DEFINITION OF CORONARY DISEASES
Coronary or ischaemic heart disease occur due to lack of blood supply to heart muscle by an increased demand or decreased coronary supply. Both elements are complimentary in hastening the actual attack. Death may occur any time before the complete recovery of the damaged cardiac muscle, which may take about 6 to 8 weeks or more.
RISK FACTORS
Hypertension, cigarette smoking, diabetes, over weight and obesity, physical inactivity, stress making mental activity and psychological environment, a positive family history of premature heart and vascular diseases, for example,starting of diseases before age 40 and abnormal electro cardiogram. The other abnormalities having are thyroid dysfunction, kidney disease and sedentary living habits. The important risk factors are given below.
DIET
DIET
A habitual dietary pattern with high intake of total calories , total fats, saturated fats, cholesterol, refined carbohydrates and salt is a ischaemic risk factor. More intake of fats.especially saturated fats,contributes significantly to the growth of the 4 important coronary-risk factors high blood pressure, diabetes, obesity and disturbance of lipid metabolism and causes thrombosis. Imbalance in lipid metabolism and katabolism leaves extra extra cholesterol and triglycerides which gets stored in fat depots and in other organs and tissues. Arteries also share this burden and get deposits of cholesterol crystals. Coronary arteries suffer the most due to their developed intimal layer. The thrombus contains cholesterol, calcification also shows cholesterol crystals, and individuals with thrombotic tendencies show hypercholesterolaemia. High fat contents in diet,specially the animal fats and hydrogenated fat produce hypercholestrolaemia. More people in countries and communities consuming high fat diet show high incidence of coronary diseases, as compared with people in poorer countries and communities consuming low fat in their diets.In USA where the general diet yields forty percent calories from fats has the highest incidence in the world.
SMOKING
Heavy smoking is shown to be to the occurrence of cardiac diseases in young age. Cigarette smoking is specially correlated with smoking in association of heart diseases. Nicotine causes vasospasm. A heavy smoking is associated with a high stung personality, and heavy smoking usually occurs during mental strain in otherwise light smokers.This fact may be responsible for the association of smoking with other stress diseases in addition to coronary cardiac diseases.
BODY BUILD
Obesity and overweight are considered to be high coronary risk factor. The observations have made and continues:- The incidence of coronary heart diseases is two and half times more among those who had more than twenty per cent increase on their young adult age weight. And also, insurance actuarial studies shows that overweight persons show 36 per cent higher mortality due to coronary diseases and cerebra vascular diseases. Death rates due to hypertension and diabetes are 75 per cent higher among obese persons than among those who are free from obesity. Obesity increases incidence of hypertension and diabetes ans hyperlipidaemia, the 3 ischaemic risk factors. The cardiac muscle itself gets its share of fact deposition and reduces the chance of establishing ischaeimc collateral circulation in times of physical, emotional or cardiac emergency. Obesity decreases exercise tolerance and increases cardiac demand due to the body-burden. Obesity increases peripheral circulatory resistance and predisposes the person to hypertension increasing the coronary cardiac risk.
HEREDITY
It is also plays a part. Anatomical defects or congenital or hereditary, specially causing disease in young age with out thrombosis or other a etiological and risk factors. The likely hood of sub lings of parents suffering from atherosclerosis or a history of coronary episodes having ischaemic cardiac diseases is observed to be much more than the others. Diabetes, hypertension and obesity are known to be transmissible.
ANATOMICAL VARIATIONS
Anatomical peculiarities and distribution of the coronary arteries may show variations in such a way that it may be easier for blood clot in arteries or it may be anatomical peculiarities which may decide the establishment of collateral circulation when thrombosis occurs.
BODY ACTIVITY
Sedentary work always acts as a high coronary risk due to the following reasons.
It reduces the ability of the ischaemic collateral circulation when the coronary blockage occurs or the myocardial demand increases, minute coronary occlusions occurs,very often through adult and middle age with out showing any signs and symptoms due to the simultaneous coronary capillary collateral circulations are established quickly. Constant exertion provides constant coronary circulation during a healthy life and serves well during the episodic periods when the artery gets blocked. Sedentary habits deprive the myocardium of these stimuli. It produces and increases the obesity which decreases the ability and threshold for exertion and myocardial efficiency and creates imbalance in lipid metabolism. Physical activity and exertion balance the fat anabolic process with adequate katabolism, thus protecting the body from increasing obesity and the arteries from cholesterol deposits,etc. A habitual sedentary worker is more likely to be a person doing highly strenuous work causing 'stress'. It seems that the disease is more prevalent in urban than in rural farm workers,may be due to fat-rich diet in western countries where they show low cholosterolaemia, atherosclerosis, ischaemic diseases low rate. Regular exercise provides relaxation and freedom mental stress , at least for a few hours in the day.
