Coronary heart disease (CHD) sometimes called ischemic heart disease is the leading cause of death in India and worldwide killing about 1 in 5 men and 1 in 8 women. It is caused by blockage in heart's blood supply by a build-up of fatty substances in the arteries. It is primarily a disease caused by lifestyle habits and conditions such as smoking, overweight, high cholesterol, high blood pressure and diabetes. The risk is more if there is a family history of CHD and there is a male relative with CHD under 55 or a female relative under 65.
Not every CHD patient has the same symptoms and angina chest pain as its most common feature. Symptoms may vary from nil to severe. Some have just a mild, uncomfortable feeling similar to indigestion, others may experience a painful feeling of heaviness or tightness, usually in the centre of the chest, which may spread to the arms, neck, jaw, back or stomach, palpitation and unusual breathlessness.
If arteries become completely blocked, it can cause a heart attack that can cause permanent damage to the heart muscle. The discomfort or pain of a heart attack is usually similar to that of angina, but is often more severe and may be associated with sweating, lightheadedness, nausea and breathlessness. Unlike angina, the symptoms of a heart attack are not usually relieved using a nitrate tablet or spray. In some cases a heart attack may be without any symptoms and it is called a silent myocardial infarction. This is more common in people with diabetes. Heart attack if not treated straight away can be fatal.
Advance Prognosis
Now a "3D map" for early detection of coronary artery disease is possible with Cardio-vascular Cartography (CCG). This non-invasive procedure using electrodes and a highly sensitive transducer to record the patient's complete cardiac and circulatory status in less than 10 minutes. Such data was earlier not possible through non-invasive methods. The record obtained includes decreased blood flow to different parts of the heart.
Assessment of a suspected CHD patient involves the medical and family history, assessing the lifestyle and taking blood tests. Further tests to confirm a diagnosis of CHD includes non-invasive tests like an electrocardiogram (ECG) to identify the structure, thickness and movement of each heart valve, X-ray to look at the heart, lungs and chest wall to rule out any other conditions that may be causing symptoms, Treadmill test (TMT) during exercise to know the effect of exercise on the heart, Cardiovascular cartography heart flow mapping, CT angiography and the invasive coronary angiography to identify whether the coronary arteries are narrowed and how severe any blockages are.
Similarly some of the other test list includes Radionuclide test, commonly known as Stress Thallium, a small amount of a radioactive isotope substance is injected into the blood. A camera picks up the radiation transmitted by the isotope as it passes through the heart to show the flow of blood to the heart muscle. Exercise or medication is used to increase the heart rate during the test. Heart imaging is also possible with Magnetic resonance testing (MRI) and Computerized tomography (CT) scan.
Management of Disease
Although coronary heart disease cannot be cured, but treatment can help manage the symptoms, improve the functioning of the heart and reduce the chances of problems such as heart attacks. Effective management includes a combination of lifestyle changes, medicines and non-invasive treatments. Invasive and surgical treatments are required in more severe cases. In most cases it is possible to eventually resume normal life. Some simple lifestyle changes include eating a healthy balanced diet, being physically active, doing regular exercise, no smoking and controlling blood cholesterol and sugar levels. These can reduce the risk of CHD, stroke and dementia and also have other health benefits.
Many different medicines are used to treat CHD. Cholesterol, high blood pressure and diabetes can usually be well controlled with medicines. Other medicines aim to slow down the heartbeat, thinning the blood and preventing it from clotting and widening the arteries. Some of these medicines can cause side effects such as headaches, dizziness and flushed skin, weakness, body-aches, and affect the memory and sexual drive. When taking any medicine for a prolonged period, therefore it is advised to have periodic blood tests especially for kidney and liver function.
The Way Out Without Surgery
Sometimes Bypass surgery and angioplasty are not successful, there may be recurrence after bypass, patient may not be fit for surgery or the patient may prefer to avoid surgery for cultural or personal choice. Now non-invasive treatments such as External Counter Pulsation (ECP) and Artery Clearance Therapy (ACT) are options for these patients without the fear and trauma of surgery and are coming up as post bypass rehabilitation support.
ACT consists of Chelation Therapy, antioxidants, nutrients, life style and stress management. Chelation Therapy protocol has been standardized by the American College for Advancement of Medicine (USA). It removes calcium from blood vessel walls and the deposits without operation with drip medication. ACT is available in USA, England, and Australia etc. and also in India. ECP is US-FDA approved mechanical process without pushing wires, stents, etc into the body. ECP dilates blood vessels and enable body to grow new blood vessels much like bypass and stem cell therapy. Most patients can walk longer distance and faster, have fewer episodes of pain chest, need less medication after ACT and ECP.
All said and done prevention is better than cure and life style modification remains the cornerstone to prevent and control heart disease and should be adopted as early as possible.
