Understanding Coronary Heart Disease

Sep 5, 2024

Cardiac Lecture: Coronary Heart Disease

Overview

  • Coronary heart disease affects about 13.2 million people.
  • Causes approximately 650,000 deaths per year in the US.
  • Involves accumulation of atherosclerotic plaque in coronary arteries.
  • Plaques begin developing at about age 9.
  • Contributes to angina, acute coronary syndromes, myocardial infarctions, heart failure.

Statistics & Impact

  • Number one cause of death.
  • 1 in 3 deaths linked to cardiovascular disease.
  • Death rate from cardiovascular disease decreased by 32.7% from 1999 to 2009.
  • Healthy lifestyle can delay cardiovascular problems by 7-14 years.
  • Cardiovascular disease costs about $273 million annually.

Risk Factors & Lifestyle Changes

  • Controllable Risk Factors: Smoking, cholesterol, diabetes, high blood pressure, lack of exercise.
  • Non-Controllable Risk Factors: Age, gender, family history.
  • Older adults can reduce risks by meeting 5 of the following 7 criteria:
    • Non-smoker
    • BMI less than 25
    • 150 minutes of moderate activity per week
    • Healthy diet
    • Total cholesterol less than 200
    • Blood pressure less than 120/80
    • Fasting plasma glucose less than 100

Gender Differences

  • Women develop heart disease on average 10 years later than men.
  • Estrogen provides cardiovascular protection but hormone replacement therapy is not cardio-protective.
  • After menopause, women’s iron levels increase, raising cardiovascular risk.

Family History

  • Family history significant if clinical coronary artery disease develops before age 45-55 for males and 55-60 for females.

Smoking

  • Stopping smoking reduces cardiovascular risk by 36%.
  • Women who smoke have heart attacks 20 years earlier than non-smokers.

Cholesterol & Diabetes

  • LDL cholesterol should be less than 70 for high-risk individuals.
  • Statins are effective in reducing LDL cholesterol.
  • Diabetes doubles cardiovascular disease risk.

Weight & Fat

  • Weight gain increases heart disease risk.
  • Belly fat (visceral fat) is particularly harmful and contributes to inflammation.

Angina

  • Stable Angina: Occurs with exertion, relieved by rest or nitroglycerin. Managed with calcium channel blockers and beta blockers.
  • Unstable Angina: Occurs at rest, indicates high risk for myocardial infarction (MI).
  • Variant Angina (Prinzmetal’s Angina): Caused by coronary artery spasm, not plaque.

Symptoms of Angina

  • Chest pain (midsternal, radiating to neck, jaw, left arm).
  • Described as tight, pressure-like, constricting.
  • Associated symptoms: shortness of breath, pallor, diaphoresis, tachycardia, anxiety, nausea, vomiting, back pain.

Diagnosis

  • History and 12-lead EKG are essential.
  • Angina shows ST depression on EKG.
  • Differentiates from MI which shows ST elevation.