is rarely described as stabbing or burning. Changingone+s position or breathing in and out does not affect the pain.

1 typical angina attack lasts minutes. If it is more fleeting or lasts for hours! it is probably not

angina.

8ain is usually in the chest under the breast bone. It often radiates to the neck! #aw! or leftshoulder and arm. ;ess commonly! patients report symptoms that radiate to the right arm or back!or even to the upper abdomen.

0table angina is usually relieved by rest or by taking nitroglycerine under the tongue.

=ther symptoms that may indicate angina or accompany the pain or pressure in the chest include/

0hortness of breath

Jausea! vomiting! and cold sweats

1 feeling of indigestion or heartburn

&ne2plained fatigue after activity (more common in women)

Diiness or lightheadedness

8alpitations

Unsta'le Angina and Symptoms o" #ossi'le !eart Attac%

&nstable angina is a much more serious situation and is often an intermediate stage between stableangina and a heart attack! in which an artery leading to the heart (a coronary artery) becomes completelyblocked. 1 patient is usually diagnosed with unstable angina under one or more of the followingconditions/

8ain awakens a patient or occurs during rest.

1 patient who has never e2perienced angina has severe or moderate pain during mild e2ertion

(walking two level blocks or climbing one flight of stairs).

0table angina has progressed in severity and freGuency within a $?month period! and medications

are less effective in relieving its pain.

*ainting episode.

&nstable angina is now usually discussed as part of a condition called acute coronary syndrome(1C0).1C0 also includes people with a condition called J03


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conditions (such as lung disease and heart failure). he doctor also evaluates the severity of the angina.=ther factors that pose a high risk for 1C0 include/

1ge % years or older

3vidence of severe heart tissue in#ury

Having a history of severe chronic angina

Having abnormal lung sounds called rales (a bubbling or crackling sound) on e2amination

0?segment deviation on the electrocardiogram

Having either very slow or very fast heat beats

Having very low blood pressure

Heart Attack.1 full?blown heart attack occurs with severe damage to the heart! which blocks o2ygen.

8eople with known heart disease and any unusual chest pain or other symptoms described above that do

not clear up with medications should call OFF. he degree of pain and the specific symptoms before aheart attack vary greatly among individuals. 0ymptoms can be abrupt! gradual! or intermittent. 0omestudies suggest that nearly half of patients having a heart attack do not have chest pain as the primarysymptom. 8atients most likely to have atypical symptoms are women and the very elderly (although theycan certainly have classic heart attack symptoms as well).

Symptoms That Are Less Likely to Indicate Angina or a Heart Attack.he following symptoms are lesslikely to be due to coronary artery disease/

0harp pain brought on by breathing in and or when coughing

8ain that is mainly or only in the middle or lower abdomen

8ain that can be pinpointed with the top of one finger

8ain that can be reproduced by moving or pressing on the chest wall or arms

8ain that is constant and lasts for hours (although no one should wait hours if they suspect they

are having a heart attack)

8ain that is very brief and lasts for a few seconds

8ain that spreads to the legs

However! the presence of these symptoms does not always rule out a serious heart event.

.ther Types o" Angina

rin!metal"s Angina. 1 third type of angina! called variant or 8rinmetal+s angina! is caused by a spasm ofa coronary artery. It almost always occurs when the patient is at rest. 1bout two?thirds of people with ithave severe atherosclerosis in at least one ma#or blood vessel. Irregular heartbeats are common! but thepain is generally relieved immediately with standard treatment.

Silent Ischemia. 0ome people with severe coronary artery disease do not have angina pain. hiscondition is known as silent ischemia! which some e2perts attribute to the brain abnormaly processing


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heart pain. his is a dangerous condition because patients have no warning signs of heart disease. 0omestudies suggest that people with silent ischemia have higher complication and mortality rates than those

with angina pain. (1ngina pain may actually protect the heart by conditioning it before a heart attack.)

