Coronary Disease

Coronary heart disease is the term commonly used to describe the accumulation of fat deposits of fibrous tissue (plaques) inside the arteries that supply blood to the heart, or coronary arteries. This buildup of plaque in coronary arteries is called coronary atherosclerosis and may lead to these blood vessels become significantly narrower. Consequently, there is a decrease in the blood supply to certain areas of the heart muscle, which triggers a type of chest pain called angina pectoris. Atherosclerosis may also lead to the formation of a blood clot in a coronary artery narrowed. This event is responsible for the occurrence of a heart attack, which can cause significant injury to the heart muscle.

Factors that increase the risk of developing coronary heart disease are basically the same that increase the risk of developing atherosclerosis:

• High level of blood cholesterol

• High level of LDL cholesterol, commonly called "bad cholesterol"

• Low level of HDL cholesterol, commonly called "good cholesterol"

• High blood pressure (hypertension)

• Diabetes

• Family history of coronary heart disease at an early age

• Smoking

• Obesity

• Physical inactivity (sedentary lives with very little practice regular exercise)

Diseases of the circulatory system, usually associated with coronary heart disease are the leading cause of death in Portugal, accounting for about one third of the deaths in our country. An earlier stage of life, men have a higher risk of coronary heart disease than women. However, after menopause women's risk turns out to match the man.

Prevention

The patient may help prevent coronary heart disease to control their risk factors for atherosclerosis. For this purpose, the patient must:

• Quitting smoking.

• Eat a healthy diet.

• Reduce elevated LDL cholesterol ("bad cholesterol").

• Reduce high blood pressure.

• Lose weight and workout to prevent diabetes.

Treatment

Coronary heart disease is caused by atherosclerosis treated with:

• Changes in lifestyle. These include losing weight when patients are obese, quitting smoking, dieting and taking drugs to lower high cholesterol, exercise regularly practice and perform stress reduction techniques (meditation, biofeedback, etc..).

• nitrates (including nitroglycerin). These drugs widen blood vessels (are vasodilators) by dilating the coronary arteries to increase blood flow to the heart muscle. These drugs also dilated veins of the body, which reduces the workload of the heart by temporarily reducing the volume of blood returning to the heart to be pumped.

• Beta-blockers such as atenolol and metoprolol. These drugs reduce the workload on the heart by reducing the heart rate and force of heart muscle contractions, especially during exercise. People who have had a heart attack should continue to take a beta-blocker for the remainder of life to reduce the risk of a second heart attack.

• Aspirin. Aspirin helps prevent the formation of blood clots within the narrowed coronary arteries, which can reduce the risk of a heart attack in people already suffering from coronary heart disease. Doctors often advise people with more than 50 years to take a low dose of aspirin every day to help prevent a heart attack.

• Medicines to lower cholesterol. Statins - as lovastatin, simvastatin, pravastatin and atorvastatin - had a major impact on improving the risk of heart attack and death in people with coronary heart disease or at risk for its development. Statins reduce LDL cholesterol and may increase HDL cholesterol slightly. Regularly taking a statin also helps to prevent the plates suffer breakage or fragment, which decreases the probability of a worsening of heart attack or angina pectoris. Niacin lowers LDL cholesterol, increases HDL cholesterol, and also lowers triglyceride levels. The drugs called fibrates such as gemfibrozil are used mainly by people with high triglycerides. The ezetimibe acts in the gut, reducing the absorption of cholesterol from food.

• calcium channel blockers such as nifedipine long acting, verapamil, amlodipine and diltiazem. These medications can help reduce the frequency of chest pain in patients with angina.

If stable angina constitute a limitation for the patient's physical point of view because of chest pain, the doctor will probably advise you to perform a coronary angiography (cardiac catheterization) to check if there are significant blockages. A specialist in diseases of the heart (cardiologist) may also carry out such examination to diagnose coronary heart disease when other tests are inconclusive, in an emergency when a person is having a heart attack and in some people with newly diagnosed congestive heart failure.

When one or more are encountered significant obstruction, the cardiologist will determine whether this (s) (s) can be eliminated (s) through a procedure called balloon angioplasty, also called percutaneous transluminal coronary angioplasty or PTCA. In balloon angioplasty catheter is inserted into an artery in the groin or forearm, and then, it is introduced through the circulatory system to the blocked coronary artery. Once inside the coronary artery, a small balloon situated at the catheter tip is briefly inflated to open the narrowed blood vessel. Usually, the inflation balloon is followed by placement of a stent, a wire mesh that expands with the balloon and remains within the artery to hold it open. The balloon is then deflated and the catheter is removed.

If the obstruction can not be removed by balloon angioplasty, the cardiologist will probably suggest doing pontagem coronary surgery (also known as "coronary bypass"). This surgical procedure involves the grafting of one or more blood vessels in the coronary arteries to make a deviation (bypass) in the areas of blood narrowed or clogged. The blood vessels to be grafted can be withdrawn from an artery located within the thoracic cavity of an artery of an arm or leg vein long.

The objective of treating heart attack or angina sudden deterioration is rapid restoration of blood flow in the section of the heart muscle no longer be properly irrigated. Patients receive medications to immediately relieve pain, as well as a beta-blocker to reduce the heart rate and reducing the work of the heart and aspirin in combination with other medicines for dissolving or inhibiting formation of blood clots. Whenever possible, patients are transferred to a cardiac catheterization unit to carry out an immediate angiography and balloon angioplasty in the most significant obstruction. In some people with coronary heart disease, other symptoms or complications will require additional therapeutic treatment. For example, medication may be required to treat cardiac arrhythmias (abnormal heart rhythms) a low blood pressure or heart failure.