Understanding coronary heart disease Coronary heart disease (CHD) develops when the artery supplying blood to the

heart becomes partially or wholly blocked. Its often caused by fatty deposits building up on the inside lining of the arteries. his causes symptoms of chest pain! which is temporary and treatable. CHD can result in a heart attack if the blood supply to the heart is stopped for long enough to cause damage. Heart disease is a concern for everyone. "esearch suggests there are #ust over $.% million people living with the condition in the &'. he older you are! the more likely you are to have heart disease. It affects about one in four men and one in five women aged () and over. he good news is that heart disease is largely preventable. here are small changes you can make to your diet and lifestyle which significantly reduce your risk of developing CHD in the future! or having another heart attack. 'eeping your heart healthy will also have other health benefits! reducing your risk of stroke and dementia. Avoiding coronary heart disease Coronary heart disease (CHD) is largely preventable and often caused by fatty deposits forming on the inside lining of the arteries. *ind out who+s at risk of CHD and how to reduce your chances of developing it. ,hos at risk of coronary heart disease.ou+re more likely to develop coronary heart disease if/ you smoke! you have high blood pressure! you+ve had a high blood cholesterol level! you do little physical activity! you have diabetes! you+re overweight or obese! a close relative has had a heart attack before the age of )) for a man and %) for a woman! or you+re of 0outh 1sian descent.

he good news is that you can make changes to your lifestyle that will cut your risk of developing CHD in the future. Knowing the Symptoms CHD occurs when the artery supplying blood to the heart becomes partially or wholly blocked. he main symptom is chest pain that is temporary and treatable. Heart disease can result in a heart attack if the blood supply to the heart is stopped for long enough to cause damage. When should I see a doctor? he signs and symptoms that make people go to their doctor with concerns about heart disease vary.

hey can include! for e2ample! palpitations and unusual breathlessness. If you suspect you have heart disease! the earlier you see a healthcare professional the better! because treatment and lifestyle changes can slow down the rate the disease progresses at. Being Diagnosed Doctors usually diagnose CHD from a mi2ture of information! including test results and symptoms such as angina. 3arly diagnosis! and intervention with lifestyle changes and treatment! can significantly slow the progression of the disease and keep you living life to the full. Treatment What is good coronary heart disease care? 3ffective treatment of CHD saves lives. 0ince $444! there has been a 546 reduction in deaths from heart disease in people under (). 1 national review of heart disease services set out standards which define good heart disease care/ 7 ackling the factors which increase the risk of heart disease! such as smoking! poor diet! and little physical e2ercise. 7 8reventing CHD in high risk patients and where patients have CHD avoiding complications and tackling the progression of the disease. 7 "apid treatment for heart attack! including the choice of angioplasty in a specialist cardiac centre. 7 "apid diagnosis of heart disease and access to diagnostic tests. 7 "apid access and choice of treatment centre for specialised cardiac care. Living with oronary !eart Disease 1fter your coronary heart disease (CHD) has been diagnosed and treated! particularly if you stayed in hospital! you will need a period of rehabilitation. 9y focusing on e2ercise! rela2ation and lifestyle! rehabilitation will help you get back to a normal life and keep you healthy. his is important! as CHD can be treated and managed but not cured. 0ource/ http/::www.nhs.uk:8athways:coronaryheartdisease:8ages:;anding.asp2 "isk *actors and Coronary Heart Disease A!A Scienti"ic #osition 32tensive clinical and statistical studies have identified several factors that increase the risk of coronary heart disease and heart attack. <a#or risk factors are those that research has shown significantly increase the risk of heart and blood vessel (cardiovascular) disease. =ther factors are associated with increased risk of cardiovascular disease! but their significance and prevalence haven+t yet been precisely determined. hey+re called contributing risk factors. he 1merican Heart 1ssociation has identified several risk factors. 0ome of them can be modified! treated or controlled! and some can+t. he more risk factors you have! the greater your chance of developing coronary heart disease. 1lso! the greater the level of each risk factor! the greater the risk. *or e2ample! a person with a total cholesterol of >44 mg:d; has a greater risk than someone with a total cholesterol of $5) mg:d;! even though everyone with a total cholesterol greater than $54 is considered high?risk. What are the ma$or ris% "actors that can&t 'e changed?

Increasing age @ =ver A> percent of people who die of coronary heart disease are %) or older. 1t older ages! women who have heart attacks are more likely than men are to die from them within a few weeks. (ale se) *gender+ @ <en have a greater risk of heart attack than women do! and they have attacks earlier in life. 3ven after menopause! when women+s death rate from heart disease increases! it+s not as great as men+s. !eredity (including ,ace) @ Children of parents with heart disease are more likely to develop it themselves. 1frican 1mericans have more severe high blood pressure than Caucasians and a higher risk of heart disease. Heart disease risk is also higher among <e2ican 1mericans! 1merican Indians! native Hawaiians and some 1sian 1mericans. his is partly due to higher rates of obesity and diabetes. <ost people with a strong family history of heart disease have one or more other risk factors. Bust as you can+t control your age! se2 and race! you can+t control your family history. herefore! it+s even more important to treat and control any other risk factors you have.

