Coronary Heart Disease

Life Science

Revision

CARDIOVASCULAR SYSTEM

Blood Vessels
Veins Arteries Capillaries

The Heart

Conduction system

CORONARY ARTERIES

 The heart pumps blood into arteries which take the blood to every part of the body. Like any other muscle, the heart muscle needs a good blood supply. The coronary arteries take blood to the heart muscle. The main coronary arteries branch off from the aorta. The main coronary arteries divide into smaller branches which take blood to all parts of the heart muscle.

Coronary Arteries

Coronary Heart Disease

Coronary heart disease is the term that describes what happens when the heart's blood supply is blocked or interrupted by a build-up of fatty substances in the coronary arteries. Over time, the walls of arteries can become furred up with fatty deposits. This process is known as atherosclerosis and the fatty deposits are called atheroma. If coronary arteries become narrow due to a build-up of atheroma, the blood supply to the heart will be restricted.

Arthero-sclerosis
This can cause chest painAngina If the artery becomes blocked this can cause a heart attack

 Patches of atheroma are like small fatty lumps that develop within the inside lining of arteries (blood vessels). Atheroma is also known as atherosclerosis and hardening of the arteries. Patches of atheroma are often called plaques of atheroma. A patch of atheroma makes an artery narrower. This can reduce the blood flow through the artery. In time, patches of atheroma can become larger and thicker. Sometimes, a patch of atheroma may develop a tiny crack on the inside surface of the blood vessel. This may trigger a blood clot (thrombosis) to form over the patch of atheroma, which may completely block the blood flow. Depending on the artery affected, a blood clot that forms on a patch of atheroma can cause a heart attack, a stroke, or other serious problems.

ANGINA

Angina
Angina is the feeling of chest pain, chest tightness, and sometimes breathlessness or choking. It happens when blood flow in the arteries that supply your heart is restricted. Angina typically starts when you're walking or feeling upset. It can also be brought on after a meal and by cold weather.

Symptoms include
discomfort or a tightening across your upper chest - this may be confused with indigestion pain radiating to your neck, jaw, throat, back or arms for a few minutes, disappearing quickly after resting breathlessness sweatiness

Treatment
Angina can be treated with lifestyle changes and medicines. Left untreated, it will become more frequent and the pain will get worse. Having angina means you're at a higher risk of having a heart attack

HEART ATTACK-MYOCARDIAL INFARCTION

What is a myocardial infarction?

Myocardial infarction (MI) means that part of the heart muscle suddenly loses its blood supply. Without prompt treatment, this can lead to damage to the affected part of the heart. An MI is sometimes called a heart attack Infarction means death of tissue

Blockage of artery

What happens when you have a myocardial infarction?

In an MI, a coronary artery or one of its smaller branches is suddenly blocked. The part of the heart muscle supplied by this artery loses its blood (and oxygen) supply. This part of the heart muscle is at risk of dying unless the blockage is quickly undone.

 If one of the main coronary arteries is blocked, a large part of the heart muscle is affected. If a smaller branch artery is blocked, a smaller amount of heart muscle is affected. In people who survive an MI, the part of the heart muscle that dies (infarcts) is replaced by scar tissue over the next few weeks. http://www.youtube.com/watch?v=1rKbdN 3csMA&feature=related

 The most common symptom of an MI is severe chest pain, which often feels like a heavy pressure The pain may also travel up into the jaw and down the left arm (or down both arms.) May also sweat, feel sick and feel faint. Shortness of breath.

 However, some people have only a mild discomfort in their chest when they have an MI. The pain can sometimes feel like indigestion or heartburn. A small MI occasionally happens without causing any pain (a silent MI). This is usually diagnosed when you have an ECG (heart tracing) at a later stage

Drugs
Aspirin and other antiplatelet drugs Aspirin is given as soon as possible after an MI is suspected Aspirin reduces the stickiness of platelets. Platelets are tiny particles in the blood that trigger the blood to clot. It is the platelets that become stuck onto a patch of atheroma inside an artery that go on to form the clot (thrombosis) of an MI. Another antiplatelet drug called clopidogrel is also given. This adds to the action of reducing platelet stickiness. Oxygen Oxygen works to reduce the risk of damage to the heart muscle. Pain relief Injections of heparin or a similar drug These are usually given for a few days to help prevent further blood clots forming.

Treatment to restore blood flow in the blocked coronary artery

The part of the heart muscle starved of blood does not die (infarct) immediately. If blood flow is restored within a few hours, much of the heart muscle that would have been damaged will survive. This is why an MI is a medical emergency, and treatment is given urgently. The quicker the blood flow is restored, the better the outlook.

