Coronary Artery Disease

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Coronary Artery Disease

 

Atherosclerosis is the main cause of CAD.

 

Normally, the coronary arteries carry oxygen-enriched blood to the

heart. In coronary artery disease, fatty deposits or plaque

accumulate along the walls of the coronary arteries, obstructing the

flow of blood. This inadequate blood supply deprives the heart muscle

of oxygen and damages the heart tissue. On average, men develop it

about 10 years earlier than women, because until menopause, women are

protected from the disease by high levels of estrogen. However, after

menopause, the disease becomes more common among women. Among people

aged 75 and older, a higher proportion of women have the disease,

because women live longer.

 

 

Risk factors include:

 

High cholesterol, smoking, genetic pre-disposition, obesity, a

sedentary lifestyle, hypertension, alcoholism, diabetes mellitus,

hypothyroidism

 

Certain disorders increase the risk of coronary artery disease. They

include high levels of the amino acid homocysteine in the blood

(hyperhomocysteinemia), diabetes, and low levels of thyroid hormones

(hypothyroidism). Diabetes greatly increases the risk. Many people

with diabetes have high blood pressure, have high cholesterol levels,

are obese, and tend to be physically inactive. The cause of death in

more than 80% of people with diabetes is a heart or blood vessel

disorder.

 

Whether infection with certain organisms contributes to the

development of coronary artery disease is uncertain. The organisms

suspected include Chlamydia pneumoniae (which can cause pneumonia),

Helicobacter pylori (which can contribute to stomach ulcers), and a

virus (as yet unidentified). Nonetheless, inflammation, whether

caused by infection or not, appears to contribute to the development

of coronary artery disease. If an atheroma becomes inflamed, it

softens and is more likely to rupture, and blood clots are more

likely to form.

 

 

Prevention includes:

 

Diet

 

Dietary control over high fat, high cholesterol and high saturated

fat intake.

 

Diet should include phytochemicals (5-7 servings of fruits and

vegetables daily), 30grams of fiber, flavinoids (found in red and

purple grapes, red wine and black tea ) vitamins, C, E, B12 and Folic

acid. A diet high in fish oils (omega-3 polyunsaturated fatty acids)

decreases risk.

 

Limiting the amount of fat to no more than 25 to 35% of daily

calories is recommended to promote good health. However, some experts

believe that fat must be limited to 10% of daily calories to reduce

the risk of coronary artery disease. A low-fat diet also helps lower

high total and LDL (the bad) cholesterol levels, another risk factor

for coronary artery disease.

 

The type of fat consumed is important. There are three types:

saturated, monounsaturated, and polyunsaturated. Saturated fats are

found in meats, non-skim dairy products, and artificially

hydrogenated vegetable oils. The more solid the product, the higher

the proportion of saturated fats. Monounsaturated fats are found in

olive oil and canola oil. Polyunsaturated fats include omega-3 fats,

contained in deep-sea fatty fish (such as mackerel, salmon, and

tuna), and omega-6 fats, contained in vegetable oils. The ideal

combination of types of fats is unknown. However, a diet high in

saturated fats is known to promote coronary artery disease, and a

diet high in monounsaturated or omega-3 fats is less likely to do so.

Thus, eating fish regularly is recommended.

 

A high-fiber diet is also recommended. There are two kinds of fiber.

Soluble fiber (which dissolves in liquid) is found in oat bran,

oatmeal, beans, peas, rice bran, barley, citrus fruits, strawberries,

and apple pulp. It helps lower high cholesterol levels. It may

decrease or stabilize high blood sugar levels and increase low

insulin levels. Thus, soluble fiber may help people with diabetes

reduce their risk of coronary artery disease. Insoluble fiber (which

does not dissolve in liquid) is found in most grains and grain

products and in fruits and vegetables such as apple skin, cabbage,

beets, carrots, brussels sprouts, turnips, and cauliflower. It helps

with digestive function. However, eating too much fiber can interfere

with the absorption of certain vitamins and minerals.

Eating soy products, such as tofu and tempeh, also seems to reduce

the risk of coronary artery disease.

 

 

Exercise

 

Exercise should include cardiovascular aerobic activity 3- 4 times

weekly. Weight baring exercise for 30 minutes to strengthen and

maintain bone and muscle mass.

 

Exercise that promotes endurance (aerobic exercise such as brisk

walking, bicycling, and jogging) or muscle strength (resistance

training with free weights or weight machines) helps prevent coronary

artery disease. People who are out of shape or who have not exercised

in a long time should consult their doctor before they start an

exercise program.

 

 

Pathophysiology of the Disease

 

Coronary artery disease is due to atherosclerosis that develops in

the arteries that encircle the heart and supply it with blood--the

coronary arteries and their branches. As the atheromas grow, they

bulge into the arteries, narrowing the interior (lumen) of the

arteries and partially blocking blood flow. With time, calcium

accumulates in the atheromas. An atheroma may rupture. Blood may

enter a ruptured atheroma, making it larger, so that it narrows the

artery even more. The rupture of an atheroma triggers the formation

of a blood clot (thrombus). The clot may further narrow or even block

the artery, or the clot may detach (becoming an embolus) and block

another artery further downstream.

 

As an atheroma blocks more and more of a coronary artery, the supply

of oxygen-rich blood to the heart muscle (myocardium) can become

inadequate. An inadequate blood supply to the heart muscle is called

myocardial ischemia. If the heart does not receive enough blood, it

can no longer contract and pump blood normally. If an atheroma blocks

an artery completely, the area of the heart muscle supplied by the

artery dies, and a heart attack results. Coronary artery disease is

the most common cause of myocardial ischemia. The major complications

of coronary artery disease are chest pain due to myocardial ischemia

(angina) and heart attack (myocardial infarction).

Sign and Symptoms

 

Heart disease can present with:

#1 sign of Dyspnea

#2 is Angina (angina pectoris) aka: chest pain

as well as: pain, arrhythmias, orthopnea, weakness, fatigue

 

 

Andrew Pacholyk LMT, MT-BC, CA

Peacefulmind.com

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