What Is Coronary Heart Disease?

Coronary heart disease (CHD) is a disease in which a waxy substance called

plaque builds up inside the coronary arteries. These arteries supply oxygen-rich
blood to your heart muscle. When plaque builds up in the arteries, the condition is
called atherosclerosis .The build-up of plaque occurs over many years. Other
Names for Coronary Heart Disease are atherosclerosis, Coronary artery disease,
Hardening of the arteries, Heart disease, narrowing of the arteries
What Causes Coronary Heart Disease?
Research suggests that coronary heart disease (CHD) starts when certain factors
damage the inner layers of the coronary arteries. These factors include:
Smoking
High levels of certain fats and cholesterol in the blood
High blood pressure
High levels of sugar in the blood due to insulin resistance or diabetes
Blood vessel inflammation
Plaque might begin to build up where the arteries are damaged. The build-up of
plaque in the coronary arteries may start in childhood. Over time, plaque can
harden or rupture (break open). Hardened plaque narrows the coronary arteries and
reduces the flow of oxygen-rich blood to the heart. This can cause angina (chest
pain or discomfort). If the plaque ruptures, blood cell fragments called platelets
stick to the site of the injury. They may clump together to form blood clots. Blood
clots can further narrow the coronary arteries and worsen angina. If a clot becomes
large enough, it can mostly or completely block a coronary artery and cause
a heart attack.
How Is Coronary Heart Disease Diagnosed?
Your doctor will diagnose coronary heart disease (CHD) based on your medical
and family histories, your risk factors for CHD, a physical exam, and the results
from tests and procedures. No single test can diagnose CHD. If your doctor thinks
you have CHD, he or she may recommend one or more of the following tests.
EKG (Electrocardiogram)- An EKG is a simple, painless test that detects and
records the heart's electrical activity. The test shows how fast the heart is beating
and its rhythm (steady or irregular). An EKG also records the strength and timing
of electrical signals as they pass through the heart. An EKG can show signs of
heart damage due to CHD and signs of a previous or current heart attack.
Stress Testing- During stress testing, you exercise to make your heart work hard
and beat fast while heart tests are done. If you can't exercise, you may be given
medicine to raise your heart rate. When your heart is working hard and beating
fast, it needs more blood and oxygen. Plaque-narrowed arteries can't supply
enough oxygen-rich blood to meet your heart's needs.
A stress test can show possible signs and symptoms of CHD, such as:
Abnormal changes in your heart rate or blood pressure
Shortness of breath or chest pain
Abnormal changes in your heart rhythm or your heart's electrical activity
If you can't exercise for as long as what is considered normal for someone your
age, your heart may not be getting enough oxygen-rich blood. However, other
factors also can prevent you from exercising long enough (for example, lung
diseases, anaemia, or poor general fitness). As part of some stress tests, pictures are
taken of your heart while you exercise and while you rest. These imaging stress
tests can show how well blood is flowing in your heart and how well your heart
pumps blood when it beats.
Echocardiography- Echocardiography (echo) uses sound waves to create a
moving picture of your heart. The picture shows the size and shape of your heart
and how well your heart chambers and valves are working. Echo also can show
areas of poor blood flow to the heart, areas of heart muscle that aren't contracting
normally, and previous injury to the heart muscle caused by poor blood flow.
Chest X Ray- A chest x ray takes pictures of the organs and structures inside your
chest, such as your heart, lungs, and blood vessels. A chest x ray can reveal signs
of heart failure, as well as lung disorders and other causes of symptoms not related
to CHD.
Blood Tests- Blood tests check the levels of certain fats, cholesterol, sugar, and
proteins in your blood. Abnormal levels might be a sign that you're at risk for
CHD.
Coronary Angiography and Cardiac Catheterization
Your doctor may recommend coronary angiography if other tests or factors show
that you're likely to have CHD. This test uses dye and special x rays to show the
insides of your coronary arteries. To get the dye into your coronary arteries, your
doctor will use a procedure called cardiac catheterization .A thin, flexible tube
called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck.
The tube is threaded into your coronary arteries, and the dye is released into your
bloodstream. Special x rays are taken while the dye is flowing through your
coronary arteries. The dye lets your doctor study the flow of blood through your
heart and blood vessels. Cardiac catheterization usually is done in a hospital.
You're awake during the procedure. It usually causes little or no pain, although you
may feel some soreness in the blood vessel where your doctor inserts the catheter.
How Is Coronary Heart Disease Treated?
Treatments for coronary heart disease (CHD) include lifestyle changes, medicines,
and medical procedures.
Lifestyle Changes
Making lifestyle changes often can help prevent or treat CHD. Lifestyle changes
might be the only treatment that some people need.
Follow a Healthy Diet
A healthy diet is an important part of a healthy lifestyle. Following a healthy diet
can prevent or reduce high blood pressure and high blood cholesterol and help you
maintain a healthy weight. Foods high in soluble fibre also are part of a healthy
diet. They help prevent the digestive tract from absorbing cholesterol.
These foods include:
Whole-grain cereals such as oatmeal and oat bran
Fruits such as apples, bananas, oranges, pears, and prunes
Legumes such as kidney beans, lentils, chick peas, black-eyed peas, and lima
