REVIEW ON ISCHEMIC HEART DISEASES AND ITS MEDICATION

 

 

Classification of coronary artery diseases:

Classification of Coronary Artery diseases

Figure 4: Classification of Coronary Artery diseases

Coronary diseases are mainly of an 3 types:

1] Obstructive coronary artery diseases:
These type of an diseases mainly cause an blockage in an arteries and by an clotting an blood it narrowed an blood vessels. In these an 30% of an blockage an done in arteries is known as obstructive coronary artery disease

2] Non-obstructive coronary artery diseases:
In these types of an diseases mainly cause an inappropriately constrict or malfunction after branching into vessels or are squeezed by overlying an heart muscles. In these type of disease the 50% of blockage is done, is known as an Non- obstructive coronary artery disease.

3] Spontaneous coronary artery dissection (SCAD):
In these type in which suddenly split in an arteries is known as spontaneous Coronary artery dissection.

Risk factors for coronary heart disease: (Kwak SM, et al.,2012)
A risk factor is something that increases your likelihood of getting a disease. There are several factors that can increase the risk of developing CHD. The main ones are:
• Smoking
• High blood pressure
• High blood cholesterol
• Diabetes  
• Being physically inactive
• Being overweight or obese
• Family history of heart disease
• Ethnic background
• Sex - men are more likely to develop CHD at an earlier age than women.
• Age - the older you are, the more likely you are to develop CHD.
• The more risk factors you have, the more likely you are to develop CHD.  Even though you can’t change all your risk factors, there is plenty you can do to reduce your risk and help to protect your heart. [ Kerola, AM, et al.,2012]

Signs and symptoms [Kontos, MC et al.,2010]
Chest pain that occurs regularly
with activity, after eating, or at other predictable times is termed stable angina and is associated with narrowing’s of the arteries of the heart. Angina that changes in intensity, character or frequency is termed unstable. Unstable angina may precede myocardial infarction. (Kwak SM, et al.,2012)

The main symptoms are as follows:
1] Mild chest pain
2] Heaviness
3] Tightness
4] Burning
5] Squeezing

The image showing the difference between the normal and affected blood artery:

Pathophysiology:

Macrography of an Coronary Artery In Disease

Figure 5: Macrography of an Coronary Artery In Disease

Micrograph is a coronary artery with the most common form of coronary artery disease (atherosclerosis) and marked luminal narrowing. Masson's trichrome . Limitation of blood flow to the heart causes ischemia (cell starvation secondary to a lack of oxygen) of the heart's muscle cells. The heart's muscle cells may die from lack of oxygen and this is called a myocardial infarction (commonly referred to as a heart attack). It leads to damage, death, and eventual scarring of the heart muscle without a regrowth of heart muscle cells. Chronic high-grade narrowing of the coronary arteries can induce transient ischemia which leads to the induction of a ventricular arrhythmia, which may terminate into a dangerous heart rhythm known as ventricular fibrillation, which often leads to death. (Ambrose, John et al.,2015)

Typically, coronary artery disease occurs when part of the smooth, elastic lining inside a coronary artery (the arteries that supply blood to the heart muscle) develops atherosclerosis. With atherosclerosis, the artery's lining becomes hardened, stiffened, and accumulates deposits of calcium, fatty lipids, and abnormal inflammatory cells – to form a plaque. Calcium phosphate (hydroxyapatite) deposits in the muscular layer of the blood vessels appear to play a significant role in stiffening the arteries and inducing the early phase of coronary arteriosclerosis. This can be seen in a so-called metastatic mechanism of calciphylaxis as it occurs in kidney diseases and hemodialysis (Rainer Liedtke 2008).

Although these people suffer from a kidney dysfunction, almost fifty percent of them die due to coronary artery disease. Plaques can be thought of as large "pimples" that protrude into the channel of an artery, causing a partial obstruction to blood flow. People with coronary artery disease might have just one or two plaques, or might have dozens distributed throughout their coronary arteries. A more severe form is chronic total occlusion (CTO) when a coronary artery is completely obstructed for more than 3 months.

Diagnosis

Figure 6: Coronary Angiogram of Man And Women

For symptomatic people, stress echocardiography can be used to make a diagnosis for obstructive coronary artery disease. The use of echocardiography, stress cardiac imaging, and/or advanced non-invasive imaging is not recommended on individuals who are exhibiting no symptoms and are otherwise at low risk for developing coronary disease. (American College of Cardiology 2013)

The main diagnosis for an coronary are as follows:
1] Baseline electrocardiography (ECG)
2] Exercise ECG – Stress test
3] Exercise radioisotope test (nuclear stress test, myocardial scintigraphy)
4] Echocardiography (including stress echocardiography)
5]Coronary angiography.

Coronary Artery Bypass Surgery.

Coronary Artery Bypass Surgery

A surgeon creates a graft to bypass blocked coronary arteries using a vessel from another part of your body. This allows blood to flow around the blocked or narrowed coronary artery. Because this requires open-heart surgery, it's most often reserved for cases of multiple narrowed coronary arteries. (Stergiopoulos K, et al.,2014 )

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