By Dr. Rachna Pande
Sickness and deaths due to many infectious diseases have been reduced in today’s modern world, due to advancement in diagnosis and treatment of these diseases. But sickness and deaths due to various non-communicable diseases, like coronary artery disease (CAD) are on the increase.
Coronary artery disease is the condition where, coronary arteries, (blood vessels supplying blood to the heart) are blocked, cutting off blood supply, resulting in damage to part of the heart. Symptoms depend on whether a large or small vessel is occluded and whether surrounding blood vessels are able to maintain blood supply to the affected part efficiently or not.
The inner lining of blood vessels tends to get damaged by the turbulence of blood flow. There is deposition of fat on this lining (atherosclerosis), a process which progressively leads to partial or total occlusion of the vessel.
It is vital to know the risk factors of atherosclerosis. Some factors are not modifiable. Heredity and advancing age is one of them. It is said that men after age 40 and women above 50 years of age are susceptible to develop CAD. Up to menopause women are protected by estrogen. i.e. feminizing hormone, from CAD. But after menopause, they become more prone than men.
Obesity particularly abdominal obesity is an avoidable risk factor for CAD. As one approaches middle age, belly bulges appear in majority of people. Due to obesity, one tends to develop diabetes, high blood pressure and CAD. High cholesterol levels in the blood accelerate the risk of developing CAD directly and also indirectly by augmenting obesity.
Taking a healthy diet and good physical exercise can help control this factor very well. Alcohol tends to increase the blood glucose and cholesterol levels, both being risk factors for CAD. It also contributes to obesity by providing calories. One should quit alcohol to keep the heart healthy and avoid CAD.
Nicotine present in cigarettes augments deposition of lipids in blood vessels and also causes narrowing of their lumen. It is therefore a high risk factor for CAD. Giving up smoking is known to reduce the incidence of CAD. Even in people who have suffered from it are known to improve to a great extent after quitting smoking.
Hypertension and diabetes mellitus are other avoidable risk factors for developing CAD. They can be easily controlled by adhering to the dietary restrictions and prescribed medicines. The other important thing needed is to avoid stress both physical and mental.
Stress leads to release of adrenaline and cortisol in the body, which in turn increases blood pressure and tends to precipitate and augment CAD. Avoiding physical stress does not mean a, “bed rest”. One should indulge in physical activity according to one’s capability. Activities like lifting or pushing heavy weights are harmful and should be avoided, but walking, light jogging, yoga, e.t.c. are good. Any exercise should be done for a short time initially and then increased slowly in frequency and time.
One should try to keep the mind relaxed. Mental stress leads not only to CAD but many other diseases as well. Mental relaxation can be achieved by prayers, meditation, yoga, e.t.c. techniques.
All these risk factors are present in abundance in modern urban living; hence CAD can be called as bane of modern life.
The most common symptom of CAD is left sided chest pain which occurs on exertion and is relieved by rest. One feels like being suffocated. The pain may occur on or radiate to left upper limb, wrist, jaw, upper shoulder, e.t.c., multiple sites. There may be associated sweating, tiredness, nausea, e.t.c., symptoms.
Diagnosis is suspected clinically and confirmed by electrocardiogram, cardiac echo and coronary angiography. Treatment is by drugs. Interventions involving repair of the blocked coronary vessel by various techniques like bypass surgery or stent implantation are also useful.
CAD can be thus easily prevented. Only thing needed is for the individual to be aware of the risk factors and avoid them.
Dr. Rachna Pande, Specialist internal medicine. E-mail: firstname.lastname@example.org
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