Coronary Heart Disease

Question 1

What is coronary heart disease also known as?

Answer 1

Ischaemic heart disease or coronary artery disease.

Question 2

How is the heart muscle constantly supplied with glucose and oxygen?

Answer 2

It requires glucose and oxygen as it continuously contracts.

Blood flowing through the heart does not supply the cardiac muscle with glucose and oxygen. Instead, a series of branching coronary arteries spread over the surface of the heart, with smaller vessels penetrating the heart muscle.

This means that all parts of the heart muscle are close to a blood supply, which allows glucose and oxygen to diffuse into the muscle cells.

Question 3

What is CHD?

Answer 3

Any narrowing or blockage of the coronary arteries, causing the supply of glucose and oxygen to reduce or cut off completely.

Question 4

What is ischaemia?

Answer 4

Lack of oxygen in a a tissue, seeding the term ‘ischaemic heart disease’.

Consequences differ as different areas cause more of less serious complications.

Question 5

What causes narrowing or blockages in the coronary arteries?

Answer 5

This occurs due to a build up of fatty substances in the walls of the arteries.
This process is called atherosclerosis, and fatty deposits are called atheroma.

Question 6

What can start to form in the narrowed arteries?

Answer 6

Blood clots, also known as thrombosis.

Question 7

What happens if a blood clot completely blocks an artery?

Answer 7

The heart muscle supplied by that artery becomes starved of oxygen and glucose and starts to die.

This is called myocardial infarction, or a heart attack.

Question 8

What are the risk factors for CHD?

Answer 8

• Hypertension
• Smoking
• Excessive alcohol consumption
• High cholesterol
• Diabtetes
• Age and sex
• Genetics
• Ethnicity

Question 9

How is hypertension a risk factor for CHD?

Answer 9

This is high blood pressure, which thickens the walls of the arteries, reducing the diameter of the lumen.

This narrowing increased blood pressure further, and an increased in blood pressure can damage the lining of the arteries.

This increases the likelihood of atheroma developing.

Question 10

How is smoking a risk for CHD?

Answer 10

Smoking mostly affects the lungs, but it is possible that nicotine constricts the arteries, raising blood pressure.

Question 11

How is high cholesterol a risk factor for CHD?

Answer 11

This is due to high concentrations of low-density lipoprotein (LDL) in the blood.

LDL transports cholesterol from the liver to the tissues, where it is used to make cell membranes.

If the diet is high in fat, particularly saturated fat, the conc. of LDL increases, so more cholesterol is delivered to the tissue and this increases the risk of atherosclerosis.

Question 12

How is diabetes a risk factor for CHD?

Answer 12

It increases the risk of atherosclerosis.

Question 13

How is age and sex a risk factor for CHD?

Answer 13

This risk of CHD increases with age as damage to the arteries developed slowly.

Males are more likely to get it in middle age.

Question 14

How is genetics a risk factor for CHD?

Answer 14

The risk of identical twins dying for CHD is about 4x greater than the risk for non identical twins.

Question 15

How is ethnicity a risk factor for CHD?

Answer 15

In the UK, people of African Caribbean, Black African or south Asian background have a great risk of CHD.

This is because they’re more likely to have other risk factors, like hypertension and diabetes.

Question 16

What are the symptoms of CHD?

Answer 16

Symptoms depend on the degree of and location of the narrowing coronary arteries.

• Chest pain (angina) as the heart muscles become starved of blood.
• Shortness of breath as the heart is less able to pump blood around the body.
• Pain throughout body
• Feeling faint
• Feeling sick (nausea)

Question 17

What can happen if CHD is undetected or untreated?

Answer 17

It can lead to myocardial infarction (a heart attack), when a whole segment of the heart muscle is starved of oxygen (ischaemia) and begins to die.

Blockages of one of the larger coronary arteries can be fatal.

Question 18

How does CHD affect mental health?

Answer 18

It can cause a decline in mental health as a result of the symptoms, concern over the risk of a heart attack and the need to make lifestyle changes may be stressful.

Question 19

What lifestyle change can be made to improve CHD?

Answer 19

• Healthy diet
• Exercise
• Quit smoking
• Maintain a healthy weight
• Manage stress
• Lower cholesterol and blood pressure

Question 20

What are the treatments for CHD?

