Although testing cam be valuable in detecting existing blockages in your coronary arteries before sudden death, angina pectoris, or a heart attack occurs, ideally you should try to prevent blockages from forming in the first place. This why it is important  for you to understand how Atherosclerosis develops, and what factors accelerate it. Even if you already have coronary heart disease and have had coronary artery bypass surgery, you will want to decrease the chance that the blockages will return.

Coronary heart disease results from the gradual development of Atherosclerosis in the coronary arteries. The term Atherosclerosis comes from the greek atheroma, meaning porridge, and skleros, meaning hard. At birth our coronary arteries are completely open, no blockages are present, and blood flow is unimpaired. Between the ages of 10 and 20, small deposits of lipid, called “fatty streaks,” begin to appear in the lining of the coronary arteries. Over time, some fatty streaks change gradually into larger deposits, called “fibrous Plaques.” As the fibrous plaque forms, it protrudes into the opening of the coronary artery.

These aerly stages of Atherosclerosis progress slowly through the teen age years and through the twenties and thirties, but by age 45 or 50 many people in our society have more advanced Atherosclerosis that may lead to coronary heart disease. If you have risk factors or have inherited a genetic problem in processing fat in your body, you are much more likely to have Atherosclerosis. The same factors may accelerate the early deposits of fatty streaks in the coronary arteries of your children.

Atherosclerosis has afflicted many populations throughout the history of mankind. For example, it has been found in egyptian mummies, but not all mammals are not susceptible to this disease. rats and dogs are quite resistant, at least partly because most of their blood cholesterol is in high density lipoproteins (HDL), the “good” cholesterol. In contrast, humans carry most of their blood cholesterol in low density lipoproteins (LDL), which promote Atherosclerosis. When animals consume diets rich in cholesterol or saturated fat, those that are susceptible, such as some nonhuman primates and rabbits, develop Atherosclerosis; those that are resistant, such as dogs and rats, do not.

The relationship between cholesterol in the diet and Atherosclerosis was first observed in rabbits in 1908 by a russian pathologist name Ignatowsky. Later studies of nonhuman primates demonstrated the direct relationship between cholesterol and saturated fat in the diet, cholesterol level in the blood, and the development of Atherosclerosis.

Can The Process of Atherosclerosis Be Reversed?

The answer is yes. Studies have shown that when the level of cholesterol in the blood of nonhuman primates is lowered by diet or drugs, the deposits of Atherosclerosis in their coronary arteries become smaller. A study has also shown this to be true in humans.

In the 1960s, medical researchers established that not all countries had the same amount of Atherosclerosis in their populations. The international Coronary Heart Disease and Atherosclerosis project studied people in 14 different countries. Arteries from 22,509 people who died between the ages of 10 and 69 years were examined under the microscope. In his book Geographic Pathology Of Coronary Heart Disease and Atherosclerosis DR. Henry McGill ranked  twelve of the fourteen populations according to fat intake, blood cholesterol level, and Coronary Heart Disease and Atherosclerosis. He found a direct and highly significant relationship between these factors; locations with greatest amount of Coronary Heart Disease and Atherosclerosis, such as the United States and Norway, had significantly higher average blood cholesterol levels and a significantly greater fat consumption.

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This article will describe coronary heart disease and its causes, and presents evidence linking intake of dietary cholesterol and fat with rates of coronary heart disease.

How is coronary heart disease detected?

Unfortunately, in one third of all cases the first sign of coronary heart disease is sudden, unexpected death. The victims are completely unaware of the blockages in their coronary arteries until it is too late.

In the rest of the cases, coronary heart disease first appears as chest pain or even a heart attack. Chest pain due to coronary heart disease is usually brought on by physical exertion. Physical activity  increases the demand  of the heart muscle  for oxygen; if significant blockage is present in a coronary artery, the demand cannot be met. This produces pain, usually in the middle of the chest behind the breastbone. The pain is often pressing or constrictive. Some people describe it by clinching their fist over their chest. The pain may radiate up into the throat or jaw.

You may have heard the phrase angina pectoris used to describe such pain (angina from the latin for throat, pectoris from the latin for chest). The pain of angina pectoris may also radiate up into the left shoulder and down the left arm. when triggered by exercise or exertion, angina pectoris is usually relieved by rest. Occasionally, angina is brought on by tension or emotions; or it may occur after eating a meal, or even at night when sleeping. Angina that occurs at rest is an indicator of even more serious atherosclerosis, because the heart is not getting enough oxygen even when it is not working hard. Angina pectoris may be the first signal that you have underlying coronary heart disease.

A heart attack develops when a clot forms on top of the blockage in a coronary artery. This completely prevents blood from flowing through the artery, and deprives the tissue beyond the blockage of needed oxygen and nutrients. The cells in the heart muscle (myocardium) then die, producing what is commonly referred to as a heart attack (myocardial infarction).

Often the first sign of a heart attack is the development of pressing chest pain. When a heart attack is taking place, the chest pain is often not relieved by rest. This persistent chest pain is often also accompanied by weakness, fainting, profuse sweating, nausea, and vomiting. Emergency medical attention is needed, and hospitalization is required. When  a heart attack occurs, the part of the heart muscle that is injured is left with a scar.

Is your heart being deprived of oxygen without symptoms?

If you have significant blockages in your coronary arteries, you may be having “silent” episodes in which your heart muscle is not receiving enough oxygen (ischemia). Such episodes are transient, lasting only several minutes at a time, and are termed “silent myocardial ischemia” by heart doctors (cardiologists). People with this problem may be totally without symptoms, may have suffered a heart attack but gone on to be symptom free, or may have attacks of angina alternating with episodes of silent ischemia.

How common is silent ischemia?

Some doctors estimate that 2 to 3 out of every 100 men have silent ischemia during exercise; that survivors of heart attacks have one chance in tenof having silent icshemia; and that of the four million patients with angina pectoris in this country, about 80% also have episodes of silent ischemia. If you are having angina attacks, you probably are having more episodes od ischemia than is suggested by your angina attacks alone.

How is ischemia detected? Your doctor can use several different tests.

Resting electrocardiogram. The electrocardiogram (or EKG) is the best known test for heart disease. The muscle cells of your heart contract in response to electrical impulses from the nerves. Electrodes attached to your body detect these impulses as they travel through the various parts of your heart. The recording or tracing that results is the EKG. If part of your heart muscle has been damaged by a heart attack, the electrical impulses do not travel through it properly, producing an abnormal EKG. A resting EKG can also detect abnormalities (arrhythmias) in the rhythm of your heart.

The resting EKG has its limitations. For example, about three out of four patients with angina pectoris have normal resting EKGs. Many patients with with significant blockages of their coronary arteries have normal EKGs. Having a normal resting EKG does not mean that you do not have any blockages in your coronary arteries, nor does it mean you can ignore risk factors you may have for coronary heart disease.

Other tests to ask your doctor about.

Stress Exercise Electrocardiogram (Stress Test).

Stress Thallium Exercise Electrocardiogram (Stress Thallium Test).

Holter EKG Monitoring.

Coronary Angiography.

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