What are the ma$or ris% "actors you can modi"y- treat or control 'y changing your li"estyle or ta%ing medicine? To'acco smo%e @ 0mokers+ risk of developing coronary heart disease is $C5 times that of nonsmokers. Cigarette smoking is a powerful independent risk factor for sudden cardiac death in patients with coronary heart diseaseD smokers have about twice the risk of nonsmokers. Cigarette smoking also acts with other risk factors to greatly increase the risk for coronary heart disease. 8eople who smoke cigars or pipes seem to have a higher risk of death from coronary heart disease (and possibly stroke) but their risk isn+t as great as cigarette smokers+. 32posure to other people+s smoke increases the risk of heart disease even for nonsmokers. !igh 'lood cholesterol @ 1s blood cholesterol rises! so does risk of coronary heart disease. ,hen other risk factors (such as high blood pressure and tobacco smoke) are present! this risk increases even more. 1 person+s cholesterol level is also affected by age! se2! heredity and diet. !igh 'lood pressure @ High blood pressure increases the heart+s workload! causing the heart to thicken and become stiffer. It also increases your risk of stroke! heart attack! kidney failure and congestive heart failure. ,hen high blood pressure e2ists with obesity! smoking! high blood cholesterol levels or diabetes! the risk of heart attack or stroke increases several times. #hysical inactivity @ 1n inactive lifestyle is a risk factor for coronary heart disease. "egular! moderate?to?vigorous physical activity helps prevent heart and blood vessel disease. he more vigorous the activity! the greater your benefits. However! even moderate?intensity activities help if done regularly and long term. 8hysical activity can help control blood cholesterol! diabetes and obesity! as well as help lower blood pressure in some people. .'esity and overweight @ 8eople who have e2cess body fat @ especially if a lot of it is at the waist @ are more likely to develop heart disease and stroke even if they have no other risk factors. 32cess weight increases the heart+s work. It also raises blood pressure and blood cholesterol and triglyceride levels! and lowers HD; (EgoodE) cholesterol levels. It can also make diabetes more likely to develop. <any obese and overweight people may have difficulty losing weight. 9ut by losing even as few as F4 pounds! you can lower your heart disease risk. Dia'etes mellitus @ Diabetes seriously increases your risk of developing cardiovascular disease. 3ven when glucose (blood sugar) levels are under control! diabetes increases the risk of heart disease and stroke! but the risks are even greater if blood sugar is not well controlled. 1bout three?Guarters of people with diabetes die of some form of heart or blood vessel disease. If

you have diabetes! it+s e2tremely important to work with your healthcare provider to manage it and control any other risk factors you can. What other "actors contri'ute to heart disease ris%? Individual response to stress may be a contributing factor. 0ome scientists have noted a relationship between coronary heart disease risk and stress in a person+s life! their health behaviors and socioeconomic status. hese factors may affect established risk factors. *or e2ample! people under stress may overeat! start smoking or smoke more than they otherwise would. Drinking too much alcohol can raise blood pressure! cause heart failure and lead to stroke. It can contribute to high triglycerides! cancer and other diseases! and produce irregular heartbeats. It contributes to obesity! alcoholism! suicide and accidents. he risk of heart disease in people who drink moderate amounts of alcohol (an average of one drink for women or two drinks for men per day) is lower than in nondrinkers. =ne drink is defined as F?F:$ fluid ounces (fl oH) of A4?proof spirits (such as bourbon! 0cotch! vodka! gin! etc.)! F fl oH of F44?proof spirits! 5 fl oH of wine or F$ fl oH of beer. It+s not recommended that nondrinkers start using alcohol or that drinkers increase the amount they drink. Source/ 1merican Heart 1ssociation http/::www.americanheart.org:presenter.#html-identifierI5($% Alternative 0ames Coronary artery diseaseD 1rteriosclerotic heart diseaseD CHDD C1D auses Coronary heart disease is usually caused by a condition called atherosclerosis! which occurs when fatty material and a substance called plaGue builds up on the walls of your arteries. his causes them to get narrow. 1s the coronary arteries narrow! blood flow to the heart can slow down or stop! causing chest pain (stable angina)! shortness of breath! heart attack! and other symptoms. Coronary heart disease (CHD) is the leading cause of death in the &nited 0tates for men and women. 1ccording to the 1merican Heart 1ssociation! more than F) million people have some form of the condition. <en in their 54s have a higher risk of CHD than women. 9ut! as women get older! their risk increases so that it is almost eGual to a man+s risk. 0ee/ Heart disease and women <any things increase your risk for CHD. 9ad genes (heredity) can increase your risk. .ou+re more likely to develop the condition if someone in your family has had it ?? especially if they had it before age )4. .our risk for CHD goes up the older you get. he following factors also increase your risk of CHD/ Diabetes High blood pressure High ;D; EbadE cholesterol ;ow HD; EgoodE cholesterol

<enopause Jot getting enough physical activity or e2ercise =besity 0moking

Higher?than?normal levels of inflammation?related substances may also increase your risk for a heart attack. 0uch substances include C?reactive protein and fibrinogen. Increased levels of a chemical called homocysteine! an amino acid! are also linked to an increased risk of a heart attack. Symptoms 0ymptoms may be very noticeable! but sometimes you can have the disease and not have any symptoms. Chest pain or discomfort (angina) is the most common symptom. .ou feel this pain when the heart is not getting enough blood or o2ygen. How bad the pain is varies from person to person. here are two main types of chest pain/ 1typical chest pain ?? often sharp and comes and goes. .ou can feel it in your left chest! abdomen! back! or arm. It is unrelated to e2ercise and not relieved by rest or a medicine called nitroglycerin. 1typical chest pain is more common in women. ypical chest pain ?? feels heavy or like someone is sGueeHing you. .ou feel it under your breast bone (sternum). he pain usually occurs with activity or emotion! and goes away with rest or a medicine called nitroglycerin.

1dults with typical chest pain have a higher risk of CHD than those with atypical chest pain. =ther symptoms include/ Angina 1ngina is the primary symptom of coronary artery disease and! in severe cases! of a heart attack. It is typically e2perienced as chest pain and occurs when the heart muscle does not get as much blood (and! as a result! as much o2ygen) as it needs for a given level of work (ischemia). 1ngina is usually referred to as one of two states/ 0hortness of breath Heart attack ?? in some cases! the first sign of CHD is a heart attack *atigue with activity (e2ertion)

Stable Angina (which is predictable) Unstable Angina (which is less predictable and a sign of a more serious situation)

he intensity of the pain does not always relate to the severity of the medical problem. 0ome people may feel a crushing pain from mild ischemia! while others might e2perience only mild discomfort from severe ischemia. 1ngina itself is not a disease. <uch evidence indicates that onset of angina fewer than 5A hours before a heart attack may be protective! possibly by conditioning the heart to resist the damage resulting from the attack. 1ngina may be e2perienced in different ways and can be mild! moderate! or severe. Sta'le Angina and hest #ain Stable Angina. 0table angina is predictable chest pain. 1lthough less serious than unstable angina! it can be e2tremely painful or uncomfortable. It is usually relieved by rest and responds well to medical treatment (typically nitroglycerin). 1ny event that increases o2ygen demand can cause an angina attack. 0ome typical triggers include/ 32ercise Cold weather 3motional tension ;arge meals

