CONTENTS 3 Introduction 4 The Human Heart 5 Symptoms of Coronary Heart Disease 5 Heart Attack 5 Sudden Death 5 Angina 6 Angina Pectoris 6 Signs and Symptoms 7 Different Forms of Angina 8 Causes of Angina 9 Atherosclerosis 9 Plaque 10 Lipoproteins 10 Lipoproteins and Atheroma 11 Risk Factors 11 Family History 11 Diabetes 11 Hypertension 11 Cholesterol 12 Smoking 12 Multiple Risk Factors 13 Diagnosis 14 Drug Treatment 14 Nitrates 14 Beta-blockers 15 Calcium antagonists 15 Other Medications 16 Surgery 16 Coronary Bypass Surgery 17 Angioplasty 18 Self-Help 20 Type-A Behaviour Pattern 21 Cardiac Rehab Program 22 Conclusion 23 Diagrams and Charts 26 Bibliography INTRODUCTION In today's society, people are gaining medical knowledge at quite a fast pace. Treatments, cures, and vaccines for various diseases and disorders are being developed constantly, and yet, coronary heart disease remains the number one killer in the world. The media today concentrates intensely on drug and alcohol abuse, homicides, AIDS and so on. What a lot of people are not realizing is that coronary heart disease actually accounts for about 80% of all sudden deaths. In fact, the number of deaths from heart disease approximately equals to the number of deaths from cancer, accidents, chronic lung disease, pneumonia and influenza, and others, COMBINED. One of the symptoms of coronary heart disease is angina pectoris. Unfortunately, a lot of people do not take it seriously, and thus not realizing that it may lead to other complications, and even death. THE HUMAN HEART In order to understand angina, one must know about our own heart. The human heart is a powerful muscle in the body which is worked the hardest. A double pump system, the heart consists of two pumps side by side, which pump blood to all parts of the body. Its steady beating maintains the flow of blood through the body day and night, year after year, non-stop from birth until death. The heart is a hollow, muscular organ slightly bigger than a person's clenched fist. It is located in the centre of the chest, under the breastbone above the sternum, but it is slanted slightly to the left, giving people the impression that their heart is on the left side of their chest. The heart is divided into two halves, which are further divided into four chambers: the left atrium and ventricle, and the right atrium and ventricle. Each chamber on one side is separated from the other by a valve, and it is the closure of these valves that produce the "lubb-dubb" sound so familiar to us. (see Fig. 1 - The Structure of the Heart) Like any other organs in our body, the heart needs a supply of blood and oxygen, and coronary arteries supply them. There are two main coronary arteries, the left coronary artery, and the right coronary artery. They branch off the main artery of the body, the aorta. The right coronary artery circles the right side and goes to the back of the heart. The left coronary artery further divides into the left circumflex and the left anterior descending artery. These two left arteries feed the front and the left side of the heart. The division of the left coronary artery is the reason why doctors usually refer to three main coronary arteries. (Fig. 2 - Coronary Arteries) SYMPTOMS OF CORONARY HEART DISEASE There are three main symptoms of coronary heart disease: Heart Attack, Sudden Death, and Angina. Heart Attack Heart attack occurs when a blood clot suddenly and completely blocks a diseased coronary artery, resulting in the death of the heart muscle cells supplied by that artery. Coronary and Coronary Thrombosis2 are terms that can refer to a heart attack. Another term, Acute myocardial infarction2, means death of heart muscle due to an inadequate blood supply. Sudden Death Sudden death occurs due to cardiac arrest. Cardiac arrest may be the first symptom of coronary artery disease and may occur without any symptoms or warning signs. Other causes of sudden deaths include drowning, suffocation, electrocution, drug overdose, trauma (such as automobile accidents), and stroke. Drowning, suffocation, and drug overdose usually cause respiratory arrest which in turn cause cardiac arrest. Trauma may cause sudden death by severe injury to the heart or brain, or by severe blood loss. Stroke causes damage