Coronary heart diseases and cardiovascular diseases have come into the spotlight due to the recent boom in non-communicable diseases, in the world. The world health organization (WHO) has prioritized prevention and control of these non-communicable diseases in their health care strategies. Ischemic heart diseases, diabetes, hypertension, and chronic lung diseases are the four most devastating non-communicable diseases in the world today. Ischemic heart disease and coronary heart disease are the same. The term “cardiovascular diseases” covers a broad spectrum of heart and blood vessel related diseases. Thus, coronary heart disease is a type of cardiovascular diseases.
Cardiovascular Disease (CVD)
Cardiovascular diseases can be broadly classified into heart diseases and blood vessel related diseases. Heart diseases may be due to poor blood supply (Ex: ischemic heart disease), abnormal electrical activity (Ex: arrhythmias), abnormal heart muscle function (Ex: cardiomyopathies) and structural defects (Ex: Valve disease and septal defects). Heart diseases may be present since birth (Congenital) or develop later (acquired). Heart disease may be sudden (acute) or long standing (chronic). Blood vessel may get thickened with age, blocked due to atheromatous plaque formation (Ex: peripheral vascular disease) and inflammation (Ex: vasculitis). There are many disease mechanisms which damage the heart structurally or functionally.
Coronary Heart Disease (CHD)
Coronary heart disease is a specific type of heart disease due to poor blood supply to the heart muscle through the coronary arteries. There are two main coronary arteries which branch off from the ascending aorta just after it exits the heart. They are the left and the right coronary arteries. The left coronary artery immediately divides into two branches; the circumflex and the anterior descending. Clinically, these two branches are considered as separate arteries; thus, the name triple vessel disease (when all three arteries have blocks in them). Like all arteries, coronary arteries get narrowed with age. The vessel wall thickens and loses the elasticity that they once had. Smoking, alcohol, and other toxins (but mainly smoking) damage the inner lining of the blood vessels (the endothelium) and trigger the process of plaque formation. High serum cholesterol levels and diabetes significantly increase the risk of plaque formation. Once a plaque forms, the blood supply to the area supplied by the artery reduces. This causes severe, tightening type chest pain behind the sternum with difficulty in breathing and sweating. This is called angina and, in a major heart attack, it can be lasting for more than 20 minutes.
This types of chest pain need hospital admission, urgent ECG, and if a heart attack is there, urgent treatment. Aspirin, clopidogrel, and statins are the first set of drugs used. According to the ECG finding the doctors may classify the heart attack as NSTEMI or STEMI. STEMI is more serious than a NSTEMI, and it needs thrombolysis. Thrombolysis is a dangerous procedure where certain drugs are given to dissolve the clots blocking the arteries. NSTEMI needs heparinization only. Once the immediate management is over, beta blockers (if there is no heart failure), ACE inhibitors, aspirin, clopidogrel, statins are started. Antihypertensive drugs are indicated if the blood pressure is high.
Coronary heart disease is a condition with deadly complications. Cardiac arrest, cardiogenic shock, arrhythmias, heart failure, cardiomyopathies, myocarditis, endocarditis, pericarditis, valve disorders, septal defects, myocardial rupture, cardiac tamponade, post infarction malignant arrhythmias, and ventricular aneurysms are possible complications.
Cardiovascular diseases are a broad group of diseases which includes coronary heart diseases.
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