Coronary Heart Disease And Diet Management

Coronary Heart Disease

Coronary artery disease develops when the major blood vessels that supply your heart with blood, oxygen and nutrients (coronary arteries) become damaged or diseased. Cholesterol-containing deposits (plaque) in your arteries and inflammation are usually to blame for coronary artery disease.

Symptoms

If your coronary arteries narrow, they can't supply enough oxygen-rich blood to your heart — especially when it's beating hard, such as during exercise. At first, the decreased blood flow may not cause any coronary artery disease symptoms. As plaque continues to build up in your coronary arteries, however, you may develop coronary artery disease signs and symptoms, including:

1. Chest pain (angina). You may feel pressure or tightness in your chest, as if someone were standing on your chest. This pain, referred to as angina, usually occurs on the middle or left side of the chest. Angina is generally triggered by physical or emotional stress.

The pain usually goes away within minutes after stopping the stressful activity. In some people, especially women, this pain may be fleeting or sharp and felt in the neck, arm or back.

2. Shortness of breath. If your heart can't pump enough blood to meet your body's needs, you may develop shortness of breath or extreme fatigue with exertion.
3. Heart attack. A completely blocked coronary artery will cause a heart attack. The classic signs and symptoms of a heart attack include crushing pressure in your chest and pain in your shoulder or arm, sometimes with shortness of breath and sweating.

Women are somewhat more likely than men are to experience less typical signs and symptoms of a heart attack, such as neck or jaw pain. Sometimes a heart attack occurs without any apparent signs or symptoms.

 

Causes

Coronary artery disease is thought to begin with damage or injury to the inner layer of a coronary artery, sometimes as early as childhood. The damage may be caused by various factors, including:

• Smoking
• High blood pressure
• High cholesterol
• Diabetes or insulin resistance
• Sedentary lifestyle

Once the inner wall of an artery is damaged, fatty deposits (plaque) made of cholesterol and other cellular waste products tend to accumulate at the site of injury in a process called atherosclerosis. If the surface of the plaque breaks or ruptures, blood cells called platelets will clump at the site to try to repair the artery. This clump can block the artery, leading to a heart attack.

        

Diagnosis

The doctor will ask questions about your medical history, do a physical exam and order routine blood tests. He or she may suggest one or more diagnostic tests as well, including:

• Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack or one that's in progress.

In other cases, Holter monitoring may be recommended. With this type of ECG, you wear a portable monitor for 24 hours as you go about your normal activities. Certain abnormalities may indicate inadequate blood flow to your heart.

• Echocardiogram. An echocardiogram uses sound waves to produce images of your heart. During an echocardiogram, your doctor can determine whether all parts of the heart wall are contributing normally to your heart's pumping activity.

Parts that move weakly may have been damaged during a heart attack or be receiving too little oxygen. This may indicate coronary artery disease or various other conditions.

• Stress test. If your signs and symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG. This is known as an exercise stress test. In some cases, medication to stimulate your heart may be used instead of exercise.

Some stress tests are done using an echocardiogram. For example, your doctor may do an ultrasound before and after you exercise on a treadmill or bike. Or your doctor may use medication to stimulate your heart during an echocardiogram.

Doctors may also use medications to stimulate your heart during an MRI. Doctors may use this imaging test to evaluate you for coronary artery disease.

Another stress test known as a nuclear stress test helps measure blood flow to your heart muscle at rest and during stress. It's similar to a routine exercise stress test but with images in addition to an ECG. A tracer is injected into your bloodstream, and special cameras can detect areas in your heart that receive less blood flow.

• Cardiac catheterization and angiogram. To view blood flow through your heart, your doctor may inject a special dye into your coronary arteries. This is known as an angiogram. The dye is injected into the arteries of the heart through a long, thin, flexible tube (catheter) that is threaded through an artery, usually in the leg, to the arteries in the heart.

This procedure is called cardiac catheterization. The dye outlines narrow spots and blockages on the X-ray images. If you have a blockage that requires treatment, a balloon can be pushed through the catheter and inflated to improve the blood flow in your coronary arteries. A mesh tube (stent) may then be used to keep the dilated artery open.

• Heart scan. Computerized tomography (CT) technologies can help your doctor see calcium deposits in your arteries that can narrow the arteries. If a substantial amount of calcium is discovered, coronary artery disease may be likely.

A CT coronary angiogram, in which you receive a contrast dye injected intravenously during a CT scan, also can generate images of your heart arteries.

Diet indications

Diet is an important risk factor in coronary heart disease. Food-related risk factors include obesity, high blood pressure, uncontrolled diabetes and a diet high in saturated fats.

A low-saturated fat, high-fibre, high plant food diet can substantially reduce the risk of developing heart disease.

Fats can wreak havoc on our bodies and contribute to weight gain if we eat too much. Although we need fats in our diet, many of us are unaware of how to maintain a healthy weight because we’re not consuming the right amount and types of fat. Cutting down on fat is not as hard as we think, and it doesn’t necessarily mean we have to give up our favourite foods. Get started with these simple tips.

Limiting how much saturated and trans fats you eat is an important step to reduce your blood cholesterol and lower your risk of coronary artery disease.

Eat a healthy, balanced diet

A low-fat, high-fibre diet is recommended, which should include plenty of fresh fruit and vegetables (five portions a day) and whole grains.

You should limit the amount of salt you eat to no more than 6g (0.2oz) a day as too much salt will increase your blood pressure. 6g of salt is about one teaspoonful.

There are two types of fat: saturated and unsaturated. You should avoid food containing saturated fats, because these will increase the levels of bad cholesterol in your blood.

Foods high in saturated fat include:

·         Meat pies

·         Sausages and fatty cuts of meat

·         Butter

·         Ghee – a type of butter often used in Indian cooking

·         Lard

·         Cream

·         Hard cheese

·         Cakes and biscuits

Foods that contain coconut or palm oil

However, a balanced diet should still include unsaturated fats, which have been shown to increase levels of good cholesterol and help reduce any blockage in your arteries.

Foods high in unsaturated fat include:

·         Oily fish

·         Avocados

·         Nuts and seeds

·         Sunflower, rapeseed, olive and vegetable oils

Prognosis

It is important to appreciate that the average remaining life expectancy after achieving 80 years is about 8 years. Despite declines in coronary heart disease (CHD) mortality rate, CHD remains a serious concern among older adults because of the increased number of people living beyond 65 years.

Prevention

There are a number of lifestyle changes or self-management steps that can be taken to prevent or reduce the risk of developing coronary heart disease. These include:

·         Eating a healthy, balanced diet (see heart disease prevention - diet)

·         Limiting alcohol intake

·         Avoiding smoking

·         Undertaking regular physical exercise – 30 minutes most days of the week (see heart disease prevention - exercise )

·         Maintaining a healthy body weight

·         Maintaining healthy blood cholesterol levels

·         Effectively treating medical conditions such as type 2 diabetes and high blood pressure

·         Being aware of risk factors.

·         Self-awareness and education to minimize risk factors is important in helping to prevent and control coronary heart disease.