1ngina attacks can happen at any time during the day! but most occur between % a.m. and noon. 0pecific symptoms that are more likely to indicate angina include/

1ngina pain or discomfort is typically described by patients as fullness or tingling! sGueeHing! pressure! heavy! suffocating! or griplike. It is rarely described as stabbing or burning. Changing one+s position or breathing in and out does not affect the pain. 1 typical angina attack lasts minutes. If it is more fleeting or lasts for hours! it is probably not angina. 8ain is usually in the chest under the breast bone. It often radiates to the neck! #aw! or left shoulder and arm. ;ess commonly! patients report symptoms that radiate to the right arm or back! or even to the upper abdomen. 0table angina is usually relieved by rest or by taking nitroglycerine under the tongue.

=ther symptoms that may indicate angina or accompany the pain or pressure in the chest include/ 0hortness of breath Jausea! vomiting! and cold sweats 1 feeling of indigestion or heartburn &ne2plained fatigue after activity (more common in women) DiHHiness or lightheadedness 8alpitations

Unsta'le Angina and Symptoms o" #ossi'le !eart Attac% &nstable angina is a much more serious situation and is often an intermediate stage between stable angina and a heart attack! in which an artery leading to the heart (a coronary artery) becomes completely blocked. 1 patient is usually diagnosed with unstable angina under one or more of the following conditions/ 8ain awakens a patient or occurs during rest. 1 patient who has never e2perienced angina has severe or moderate pain during mild e2ertion (walking two level blocks or climbing one flight of stairs). 0table angina has progressed in severity and freGuency within a $?month period! and medications are less effective in relieving its pain. *ainting episode.

&nstable angina is now usually discussed as part of a condition called acute coronary syndrome (1C0). 1C0 also includes people with a condition called J0 3<I (non 0 ?segment elevation myocardial infarction) ?? also referred to as non?K wave heart attack. ,ith J0 3<I! blood tests suggest a developing heart attack. hese conditions are less severe than heart attacks but may develop into full?blown attacks without aggressive treatment. L*or more information! see In-Depth Report MF$/ Heart attack and acute coronary syndrome.N Doctors use a number of factors to help predict which patients with unstable angina or acute coronary syndrome are most at risk for developing a heart attack. *irst! patients are categoriHed by whether they have a history of heart disease or risk factors for heart disease (such as diabetes! high blood pressure! and peripheral artery disease) or other complicating

conditions (such as lung disease and heart failure). he doctor also evaluates the severity of the angina. =ther factors that pose a high risk for 1C0 include/ 1ge %) years or older 3vidence of severe heart tissue in#ury Having a history of severe chronic angina Having abnormal lung sounds called rales (a bubbling or crackling sound) on e2amination 0 ?segment deviation on the electrocardiogram Having either very slow or very fast heat beats Having very low blood pressure

Heart Attack. 1 full?blown heart attack occurs with severe damage to the heart! which blocks o2ygen. 8eople with known heart disease and any unusual chest pain or other symptoms described above that do not clear up with medications should call OFF. he degree of pain and the specific symptoms before a heart attack vary greatly among individuals. 0ymptoms can be abrupt! gradual! or intermittent. 0ome studies suggest that nearly half of patients having a heart attack do not have chest pain as the primary symptom. 8atients most likely to have atypical symptoms are women and the very elderly (although they can certainly have classic heart attack symptoms as well). Symptoms That Are Less Likely to Indicate Angina or a Heart Attack. likely to be due to coronary artery disease/ 0harp pain brought on by breathing in and or when coughing 8ain that is mainly or only in the middle or lower abdomen 8ain that can be pinpointed with the top of one finger 8ain that can be reproduced by moving or pressing on the chest wall or arms 8ain that is constant and lasts for hours (although no one should wait hours if they suspect they are having a heart attack) 8ain that is very brief and lasts for a few seconds 8ain that spreads to the legs he following symptoms are less

However! the presence of these symptoms does not always rule out a serious heart event. .ther Types o" Angina rin!metal"s Angina. 1 third type of angina! called variant or 8rinHmetal+s angina! is caused by a spasm of a coronary artery. It almost always occurs when the patient is at rest. 1bout two?thirds of people with it have severe atherosclerosis in at least one ma#or blood vessel. Irregular heartbeats are common! but the pain is generally relieved immediately with standard treatment. Silent Ischemia. 0ome people with severe coronary artery disease do not have angina pain. his condition is known as silent ischemia! which some e2perts attribute to the brain abnormaly processing

heart pain. his is a dangerous condition because patients have no warning signs of heart disease. 0ome studies suggest that people with silent ischemia have higher complication and mortality rates than those with angina pain. (1ngina pain may actually protect the heart by conditioning it before a heart attack.) Syndrome #. 0yndrome P is a condition that occurs when patients have atypical angina chest pain. heir electrocardiograms are abnormal during a stress test! but they have no signs of blocked arteries. It is more likely to occur in women. 1lthough it is unclear what causes this condition! imaging tests suggest that 0yndrome P may also be caused by ischemia! as is angina .ther auses o" hest #ain or Discom"ort Chest pain is a very common symptom in the emergency room! but heart problems account for only F4 ? >>6 of all episodes. =ther causes of chest pain or discomfort include/ 8roblems affecting the ribs and chest muscles include in#ured muscles! fractures! arthritis! muscle spasms! and infections 1n2iety attacks Qastrointestinal disorders (gallstone attacks! peptic ulcer disease! hiatal hernia! heartburn) 1sthma "upture of the aorta Collapsed lung 1cute inflammation of the heart 9lood clot in the lung (pulmonary embolism) High thyroid levels (hyperthyroidism) 1nemia Rasculitis (a group of disorders that cause inflammation of the blood vessels)

What to Do When Symptoms .ccur Individuals who e2perience symptoms of a heart attack should take the following actions/ *or angina patients! take one nitroglycerin dose either as an under?the?tongue tablet or in spray form at the onset of symptoms. ake another dose every ) minutes up to three doses or when the pain is relieved! whichever comes first. Call OFF or the local emergency number. his should be the first action taken if angina patients continue to e2perience chest pain after taking the full three doses of nitroglycerin. However! only $46 of heart attacks occur in patients with long?standing angina. herefore! anyone who with heart disease or risk factors for it who has heart attack symptoms should contact emergency services. he patient should chew an aspirin ($)4 ? )44 mg) and be sure that emergency health providers are informed of this so an additional dose is not given.