Answer 20

It can’t be cured but the symptoms can be managed, and the risk of a heart attack can be reduced.

• Blood thinning medication
• Statins
• Beta blockers
• Angioplasty & stent
• Coronary artery bypass graft
• Heart transplant

Question 21

How does blood thinning medication treat CHD?

Answer 21

These are also known as anticoagulants, and can prevent the formation of blood clots by reducing platelet aggregation or targeting specific clotting factors.

Therefore reducing the risk of thrombosis.

However, blood clotting is important for the protective mechanism during injury, so they can cause the person to bleed easily.

Question 22

What are 3 types of blood thinning medication?

Answer 22

• Aspirin is an anti platelet that prevents platelets from sticking together, reducing clots.
• Warfarin inhibits the production of certain clotting factors in the liver, making blood less likely to clot.
• Direct-oral anticoagulants (DOACS) target specific clotting factors in the blood.

Question 23

What are the side effects of blood thinning medication?

Answer 23

• Possible blood in urine
• Bleed easily
• Bruising
• Nose bleeds
• Vomiting blood
• Heavy periods

Question 24

How do statins treat CHD?

Answer 24

They lower the concentration of LDL cholesterol, reducing the risk of atherosclerosis.

They reduce the production of cholesterol in the liver, therefore lowering the bad LDL cholesterol levels in the blood.

This protects against heart disease as lowering cholesterol levels reduces the plaque build up in the arteries, improving blood flow.

These are taken in tablet for once a day.

Question 25

What are the side effects of statins?

Answer 25

• Headaches
• Dizziness
• Sickness
• Tiredness
• Constipation
• Muscle pain

Question 26

How do beta blockers treat CHD?

Answer 26

They block the effects of adrenaline acting on the sinoatrial node and slow down the heart.

This reduces blood pressure and the workload of the heart. This can relieve chest pain and improve heart function.

This prevents heart attacks and abnormal heart rhythms.

They do this by binding to the beta receptors, so when hormones are released they bind to the beta receptors, blocking hormone effects.

These are taken twice a day.

Question 27

What are the side effects of beta blockers?

Answer 27

• Tiredness
• Cold fingers and toes
• Erectile dysfunction
• Sickness

Question 28

What is an angioplasty and how does it treat CHD?

Answer 28

This involves inserting a balloon to widen narrowed arteries or a wire mesh stent that also helps to keep the artery open. The two procedures are often combined.

This improves blood flow and therefore oxygen and glucose supply to the heart.

Question 29

Explain the process of an angioplasty.

Answer 29

• A build up of cholesterol blocks the blood flow through an artery.
• A stent with a balloon is inserted into a partially blocked artery.
• The balloon is inflated to expand the stent.
• The balloon is removed from the expanded stent.

Question 30

How long do stents last?

Answer 30

They’re permanent.

There is a 2-3% chance of the narrowing coming back within the first 6-9 months.

Lifestyle changes manage this risk.

Question 31

What are the risks associated with stents?

Answer 31

• Bruising at the site of insertion, which clears in a couple weeks.
• The risk of bleeding is lower in the wrist than the groin because the artery sits just under the skin, so pressure is more effective at stopping the bleeding.

Question 32

What is the recovery for an angioplasty like?

Answer 32

If planned, the heart generally recovers right away.

Immediate recovery is more likely if the wrist is used, as if the groin is used you will need to be under observation for site bleeding for 4-6 hours.

Recovery may take longer, if you have had a heart attack.

Question 33

What is a coronary artery bypass graft and how does it treat CHD?

Answer 33

It uses a blood vessel, usually a vein from the patients leg, to bypass one or more narrowed coronary arteries.

This allows for improved blood flow to the heart.

Question 34

How does a heart transplant treat CHD?

Answer 34

This a surgery that can be used in cases where a heart attack is not fatal but causes heart failure.

Heart failure is when the heart is no longer able to maintain an adequate flow of blood throughout the body.

Question 35

What are the risks of a heart transplant?

Answer 35

• The availability of the surgery depends on the availability of a suitable organ from a recently deceased donor.

• There is a risk of organ rejection, so immunosuppressant drugs must be taken for the rest of their life.