Syndrome #. 0yndrome P is a condition that occurs when patients have atypical angina chest pain. heirelectrocardiograms are abnormal during a stress test! but they have no signs of blocked arteries. It is

more likely to occur in women. 1lthough it is unclear what causes this condition! imaging tests suggestthat 0yndrome P may also be caused by ischemia! as is angina

.ther auses o" hest #ain or Discom"ort

Chest pain is a very common symptom in the emergency room! but heart problems account for only F4 ?>>6 of all episodes.

=ther causes of chest pain or discomfort include/

8roblems affecting the ribs and chest muscles include in#ured muscles! fractures! arthritis! muscle

spasms! and infections

1n2iety attacks

Qastrointestinal disorders (gallstone attacks! peptic ulcer disease! hiatal hernia! heartburn)

1sthma

"upture of the aorta

Collapsed lung

1cute inflammation of the heart

9lood clot in the lung (pulmonary embolism)

High thyroid levels (hyperthyroidism)

1nemia

Rasculitis (a group of disorders that cause inflammation of the blood vessels)

What to Do When Symptoms .ccur

Individuals who e2perience symptoms of a heart attack should take the following actions/

*or angina patients! take one nitroglycerin dose either as an under?the?tongue tablet or in spray

form at the onset of symptoms. ake another dose every minutes up to three doses or when the

pain is relieved! whichever comes first. Call OFF or the local emergency number. his should be the first action taken if angina patients

continue to e2perience chest pain after taking the full three doses of nitroglycerin. However! only$46 of heart attacks occur in patients with long?standing angina. herefore! anyone who withheart disease or risk factors for it who has heart attack symptoms should contact emergencyservices.

he patient should chew an aspirin ($4 ? 44 mg) and be sure that emergency health providers

are informed of this so an additional dose is not given.


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8atients with chest pain should go immediately to the nearest emergency room! preferably

traveling by ambulance. hey should not drive themselves.

1)ams and Tests


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1 depressed or horiontal 0 wave suggests some blockage and the presence of a heart

disease! even if there is no angina present. (his finding! however! is not very accurate!particularly in women! and can occur without heart problems).

0 elevations and K waves are the most important wave patterns in diagnosing and determining

treatment for a heart attack. hey suggest that an artery to the heart is blocked! and that the fullthickness of the heart muscle is damaged. 0 segment elevations do not always mean the

patient has a heart attack. 1nd! some heart attack patients do not have elevated 0 segments.=ther factors are important in making a diagnosis.

1)ercise Stress Test

32ercise stress test for evaluation of coronary artery disease may be performed in the followingsituations/

8atients with possible or probable angina to help determine the likelihood of coronary artery

disease being present

8atients who were previously stable who began having symptoms

0elected adults who do nothave symptoms of heart disease but are at moderate risk to high risk

for developing heart disease (a F4 ? $46 chance within F4 years).


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Interpreting Results.o accurately assess heart problems! a variety of factors are measured or monitoredusing the 3CQ and other tools during e2ercise. hey include/

32ercise capacity. his is a measure of a person+s capacity to reach certain metabolic rates.

0 waves on the 3CQ. Doctors specifically look for abnormalities in part of the wave tracing

called an 0 segment. 1 certain type of 0 segment depression may suggest the presence of

heart disease. However! gender! drugs! and other medical conditions can affect the 0 segment.

Heart rate. his is how fast the heart rate goes during e2ercise and how Guickly it returns to

normal recovery. 9ased on age and other factors! everyone+s heart rate should go up to a certainlevel during e2ercise. If it does not go up to the e2pected level! the patient is considered at risk forheart problems.

Changes in systolic blood pressure. Qenerally! the blood pressure will go up during e2ercise.

=2ygen levels may also be measured.