8atients with chest pain should go immediately to the nearest emergency room! preferably traveling by ambulance. hey should not drive themselves.

1)ams and Tests <any tests help diagnose CHD. &sually! your doctor will order more than one test before making a definite diagnosis. ests may include/ Coronary angiography:arteriography 3lectrocardiogram (3CQ) 3lectron?beam computed tomography (39C ) to look for calcium in the lining of the arteries ?? the more calcium! the higher your chance for CHD 32ercise stress test 3chocardiogram <agnetic resonance angiography Juclear scan

Diagnosis <any tests can diagnose possible heart disease. he choice of which (and how many) tests to perform depends on the patient+s risk factors! history of heart problems! and current symptoms. &sually the tests begin with the simplest and may progress to more complicated ones. ,outine Tests to Determine ,is% "or !eart Disease Doctors routinely check for high blood pressure and unhealthy cholesterol levels in all older adults. 0pecific tests are also important in people who may have risk factors or symptoms of diabetes. 1lectrocardiograms *1 2s+ 1n electrocardiogram (3CQ) measures and records the electrical activity of the heart. 9etween $) ? )46 of people who suffer from angina or silent ischemia! however! have normal 3CQ readings. he waves measured by the 3CQ correspond to the contraction and rela2ation pattern of the different parts of the heart. 0pecific waves seen on an 3CQ are named with letters/ 8. he 8 wave is associated with the contractions of the atria (the two chambers in the heart that receive blood from outside). K"0. he K"0 is a series of waves associated with ventricular contractions. ( he ventricles are the two ma#or pumping chambers in the heart.) and &. hese waves follow the ventricular contractions.

he most important wave patterns in diagnosing and determining treatment for heart disease and heart attack are called ST ele$ations and % &a$es.

1 depressed or horiHontal 0 wave suggests some blockage and the presence of a heart disease! even if there is no angina present. ( his finding! however! is not very accurate! particularly in women! and can occur without heart problems). 0 elevations and K waves are the most important wave patterns in diagnosing and determining treatment for a heart attack. hey suggest that an artery to the heart is blocked! and that the full thickness of the heart muscle is damaged. 0 segment elevations do not always mean the patient has a heart attack. 1nd! some heart attack patients do not have elevated 0 segments. =ther factors are important in making a diagnosis.

1)ercise Stress Test 32ercise stress test for evaluation of coronary artery disease may be performed in the following situations/ 8atients with possible or probable angina to help determine the likelihood of coronary artery disease being present 8atients who were previously stable who began having symptoms 0elected adults who do not have symptoms of heart disease but are at moderate risk to high risk for developing heart disease (a F4 ? $46 chance within F4 years). <oreover! heart blockage without angina (silent ischemia) may suggest a more severe condition! at least in men. *ollow?up of patients with known heart disease or 1fter coronary bypass surgery or percutaneous procedure o determine somebodys functional capacity (how well the heart can respond when e2tra demand is needed) 8atients with certain types of heart rhythm disturbances 8atients with no symptoms of heart disease who have diabetes 1fter a heart attack! either before leaving the hospital or soon afterwards

'asic rocedure. 1 stress test (e2ercise tolerance test) monitors the patient+s heart rhythms! blood pressure! and clinical status. It can tell how well the heart handles work and if parts of the heart have decreased blood supply. 1 typical stress test involves/ he patient walks on a treadmill or rides a stationary bicycle. 32ercise continues until the heart is beating at least A)6 of its ma2imum rate! until symptoms of heart trouble occur (changes in blood pressure! heart rhythm abnormalities! angina! fatigue)! or the patient simply wants to stop. *or patients who cannot e2ercise! the doctor may administer dobutamine or arbutamine! which are drugs that simulate the stress of e2ercise.

1n 3CQ is used to monitor heart rhythms during a stress test. (1n echocardiogram or more advanced imaging techniGue may also be used to visualiHe the actions of the heart and blood flow.) <ore than $)6 of patients stop e2ercising before they reach their own ma2imum limits because of fear of a heart event. 8atients should be reassured that the activities performed in the test under the guidance of a professional are safe.

Interpreting Results. o accurately assess heart problems! a variety of factors are measured or monitored using the 3CQ and other tools during e2ercise. hey include/ 32ercise capacity. his is a measure of a person+s capacity to reach certain metabolic rates. 0 waves on the 3CQ. Doctors specifically look for abnormalities in part of the wave tracing called an 0 segment. 1 certain type of 0 segment depression may suggest the presence of heart disease. However! gender! drugs! and other medical conditions can affect the 0 segment. Heart rate. his is how fast the heart rate goes during e2ercise and how Guickly it returns to normal recovery. 9ased on age and other factors! everyone+s heart rate should go up to a certain level during e2ercise. If it does not go up to the e2pected level! the patient is considered at risk for heart problems. Changes in systolic blood pressure. Qenerally! the blood pressure will go up during e2ercise. =2ygen levels may also be measured.

