The cardiovascular system (comprising of the heart, arteries and veins) is
essential for keeping homeostasis balanced throughout the body.

The heart works as a pump to push blood containing oxygen and nutrients
through the extensive network of arteries and arterioles to replenish
organs, tissues and respiring cells, once replenishment has taken place
waste products and carbon dioxide are removed and taken back to the heart
in the blood stream through veins and venules to be redirected through the
pulmonary circulation back to the lungs to be deoxygenised (see appendix

The heart also needs to be replenished with oxygen rich blood to survive;
blood is supplied to the heart by the coronary circulation (see appendix

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Just like any other organ in the body, the heart and surrounding vessels
are susceptible to disease. One of these many diseases is Coronary Heart

Coronary heart disease is the most common cause of premature death in the
United Kingdom. On average every year 110.000 people die from heart
related diseases, whilst 300.000 people have heart attacks and more than
1.4 million suffer from angina, (British Heart Foundation 2001).CHD is
caused by a number of “risk factors” (risk factors are issues that can
contribute to a disease). Risk factors associated with CHD are high blood
pressure (hypertension), cigarette smoking, alcohol, physical inactivity,
obesity (being overweight), and high blood cholesterol.

As fatty foods are consumed and digestion initiates, saturated fats from
the digested food is broken down by the liver to produce cholesterol.

Passing into the bloodstream the cholesterol combines with proteins to
create “lipoproteins”. Lipoproteins are used for transporting numerous
types of lipids to and from the cells. Lipoproteins are divided into two
categories, high density lipoproteins (HDL) and low density lipoproteins
(LDL). HDL’s remove excess cholesterol from the cells and transports it to
the liver to be destroyed, whereas LDL’s are responsible for supplying
cells with cholesterol. The cells in the body have LDL receptors attached
to them. Once inside the cell the LDL is broken down and cholesterol is
released to fulfil the cells requirements.When the cell has adequate
cholesterol to function a negative feedback prevents the cell from making
new LDL receptors.Unfortunately CHD can also be a genetic disease,
thought to be caused by a mutation in the apolipoprotein B (main protein in
the low density lipoprotein group).The mutation causes insufficient
production of receptors and therefore high levels of cholesterol are
released increasing the susceptibility to CHD.With the combination of
high levels of LDL and raised levels of homocysteine (an amino acid,
building blocks that make up protein) derived from methionine another amino
acid which is found in eggs, milk and meat atherosclerosis occurs (see
appendix 3).

Atherosclerosis is caused by a build-up of cholesterol and fatty substances
on the inner wall of the artery, beginning as fatty streaks which gradually
develop to form lumps known as plaques (see appendix 4). Raised
homocysteine levels damage the lining of the artery whilst plaques assist
the walls of the artery to thicken and harden therefore the lumen of the
artery narrows. This results in myocardial ischemia (poor blood flow to
the heart) and the oxygen needs being suspended (hypoxia). As the hearts
requests for oxygen surpass the amount available the heart omits warning
signs in the form of tightening and pain in the chest, sometimes extending
to the upper extremities, lumber area and abdomen, this is clinically
referred to as stable angina. In extreme cases of atherosclerosis the
plaques in the misshapen coronary artery affect blood flow resulting in the
development of blood clots (thrombus) When a thrombus occurs (see appendix
5), it blocks the artery triggering an attack of unstable angina, if the
heart continues to be starved of oxygen for more than a few minutes the
heart muscle begins to die resulting in myocardial infarction (heart
attack). Myocardial infarction can contribute to total starvation of the
heart resulting in congestive heart failure and inventively death.

Some heart attacks can be looked upon as warning signs and that a change in
lifestyle is required. There are many prescribed medications available to
reduce the risks of heart failure, for example; aspirin is used to reduce
the stickiness of the platelets therefore reducing the risk of blood clots
(thrombus). Diuretics (which target the kidneys to increase excretion of
water in the urine) these reduce blood pressure and build-up of water in
tissues (oedema). Lipid lowering drugs (statins) raise the amount of high
density lipoproteins (good cholesterol) and lower low density lipoproteins
(bad cholesterol), these work by inhibiting the enzyme involved in the
synthesis of cholesterol. The administration of these drugs are designed
to be incorporated into a newly modified lifestyle.

Practitioners will advise CHD patients to reassess their former standard of
living and introduce an alternative healthier option.To achieve an
overall healthy eating plan the patient should endeavour to consume five
fruit and vegetable portions daily, use only low fat or fat-free dairy
products, include six wholegrain foods (found in cereals and bread), eat
only lean meat and remove skin from poultry, try to include two portions of
fish weekly, especially fatty fish (sardines, pilchards) containing large
amounts of omega 3 oils as it helps to reduce the risk of CHD and improves
the chance of survival after a heart attack. Limit sugary foods and foods
with no nutritional value (fast food fries), cut down on trans-fats
(partially hydrogenated vegetable oils) these consist of pastries, crisps
and some margarines. Avoid using sodium (salt), limit alcohol intake to
one drink a day or if possible cease drinking alcohol altogether.

If a CHD patient follows a sensible diet, controls other risk factors,
(smoking and alcohol) partakes in exercise (which helps to lower and
control blood pressure, and combined with a healthy diet increases physical
fitness) and takes possible medication prescribed by the doctor (some
patients may not be administrated any medication), there is a strong
possibility the patient will carry on to have an extended healthier life.

Although the majority of all patients will need to attend the doctors
surgery for regular health checks (blood cholesterol tests, blood pressure
checks and weight checks) to clarify the body is still responsive to the
alternative changes. In some CHD patients modifying risk factors are not
enough and surgery is performed to combat chances of heart failure.

Surgery of the coronary arteries isreferredtoasPercutaneous
Transluminal Coronary Angioplasty (PTCA). Several types of procedures may
be performed ranging from balloon angioplasty (a small balloon inserted
into the blocked artery to widen the artery for blood flow) (see appendix
6); to coronary artery bypass (patches of veins and arteries from another
part of the body are removed and placed into the heart in an attempt to
bypass the blocked arteries) (see appendix 7).All surgical procedures
have the chance of failure especially with the delicate tissues of the

The fundamental key to coronary heart disease is prevention.People live
in ignorance about disease and only show signs of interest if the
unthinkable happens to them or a family member.If the whole population
was to be forewarned about the risk of CHD or coronary heart failure at an
earlier age the consequences could be lessened.Children should be
educated on how diseases can affect the body and also how to avoid them;
they should be taught how to look after their bodies, physically through
exercise, eating healthier diets and the avoidance of smoking and drinking.

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