&sing these and other measures! doctors can determine risk fairly accurately! particularly for men withchronic stable angina. he test has limitations! however! and some are significant. In patients with

suspected unstable angina! normal or low risk results may not be as accurate in predicting future risk ofcardiac events. In addition! for many reasons! the test is less accurate in women! and an echocardiogrammay be a more accurate procedure for them. 1bout F46 of patients! particularly younger people! will havefalse positive test results. In such cases! test results indicate abnormalities when there are no heartproblems.

1chocardiograms

1n echocardiogram is a noninvasive test that uses ultrasound images of the heart. his test is moree2pensive than an 3CQ! but it can be very valuable! particularly in identifying whether there is damage tothe heart muscle and the e2tent of heart muscle damage.

1 stress echocardiogram may be performed to further evaluate abnormal findings from an e2ercisetreadmill test or a routine echocardiogram. 32amples include identifying e2actly which part of the heartmay be involved and Guantifying how much muscle has been infected. It may be the first test done whenthe e2ercise treadmill test cannot be performed due to certain abnormal rhythms.

,adionuclide Imaging

"adionuclide procedures use imaging techniGues and computer analyses to plot and detect the passageof radioactive tracers through the region of the heart. 0uch tracing elements are typically givenintravenously. "adionuclide imaging is useful for diagnosing and determining/

0everity of unstable angina when less e2pensive diagnostic approaches are unavailable or

unreliable

0everity of chronic coronary artery disease

0uccess of surgeries for coronary artery disease.

,hether a heart attack has occurred

Rarious imaging techniGues may be used with radionuclide procedures! including/

8lanar scintigraphy! the oldest scanning techniGue! uses a special overhead camera.


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0ingle?photon emission computed tomography (083C) uses a camera that rotates around the

patient and takes pictures of EslicesE of the heart. It is more accurate than planar imaging inprecisely locating problems in the arteries.

8ositron?emission tomographic (83) scanners employ multiple rings that surround the patients!

which detect and record atomic particles (photons) that are emitted by the tracer elements (such

as radioactive o2ygen! nitrogen! or carbon). It is more e2pensive and less widely available than083C. Its e2act role in diagnosing and following coronary artery disease is not yet known.

(yocardial er)usion *'lood +lo&, Imaging Test *also called the Thallium Stress Test,. his radionuclidetest is typically used with an e2ercise stress test to determine blood flow to the heart muscles. It is areliable measure of severe heart events. It may be useful in determining the need for angiography if Cscans have detected calcification in the arteries. 1bout a minute before the patient is ready to stope2ercising! the doctor administers a radioactive tracer into the intravenous line. (racers include thallium!technetium! or sestamibi.) Immediately afterwards! the patient lies down for a heart scan! usually with aplanar scintigraphy or with 083C. If the scan detects damage! more images are taken > or 5 hours later.Damage due to apriorheart attack will persist when the heart scan is repeated. In#ury caused by angina!however! will have resolved by that time.

Radionuclide Angiography.his is a techniGue for visualiing the chambers and ma#or blood vessels ofthe heart. It uses an in#ected radioactive tracer and can be performed during e2ercise! at rest! or with useof stress?inducing drugs. It is an e2cellent test for assessing the heart+s pumping action and determiningthe severity of coronary artery disease. It is an alternative to echocardiograms in certain situations.

Angiography

1ngiography is an invasive test. It is used for patients who show strong evidence for severe obstructionon stress and other tests! and for patients with acute coronary syndrome. It is reGuired when there is aneed to know the e2act anatomy and disease present within the coronary arteries. 1 limitation ofangiography is that it is not always the most occluded (blocked) blood vessel that causes the ne2t heartattack. In an angiography procedure/

1 narrow tube is inserted into an artery! usually in the leg or arm! and then threaded up through

the body to the coronary arteries.

1 dye is in#ected into the tube! and an 2?ray records the flow of dye through the arteries.

his process provides a map of the coronary circulation! revealing any blocked areas.

44 of these operations every year). 1llergic reactions can also occur. heprocedure is e2pensive! and F4 ? >46 of patients who have this procedure have normal results.