&sing these and other measures! doctors can determine risk fairly accurately! particularly for men with chronic stable angina. he test has limitations! however! and some are significant. In patients with suspected unstable angina! normal or low risk results may not be as accurate in predicting future risk of cardiac events. In addition! for many reasons! the test is less accurate in women! and an echocardiogram may be a more accurate procedure for them. 1bout F46 of patients! particularly younger people! will have false positive test results. In such cases! test results indicate abnormalities when there are no heart problems. 1chocardiograms 1n echocardiogram is a noninvasive test that uses ultrasound images of the heart. his test is more e2pensive than an 3CQ! but it can be very valuable! particularly in identifying whether there is damage to the heart muscle and the e2tent of heart muscle damage. 1 stress echocardiogram may be performed to further evaluate abnormal findings from an e2ercise treadmill test or a routine echocardiogram. 32amples include identifying e2actly which part of the heart may be involved and Guantifying how much muscle has been infected. It may be the first test done when the e2ercise treadmill test cannot be performed due to certain abnormal rhythms. ,adionuclide Imaging "adionuclide procedures use imaging techniGues and computer analyses to plot and detect the passage of radioactive tracers through the region of the heart. 0uch tracing elements are typically given intravenously. "adionuclide imaging is useful for diagnosing and determining/ 0everity of unstable angina when less e2pensive diagnostic approaches are unavailable or unreliable 0everity of chronic coronary artery disease 0uccess of surgeries for coronary artery disease. ,hether a heart attack has occurred

Rarious imaging techniGues may be used with radionuclide procedures! including/ 8lanar scintigraphy! the oldest scanning techniGue! uses a special overhead camera.

0ingle?photon emission computed tomography (083C ) uses a camera that rotates around the patient and takes pictures of EslicesE of the heart. It is more accurate than planar imaging in precisely locating problems in the arteries. 8ositron?emission tomographic (83 ) scanners employ multiple rings that surround the patients! which detect and record atomic particles (photons) that are emitted by the tracer elements (such as radioactive o2ygen! nitrogen! or carbon). It is more e2pensive and less widely available than 083C . Its e2act role in diagnosing and following coronary artery disease is not yet known.

(yocardial er)usion *'lood +lo&, Imaging Test *also called the Thallium Stress Test,. his radionuclide test is typically used with an e2ercise stress test to determine blood flow to the heart muscles. It is a reliable measure of severe heart events. It may be useful in determining the need for angiography if C scans have detected calcification in the arteries. 1bout a minute before the patient is ready to stop e2ercising! the doctor administers a radioactive tracer into the intravenous line. ( racers include thallium! technetium! or sestamibi.) Immediately afterwards! the patient lies down for a heart scan! usually with a planar scintigraphy or with 083C . If the scan detects damage! more images are taken > or 5 hours later. Damage due to a prior heart attack will persist when the heart scan is repeated. In#ury caused by angina! however! will have resolved by that time. Radionuclide Angiography. his is a techniGue for visualiHing the chambers and ma#or blood vessels of the heart. It uses an in#ected radioactive tracer and can be performed during e2ercise! at rest! or with use of stress?inducing drugs. It is an e2cellent test for assessing the heart+s pumping action and determining the severity of coronary artery disease. It is an alternative to echocardiograms in certain situations. Angiography 1ngiography is an invasive test. It is used for patients who show strong evidence for severe obstruction on stress and other tests! and for patients with acute coronary syndrome. It is reGuired when there is a need to know the e2act anatomy and disease present within the coronary arteries. 1 limitation of angiography is that it is not always the most occluded (blocked) blood vessel that causes the ne2t heart attack. In an angiography procedure/ 1 narrow tube is inserted into an artery! usually in the leg or arm! and then threaded up through the body to the coronary arteries. 1 dye is in#ected into the tube! and an 2?ray records the flow of dye through the arteries. his process provides a map of the coronary circulation! revealing any blocked areas. <a#or complications include stroke! heart attacks! and kidney damage. hese risks are very low (about 4.F6)! however! if the procedure is done in an e2perienced medical center (one that performs at least >44 of these operations every year). 1llergic reactions can also occur. he procedure is e2pensive! and F4 ? >46 of patients who have this procedure have normal results. (agnetic Resonance Angiography *(RA,. <"1 is a very promising noninvasive imaging techniGue that can provide three?dimensional images of the ma#or arteries to the heart and identify disease with high accuracy. 32perts believe this approach will eventually be a good alternative to angiography. omputed Tomography Computed tomography (C ) scans continue to be evaluated for several uses regarding coronary artery disease.

-alcium Scoring -T Scans o) the Heart . <ay be used to detect calcium deposits on the arterial walls. he presence of calcium correlates well with the presence of atherosclerosis of the heart. If the calcium score is very low! a patient is unlikely to have coronary artery disease. 1 higher calcium score may indicate an increased risk of current and future coronary artery disease. However! the presence of calcium does not necessarily signify narrowing of the arteries that would need further immediate evaluation or treatment. "esults may unnecessarily lead to increased an2iety and may also lead to further unnecessary testing and treatment. -T Angiography. C scans are also used to visualiHe the coronary arteries. ,hen compared to invasive angiography! C angiography is not as accurate in identifying who truly has coronary artery disease and who does not. 0tudies have shown that a negative C angiography is fairly accurate in predicting patients who do not have coronary artery disease. However! its e2act role in evaluation of patients with suspected heart disease is not clearly defined. <ore research is needed to determine the benefits of C scanning in specific individuals.

1dvanced C techniGues are improving accuracy! including/ .lectron 'eam -omputed Tomography. 3lectron beam computed tomography (39C ) is a C techniGue that scans the heart so Guickly that the motion of the heart appears froHen. his procedure identifies calcification. (ultidetector -omputed Tomography. 1nother C techniGue called multidetector computed tomography (<DC ) is able to take pictures of the entire heart in F millimeter slices in the time it takes for a patient to hold one breath. 1 $44% study indicated that <DC tends to have a high Sfalse?positiveT rate (indicating disease when it is not actually there)! but for some patients the test may be helpful in ruling out coronary artery disease.