beans
A diet rich in fruits and vegetables can increase important cholesterol-lowering
compounds in your diet. These compounds, called plant stanols or sterols, work
like soluble fibre. A healthy diet also includes some types of fish, such as salmon,
tuna (canned or fresh), and mackerel. These fish are a good source of omega-3
fatty acids. These acids may help protect the heart from blood clots and
inflammation and reduce the risk of heart attack. Try to have about two fish meals
every week.
You also should try to limit the amount of sodium (salt) that you eat. This means
choosing low-salt and "no added salt" foods and seasonings at the table or while
cooking. The Nutrition Facts label on food packaging shows the amount of sodium
in the item. Try to limit drinks that contain alcohol. Too much alcohol will raise
your blood pressure and triglyceride level. (Triglycerides are a type of fat found in
the blood.) Alcohol also adds extra calories, which will cause weight gain.
Be Physically Active
Routine physical activity can lower many CHD risk factors, including LDL ("bad")
cholesterol, high blood pressure, and excess weight. People gain health benefits
from as little as 60 minutes of moderate-intensity aerobic activity per week. The
more active you are, the more you will benefit.
Maintain a Healthy Weight
Maintaining a healthy weight can lower your risk for CHD. A general goal to aim
for is a body mass index (BMI) of less than 25. BMI measures your weight in
relation to your height and gives an estimate of your total body fat A BMI between
25 and 29.9 is considered overweight. A BMI of 30 or more is considered obese. A
BMI of less than 25 is the goal for preventing and treating CHD.
Quit Smoking
If you smoke, quit. Smoking can raise your risk for CHD and heart attack and
worsen other CHD risk factors.
Manage Stress
Learning how to manage stress, relax, and cope with problems can improve your
emotional and physical health. Having supportive people in your life with whom
you can share your feelings or concerns can help relieve stress. Physical activity,
medicine, and relaxation therapy also can help relieve stress.
Medicines
You may need medicines to treat CHD if lifestyle changes aren't enough.
Medicines can:
Reduce your hearts workload and relieve CHD symptoms
Decrease your chance of having a heart attack or dying suddenly
Lower your cholesterol and blood pressure
Prevent blood clots
Prevent or delay the need for a procedure or surgery (for example,
angioplasty or coronary artery bypass grafting (CABG))
Medicines used to treat CHD include anticoagulants, also called blood thinners;
aspirin and other anticlotting medicines; ACE inhibitors; beta blockers; calcium
channel blockers; nitroglycerin; glycoprotein IIb-IIIa; statins; and fish oil and other
supplements high in omega-3 fatty acids.
Procedures and Surgery
You may need a procedure or surgery to treat CHD. Both angioplasty and CABG
are used to treat blocked coronary arteries. You and your doctor can discuss which
treatment is right for you.
Angioplasty
Angioplasty is a nonsurgical procedure that opens blocked or narrowed coronary
arteries. This procedure also is called percutaneous coronary intervention, or PCI.A
thin, flexible tube with a balloon or other device on the end is threaded through a
blood vessel to the narrowed or blocked coronary artery. Once in place, the balloon
is inflated to compress the plaque against the wall of the artery. This restores blood
flow through the artery. During the procedure, the doctor may put a small mesh
tube called a stent in the artery. The stent helps prevent blockages in the artery in
the months or years after angioplasty.
Coronary Artery Bypass Grafting
CABG is a type of surgery. In CABG, arteries or veins from other areas in your
body are used to bypass (that is, go around) your narrowed coronary arteries.
CABG can improve blood flow to your heart, relieve chest pain, and possibly
prevent a heart attack.
Cardiac Rehabilitation
Your doctor may prescribe cardiac rehabilitation (rehab) for angina or after
CABG, angioplasty, or a heart attack. Almost everyone who has CHD can benefit
from cardiac rehab. Cardiac rehab is a medically supervised program that may help
improve the health and well-being of people who have heart problems.
Rehab has two parts:
Exercise training. This part helps you learn how to exercise safely,
strengthen your muscles, and improve your stamina. Your exercise plan will
be based on your personal abilities, needs, and interests.
Education, counselling, and training. This part of rehab helps you understand
your heart condition and find ways to reduce your risk for future heart
problems. The rehab team will help you learn how to cope with the stress of
adjusting to a new lifestyle and deal with your fears about the future.
How Can Coronary Heart Disease Be Prevented or Delayed?
Taking action to control your risk factors can help prevent or delay coronary heart
disease (CHD). Your risk for CHD increases with the number of risk factors you
have. One step you can take is to adopt a healthy lifestyle. Following a healthy diet
is an important part of a healthy lifestyle.
A healthy diet includes a variety of vegetables and fruits. It also includes whole
grains, fat-free or low-fat dairy products, and protein foods, such as lean meats,
poultry without skin, seafood, processed soy products, nuts, seeds, and beans and
peas. A healthy diet is low in sodium (salt), added sugars, solid fats, and refined
grains. Solid fats are saturated fat and Trans fatty acids. Refined grains come from
processing whole grains, which results in a loss of nutrients (such as dietary fibre).
If you're overweight or obese, work with your doctor to create a reasonable weight-
loss plan. Controlling your weight helps you control CHD risk factors. If lifestyle
changes aren't enough, you also may need medicines to control your CHD risk
factors. Take all of your medicines as prescribed.














