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1.1     Coronary Heart Disease:

The arteries are the tubes that carry blood from the heart to the rest
of the body. As part of the ageing process the arteries become less elastic and
their diameter may narrow. On occasion, a clot may form in a narrowed artery
and block it. The muscle of the heart has four major coronary arteries
feeding it. These arteries are prone to hardening (atherosclerosis). As the
arteries become diseased their capacity is reduced and the heart muscle may
become weaker. This chronic problem may lead to angina (central chest pain on
effort) or heart failure. Sometimes a blood clot forms blocking a coronary
artery (coronary thrombosis). The heart muscle, suddenly deprived of oxygen, is
the site of the typical acute central chest pain. A severe heart attack is one
of the commonest causes of death.

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An interesting recent development has been evidence that coronary artery
disease may have an infectious cause. One study has shown that men who had
received antibiotics for infections were subsequently less likely to have
coronary problems.


or blockage of one or more arteries that supply blood to the heart, usually due
to atherosclerosis (hardening of the arteries). Abbreviated CAD. A major cause
of illness and death, CAD begins when hard cholesterol substances (plaques) are deposited within a
coronary artery. The plaques in the coronary arteries can lead to the formation
of tiny clots that can obstruct the flow of blood to the heart muscle,
producing symptoms and signs of CAD, including chest pain (angina pectoris), heart attack (myocardial infarction), and sudden
death. Treatment for CAD includes bypass surgery, balloon angioplasty, and the
use of stents.

Prevalence and Incidence:

Cardiovascular diseases are becoming
a major health burden in developing countries. These are the number 1 cause of
death globally: more people die annually from Cardiovascular diseases than from
any other cause. An estimated 17.7 million people died from CVDs in 2015,
representing 31% of all global deaths. Of these deaths, an estimated 7.4
million were due to coronary heart disease and 6.7 million were due to stroke.

Over three quarters of CVD deaths
take place in low- and middle-income countries. Out of the 17 million premature
deaths (under the age of 70) due to noncommunicable diseases in 2015, 82% are
in low- and middle-income countries, and 37% are caused by CVDs.

World Health Organization (WHO) estimates
that in the low-income countries the number of deaths due to cardiovascular
disease (CVD) is on steady rise Eighty percent of the deaths due to CVD and 86%
of the global burden of CVD are in the developing countries including Pakistan.

the 2000 persons studied 125 (6.25%) had documented IHD. Pakistan’s population
is currently estimated as 163 million. Only half this population is more than
20 years old. Therefore, the results are applicable to 81.5 million persons.
The disease burden of IHD is therefore estimated as 5.09375 million. IHD was
seen more commonly in men compared to women in all age groups despite variation
in other risk factors. Relative difference in CHD prevalence between sexes was
largest among the youngest subjects up to 50 years old and smallest among the subjects
58-65 years old. Pakistani population
has one of the highest risks of coronary
heart disease (CHD) in the world. In Pakistan, 30 to 40 per cent of all deaths are due to cardiovascular diseases (CVD).
The CHD deaths in Pakistan has
reached about 200,000 per year that is 410/100,000 of the population. But the
Incidence of Ischemic heart disease(IHD) in developing countries is very
scarce, and routinely collected data are often incomplete and unreliable.


1.3 Mortality and Morbidity of Coronary heart disease:

Ischaemic heart
disease (IHD) is estimated to be the leading cause of mortality in the world
and in high-income countries it is also the leading cause of premature
mortality and disability. Each year IHD kills an estimated 7 million people
representing 13% of all male deaths and 12% of all female deaths. Moreover, 56%
of those deaths occur before age 75 years (2). Recent recorded death rates from
IHD vary widely across countries; age-standardized rates for males for the
population aged over 30 range from more than 900 per 100,000 in some Eastern
European countries (Turkmenistan, Republic of Moldova, Belarus, Ukraine) to 84
per 100,000 in Japan; for females, the corresponding range is from more than
500 per 100,000 in Turkmenistan, Republic of Moldova and Ukraine to less than
50 per 100,000 in France and Japan. Heart disease is
the leading cause of
death for both men and women. More
than half of the deaths due to heart disease in 2015 were in men.1
About 630,000 Americans die
from heart disease each year—that’s 1 in every 4 deaths.1

1.4     Signs and Symptoms:

The most common symptom of coronary artery disease
is angina, or chest pain. Angina can be described as a discomfort,
heaviness, pressure, aching, burning, fullness, squeezing, or painful feeling
in your chest. It can be mistaken for indigestion or heartburn.
Angina may also be felt in the shoulders, arms, neck, throat, jaw, or back.

symptoms of coronary artery disease include:

Shortness of breath

(irregular heart beat)

A faster heartbeat

Weakness or dizziness


1.5     Risk Factors of CHD:

High blood cholesterol and
triglyceride levels (a type of fat found in the blood)

High blood pressure.

Diabetes and prediabetes.

Overweight and obesity.


Lack of physical activity.

Unhealthy diet.



test CHD your doctor will:

Ask about your medical and family history

Check your blood pressure

Do a blood test to assess your
cholesterol level

Before having the cholesterol test, you may be
asked not to eat for 12 hours so there is no food in your body that could
affect the result.

Further tests

To confirm a suspected
diagnosis, you may be referred for more tests. Many different tests are used to
diagnose heart-related problems, including:

stress tests
Blood tests
Coronary angiography 
Magnetic resonance imaging (MRI) scans 
Computerised tomography (CT) scans


The importance of
preventing and controlling risk factors such as smoking, fatty diet, sedentary
lifestyle and stress should be avoided, as they are the main areas of focus in
prevention. Avoiding foods rich in saturated fats is vital to reduce lipid
levels in the blood and prevent arteriosclerosis. Adequate regular exercise is
also essential.

Introduction of CABG Surgery:

artery bypass grafting (CABG) is a type of heart surgery for patients with
severe coronary heart disease (CHD), a leading cause of death in Western
countries. The disease is characterized by gradual build-up of fatty and
calcium deposits (plaque) within the arteries that supply blood to the heart.
This reduces the amount of blood flow to the heart, causing chest pain, or if
the arteries are blocked completely, causing a heart attack. The aims of CABG
surgery are to reduce symptoms, reduce the risk of heart attack and improve
survival.  Currently around half a million patients worldwide undergo CABG
each year. There is a real possibility that these numbers will increase with a
growing elderly population, an increasing epidemic of diabetes and obesity which
all predispose to the development of CAD, and an increasing realisation that
PCI may merely delay definitive treatment.

1.8.1    Definition:

CABG is a technique that involves using an artery or vein from elsewhere
in the body to bypass the blocked vessels, restoring adequate blood flow to the
heart. The artery or vein is attached around the blockage, so that there is a
new pathway for oxygenated blood to reach the heart muscle.

CABG is one treatment for CHD. During CABG, a
healthy artery or vein from the body is connected, or grafted, to the blocked
coronary artery. The grafted artery or vein bypasses (that is, goes around) the
blocked portion of the coronary artery.

This creates a new passage, and oxygen-rich blood
is routed around the blockage to the heart muscle.



1.9     Goals of
CABG Surgery:

Improving your quality of life and decreasing
angina and other CHD symptoms.

Allowing you to resume a more active lifestyle.

Improving the pumping action of your heart if it
has been damaged by a heart attack.

Lowering the risk of a heart attack (in some
patients, such as those who have diabetes

Improving your chance of survival.

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