Coronary heart disease (CHD) is characterized by plaque buildup in the arteries which leads to heart attacks or strokes. 

It is often used interchangeab with coronary artery disease (CAD) thus CHD is a result of CAD. 

It occurs when plaque accumulates in coronary arteries limiting blood flow to the heart muscle and preventing oxygen supply. 

This condition can be chronic by causing the artery to narrow over time or acute resulting from a sudden plaque rupture and blood clot formation. 

Most individuals experience plaque buildup in childhood and worsen with age. 

Coronary artery disease is the leading cause of death for both men and women accounting for one-third of all deaths. 

A significant portion of these fatalities occur in low resource areas, where men mortality rate is five times higher than women and this difference decreases with age. 

Coronary heart disease is more common in developed countries where lifestyle factors such as poor diet, lack of physical activity, and smoking are more prevalent. 

However, the incidence also increases in developing countries as these countries adopt westernized lifestyles. 

According to the World Health Organization the CHD is the leading cause of death globally by taking an estimated 17.9 million lives each year. 

The prevalence is estimated to be around 10% with the highest rates in high-income countries. 

The mortality rate varies depending on the disease stage and it is generally high with up to 20% of people passing away within a year of the diagnosis. 

CHD is caused by the accumulation of atherosclerotic plaque in coronary arteries primarily composed of lipid-laden macrophages or foam cells. 

These macrophages form a fatty streak in the intima layer subendothelial space forming when monocytes absorb oxidized LDL particles. 

T cells and growth factors stimulate the formation of subendothelial plaque which narrows vessel lumens and restricts blood flow that leading to chest pain or heart attacks. Smooth muscle cells absorb oxidized LDL particles and collagen depositing them with macrophages, increasing foam cell count. 

Atherosclerotic plaque is a type of heart disease that can grow or become stable over time. 

As it becomes stable, a fibrous cap forms and the lesion calcifies. 

As the plaque grows it restricts blood flow to the heart muscle by causing chest pain. 

However, symptoms subside during rest. To cause angina at rest and the plaque must be at least 90% stenosed. 

Sometimes, the plaque ruptures, exposing tissue factors and leading to thrombosis which is resulting in acute coronary syndrome like unstable angina, NSTEMI, or STEMI. 

Coronary heart disease has various contributing factors that can be divided into non-modifiable and modifiable. 

Non-modifiable factors include characteristics such as gender, age, family history, and genetics that cannot be altered. 

Modifiable risk factors include behaviors and lifestyle modifications like smoking, obesity, lipid levels, and psychosocial variables which can be changed. 

The prevalence rate of ischemic heart diseases is enhanced in the Western world that attributed to a faster-paced lifestyle leading to unhealthy eating habits like fast-food consumption. 

In the US there is a better primary care in higher socioeconomic groups has led to a higher disease incidence in later stages of life. 

Smoking remains the leading cause of cardiovascular diseases, with a prevalence of 15.5% among adults in the United States in 2016. 

Elevated levels of LDL will significantly contribute to the development of CHD while high HDL cholesterol levels can lower the risk of the disease. 

The varying prognosis factors were based on severity of the condition and individual health. 

Early diagnosis and treatment will improve the prognosis and reduce complications. 

 Adapting to good lifestyle changes and avoiding sedentary lifestyle can also improve prognosis. 

However, even with treatment, CHD can lead to serious complications like heart attacks or heart failure and can be fatal in some cases. 

Age Groups: 

Younger Adults (Under 45): It presents with atypical symptoms  which include chest discomfort or fatigue during physical activity. 

Middle-aged Adults (45-64): Classic symptoms may include chest pain or discomfort during physical exertion or emotional stress. 

Older Adults (65 and above): Symptoms may be less typical and may include shortness of breath, fatigue, or confusion. 

Comorbidities such as diabetes and hypertension may complicate the clinical picture. 

Vital Signs: 

Blood Pressure: It is a common risk factor for CHD, and monitoring blood pressure is essential. 

Heart Rate: An irregular or elevated heart rate may be indicative of underlying cardiovascular issues. 

Cardiovascular Examination: 

Pulse: Assessing the strength, regularity, and rate of the pulse can provide insights into cardiac function. 

Heart Sounds: Listening for abnormal heart sounds, such as murmurs or extra heart sounds (S3 or S4), can indicate cardiac dysfunction. 

Hypertension: High blood pressure is one of the main causes of coronary heart disease. 

