Coronary Heart Disease

• Coronary heart disease


  Blockage in the heart's blood supply from the build up of fatty substances, can lead to myocardial infarction/heart attack
• Emergencies


  • Myocardial infarction- STEMI (High ST waves) on ECG due to complete blockage of coronary artery or Non-STEMI due to an incomplete blockage. Troponin biomarkers present
  • Unstable angina- unexpected, severe chest pain
  • Stable angina- predictable and manageable
• Atherosclerosis


  1. Atheroma (fatty material) builds up in the artery walls and narrows the arteries

  2. Once the endothelium has damage, inflammatory cells migrate to subendothelium and differentiate into macrophages

  3. The macrophages digest low-density lipoprotein (LDL) and transform into foam cells which create fatty streaks

  4. The macrophages release chemoattractants and cytokines
• Location of blockage


  • Left coronary artery directly affects left ventricle
  • Right coronary artery directly affects right ventricle
  • Circumflex artery
• Myocardial infarction


  Central chest pain- heaving/squeezing, Pain- crushing, Pain radiating down left arm and neck, Nausea, shortness of breath and light-headed
• ECG shows elevated ventricle contraction (ST waves) in STEMI
• Angina


  Atherosclerotic plaque partially blocks coronary artery so there's restricted blood flow, leading to a stabbing pain in the chest due to a lack of oxygen to the heart, Triggers are in exertion, cold conditions, stress and after meals
• Hardening of arteries


  Cholesterol is deposited in artery walls so pliability of arteries is reduced causing increased peripheral resistance to blood flow (afterload), Leads to high blood pressure and develops over decades
• Controllable risk factors


  • High BP
  • High cholesterol
  • Smoking
  • Obesity
  • Diabetes
  • Unhealthy diet
  • Alcohol
  • Stress and anxiety
• Uncontrollable risk factors


  • Family history
  • Age
  • Sex
  • Ethnicity
  • Genetics