(agnetic Resonance Angiography *(RA,.


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alcium Scoring T Scans o) the Heart.


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8rocedures to treat and diagnose CHD are called percutaneous coronary interventions! or 8CIs.1ngioplasty and stenting are types of 8CIs. =ther types include/

Coronary atherectomy

Coronary radiation implant or coronary brachytherapy

Coronary brachytherapy delivers radiation into the coronary arteries. his treatment is only for patientswho have had a stent?related problems.

0urgeries used to treat CHD include/

Coronary artery bypass surgery


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Side ))ects.9eta?blocker side effects include fatigue! lethargy! vivid dreams and nightmares! depression!memory loss! and diiness. hey can lower HD; (SgoodT) cholesterol. 9eta blockers are categoried asnon?selective or selective. Jon?selective beta blockers! such as carvedilol and propranolol! can narrowbronchial airways. hese beta?blockers should not be used by patients with asthma! emphysema! orchronic bronchitis.

81I3J0 0H=&;D J3R3" 19"&8; 0=8 1'IJQ H303 D"&Q0. he sudden withdrawal ofbeta?blockers can rapidly increase heart rate and blood pressure. he doctor may advise a patient toslowly decrease the dose before stopping completely.

Angiotensin onverting 1n4yme *A1+ Inhi'itors

1ngiotensin converting enyme (1C3) inhibitors are important heart?protective drugs! particularly forpeople with diabetes and high blood pressure. hey reduce the production of angiotensin! a chemical thatcauses arteries to narrow! and so are commonly used to lower blood pressure. hey may also reduce riskfor heart attack! stroke! complications of diabetes! and death in patients at high risk for heart disease.

1C3 inhibitors are indicated for/

8atients with coronary artery disease who also have diabetes or who have left ventricular

dysfunction (when the heart+s main chamber does not pump as well as it should).

here is good evidence to prescribe these medications for most patients with coronary artery

disease or any other vascular diseases! such as peripheral vascular disease.

1C3 inhibitors include captopril (Capoten)! ramipril (1ltace)! enalapril (Rasotec)! Guinapril (1ccupril)!benaepril (;otensin)! perindopril (1ceon)! and lisinopril (8rinivil! Uestril).

Side ))ects.0ide effects of 1C3 inhibitors are uncommon but may include an irritating cough! e2cessivedrops in blood pressure! and allergic reactions. In the past! doctors sometimes avoided giving aspirin topatients who were taking 1C3 inhibitors because the combination was believed to cause kidneyproblems. 9ut! a $44 study of patients with both coronary artery disease and heart failure found that

taking aspirin and 1C3 inhibitor together is safe. he researchers also noted that taking aspirin with an1C3 inhibitor can significantly reduce the risk of death for older patients with C1D and heart failure. L*ormore information! see In-Depth ReportMF5/ High blood pressure.N

0itrates

Jitrates have been used in the treatment of angina for over F44 years. hese drugs release nitric o2ide!thereby rela2ing the smooth muscles in blood vessels. hese medications are used primarily for control ofangina symptoms.


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Rapid Acting /itrates. "apid?acting nitrates are used to treat acute attacks. Jitroglycerin is the mostwidely used drug for this purpose. It can be administered under the tongue (sublingually or as a spray) orpocketed between the upper lip and gum (buccally) and can relieve angina within minutes. he procedurefor taking nitroglycerin during an attack is as follows/

1t the onset of an angina attack! the patient administers one sublingual or buccal tablet or one

metered dose of the spray.

If the pain is not relieved within minutes the patient takes a second dose a third can be taken

after another minutes if symptoms persist.

If pain continues after a total of three doses in F minutes! the patient should go immediately tothe nearest emergency room.

Jitroglycerin is very volatile so its potency can be easily lost. 8atients should take the followingprecautions/

'eep no more than F44 tablets on hand! stored in their original container.

,hen first opened! the cotton filler should be discarded! and the cap screwed on tightly

immediately after each use.

