CORONARY HEART DISEASE

Normal artery (left) vs artery clogged by cholesterol (right) 

CORONARY HEART DISEASE (MYOCARDIAL ISCHEMIA)

What is coronary heart disease?

  • Occurs when there is insufficient blood flow to your heart (the heart does not receive enough oxygen).

  • Insufficient blood flow is usually caused by coronary arteries that are partially or completely clogged.

  • This condition can deteriorate the heart's ability to pump properly (heart rhythm becomes abnormal).

  • A coronary artery that is suddenly clogged can eventually lead to a heart attack.

Chest pain is one of the signs that you may have coronary heart disease

What are the indications?

Some of the signs that you may have coronary heart disease are:

  • Heart palpitations

  • Shortness of breath when you exercise

  • Pain in the neck or jaw

  • Frequently vomiting

  • Always sweating

  • Constantly fatigue

  • Chest pain (usually on the left side)

  • Pain on shoulder or arm

  • Frequent dizziness

What are the causes?

Arterial blockage can occur quickly or slowly. Among the causes of coronary heart disease are:

  • High blood cholesterol level.

  • Diabetes (Type 1 and type 2)

  • High blood pressure: Accelerates the accumulation of cholesterol in the arteries.

  • Obesity: Often, obesity contributes to diabetes, high blood pressure and high blood cholesterol levels.

  • Smoking: Increases the risk of blood coagulation in the arteries.

Heart-healthy food

Clogged artery (left) vs normal artery (right) detected using coronary angiography

Coronary artery bypass surgery uses blood vessel taken from the leg

  • Coronary artery bypass surgery: Using blood vessels from other parts of your body to form a bypass that allow blood to flow beyond the clogged coronary artery.

  • Angioplasty and stenting: The narrow part of your artery is expanded with small balloons and small wire coils to unclog the artery.

  • Enhanced external counterpulsation (EEC): Using a tool that applies pressure around the foot (presses the blood vessels) to increase blood flow to the heart.

  • Specialized medicines: To increase blood flow to the heart (such as nitrates, aspirin, cholesterol-lowering drugs)

When do you need to see a doctor?

  • Make an appointment with your doctor if you recognize signs of coronary heart disease.

  • Each hospital has different methods for screening coronary heart disease.

  • Discuss the coronary heart disease screening with your doctor. Together with a physician, you can decide what is best for you.

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How to get ready with your appointments?

For your preparation, a medical specialist may ask you some questions as follows:

  • Are the signs of your illness occurring continuously or occasionally?

  • How severe are the illness signs on your body?

  • Since when did you begin to experience the signs of the illness?

  • Do you have family members who have had the disease?

  • What triggers the signs of your illness to be more severe? (if any)

  • What do you usually do to relieve any signs of your illness?

 

 

What you can do to prepare before the appointment is:

  • List the signs of your illness.

  • Know any restriction that needs to be done before the appointment. Make sure to ask first what to do before appointment (such as limiting your diet, etc.).

  • List all the medicines, vitamins or supplements you consume.

  • If possible, invite family members or friends to be with you. Sometimes we find it difficult to remember all the information during the appointment. Your companion might just help you with this.

  • List your personal information that can help your doctor in investigating your illness (such as major stresses in your life or any changes in your life recently).

  • List all the questions you would like to ask your doctor.

Here are some general questions that you can ask your doctor:

  • What are the possible causes for signs of illness that appear on me?

  • What method of screening should I take? Do I need to make any necessary arrangements before doing the screening?

  • What is the severity of my illness?

  • Should I get a second doctor's opinion of my condition?

  • What are the treatment options that are suitable for my condition?

  • Are there any side effects for each treatment?

  • How does each treatment option affect my daily life?

  • How big is my possibility of getting completely healed from the disease if I undergo the treatment?

  • Do I need to undergo the treatment immediately without delay?

  • How long will the treatment last?

  • How often should I get examined after treatment?

  • What are the complications that I need to face in the future?

  • What other alternatives are available apart from the medicines you prescribed? (if any)

  • Do I need to make any changes to my lifestyle? What nutrition and level of activity are appropriate for my condition?

  • What else can I do to protect my health?

  • I have other health problems. How can I best manage this situation?

If you have any other questions, do not hesitate to ask the doctor during your appointment.

Updated: March 4, 2019

References:

  1. Papadakis, Maxine A., McPhee, Stephen J., Rabow, Michael W. CURRENT Medical Diagnosis and Treatment. 58th ed. McGraw Hill Professional, 2018.

  2. Beirman, Robin., Engel, Roger. An A-Z of Symptoms and Signs. Palgrave Macmillan Australia, 2009.

  3. Porter, Robert S. The Merck Manual of Patient Symptoms: A Concise, Practical Guide to Etiology, Evaluation and Treatment. Wiley, 2008.

  4. Griffith, Henry W. Complete Guide to Symptoms, Illness & Surgery. 3rd ed. Body Press/Perigree Books, 1995.

  5. Centers for Disease Control and Prevention. 2019. Heart Disease. [https://www.cdc.gov/heartdisease/]. Accessed 24 February 2019.

  6. National Health Service. 2019. Coronary Heart Disease. [https://www.nhs.uk/conditions/coronary-heart-disease/]. Accessed 27 February 2019.

How to avoid & control it?

Measures that can be taken to prevent coronary heart disease are:

  • All adults aged 20 years and above should examine their cholesterol levels with a doctor at least once every 5 years. If you have high cholesterol level, you need to do examination more often based on your doctor's advice.

  • It is ideal to do blood pressure checks every year with a doctor as an adult.

  • Exercise regularly to lose weight and maintain a healthy body.

 

  • Eat heart-healthy food such as:

    • Fish

    • Lean meat and chicken

    • Vegetables

    • Fruits (especially orange, papaya, berries and avocados)

    • Low-fat dairy products

    • Nuts (especially almonds and walnuts)

    • Cereals (especially oats)

 

  • Reduce or stop smoking completely.

How it is detected?

If you have any signs of coronary heart disease that have been mentioned, discuss with the doctor about your specific situation. With the advice of a doctor, you can decide whether the screening method is right for you.

Among the frequently used examination method are:

  • Cardiac CT scan: Able to determine the presence of cholesterol thickening in arteries that will cause clogging.

  • Pressure tests: Your blood pressure, heart rate and breathing rate are monitored during the test (involving physical activity) to detect heart problems.

  • Echocardiogram: Uses sound waves at the heart to detect any abnormal condition.

  • Electrocardiogram (ECG): Your heart's electrical activity is monitored for any abnormal condition.

  • Coronary angiography: Uses X-rays and dye to see the inside of your blood vessels.

  • Nuclear scan: Uses low amount of radioactive material to detect blood flow problems.

How it is treated?

Discuss with your doctor what type of treatment is best for your specific situation.

Among the methods to treat coronary heart disease are:

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