Smoking: Tobacco use is the major modifiable risk factor. 

Physical Inactivity: Lack of exercise is a risk factor for CHD. 

Chronic Stable Angina: Patients may experience chest pain during stress or exertion. 

Myocardial Infarction (Heart Attack): Sudden and severe chest pain which oftens radiating to the left arm. 

Lifestyle Modifications: 

• Dietary Changes: Adopting a heart-healthy diet that is low in saturated and trans fats. 
• Regular Exercise: Engaging in the regular physical activity to improve cardiovascular health. Exercise helps control weight, lower blood pressure, and improve overall well-being. 
• Smoking Cessation: Quitting smoking is essential, as tobacco use is a major risk factor for CHD. 

Medications: 

• Antiplatelet Agents: To lower the likelihood of blood clot development, doctors may give aspirin or similar antiplatelet drugs. 
• Statins: Cholesterol-lowering medications to manage lipid levels and reduce the progression of atherosclerosis. 
• Beta-Blockers: These medications help reduce heart rate and blood pressure, decreasing the workload on the heart. 

Percutaneous Coronary Intervention (PCI): 

• Angioplasty:A balloon-tipped catheter is used to open restricted or obstructed coronary arteries, allowing more blood to circulate to the heart. 
• Stent Placement: A mesh tube (stent) may be inserted during angioplasty to help keep the artery open. 

Coronary Artery Bypass Grafting (CABG): 

• Surgical Procedure: In cases of severe coronary artery disease, CABG may be recommended. It involves rerouting blood around blocked arteries using grafts from other blood vessels. 

Cardiac Rehabilitation: 

• Structured Program: Rehabilitation programs offer supervised exercise, education, and support to help patients recover from a heart event, improve cardiovascular fitness, and adopt a heart-healthy lifestyle. 

Cardiology, General

Lifestyle Modifications: 

Dietary Changes: Maintaining a healthy diet is mandatory in the prevention of heart diseases. Increase the daily consumption of fruits, vegetables, whole grain products, lean meats, and foods rich in omega-3 fatty acid. 

Weight Management: To achieve and sustain a healthy weight, it is recommended to ensure one follows a healthy lifestyle through engaging in physical activities and taking healthy meals. 

Regular Exercise: Performing aerobic exercises like brisk walking, cycling, or swimming is beneficial to boosting cardiovascular capability, managing weight problems, and reducing high blood pressure levels. The recommended amount of physical activity is at least 150 minutes of moderate-intensity exercise per week. 

Smoking Cessation: They describe it as one of the most important nonpharmacological approaches. It helps to minimize the chances of further damage to the coronary arteries as well as enhance the global cardiovascular conditions. 

Cardiac Rehabilitation: 

Structured Exercise Programs: Cardiac rehabilitation is a supervised exercise program designed for an individual patient’s requirements to enhance the cardiovascular physical fitness and improvement of the patient. 

Education and Counseling: Rehabilitation services provide education throughout the process and provide information regarding the selection of appropriate diet and regularity with which to take medications, stress management.

Stress Management: 

Mind-Body Techniques: Some of the practices that have been used in reducing stress include: practice deep breathing, yoga, and mindfulness meditation. 

Counseling and Psychotherapy: Psycho-social conditions such as anxiety or depression should always be managed sufficiently for an individual to achieve optimal health. 

Cardiology, General

Aspirin Therapy: The most used antiplatelet agent is aspirin. It operates by blocking an enzyme (cyclooxygenase) that plays a role in activating platelets and inhibiting platelet aggregation. Low dose aspirin, typically 81 milligrams per day, is often prescribed to be taken in the long term by patients with CHD, especially those who had a myocardial infarction or stroke 

Clopidogrel, Ticagrelor, and Prasugrel: It used in combination with aspirin along with stent placement. They work by blocking specific platelet receptors which provides the antiplatelet effects. 

Cardiology, General

Atorvastatin: It works by reducing the activity of HMG-CoA reductase, an enzyme that is involved in the biogenesis of cholesterol in the liver. Because it helps to lower the cholesterol levels in the bloodstream by promoting the removal of LDL-C from the body. Atorvastatin is marketed in different forms and its dosage depends more on the level of cholesterol and risk factors associated with heart diseases. Doses used commonly range from 10 mg to 80 mg daily. 