1 supply should always be kept close at hand in case of an attack! with the rest kept in a cool dry

place.

Intermediate to Long-Term /itrates.0ublingual tablets of isosorbide dinitrate have a somewhat sloweronset of action than nitroglycerin and are useful for preventing e2ercise angina. =intments! patches! andoral tablets are used for longer?term prevention of angina attacks/

ransdermal patches are applied in the morning to any hair? or in#ury?free area on the chest!

back! stomach! thigh! or upper arm. Hands should be washed after each patch or ointmentapplication! and sites of application should be rotated to avoid skin irritation.


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Jitroglycerin ointment is applied by measuring out an even amount on an applicator paper and

then placing! not rubbing or massaging! it on the chest! stomach! or thigh. 1ny ointment thatremains from the previous application should be removed.

;ong?acting forms may lose their effectiveness over time! so doctors generally schedule nitrate?freebreaks to prevent tolerance. 0ome concern e2ists that nitrate?free periods might increase the risk for

angina and adverse heart events. =ne large study! however! found no increased danger when patientsused a nitroglycerine patch with scheduled breaks. he use of high blood pressure drugs known as 1C3inhibitors may help prevent tolerance to nitrates.

Side ))ects.Jitrates have many side effects! some of which can be serious.

Common side effects of nitrates include headaches! diiness! nausea and vomiting! blurred vision! fastheartbeat! sweating! and flushing on the face and neck. ;ow blood pressure and diiness can berelieved by lying down with the legs elevated. hese effects are significantly worsened by alcohol! beta?blockers! calcium channel blockers! sildenafil (Riagra)! and certain antidepressants. he doctor mayprescribe medicines to lessen these side effects. 8atients should contact their doctor if these side effectsare persistent or severe.

0erious side effects reGuiring immediate medical help include fever! #oint or chest pain! sore throat! skinrash (especially on the face)! unusual bleeding or bruising! weight gain! and swelling of the ankles.

0ithdra&al.,ithdrawal from nitrates should be gradual. 1brupt termination may cause angina attacks.

alcium hannel Bloc%ers *Bs+

Calcium channel blockers reduce heart rate and slightly dilate the blood vessels of the heart! therebydecreasing o2ygen demand and increasing o2ygen supply. hey also reduce blood pressure. CC9s varychemically! however! and although some are helpful! others may even be dangerous for certain patients

with angina.

;ong?acting nifedipine (1dalat! 8rocardia) and nisoldipine (0ular) and newer CC9s! such asamlodipine (Jorvasc) and nicardipine (Cardene)! may be beneficial for some patients with angina.hey can be considered alone for patients who cannot tolerate beta?blockers! but may providethe best results when used in combination with a beta?blocker. 0tudies suggest that they reducethe need for repeat angioplasties. heir effects on other outcomes! including mortality rates andheart attack! are less clear.

0hort?acting CC9s! including short?acting forms of verapamil! diltiaem! nifedipine! and

nicardipine! are helpful for many patients with 8rinmetal+s angina. However! short?acting forms ofcertain CC9s! such as nifedipine and nisoldipine! have been associated with severe and evendangerous side effects! including an increase in heart attacks and sudden death in some patients

with unstable angina. hey also increase the risk for adverse effects in patients with stableangina. 0hort?acting CC9s are! therefore! not used for stable or unstable angina.

here is no strong evidence that any calcium channel blockers improve survival rates. =verdose cancause dangerously low blood pressure and slow heart beats. 8atients with heart failure have a higher riskfor death with these drugs and should not take them. Jo one taking any calcium channel blocker should

withdraw abruptly because such action could dangerously increase the risk of high blood pressure. Jote/Qrapefruit and 0eville oranges boost the effects of CC9s! sometimes to to2ic levels. ("egular oranges donot appear to pose any haard.)


