Understanding Heart Disease

Heart disease, or known as cardiac disease or cardiovascular disease, is the number one killer in the United States of America as well as the primary cause of death in the world. A heart attack can kill without warning and has become common among those 60 years and above. Still, there is an increasing case of heart disease among those 40 years old.

Since heart disease proceeds silently and attacks suddenly, it’s particularly important for us to recognize this disease better, especially in terms of its symptoms, risk factors, warnings, prevention, treatment and diagnosis.

In general, Coronary Heart Disease (CHD) can be grouped into five categories as follow:

1. Acute myocardial infarction/ acute heart disease
2. Silent/ asymptomatic/ no symptoms
3. Unstable chest pain
4. Sudden death
5. Stable angina pectoris/ stable chest pain

What are the Symptoms of CHD?

Chest pain (or angina) is the main symptom of CHD. Its common pain is characterized as crushing, located central or on the left part of the chest and it often occurs with exertion but gets better after rest. Even though its classical chest pain is crushing in nature, it can sometimes be heaviness or even chest discomfort.

Pain is described as jaw pain, arm pain, shoulder pain and gastric pain when one experiences atypical chest discomfort, and this situation is occasionally happened among the elderly people. Very often, this type of pain can be felt as difficulty in breathing or fatigue.

The primary cause of coronary artery disease is atherosclerosis, a medical condition when plaque or fatty material builds up in the lining of the damaged artery, causing less blood supply to the heart. When the blood vessels are narrowed and the plaques rupture, it can lead to blood clotting that can completely act as a blockage to the artery, causing less blood supply to the heart muscle and eventually, the heart gets damaged and dies. It is always during this moment that heart attack occurs which can be life-threatening to a sufferer.

What are Risk Factors for CHD?

High blood pressure, smoking, a family record of premature heart disease (genetic), diabetes mellitus, high cholesterol levels or dyslipidemia are five of the main risk factors contributing to the CHD.

Patients with diabetes mellitus are always viewed as a CHD equivalent since they are more likely to have a same risk of getting a cardiac disease.

Other risk factors of getting cardiovascular disease include metabolic syndrome, stress, lack of exercise, high homocysteine levels, high CRP levels, presence of protein in the urine (or proteinuria) and obesity.

In short, it’s vital to know about the disease and its symptoms, signs and warnings, and to detect and treat all the underlying risk factors to help reduce the risk of getting or developing CHD.

What are the Diagnosis Tests for CHD?

Before going for a series of diagnostic tests, the patient will have to initially complete their medical history. Then, a doctor will direct them to undergo a thorough physical examination, followed by an electrocardiogram (ECG).

In case the patient has already had a heart attack, a resting ECG will display changes. In most cases, a stress test/ stress ECG is useful to help detect CHD or blockages of arteries.

Besides ECG, there are also numerous ways available to help diagnose heart disease. They include Echocardiogram, Multislice/ Spiral Completed Tomogram (CT) and Coronary Angiogram.

Echocardiogram is basically an ultrasound examination of the heart, allowing its structure and function to be displayed. With this test, any valvular, enlargement or functional abnormalities of the heart can effectively be quantified and detected. When this test is combined with exercise, it’s known as Stress Echocardiogram.

Multislice/ Spiral Completed Tomogram (CT) is used to detect and quantify the calcium deposits in the coronary artery and in order to enable visualization of the coronary arteries, it’s combined with contrast injection. However, in calcified or stented arteries, this option is inaccurate in comparison to a coronary angiogram.

Coronary angiogram is a diagnostic test which is used to diagnose narrowing or blocked arteries. In this test, a small tube or catheter will be inserted into a blood vessel (or an artery) either in the arm or groin and guided into the coronary arteries. Next, contrast is injected to enable the capture of clear images of the coronary arteries.

What are the Medications Used to Help Treat or Reduce Chest Pain?

In order to help reduce or treat chest pain, several medications are commonly prescribed by the doctor. These medications include:

Statins

Statins is a cholesterol-lowering medication that is used to help stabilize the plaque. It also helps prevent further build-up and narrowing of the blood vessels (or arteries).

Aspirin

Aspirin is another common anti-platelet agent prescribed to help prevent clot building within the arteries.

Nitroglycerin (GTN) Tablets

GTN tablets are always prescribed to help reduce chest pain and to dilate the blood vessels. This medication can be dissolved under the tongue.

When to Do Revascularisation?

If the prescribed medication cannot work efficiently to reduce the chest pain, then the patient needs to undergo a medical procedure called revascularisation to help improve their blood flow in the coronary arteries. This procedure could be stenting, coronary artery bypass surgery or coronary angioplasty.

Coronary angioplasty

Coronary angioplasty is a medical procedure where a balloon is inserted into the coronary artery. In this procedure, when the balloon compresses the plaque, the narrowed artery will be widened.

Stenting

Stenting is a procedure whereby metal devices (or stents) are inserted into the narrowed artery to help keep it open for a better and smooth blood supply to the heart. Nowadays, doctors will utilize a special Drug Eluting Stents (DES) which are generally stents coated with specific drugs to help reduce chances of restenosis while keeping arteries open.

Coronary Artery Bypass Surgery

The patients need to undergo coronary artery bypass surgery if they experience severe blockage or narrowing of the coronary arteries. This surgery procedure is vital to assist in creating a road or a new pathway for enabling the blood to flow towards the heart muscles.

How Could You Prevent or Reduce CHD?

1. Lowering your Low Density Lipoprotein (LDL or bad cholesterol) and Triglyceride (TG) levels by reducing unhealthy intake of fats and cholesterol as they will give rise to a risk of coronary heart disease due to a build-up of plaque within the arteries, called atherosclerosis. Saturated fat, and trans fat should be reduced to 7%, 1% respectively of your total daily calories, while cholesterol should be reduced to 300mg for healthy adults and less than 200mg for those with higher LDL levels. Butter, margarine, shortening, high-fat meats, cheese, red meat, hydrogenated margarine, bacon fat, lard, cocoa butter, kernel oil and dairy products can contribute significant amounts of saturated fats in your diet and thus should be cut back. Instead, choose olive oil or canola oil which is monounsaturated fats for the sake of your health. Always substitute soy protein and legumes (such as lentils, peas) for animal protein.
2. Eat plenty of fresh organically grown fruits and vegetables to provide your body with essential vitamins, minerals, trace elements and dietary fibres. Adding whole grains in your daily diet is also a good choice as this food will help regulate blood pressure and heart health.
3. Get enough exercise to improve your heart fitness.
4. You can modify CHD risk factors by stopping smoking, adopting a healthy lifestyle, limiting caffeinated and alcoholic drinks.
5. Reduce the intake of salt, sugary and processed foods.
6. Do not live under stress or anger as it will cause your heart to beat faster.
7. To avoid the occurrence of CHD, you will need medication to keep your high blood pressure at bay. If you have diabetes, you must control your blood sugar levels by taking medication, managing your diet and doing physical activity. You may need medication to keep your high blood cholesterol under control.
8. In case you have a sudden heart attack, call your doctor immediately!

Final Remark:

As the saying goes, prevention is better than cure. Living and eating healthily are a better way to help avoid getting any diseases. Additionally, you should know and treat your risk factor and please contact the doctor right away if you have been experiencing or have any symptoms, abnormal signs or you are unsure of on your heart health!