Emergency angioplasty
The best treatment if it is available and can be done within a few hours of symptoms starting. In this procedure a tiny wire with a balloon at the end is put into a large artery in the groin or arm. It is then passed up to the heart and into the blocked section of a coronary artery using special X-ray guidance. The balloon is blown up inside the blocked part of the artery to open it wide again. A stent may be left in the widened section of the artery. A stent is like a wire mesh tube which gives support to the artery and helps to keep the artery widened.

Angioplasty

Injection of a clot busting drug

Alternative to emergency angioplasty. In reality, this is the more common treatment as it can be given easily and quickly in most situations. Some ambulance crews are trained to give this treatment. A common clot buster drug used in the UK is called streptokinase. This drug should not be given again if another MI occurs in the future. This is because antibodies develop to it and it will not work so well a second time. An alternative clot buster drug should be given

 http://www.patient.co.uk/video/Heartattack.htm

PREVENTION

Smoking
Lifetime smoking roughly doubles your risk of developing heart disease. The chemicals in tobacco get into the bloodstream from the lungs and damage the arteries and other parts of the body. Your risk of having a stroke, and developing other diseases such as lung cancer are also increased Stopping smoking is often the single most effective thing that a person can do to reduce their health risk. The increased risk falls rapidly after stopping smoking (although it takes a few years before the excess risk reduces completely).

Lack of physical activity - a sedentary lifestyle

People who are physically active have a lower risk of developing cardiovascular diseases compared with inactive people. To gain health benefits you should do at least 30 minutes of moderate physical activity, on most days (at least five days per week). 30 minutes in a day is probably the minimum to gain health benefits. However, you do not have to do this all at once. Moderate physical activity means that you get warm, mildly out of breath, and mildly sweaty. For example: brisk walking, jogging, swimming, cycling, etc. However, research studies do suggest that the more vigorous the exercise, the better for health - particularly for preventing heart disease. On most days. You cannot store up the benefits of physical activity. You need to do it regularly.

Obesity and overweight

On average, if someone is obese and reduces their weight by 10%, the chance of dying at any given age is reduced by about 20%. This is mainly because they are less likely to develop cardiovascular diseases, diabetes, or certain cancers. The increased health risk of obesity is most marked when the excess fat is mainly in the abdomen rather than on the hips and thighs. As a rule, a waist measurement of 102 cm or above for men (92 cm for Asian men) and 88 cm or above for women (78 cm for Asian women) is a significant health risk.

Diet
Eating healthily helps to control obesity, and lower cholesterol level. Also, there is some evidence that eating oily fish (herring, sardines, mackerel, salmon, kippers, pilchards, fresh tuna, etc) helps to protect against heart disease. It is probably the omega-3 fatty acids in the fish oil that helps to reduce the build-up of atheroma. Also, fruit and vegetables, as well as being low in fat, also contain antioxidants and vitamins which may help to prevent atheroma building up. LIMIT SALT to no more than 6 g a day (and less for children).

Alcohol
Drinking a small or moderate amount of alcohol probably reduces the risk of developing cardiovascular diseases (38% compared with teetotallers in one study). That is, 1-2 units per day - which is up to 14 units per week. Drinking more than 15 units per week does not reduce the risk, and drinking more than the recommended upper limits can be harmful. That is, men should drink no more than 21 units per week (and no more than four units in any one day). Women should drink no more than 14 units per week (and no more than three units in any one day).

High blood pressure

You should have your blood pressure checked at least every 3-5 years. High blood pressure usually causes no symptoms, so you will not know if it is high unless you have it checked. However, over the years, high blood pressure may do some damage to the arteries and put a strain on your heart. In some cases, high blood pressure can be lowered by: losing some weight if you are overweight, regular physical activity, and eating healthily. Medication may be advised if your blood pressure remains high.

Cholesterol and other lipids

In general, the higher the blood cholesterol level, the greater the risk of developing cardiovascular diseases. The risk that a high cholesterol level poses is greater if you also have other risk factors such as diabetes or high blood pressure. As a rule, no matter what your cholesterol level is, then lowering the level reduces your risk. This is why people at high risk of developing a cardiovascular disease are offered medication to lower their cholesterol level. A high blood level of triglyceride, another type of lipid (fat), also increases the health risk.

Total cholesterol
desirable borderline high high < 200 200 - 239 < 5.1 5.1 - 6.1

> 239

> 6.1

Diabetes and kidney disease

The increased risk that these conditions pose to developing cardiovascular diseases can be modified. For example, good control of blood sugar levels in people with diabetes reduces the risk. Good control of blood pressure in people with diabetes and kidney diseases reduces the risk.

Tips for report

Read nursing journal Nursing times & Nursing Standard British Heart Foundation website Discuss this is where you will pick up marks, if you do this correctly. Put forward different viewpoints on prevention. Evaluate dont just be descriptive. Keep references as you go along