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.ther Drugs

"anolaine ("ane2a) was approved in $44% for treatment of chronic angina. It is recommended forpatients who have not responded to other angina drugs. "anolaine is taken in combination withamlodipine! beta?blockers! or nitrates. he drug appears to work better in men than in women

1)perimental Drugs

1ene Therapy and Angiogenesis.8roteins known as growth factors are being investigated for their abilityto grow new blood vessels for supplying o2ygen to the heart. 1fter promising small trials! two largestudies of genetically engineered forms of vascular endothelial growth factor (R3Q*) and fibroblastgrowth factor L*Q* (QenerP)N failed to detect any benefits. 0tudies on therapies that actually geneticallyencode these proteins are underway.

.utloo% *#rognosis+

3veryone recovers differently. 0ome people can maintain a healthy life by changing their diet! stoppingsmoking! and taking medications e2actly as the doctor prescribes. =thers may need medical procedures

such as angioplasty or surgery.

1lthough everyone is different! early detection of CHD generally results in a better outcome.

#ossi'le omplications

Heart attack

Heart failure

&nstable angina

0udden death

When to ontact a (edical #ro"essional

If you have any of the risk factors for CHD! set up an appointment with your doctor to discuss preventionand possible treatment.

If you have angina! shortness of breath! or symptoms of a heart attack! immediately contact your healthcare provider! call the local emergency number (such as OFF)! or go to the emergency room.

0ee your health care provider regularly. ips for preventing CHD or lowering your risk of the disease/

1void or reduce stress as best as you can.

Don+t smoke.

3at well?balanced meals that are low in fat and cholesterol and include several daily servings of

fruits and vegetables.

Qet regular e2ercise. If your weight is considered normal! get at least >4 minutes of e2ercise

every day. If you are overweight or obese! e2perts say you should get %4 to O4 minutes ofe2ercise every day.

'eep your blood pressure! blood sugar! and cholesterol under control.
http://health.nytimes.com/health/guides/disease/heart-attack/overview.htmlhttp://health.nytimes.com/health/guides/disease/unstable-angina/overview.htmlhttp://health.nytimes.com/health/guides/disease/heart-attack/overview.htmlhttp://health.nytimes.com/health/guides/disease/unstable-angina/overview.html


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*or patients with heart disease! the doctor will start or consider medication! increase dosage ofmedication! or add new medication when/

;D; cholesterol is F44 mg:d; or higher

;D; cholesterol is greater than 4 mg:d;. 1ccording to national guidelines! treating a patient with

;D; cholesterol levels between 4 ? F44 mg:d; is not reGuired but is considered reasonable. his

would be true particularly for patients who have had a recent heart attack or have known heartdisease along with diabetes! current cigarette smoking! poorly controlled high blood pressure! ormetabolic syndrome (high triglycerides! low HD;! and obesity).

0tatins are the most important of the cholesterol?lowering drugs. 9rands include lovastatin (


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If you smoke then you need to Guit. here is nothing that increases the risk of coronary heart diseaseGuite like smoking. 3very year more than F>! 444 people in the &nited 0tates die from heart disease thatis caused or e2acerbated by the use of tobacco. he risk of death from this disease increases two tothree times with the continued use of cigarettes.

here are also certain medical treatments and procedures that are effective in the f ight against coronary

heart disease. here are a number of medications that help reduce blood pressure or lower levels of ;D;cholesterol! but like any drug there are also side affects to using them. 0urgery is also an option when thedisease has reached the life threatening stage but for most people living a healthy lifestyle will preventthem from ever having to see an operating room.

1voiding the type of lifestyle that leads to coronary heart disease can help millions of people live long andhealthy lives without the fear that they may fall victim to this deadly disease.

1ndrew 9icknell is a writer who researches a wide range of sub#ects. o learn more about coronary heartdiseaseplease visit his website Heart Disease by clicking here.

Source/ 14ine 6rticles http/77e4inearticles8com7?The35ight3Against3oronary3!eart3Disease9id:;

Documents

Understanding Coronary Heart Disease