Treatment reatment depends on your symptoms and how severe the disease is. If you have coronary artery disease that does not cause symptoms! you can be treated with either medicine or angioplasty with stenting. "ecent studies show that medicine and angioplasty with stenting have eGual benefits. 1ngioplasty with stenting does not help you live longer! but it can reduce angina or other symptoms of CHD. 1ngioplasty with stenting! however! can be a life?saving procedure if you are having a heart attack. <edications used to treat CHD include/ 1C3 inhibitors to lower blood pressure 9lood thinners (antiplatelet drugs) to reduce your risk of blood clots 9eta?blockers to lower heart rate! blood pressure! and o2ygen use by the heart Calcium channel blockers to rela2 arteries! lowering blood pressure and reducing strain on the heart Diuretics to lower blood pressure Jitrates (such as nitroglycerin) to stop chest pain and improve blood supply to the heart 0tatins to lower cholesterol

8rocedures to treat and diagnose CHD are called percutaneous coronary interventions! or 8CIs. 1ngioplasty and stenting are types of 8CIs. =ther types include/ Coronary atherectomy Coronary radiation implant or coronary brachytherapy his treatment is only for patients

Coronary brachytherapy delivers radiation into the coronary arteries. who have had a stent?related problems. 0urgeries used to treat CHD include/ Coronary artery bypass surgery <inimally invasive heart surgery

;ifestyle changes are very important. .our doctor may tell you to/ 1void or reduce the amount of salt (sodium) you eat 3at a heart healthy diet ?? one that is low in saturated fats! cholesterol! and trans fat Qet regular e2ercise and maintain a healthy weight 'eep your blood sugar strictly under control if you have diabetes 0top smoking

;ifestyle changes are the first approach for all degrees of coronary artery disease. Depending on severity and individual conditions! patients may also need one or more medications! surgery! or both. <any types of medications are used to treat angina and C1D. Beta3Bloc%ers 9eta?blockers are useful for preventing angina attacks and reducing high blood pressure. hey reduce the heart+s o2ygen demand by slowing the heart rate and lowering blood pressure. hey are recogniHed for reducing deaths from heart disease and from heart surgeries! including angiography and coronary bypass. 9eta?blockers are used or recommended in a number of situations/ hey are started in nearly all patients who have #ust had a heart attack or acute coronary syndrome. hey are the drugs of choice for older patients with stable angina and may also be beneficial for people with silent ischemia. hey are! however! less useful for the treatment of 8rinHmetals angina. hey may be used alone or with other medications for management of rhythm disturbances or high blood pressure.

Speci)ic 'eta-blockers. 9eta?blockers include propranolol (Inderal)! carvedilol (Coreg)! bisoprolol (Uebeta)! acebutolol (0ectral)! atenolol ( enormin)! labetalol (Jormodyne! randate)! metoprolol (;opressor! oprol?P;)! and esmolol (9revibloc). 1 nasal spray form of propranolol appears to be very helpful in reducing e2ercise?induced angina attacks.

Side .))ects. 9eta?blocker side effects include fatigue! lethargy! vivid dreams and nightmares! depression! memory loss! and diHHiness. hey can lower HD; (SgoodT) cholesterol. 9eta blockers are categoriHed as non?selective or selective. Jon?selective beta blockers! such as carvedilol and propranolol! can narrow bronchial airways. hese beta?blockers should not be used by patients with asthma! emphysema! or chronic bronchitis. 81 I3J 0 0H=&;D J3R3" 19"&8 ;. 0 =8 1'IJQ H303 D"&Q0. he sudden withdrawal of beta?blockers can rapidly increase heart rate and blood pressure. he doctor may advise a patient to slowly decrease the dose before stopping completely. Angiotensin onverting 1n4yme *A 1+ Inhi'itors

1ngiotensin converting enHyme (1C3) inhibitors are important heart?protective drugs! particularly for people with diabetes and high blood pressure. hey reduce the production of angiotensin! a chemical that causes arteries to narrow! and so are commonly used to lower blood pressure. hey may also reduce risk for heart attack! stroke! complications of diabetes! and death in patients at high risk for heart disease. 1C3 inhibitors are indicated for/ 8atients with coronary artery disease who also have diabetes or who have left ventricular dysfunction (when the heart+s main chamber does not pump as well as it should). here is good evidence to prescribe these medications for most patients with coronary artery disease or any other vascular diseases! such as peripheral vascular disease.

1C3 inhibitors include captopril (Capoten)! ramipril (1ltace)! enalapril (Rasotec)! Guinapril (1ccupril)! benaHepril (;otensin)! perindopril (1ceon)! and lisinopril (8rinivil! Uestril). Side .))ects. 0ide effects of 1C3 inhibitors are uncommon but may include an irritating cough! e2cessive drops in blood pressure! and allergic reactions. In the past! doctors sometimes avoided giving aspirin to patients who were taking 1C3 inhibitors because the combination was believed to cause kidney problems. 9ut! a $44) study of patients with both coronary artery disease and heart failure found that taking aspirin and 1C3 inhibitor together is safe. he researchers also noted that taking aspirin with an 1C3 inhibitor can significantly reduce the risk of death for older patients with C1D and heart failure. L*or more information! see In-Depth Report MF5/ High blood pressure.N 0itrates Jitrates have been used in the treatment of angina for over F44 years. hese drugs release nitric o2ide! thereby rela2ing the smooth muscles in blood vessels. hese medications are used primarily for control of angina symptoms. <any nitrate preparations are available. he most commonly used are nitroglycerin! isosorbide dinitrate! and isosorbide mononitrate. Jitrates can be absorbed from the gastrointestinal tract (oral tablet)! skin (ointment or patch)! or from under the tongue (sublingual tablet or spray).

Rapid Acting /itrates. "apid?acting nitrates are used to treat acute attacks. Jitroglycerin is the most widely used drug for this purpose. It can be administered under the tongue (sublingually or as a spray) or pocketed between the upper lip and gum (buccally) and can relieve angina within minutes. he procedure for taking nitroglycerin during an attack is as follows/ 1t the onset of an angina attack! the patient administers one sublingual or buccal tablet or one metered dose of the spray. If the pain is not relieved within ) minutes the patient takes a second doseD a third can be taken after another ) minutes if symptoms persist. If pain continues after a total of three doses in F) minutes! the patient should go immediately to the nearest emergency room.