What Is Goitre (goitre)? What Causes Goitre?
Goitre is the enlargement of the thyroid gland and is not cancerous. A person with
goitre can have normal levels of thyroid hormone (euthyroidism), excessive levels
(hyperthyroidism) or levels that are too low (hypothyroidism).

The thyroid is a gland, shaped like a butterfly, located at the base of the neck, just
below the Adam's apple. If the thyroid gland grows larger than normal the patient
has a condition known as goitre. Goitres are generally painless; however, if the
gland gets very large the patient may have problems swallowing properly, and may
also develop a cough.

Goitre refers both to the enlarged thyroid gland, and the condition of having an
enlarged thyroid gland.

Historically, goitre was commonly caused by a lack of iodine in a person's diet.
However, as most countries add iodine to salt, it is more usually caused by an
imbalance in thyroid hormone production, nodules that develop in the gland, or
pregnancy. A significant number of people in some parts of the world still do
develop goitre due to diet factors.
What are the signs and symptoms of goitre?
A symptom is something the patient feels or reports, while a sign is something
other people, including the doctor detects. For example, a headache may be a
symptom while a rash may be a sign.

Some patients may have goitre and not know it because they have no symptoms.

The main symptom for a person with goitre is swelling of the thyroid gland. This
may eventually become a noticeable lump in the throat. The patient may be more
aware of it - a visible swelling at the base of the neck - when looking in the mirror
and shaving or putting on makeup.

There are two types of goitre:
Diffuse small goitre - the whole thyroid gland swells. When touched it feels
smooth.
Nodular goitre - certain parts of the thyroid gland - nodules - swell. The gland
may feel lumpy when touched.
The following symptoms may also exist when a person has goitre:
Hoarseness (voice)
Coughing more frequently than usual
A feeling of tightness in the throat
Swallowing difficulties (less common)
Breathing difficulties (less common)
What are the causes and risk factors for goitre?
A risk factor is something which increases the chances of developing a condition
or disease. For example, a risk factor for heart disease is smoking - if you smoke
regularly your risk of developing heart disease is increased.


The possible causes and risk factors for goitre include:
A diet poor in iodine - may affect people who live in areas where there is not
much iodine, or those who don't have access to iodine supplements. In many
countries iodine deficiency used to be the main cause of gaiter. It still is in some
countries, and areas within some countries.

Iodine, a trace element, exists in the soil and sea. Fish, seafood, many vegetables
and dairy products contain iodine. Our thyroid gland needs iodine in order to
make thyroid hormones. If there is not enough iodine in a person's body their
thyroid gland will get bigger so that it can produce more hormones.

Gender - women are more likely to develop goitre compared to men.
Age - people over the age of 50 are significantly more likely to have goitre
compared to younger people.
Autoimmune disease - individuals with a medical history of autoimmune
disease, as well as those with a close relative who have/had autoimmune disease
have a higher risk of developing goitre.
Pregnancy and menopause - goitre is more likely to happen after a woman
becomes pregnant, or goes through the menopause.
Some medicines - antiretroviral, immunosuppressants, amiodarone (heart
medication), and lithium increase a patient's risk of developing goitre.
Radiation - people whose neck or chest areas have been exposed to radiation
have a higher risk. This could be due to radiation treatment (radiotherapy), or
having worked in a nuclear facility, being involved in a nuclear test or accident.
Hyperthyroidism - if the thyroid is over-active it can become over-stimulated
and expand.
Hypothyroidism - an under-active thyroid gland can also result in goitre. If the
body does not have enough of the hormones produced by the thyroid gland it will
stimulate the gland to produce more, which can lead to swelling of the gland.
Some infections - there are some parasites, bacteria and fungi which are known
to increase goitre risk of the patient become infected with them.
Too much iodine - consuming too much iodine can raise the risk of developing
goitre.
Thyroid cancer - people who have thyroid cancer have a higher risk of
developing goiter.
Diagnosis of goitre
A GP (general practitioner, primary care physician) may detect a swollen thyroid
gland by feeling the patient's neck and asking him/her to swallow during a routine
physical exam. Sometimes the nodules may also be detected simply by touch. A
physical examination of the neck may also allow the doctor to assess the size of the
thyroid gland and the extent of the swelling.