STRESS
Emotional strain produces stress so the emotional strain producing experience can hasten a clinical coronary episode in persons with advanced atherosclerosis. Continued uncontrolled stress and strain develops the rigidity of vascular system and also produces systemic hypertension. The stress effects coronaries more than any other arteries and among men more than among women. The stress mechanism makes the cardiovascular system, especially the coronaries more sensitive to autonomic and hormonal stimuli and it responds above normal to precipitate the cardiac ischaemia through an increased spasm and myocardial demand. Psychological stress is shown to increase serum cholesterol and a prolonged psychological strain and tension play a roll in the long term regulation of the serum cholesterol level.
DISEASES AND CONDITIONS
Certain diseases and conditions show a high connection with the occurrence of coronary heart disease or with the conditions leading to it. Hypertension, gall bladder diseases, diabetes, kidney diseases, thyroid diseases, decreased vital capacity, abnormal electrocardiogram such as non-specific T wave abnormalities, complete bundle-branch block and left ventricular preponderance and premature cessation of ovarian activity among women, tendencies leading to thrombosis anywhere in the body have been noted to have such a high condition with the occurrence of coronary cardiac diseases and also cause more deaths in the first attack. But also can cause among survivors more earlier and worse second attacks after the first ones. The diabetic increases the diseases more often, more severely and prematurely than the non-diabetics. A cardiac failure directly due to the primary malignant hypertension should be differentiated from development of a coronary heart condition, although other factors may co-exist. High blood pressure levels are definitely associated with the cardiac disease.In many case it is the most important single complimentary factor to produce final coronary occlusion.
PREVENTION AND CONTROL
Diet control is necessary to prevent obesity to balance anabolism and katabolism. Serum cholesterol and triglyceride concentrations are controlled by diets moderate in total calories,with moderate carbohydrates,and total fat yielding less than 20% of total calories and with low saturated fat contents less than 5% of the total calories and low in cholesterol means less than 200 mg per day.Regular exercise against obesity. This keeps the myocardium in training to meet the additional demands in times of stress. Men who are sedentary workers must adopt habits of regular exercise like clergy men, soft ware engineers,etc. Weight regulation by avoiding obesity by diet restriction and regular exercise must be practiced as above. Moderation in drinking, and smoking should be stopped. Such persons have to be more careful and vigilant. Drugs are available to cut out smoking. The risk of cardiac arrest and infarct in myocardium is increased by heavy smoking, it is ,therefore, must be stopped among persons with existing risk factors. Persons with sedentary works continuously for more hours require relaxations of appropriate periods after sustained period of intense and intellectual and emotional activity, specially for all vulnerable groups is a valuable preventive measure against sustained strain of high intensity of work.
Regular medical check up to ensure that the cardiovascular and urinary systems are working normally. Control of thrombotic tendencies is a difficult one because we have no measure of detection of persons with such tendencies in the population and we have not therapeutic measures to find out or check thrombosis altogether. Anticoagulants make only marginal benefits in the management of frank and massive arterial thrombosis. They can not be used for prevention of coronary heart diseases. Habitual dietary controls may decrease the progression of the conditions by keeping the serum cholesterol at a low level. Among the vulnerable socio-economically well off communities, the doctors, lowers, judges, clergymen bank officials, business executives, industrial organizers, etc, show a high tendency to get disease most commonly. Therefore, the steps should be taken to detect vulnerable groups and individuals among those groups and then control the contributory factors relevant to them. Research in all aspects beginning from per-ischaemic conditions, to histopathological examination of autopsy materials is an important per-requisite to the formulation of authentic preventive measures. While the position can be summarized by saying that keeping the metabolism balanced, avoiding obesity by diet control and regular exercise, relaxation and maintenance of tranquility of mind and avoiding extra emotional stress producing activity and a control of smoking and alcohol consumption should be relied upon. Early diagnosis and treatment of all the antecedent conditions is essential to enhance of all our knowledge, to give us epidemiological data, to find out further deterioration hypercholesterolaemia to atherosclerosis, from arthrosis to thrombosis, from thrombosis to infarction, from infraction to aneurysm or rupture and death or a long period of invalided sickness.