Jitroglycerin is very volatile so its potency can be easily lost. 8atients should take the following precautions/ 'eep no more than F44 tablets on hand! stored in their original container. ,hen first opened! the cotton filler should be discarded! and the cap screwed on tightly immediately after each use. 1 supply should always be kept close at hand in case of an attack! with the rest kept in a cool dry place.

Intermediate to Long-Term /itrates. 0ublingual tablets of isosorbide dinitrate have a somewhat slower onset of action than nitroglycerin and are useful for preventing e2ercise angina. =intments! patches! and oral tablets are used for longer?term prevention of angina attacks/ ransdermal patches are applied in the morning to any hair? or in#ury?free area on the chest! back! stomach! thigh! or upper arm. Hands should be washed after each patch or ointment application! and sites of application should be rotated to avoid skin irritation.

Jitroglycerin ointment is applied by measuring out an even amount on an applicator paper and then placing! not rubbing or massaging! it on the chest! stomach! or thigh. 1ny ointment that remains from the previous application should be removed.

;ong?acting forms may lose their effectiveness over time! so doctors generally schedule nitrate?free breaks to prevent tolerance. 0ome concern e2ists that nitrate?free periods might increase the risk for angina and adverse heart events. =ne large study! however! found no increased danger when patients used a nitroglycerine patch with scheduled breaks. he use of high blood pressure drugs known as 1C3 inhibitors may help prevent tolerance to nitrates. Side .))ects. Jitrates have many side effects! some of which can be serious. Common side effects of nitrates include headaches! diHHiness! nausea and vomiting! blurred vision! fast heartbeat! sweating! and flushing on the face and neck. ;ow blood pressure and diHHiness can be relieved by lying down with the legs elevated. hese effects are significantly worsened by alcohol! beta? blockers! calcium channel blockers! sildenafil (Riagra)! and certain antidepressants. he doctor may prescribe medicines to lessen these side effects. 8atients should contact their doctor if these side effects are persistent or severe. 0erious side effects reGuiring immediate medical help include fever! #oint or chest pain! sore throat! skin rash (especially on the face)! unusual bleeding or bruising! weight gain! and swelling of the ankles. 0ithdra&al. ,ithdrawal from nitrates should be gradual. 1brupt termination may cause angina attacks. alcium hannel Bloc%ers * Bs+

Calcium channel blockers reduce heart rate and slightly dilate the blood vessels of the heart! thereby decreasing o2ygen demand and increasing o2ygen supply. hey also reduce blood pressure. CC9s vary chemically! however! and although some are helpful! others may even be dangerous for certain patients with angina. ;ong?acting nifedipine (1dalat! 8rocardia) and nisoldipine (0ular) and newer CC9s! such as amlodipine (Jorvasc) and nicardipine (Cardene)! may be beneficial for some patients with angina. hey can be considered alone for patients who cannot tolerate beta?blockers! but may provide the best results when used in combination with a beta?blocker. 0tudies suggest that they reduce the need for repeat angioplasties. heir effects on other outcomes! including mortality rates and heart attack! are less clear. 0hort?acting CC9s! including short?acting forms of verapamil! diltiaHem! nifedipine! and nicardipine! are helpful for many patients with 8rinHmetal+s angina. However! short?acting forms of certain CC9s! such as nifedipine and nisoldipine! have been associated with severe and even dangerous side effects! including an increase in heart attacks and sudden death in some patients with unstable angina. hey also increase the risk for adverse effects in patients with stable angina. 0hort?acting CC9s are! therefore! not used for stable or unstable angina.

here is no strong evidence that any calcium channel blockers improve survival rates. =verdose can cause dangerously low blood pressure and slow heart beats. 8atients with heart failure have a higher risk for death with these drugs and should not take them. Jo one taking any calcium channel blocker should withdraw abruptly because such action could dangerously increase the risk of high blood pressure. Jote/ Qrapefruit and 0eville oranges boost the effects of CC9s! sometimes to to2ic levels. ("egular oranges do not appear to pose any haHard.)

.ther Drugs "anolaHine ("ane2a) was approved in $44% for treatment of chronic angina. It is recommended for patients who have not responded to other angina drugs. "anolaHine is taken in combination with amlodipine! beta?blockers! or nitrates. he drug appears to work better in men than in women 1)perimental Drugs 1ene Therapy and Angiogenesis. 8roteins known as growth factors are being investigated for their ability to grow new blood vessels for supplying o2ygen to the heart. 1fter promising small trials! two large studies of genetically engineered forms of vascular endothelial growth factor (R3Q*) and fibroblast growth factor L*Q* (QenerP)N failed to detect any benefits. 0tudies on therapies that actually genetically encode these proteins are underway. .utloo% *#rognosis+ 3veryone recovers differently. 0ome people can maintain a healthy life by changing their diet! stopping smoking! and taking medications e2actly as the doctor prescribes. =thers may need medical procedures such as angioplasty or surgery. 1lthough everyone is different! early detection of CHD generally results in a better outcome. #ossi'le omplications

Heart attack Heart failure &nstable angina 0udden death

When to ontact a (edical #ro"essional If you have any of the risk factors for CHD! set up an appointment with your doctor to discuss prevention and possible treatment. If you have angina! shortness of breath! or symptoms of a heart attack! immediately contact your health care provider! call the local emergency number (such as OFF)! or go to the emergency room. 0ee your health care provider regularly. ips for preventing CHD or lowering your risk of the disease/ 1void or reduce stress as best as you can. Don+t smoke. 3at well?balanced meals that are low in fat and cholesterol and include several daily servings of fruits and vegetables. Qet regular e2ercise. If your weight is considered normal! get at least >4 minutes of e2ercise every day. If you are overweight or obese! e2perts say you should get %4 to O4 minutes of e2ercise every day. 'eep your blood pressure! blood sugar! and cholesterol under control.