The doctor may order some more tests to find out what the underlying cause might
be. Examples of possible tests include:
A hormone test - this will be done with a blood test which can show levels of
hormones produced by the thyroid as well as pituitary glands. Low blood levels
of thyroid hormone will mean the patient's thyroid is underactive. TSH (thyroid-
stimulating hormone) levels will be high if thyroid hormone levels are low. TSH
is produced by the pituitary gland in an attempt to stimulate the thyroid gland to
produce more hormones. Inversely, an overactive thyroid will show higher-than-
normal blood levels of thyroid hormone and lower-than-normal blood levels of
TSH.
An antibody test - if the blood test confirms the presence of antibodies it could
mean that the underlying cause is related to this.
Ultrasound - a transducer is held over the patient's neck. The ultrasound device
produces sound waves which bounce through the neck and return, like an echo.
The variations in the echo timings are processed and an image of the inside of
the neck can be seen by the doctor on a screen. This procedure allows the doctor
to see how big the thyroid gland is and whether there are any nodules.
A thyroid scan (radioactive iodine scan) - the patient is injected with a small
amount of radioactive iodine, usually into a vein on the inside of the elbow.
He/she lies on a table with the head stretched backward while a camera produces
an image of the thyroid on a monitor.

The radioactive iodine accumulates in the thyroid gland and shows up in the
scan.

This scan helps the doctor determine the size, structure and function of the
thyroid gland.

The amount of radiation is not hazardous to the patient's health. It may not be
suitable for pregnant women.
What are the treatment options for goitre?
The type of treatment may depend on various factors, including the size of the
thyroid gland, symptoms and their severity, and any underlying conditions. If the
patient's goitre is small, the thyroid gland is working properly and there are no
underlying conditions the doctor will probably recommend long-term monitoring,
but no treatment.
Underactive thyroid - if the patient is found to have an underactive thyroid the
doctor may prescribe the use of synthetic hormone, levothyroxine
(Levothroid, Synthroid), to make up for the shortfall. The patient will swallow a
pill once a day. Possible side effects of this hormone therapy may include:
o Muscle cramps
o Irregular heart beat
o Pain in the chest

In most cases side effects go away after a few days.

These side effects are also possible, but they are rare:
o Insomnia
o Diarrhea
o Hot flashes
o Weight loss
o Excessive sweating
o Accelerated heart beat
o Headaches

Patients who experience any of these unusual side effects should tell their doctor
immediately, because the dosage may need adjusting.
Over-active thyroid - patients with an overactive thyroid will most likely be
prescribed thionamides, which help lower the amount of thyroids hormones
being produced by the thyroid gland.

This medication is generally taken by mouth (orally). Patients may not notice
any effect for several weeks. Side effects may include:
o Skin rash (usually mild)
o Itchy skin
o Joint pain
o Nausea
o Agranulocytosis - a serious drop in the number of granulocytes. Granulocytes
are a kind of white blood cell filled with microscopic granules - small sacs
containing enzymes that digest microorganisms. This side effect is extremely
rare. If it does occur it will do so during the first three months of treatment.

Any patient who develops a fever, sore throat, mouth ulcers, or any signs of
infection, and is taking thionamides should seek immediate medical attention.

Treatment with thionamides usually lasts from two to four months.
Radioactive iodine - this is a possible treatment option for patients with an
overactive thyroid gland. The iodine is taken by mouth. The radioactive iodine
destroys thyroid cells when it reaches the thyroid gland, resulting in a smaller
goitre. The patient may end up with an under-active thyroid gland, and
subsequently need hormone therapy.
Iodine supplements - the patient will be prescribed iodine supplements if the
goiter is caused by an iodine deficiency. Iodine supplements are available OTC
(over-the-counter, no prescription required). It is important to follow the dosage
prescribed by your doctor. We do not all have the same iodine requirements.
Surgery - this is an option if the goitre is so large that the patient has problems
breathing or swallowing and other treatments have not worked.

In most cases half the thyroid gland will be surgically removed. The surgeon will
remove enough of the gland to relieve symptoms, while at the same time try not
to undermine the gland's ability to manufacture hormones. Some patients,
however, will need hormone therapy after surgery. Possible complications from
surgery include:
o Infection
o Nerve damage that affects the voice box and gives the patient a permanent
hoarse voice.
o Damage to the parathyroid glands, which regulate body calcium levels.