Simvastatin: This is achieved by reducing the activity of HMG-CoA reductase, which results in reduced synthesis of cholesterol and enhanced clearance of LDL-C. The medication is available in different forms and strengths and therefore it is suggested that a specific dosage should be taken. The doses vary from 10 mg to 40 mg a day; the higher doses are recommended for individuals with higher cardiovascular risk. 

Cardiology, General

Beta blockers plays an important role in the treatment of coronary heart disease (CHD) by reducing the workload on the heart which lowers the blood pressure and improving overall cardiovascular outcomes.  

Metoprolol: It is available in both immediate-release and extended-release formulations which is used in the treatment of angina, heart failure and hypertension. 

Atenolol: It has a longer duration of action and taken orally once a day. 

Carvedilol: Particularly beneficial in heart failure management due to its unique properties, including alpha-blocking effects. 

Cardiology, General

Nitrates play an important role in the treatment of coronary heart disease (CHD) by providing relief from angina symptoms and improving blood flow to the heart.  

Nitroglycerin: It is a rapid-acting formulation used for the acute relief of angina episodes. The tablet is placed under the tongue during chest pain to quickly reduce the symptoms. 

Isosorbide Dinitrate: It is another rapid-acting formulation used for the acute relief of angina. Tablet is placed under the tongue during an angina episode and may be used for both acute relief and long-term prevention of angina. 

Isosorbide Mononitrate: Isosorbide mononitrate is available in extended-release oral formulations which provides sustained vasodilation. 

Percutaneous Coronary Intervention (PCI): 

Angioplasty: It is a catheter inserted into the narrowed or blocked coronary artery during an angioplasty operation having a balloon at its tip. The balloon is inflated and pressed on the plaque reducing the blockage while at the same time dilating the arteries to increase blood circulation. 

Stent Placement: Sometimes a thin metallic mesh called stent is also placed at the site of the blockage to ensure that the artery does not close again. Stents are available as bare metal or drug coated and with drugs to be released to prevent re-Blocking of the artery. 

Coronary Artery Bypass Grafting (CABG): 

Surgical Procedure: It is a surgical process in which a physician connects a functional blood vessel to a part of the body needing new circulation around blocked or narrowed coronary artery. This serves as a bypass path by which blood can go to the heart’s muscle without necessarily passing through the obstruction. 

Multi-vessel Bypass: CABG is similarly suitable when there is multi vital coronary disease, that is where the arteries are blocked at more than one place. 

Atherectomy: 

Removal of Plaque: Atherectomy is a method where the blood vessel walls are grinded with the help of a small catheter containing a rotating piece that sculpts out the atherosclerotic plaque. 

Thrombectomy: 

Clot Removal: During acute coronary syndromes otherwise referred to as heart attacks, a catheter with a debulking device can be employed to clear off blood clots in the affected coronary artery. 

Intravascular Ultrasound (IVUS) 

Imaging of Blood Vessels: IVUS adopts a miniaturized catheter-mounted ultrasound transducer to take high-resolution images of lumenalian arteries. It makes easier to identify treatment approaches to be adopted and determine the effectiveness of activities to be taken. 

Cardiology, General

Primary Prevention: Identifying patients who are at high risk of CHD through parameters including age, gender, history of family members with the disease, hypertension, diabetes, smoking habits, and high cholesterol levels. Promoting heart health because of avoiding some activities such as exercise, eating healthily, avoiding smoking, and maintaining a healthy body weight. 

Secondary Prevention: In patients with diagnosed CHD or patients with history of CVS events (e. g. myocardial infarction), the principles of secondary prevention are aimed at prevention of further events. Administering antiplatelet agents, statins, beta-blockers, and ACE inhibitors/ARBs to address risk factors and enhance cardiovascular outcomes. 

Acute Management: Through early management of acute events as myocardial infarction(heart attack) and early intervention through use of advanced emergency procedures that include the use of anticoagulants and thrombolytics. 

Rehabilitation and Recovery: Featuring organized, comprehensive services such as teaching and counseling within specific programs to prepare patients who have experienced a cardiac event, to enhance cardiovascular health, and to embrace a properly healthy lifestyle. This is handling with the prevailing stress and any form of mental health disorder that may arise during this period of recovery. 

Chronic Management: Modifications on the medications depending on the evaluation and monitoring, such as antiplatelet agents, statins, beta-blockers and other therapies, in case necessary. On the other hand, supporting patients to maintain practices that are beneficial for heart health, for instance, taking healthy diets, exercising, or quitting smoking.