What is coronary heart disease?

 

Coronary Heart Disease

Coronary Heart Disease

Coronary heart disease is also called

·       Ischemic heart disease

·       Coronary artery disease

·       Atherosclerotic heart disease

·       Atherosclerotic vascular disease

Introduction of coronary heart disease:

Ischemia means decrease perfusion to the tissues.  Ischemia of the heart is called ischemic heart disease.

It is due to the narrowing of the coronary artery due to atherosclerosis leading to decrease oxygen, decrease nutrients, decrease waste excretion of the cardio myocytes.

For every cell, they require oxygen, nutrients, waste excretion for their normal function. Due to blockage of the arteries, the oxygen, nutrients and waste excretion is decreased which ultimately leads to the death of the cells (necrosis).

More than 95% myocardial infarction chances are in left ventricle due to its high pressure produced

·       Pressure in left ventricle is 0 – 125 mmHg

·       Pressure in right ventricle is 0 – 25 mmHg

Increase cardio myocytes quantity will increase pressure generation

What is coronary heart disease?

A condition of narrowing of large / medium sized arteries supplying heart tissues due to;

·       Etiological factors

·       Atheroma (atherosclerosis)

·       Inflammation

·       Spasm

What is ischemia?

Decreased perfusion to the tissues.

What is perfusion?

The flow of blood to the tissues, some tissues are high perfused

For example: kidneys, liver, brain and heart

And some are low perfused

For example: bones and skin.

Due to narrowing / blockage,  ischemia occurs, the cardio myocytes dies (necrosis)

Ischemia:

·       Low oxygen supply

·       Low nutrients

·       Low impaired waste products excretion

·       Increase free radicals (toxic to the cell)

·       Low level of anti oxidants.

Due to ischemia, cardio myocytes faces oxidation,  stress means waste products are formed these free radicals damages the cells organelles.

Free radicals such as

·       Lipid free radicals

·       Lipid per oxide

·       Superoxide

·       Hydroxide

·       Hydroxyl per oxide

If the ischemia becomes completely (100% less perfusion) in infraction.

In 99% cases, ischemia occurs in left ventricle due to its increase thickness and increase blood pressure (0 – 125 mmHg)

During ischemia the adenosine is released and irritates nerves innervated in cardio myocytes induce pain the indication signs appear we should go for lab investigation.

But in diabetes mellitus due to neuropathy adenosine cannot able to initiate pain the sign indication is masked and difficult to diagnosis.

What is atheroma?

The term used for the build up of material that adhere to the arteries.

What is atherosclerotic plaque ?

An atheroma or atherosclerotic plaque is an abnormal and reversible accumulation of material in the inner layer of an artery wall.

An atheroma can be;

·       Atherosclerotic plaque (accumulation of lipid plaque for example LDL-C)

·       Calcium deposition

What is atherosclerosis?

Atherosclerosis is atheroma due to lipid.

What is artiosclerosis?

Artiosclerosis is atheroma due to other than lipid.

What is artiolosclerosis?

Artiolosclerosis is atheroma of the smaller arteries.

What is inflammation?

Inflammation is damage the inner wall of the artery.

What is spasm?

The spasm is the phenomenon of vasoconstriction and vasodilation under the influence of nervous system, the nerves are innervated in the blood vessels.

The imbalance between the supply of perfusion and the demand of the perfusion results in myocardial infarction.

Composition of the atherosclerotic atheroma / composition of atherosclerotic plaque:

·       LDL composition

·       Attraction of monocytes

·       Foam cell generation

·       Inflammation

·       Thrombus

Risk factors for coronary heart disease:

There are two types of risk factors for coronary heart disease

1.     Modifiable Risk factors for coronary heart disease

2.     Non Modifiable Risk factors for coronary heart disease

Modifiable Risk factors for coronary heart disease:

·       Obesity

·       Smoking

·       Physical inactivity

·       Diabetes mellitus

Non Modifiable Risk factors for coronary heart disease:

·       Neuropathy

·       Male gender

·       Menopause

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