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Heart disease

Heart disease occurs when the coronary arteries become partially blocked or clogged. This blockage limits the flow of blood through the coronary arteries, the major arteries supplying oxygen-rich blood to the heart. The coronary arteries expand when the heart is working harder and needs more oxygen. If the arteries are unable to expand, the heart is deprived of oxygen (myocardial ischaemia). When the blockage is limited, chest pain or pressure called angina may occur. When the blockage cuts off the blood flow, the result is heart attack (myocardial infarction or heart muscle death).

Healthy coronary arteries are open, elastic, smooth, and slick. The artery walls are flexible and expand to let more blood through when the heart needs to work harder. The disease process is thought to begin with an injury to the linings and walls of the arteries. This injury makes them susceptible to atherosclerosis and production of blood clots (thrombosis).

Causes & Symptoms

Heart disease is usually caused by atherosclerosis. Cholesterol and other fatty substances accumulate on the inner wall of the arteries. These attract fibrous tissue, blood components, and calcium. They then harden into artery-clogging plaques. Atherosclerotic plaques often form blood clots that can also block the coronary arteries (coronary thrombosis). Congenital defects and muscle spasms of arteries or heart muscles also block blood flow. Recent research indicates that infection from organisms such as chlamydia bacteria may be responsible for some cases of heart disease.

A number of major contributing risk factors increase the chance of developing heart disease. Some of these can be changed and some cannot. The greater the number of risk factors, the greater the chance of developing heart disease.

Major Risk Factors

Major risk factors significantly increase the chance of developing heart disease. These include:

* Heredity. People whose parents have heart disease are more likely to develop it.

* Gender. Men are more likely to have heart attacks than women and to have them at a younger age. Over the age of 60, however, women have heart disease at a rate equal to that of men.

* Age. Men who are 45 years of age and older and women who are 55 years of age and older are more likely to have heart disease. Occasionally, heart disease may strike men or women in their 30s. People over 65 are more likely to die from a heart attack. Older women are twice as likely as older men to die within a few weeks of a heart attack.

* Smoking. Smoking increases both the chance of developing heart disease and the chance of dying from it. Smokers are more than twice as likely as non-smokers to have a heart attack and are two to four times more likely die from it.

* High cholesterol levels. Dietary sources of cholesterol are meat, dairy food, eggs, and other animal fat products. It is also produced by the body. Age, body fat, diet, exercise, heredity, and sex affect one's blood cholesterol. Total blood cholesterol is considered high at levels above 240 mg/dL and borderline at 200-239 mg/dL. High-risk levels of low-density lipoprotein (LDL cholesterol) begin at 130-159 mg/dL, depending on other risk factors. Risk of developing heart disease increases steadily as blood cholesterol levels increase above 160 mg/dL.

* High blood pressure. High blood pressure makes the heart work harder and weakens it over time. It increases the risk of heart attack, stroke, kidney failure, and congestive heart failure. A blood pressure of 140 over 90 or above is considered high. The risk of heart attack or stroke is raised several times for people with high blood pressure combined with obesity, smoking, high cholesterol levels or diabetes.

* Lack of physical activity. Lack of exercise increases the risk of heart disease. Even modest physical activity such as walking is beneficial if done regularly.

* Diabetes mellitus. The risk of developing heart disease is seriously increased for diabetics. More than 80% of diabetics die of some type of heart or blood vessel disease.

Contributing Risk Factors

Contributing risk factors have been linked to heart disease, but their significance is not known yet. Contributing risk factors are:

* Obesity. Excess weight increases the strain on the heart and increases the risk of developing heart disease even if no other risk factors are present. Obesity increases blood pressure and blood cholesterol and can lead to diabetes.

* Hormone replacement therapy (HRT). Even though doctors once believed that HRT could help prevent heart disease in women, use of combined hormones (oestrogen and progestin) is harmful in women who already have coronary artery disease.

* Stress and anger. Some scientists believe that poorly managed stress and anger can contribute to the development of heart disease and increase the blood's tendency to form clots (thrombosis). Stress increases the heart rate and blood pressure and can injure the lining of the arteries.

* Chest pain (angina). Angina is the main symptom of coronary heart disease but it is not always present. Other symptoms include shortness of breath, chest heaviness, tightness, pain, a burning sensation, squeezing, or pressure either behind the breastbone or in the left arm, neck, or jaws.

Treatment

Heart disease can be treated in many ways. The choice of treatment depends on the patient and the severity of the disease. Treatments include lifestyle changes and drug therapy, coronary artery bypass surgery, and percutaneous transluminal coronary angioplasty, although these are not cures. Heart disease is a chronic disease requiring lifelong care.

Herbal Treatments

Herbal medicine has a variety of remedies that may have a beneficial effect on heart disease. Garlic (Allium sativum), myrrh (Commiphora molmol) and oats (Avena sativa) may help reduce cholesterol. Hawthorn (Crataegus spp.), linden (Tilia europaea), and yarrow (Achillea millefolium) are sometimes recommended to control high blood pressure, a risk factor for heart disease. Tea, especially green tea (Camellia sinensis), is high in antioxidants; studies have shown that it may have a preventative effect against atherosclerosis. Coenzyme Q10 has been shown to be beneficial for 70% of patients with congenitive heart failure. Taurine, an amino acid found in meat and fish proteins, is used to treat heart arrhythmia. Two grams three times a day for people with congestive heart failure showed improved cardiovascular functions.

Yoga and other bodywork, massage, relaxation, aromatherapy, and music therapies may also help prevent heart disease and stop, or even reverse, the progression of atherosclerosis. Vitamin and mineral supplements that reduce, reverse, or protect against heart disease include B-complex vitamins, calcium, chromium, magnesium, L-carnitine, zinc and the antioxidant vitamins C and E. The effectiveness of vitamins C and E is still under debate, and doctors advise that they should be used in moderation.

Traditional Chinese medicine (TCM) may recommend herbal remedies, massage, acupuncture and dietary modification. A healthy diet (including cold water fish as a source of essential fatty acids) and exercise are important components of both alternative and conventional prevention and treatment strategies.

New reports on diet and heart disease have answered some questions, but others remain unclear. While one study concludes that four servings per day of fruit and vegetables are associated with a slight drop in risk of heart disease, eight or more servings per day can produce a significant drop in risk. Another study showed that consuming legumes at least four times per week lowered risk of heart disease from 11% to 22% compared with consuming legumes less than once a week. Research on antioxidants continues to send mixed messages, with some reports showing that vitamins E, C, and other antioxidants can help prevent heart disease, and other studies showing they have no effect. Many doctors and researchers therefore recommend that those wanting to follow healthy heart habits continue to eat a diet rich in antioxidants but recognize that there is probably no value in adding antioxidant supplements to a good diet.

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