Coronary Heart Disease

What It is?

Coronary Heart Disease (CHD) occurs due to the narrowing or total blockage of one or more of the coronary arteries that feed the heart thus reducing the supply of oxygen to the heart. This clogging and narrowing of the artery is due to a gradual build-up of plaque (fatty deposits, cholesterol, cellular waste products calcium and other substances) in its inner lining. This build-up of plaque may be due to a degenerative process known as atherosclerosis. Deprived of oxygen, heart tissues fed by the blocked artery die causing the heart to seize, a condition known as myocardial infarction, more commonly known as a heart attack.

This illustration shows atherosclerosis of a coronary vessel in the heart. Atherosclerosis is a process that may result in the blockage of blood flow through an artery.

Although the build up of plaque is often attributed to ageing, statistics seem to indicate that a growing number of productive adults in their 40s and 50s are also suffering from the disease with makes being five times more likely to suffer from the disease than women. Those born into a family with a history of heart disease also run a higher risk of development it along with those suffering from high blood pressure, high cholesterol or diabetes. Others who are in the high-risk category including those who are overweight and who cultivate bad habits and led unhealthy lifestyles like smoking eating foods high in fat and doing little or no exercise.

What are The Symptoms?

The symptoms associated with Coronary Heart Disease, like the pain suffered, vary from one individual to the next, with many factors to take into consideration.

The most common symptom is a 'choking' chest pain or angina, usually a sign that the heart is not getting enough blood or oxygen. This can either be triggered by emotional stress or physical exertion. Other symptoms that may occur include heart-burn and/or beavy swealing, nausea and vomiting, shortness, neck jaw, or back weakness or dizziness, an urge to constantly swallow with lightness in the throat and palpitations or a fast heart beat.

What can be Done To Treat The Disease?

The treatment for Coronary Heart Disease varies, depending on the symptoms and how far the disease has progressed. In some cases, lifestyle changes and medication may be prescribed while in the more serious cases surgery may be the only option.

To affect lifestyle changes, one needs to firstly, reduce one's weight and get into the habit of exercising regularly. Eating only foods that contain little fat, cholesterol and salt to keep high blood pressure under control and putting a stop to unhealthy habits such as smoking and excessive drinking will help greatly.

The medications that are prescribed to treat the CHD include Diuretics, which works on removing the excess fluid in the body to reduce stress on the heart and ACE-Inhibitor and Vasodilators, which are used to open up blood vessels and reduce blood pressure sodium levels and water retention. Sometimes Beta Blockers are used in a select group of patients to slow the heart rate and reduce the work of the heart.

The procedures associated with the treatment of CHD include the Coronary Bypass (Coronary Artery Bypass Graft Surgery or Coronary Revascularisation), where a section of the patient's saphenous vein, taken from the thigh or lower leg is used to re-route the flow of blood around clogged arteries to improve blood flow to the heart. Having an increased blood flow to the heart muscle can relieve chest pain and reduce the risk of a heart attack.

Another procedure is the Balloon Angioplasty (Perculaneous Transluminal Coronary Angioplasty PTCA), where a deflated balloon mounted on a catheter (thin tube) is introduced to the blocked or narrowed artery and inflated to compress the plaque and enlarge the artery.

The case of acute myocardial infarction, a coronary stent (cylindrical wine mesh) is deployed and embedded in the artery wall in aprocedure known as Primary Percutaneous Coronary Intervention or PCI. In Singapore, the highly experienced team of interventional cardiologists, nurses, technologists and radiographers at the Cardiac Department of the National University Hospital National Healthcare Group) has been carrying out primary PCI successfully on more than 250 patients since 1997.

Other treatments for CHD include Heart Valve Replacement and Heart Valve Repair Surgery.

As always prevention is better than cure and there are various tests that may be carried out to identify Coronary Disease. These include an Electorcardiogram (ECG), an Exercise Stress Test and Echocardiogram, a Computed Tomography (CT) and a Coronary Angiography.

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