At Home Christian Jessen 2014 - 68

Coronary heart disease
and angina

A build-up of fatty deposits, called atheroma, can cause
the coronary arteries to narrow or get blocked and this
can restrict blood flow to the heart. The main symptom
of coronary heart disease (CHD) is angina, which can cause
tightness or pain in the middle of your chest. The pain can
affect your arms, neck, jaw, face, back or abdomen.
What caUses it? Age is a major factor, as four
out of five people who die from coronary heart disease
are 65 or older. Men are more at risk than women and
have attacks earlier in life. Death rates from heart disease
for women are twice as high as those for all forms of
cancer and it increases as they approach menopause
and continues to rise as they get older.
Failure to exercise regularly is a cause of coronary
heart disease as physical activity helps control levels of
cholesterol and, in some cases, lowers blood pressure.
People who are overweight are more likely to develop
heart disease, even if they have no other risk factor
because excess weight puts extra strain on the heart.
Angina is often experienced on exertion.
Drinking an average of more than one alcoholic drink
a day for women or more than two drinks a day for men
increases the risk of heart disease due to its effect on
blood pressure. The higher the blood cholesterol level,
the higher the risk of coronary heart disease, too.
treatment Beta-blockers reduce how much work
the heart has to do because they slow down the heart rate.
They are very effective in preventing an angina attack.
Coronary angioplasty and stents are used to open
clogged heart arteries. There are 23,500 angioplasties
performed in the UK each year. Dr Narbeh Melikian,
consultant cardiologist and senior lecturer in cardiology
at King's College Hospital, London, says: 'Angioplasty
is now the treatment of choice for CHD as the blood
flow usually improves afterwards, plus it's a minimally
invasive procedure requiring only local anathestic.'
Fatty tissue - atheroma - responsible for narrowing
arteries, is squashed, allowing blood to flow more easily.
A catheter is inserted into an artery under local

'THE SUCCESS rATE Of
COrONArY bYpASS SUrGErY
IS ExCELLENT - EIGHT IN 10
pATIENTS HAvE LASTING rELIEf'
anaesthetic in either the groin or the arm and guided
using a video/TV screen to a coronary artery until its
tip reaches the narrowed or blocked section. A balloon
mounted on a catheter is inflated to a diameter of 3mm,
flattening the atheroma. A short tube of stainless steel
mesh - a stent - is inserted into the part of the artery
to be widened to prevent re-narrowing after angioplasty.
In coronary bypass surgery, a blood vessel is grafted
between the aorta - the main artery leaving the heart
- and a point in the coronary artery beyond the blocked
area. During the operation, a heart lung bypass machine
takes over the pumping of blood and breathing.
Around 21,000 patients undergo coronary bypass
surgery in the UK each year. The success rate of this
operation is excellent and, following surgery, around eight
in 10 patients experience immediate and lasting relief.
068 | JULY 2014

DIAGNOSTIC TESTS AND WHAT THEY TELL YOU

Treatment of heart disease is made easier by early tests and monitoring
ElEctrocardiogram (Ecg)
Measures the electrical activity of
the heart and determines the heart
rate, rhythm and function.
ExErcisE Ecg Known as exercise
stress testing, it's taken while you
exercise on a treadmill or stationary
bicycle. It is used to see if there is
a lack of blood supply through
the arteries that go to the heart.
HoltEr monitoring Also known
as 24-hour ECG, it involves ECG
recordings taken over 24 hours.
It can help diagnose palpitations,
which occur infrequently and can
easily be missed in a short test.
EcHocardiograpHy A recorder
or probe is placed on the chest wall
and it picks up the echoes reflected
from various parts of the heart and
displays them as an echocardiogram
- a picture on a screen.
magnEtic rEsonancE imaging
(mri) scan Produces detailed
pictures of internal organs, including
the heart and brain. MRI scans can
measure the flow of blood through
some of the major arteries and can
detect abnormal heart function.

positron Emission
topograpHy (pEt) scan Produces
detailed 3D images of the heart and
is used to help plan complex heart
surgery, such as a heart transplant.
A radioactive substance (radiotracer)
is injected, via a vein, prior to the
scan. The tracer gives off radiation
which is detected by the scanner.
computErisEd tomograpHy
(ct) scan High resolution images
of the heart, brain and blood vessels
are taken by X-ray to evaluate
disease of the aorta - the largest
artery in the body.
cardiac catHEtErisation
An invasive procedure to assess
whether people with angina need
surgery. It gives details about
blood pressure, the function of the
pumping chambers and valves,
and the severity and positioning of
narrowings in the coronary arteries.
The catheter - a long, flexible,
plastic tube - is inserted into a vein
or artery in the groin or arm after a
local anaesthetic is given. A dye is
then injected and obstructions in the
arteries can then be identified.



Table of Contents for the Digital Edition of At Home Christian Jessen 2014

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