STRESS
Emotional strain produces stress so the emotional strain producing experience can hasten a clinical coronary episode in persons with advanced atherosclerosis. Continued uncontrolled stress and strain develops the rigidity of vascular system and also produces systemic hypertension. The stress effects coronaries more than any other arteries and among men more than among women. The stress mechanism makes the cardiovascular system, especially the coronaries more sensitive to autonomic and hormonal stimuli and it responds above normal to precipitate the cardiac ischaemia through an increased spasm and myocardial demand. Psychological stress is shown to increase serum cholesterol and a prolonged psychological strain and tension play a roll in the long term regulation of the serum cholesterol level.
DISEASES AND CONDITIONS
Certain diseases and conditions show a high connection with the occurrence of coronary heart disease or with the conditions leading to it. Hypertension, gall bladder diseases, diabetes, kidney diseases, thyroid diseases, decreased vital capacity, abnormal electrocardiogram such as non-specific T wave abnormalities, complete bundle-branch block and left ventricular preponderance and premature cessation of ovarian activity among women, tendencies leading to thrombosis anywhere in the body have been noted to have such a high condition with the occurrence of coronary cardiac diseases and also cause more deaths in the first attack. But also can cause among survivors more earlier and worse second attacks after the first ones. The diabetic increases the diseases more often, more severely and prematurely than the non-diabetics. A cardiac failure directly due to the primary malignant hypertension should be differentiated from development of a coronary heart condition, although other factors may co-exist. High blood pressure levels are definitely associated with the cardiac disease.In many case it is the most important single complimentary factor to produce final coronary occlusion.
PREVENTION AND CONTROL
Diet control is necessary to prevent obesity to balance anabolism and katabolism. Serum cholesterol and triglyceride concentrations are controlled by diets moderate in total calories,with moderate carbohydrates,and total fat yielding less than 20% of total calories and with low saturated fat contents less than 5% of the total calories and low in cholesterol means less than 200 mg per day.Regular exercise against obesity. This keeps the myocardium in training to meet the additional demands in times of stress. Men who are sedentary workers must adopt habits of regular exercise like clergy men, soft ware engineers,etc. Weight regulation by avoiding obesity by diet restriction and regular exercise must be practiced as above. Moderation in drinking, and smoking should be stopped. Such persons have to be more careful and vigilant. Drugs are available to cut out smoking. The risk of cardiac arrest and infarct in myocardium is increased by heavy smoking, it is ,therefore, must be stopped among persons with existing risk factors. Persons with sedentary works continuously for more hours require relaxations of appropriate periods after sustained period of intense and intellectual and emotional activity, specially for all vulnerable groups is a valuable preventive measure against sustained strain of high intensity of work.
Regular medical check up to ensure that the cardiovascular and urinary systems are working normally. Control of thrombotic tendencies is a difficult one because we have no measure of detection of persons with such tendencies in the population and we have not therapeutic measures to find out or check thrombosis altogether. Anticoagulants make only marginal benefits in the management of frank and massive arterial thrombosis. They can not be used for prevention of coronary heart diseases. Habitual dietary controls may decrease the progression of the conditions by keeping the serum cholesterol at a low level. Among the vulnerable socio-economically well off communities, the doctors, lowers, judges, clergymen bank officials, business executives, industrial organizers, etc, show a high tendency to get disease most commonly. Therefore, the steps should be taken to detect vulnerable groups and individuals among those groups and then control the contributory factors relevant to them. Research in all aspects beginning from per-ischaemic conditions, to histopathological examination of autopsy materials is an important per-requisite to the formulation of authentic preventive measures. While the position can be summarized by saying that keeping the metabolism balanced, avoiding obesity by diet control and regular exercise, relaxation and maintenance of tranquility of mind and avoiding extra emotional stress producing activity and a control of smoking and alcohol consumption should be relied upon. Early diagnosis and treatment of all the antecedent conditions is essential to enhance of all our knowledge, to give us epidemiological data, to find out further deterioration hypercholesterolaemia to atherosclerosis, from arthrosis to thrombosis, from thrombosis to infarction, from infraction to aneurysm or rupture and death or a long period of invalided sickness.
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