<oderate amounts of alcohol (F glass a day for women! $ for men) may reduce your risk of cardiovascular problems. However! drinking larger amounts does more harm than good. If you have one or more risk factors for coronary heart disease! talk to your doctor about possibly taking an aspirin a day to help prevent a heart attack or stroke. ;ow?dose aspirin therapy may be prescribed if the benefit is likely to outweigh the risk of gastrointestinal side effects. Jew guidelines no longer recommend hormone replacement therapy! vitamins 3 or C! antio2idants! or folic acid to prevent heart disease. #revention Heart disease prevention is considered important before and after someone is diagnosed with heart disease. 8rimary prevention refers to measures that should be done to reduce the risk of heart disease in everyone. 0econdary prevention refers to measures to reduce the risk of progression of heart disease in a patient who has already been diagnosed. <any of these measures are similar or the same as those recommended for primary prevention. 'ey prevention measures include/ 1ll patients should stop smoking <aintaining cholesterol levels at appropriate levels using a heart healthy diet! e2ercise! and medications <aintaining an appropriate low blood pressure level <aintaining an active lifestyle 1ntiplatelet drugs <anagement of diabetes and kidney disease when present

Smo%ing essation .our doctor should ask about your smoking habits at every visit. 0moking is a chronic condition and often reGuires repeat therapy using more than one techniGue. holesterol and .ther Lipid Disorders 1ll patients should start following a heart?healthy diet and e2ercise regularly! after talking to their doctors. *or patients without heart disease! the doctor will start or consider medication! increase dosage of medication! or add new medication when/ ;D; cholesterol is FO4 mg:d; or higher. ;D; cholesterol is F%4 mg:d; or higher 1JD patient has one risk factor for heart disease. ;D; cholesterol is F>4 mg:d; or higher 1JD patient has either diabetes or two other risk factors for heart disease. ;D; cholesterol is F44 mg:d; or higher 1JD patient has diabetes. 3ven without heart disease! medication may be considered for an ;D; cholesterol of F44 mg:d;.

*or patients with heart disease! the doctor will start or consider medication! increase dosage of medication! or add new medication when/ ;D; cholesterol is F44 mg:d; or higher ;D; cholesterol is greater than (4 mg:d;. 1ccording to national guidelines! treating a patient with ;D; cholesterol levels between (4 ? F44 mg:d; is not reGuired but is considered reasonable. his would be true particularly for patients who have had a recent heart attack or have known heart disease along with diabetes! current cigarette smoking! poorly controlled high blood pressure! or metabolic syndrome (high triglycerides! low HD;! and obesity).

0tatins are the most important of the cholesterol?lowering drugs. 9rands include lovastatin (<evacor)! pravastatin (8ravachol)! simvastatin (Uocor)! fluvastatin (;escol)! atorvastatin (;ipitor)! and rosuvastatin (Crestor). 1 ma#or analysis of over $44 studies found that statins reduced the risk for heart problems by %46 and stroke by F(6. (anage !igh Blood #ressure 2eep 'lood ressure Lo& . 8eople in normal health should have a blood pressure reading of F$4:A4 mm Hg or less. 1ccording to the latest guidelines! blood pressure readings of F$4:A4 are considered normal! readings of F54:O4 or higher indicate hypertension! and readings in between the two are called pre? hypertension. 8atients with diabetes or chronic kidney disease should maintain blood pressure readings of F>4:A4 mm Hg or less! while others should be no higher than F54:O4 mm Hg. Depending on blood pressure levels and presence of either risk factors for heart disease or known coronary artery disease! patients may be recommended to try lifestyle changes first or to immediately begin medications. 0everal of the medications used to treat coronary artery disease also reduces blood pressure. The 5ight Against oronary !eart Disease 9y 1ndrew 9icknell

Coronary heart disease is the leading cause of death among all the ma#or diseases. In the &nited 0tates >% percent of the people who die do so because of some form of heart or cardiovascular disease. his number is simply staggering and points to the importance of controlling and preventing the suffering that heart disease brings. he good news is that the ma#ority of people can successfully prevent or reverse the effects of this deadly disease with some rather simple lifestyle changes. he first change that anyone with heart disease must make is dietary. oday+s fast food and processed meal in a bo2 are some of the worst choices anyone can make when it comes to the health of their cardiovascular system. 9y avoiding saturated and trans?fat that are found in fried foods and some red meats we can significantly reduce the risk posed by coronary heart disease. 9oth these types of fat cause ;D; cholesterol (the bad cholesterol) to increase in the blood stream. his can lead to a build up of plaGue which hardens and narrows the arteries leading to a heart attack or stroke. 1 diet high in fiber and low in fat is the way to go in preventing heart disease. *ruits! vegetables! low fat products! and whole grains cannot only prevent heart disease it can also reverse the effects of this dangerous condition. he second lifestyle change that needs to be made to fight the effects of coronary heart disease is e2ercise. It doesn+t have to be a drastic undertaking. It can be something as simple as taking a walk everyday or using the stairs instead of the elevator. he point is to gradually build up your cardiovascular strength and add to it as you get stronger.

If you smoke then you need to Guit. here is nothing that increases the risk of coronary heart disease Guite like smoking. 3very year more than F>)! 444 people in the &nited 0tates die from heart disease that is caused or e2acerbated by the use of tobacco. he risk of death from this disease increases two to three times with the continued use of cigarettes. here are also certain medical treatments and procedures that are effective in the fight against coronary heart disease. here are a number of medications that help reduce blood pressure or lower levels of ;D; cholesterol! but like any drug there are also side affects to using them. 0urgery is also an option when the disease has reached the life threatening stage but for most people living a healthy lifestyle will prevent them from ever having to see an operating room. 1voiding the type of lifestyle that leads to coronary heart disease can help millions of people live long and healthy lives without the fear that they may fall victim to this deadly disease. 1ndrew 9icknell is a writer who researches a wide range of sub#ects. o learn more about coronary heart disease please visit his website Heart Disease by clicking here. Source/ 14ine Disease9id:;<=<=; 6rticles http/77e4inearticles8com7?The35ight3Against3 oronary3!eart3