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The Coronary Heart Disease Bible
Like any muscle, the heart needs a persistent source 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 are unable to offer sufficient blood to the heart, the result is CHD. If not enough oxygen-carrying blood actually reaches the heart, the heart may answer with suffering called angina. The discomfort is usually felt in the chest or sometimes in the left arm and shoulder. (However, the same insufficient blood supply may give no symptoms, a problem called silent angina.)
When the blood supply is cut off fully, the final result is a heart attack. The part of the heart that does not obtain oxygen commences to die, and several of the heart muscle may be forever damaged.
So what leads to 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 pass, lessening and in some cases totally cutting off the source of oxygen and nutrients to the heart.Atherosclerosis generally develops when a person has excessive amounts of cholesterol, a fat-like substance, in the blood. Cholesterol and fat, going in the blood, build up on the walls of the arteries. The swelling narrows the arteries and can impede or block the course of blood. When the amount of cholesterol in the blood is huge, there is a deeper likelihood that it will be transferred onto the artery walls. This progression begins in most people during childhood and the teenage years, and gets worse as they get older.
In addition to high blood cholesterol, high blood pressure and smoking likewise contribute to CHD. On the average, each of these increases your risk of getting heart disease. This is why, a person who has all three risk factors is eight times more likely to acquire heart disease than someone who has none. Morbid obesity and physical inactivity are other things that can contribute to CHD. Being obese increases the likelihood of getting high blood cholesterol and high blood pressure, and a sedentary lifestyle enhances the probability of heart attack. Frequent exercising, good food regimen, and smoking cessation are vital to limiting the risk variables for CHD.
Among its indicators are chest pain (angina) or shortness of breath, which may be the initial warning signs of CHD. A person may feel heaviness, tightness, pain, burning, strain, or squeezing, usually behind the breastbone but often also in the arms, neck, or jaws. These signs usually bring the patient to a doctor for the first time. Even so, some people have heart attacks without ever getting any of these symptoms.
It is essential to recognize that there is a huge range of intensity for CHD. Some people have no indicators at all, some have mild irregular chest pain, and some have more evident and steady ache. Still others have CHD that is extreme enough to make typical everyday activities hard.
Because CHD varies so significantly from one person to another, the way a doctor determines and treats CHD will also vary a lot. The subsequent types are standard recommendations to some exams and treatments that may or may not be employed, depending on the unique situation.
There is no one simple test--some or all of the following procedures may be required. These diagnostic procedures are used to identify CHD, to establish its particular degree and severeness, and to rule out other possible causes of the symptoms.
After taking a careful medical history and being subjected to a physical examination, the doctor may make use of some tests to see how advanced the CHD is. The only certain technique to identify and evaluate the level of CHD is coronary angiography (see below); other tests can indicate a problem but do not show exactly where it is.
An examination for CHD may include the following tests:
An electrocardiogram (ECG or EKG) is a graphic record of the electrical activity of the heart as it contracts and rests. Unusual heartbeats and some areas of injury, inadequate blood flow, and heart enlargement can be recognized on the records.
A stress test (also called a treadmill test or exercise ECG) is utilized to document the heartbeat during exercise. This is done as some heart problems only pop up when the heart is working hard. In the test, an ECG is done before, during, and after exercising on a treadmill; breathing rate and blood pressure may be measured as well. Exercise tests are useful but are not completely reliable; false positives (showing a problem where none exists) and false negatives (showing no problem when something is wrong) are fairly common.
Nuclear scanning is sometimes used to show damaged areas of the heart and expose problems with the heart's pumping action. A small amount of radioactive material is injected into a vein, usually in the arm. A scanning camera tracks the nuclear material that is taken up by heart muscle (healthy areas) or not taken up (damaged areas).
Coronary angiography (or arteriography) is a test used to check out the coronary arteries. A fine tube (catheter) is put into an artery of an arm or leg and passed through the tube into the arteries of the heart. The heart and blood vessels are then recorded while the heart pumps. The picture that is seen, called an angiogram or arteriogram, will show problems such as a blockage caused by atherosclerosis.
CHD is treated in a number of ways, depending on the seriousness of the disease. For many people, CHD is handled with lifestyle changes and medications. Others with extreme CHD may need surgery. In any case, once CHD develops, it involves lifelong management.