Coronary heart disease (CHD) has become the leading cause of death today. World Health Organization (WHO) recorded more than 7 million people died from CHD in the entire world in 2002. This figure is expected to rise to 11 million people by 2020.
CHD occurs because of narrowing / blockage of the coronary blood vessels that function to distribute blood and oxygen to the heart muscle. Blockages (atherosclerotic plaque) tertumpuknya caused by fatty deposits (mainly LDL cholesterol), smooth muscle cells of blood vessels and other extracellular matrix along the walls of arteries as a result of a process that lasted many years. If blood flow is reduced significantly, then the patient should get immediate medical action.
Complaints vary CHD patients. Generally, angina pectoris, pain in the chest like a heavy pressure that sometimes spreads to the arms, jaw, and back. There is also a patient who complained of neck like a choke or feel sick in the pit of the stomach. Complaints usually occur when people perform physical activity or stress that makes the heart beat faster and demand more oxygen.
Some patients even come to the doctor in a state of heart attack (acute myocardial infarction) with more severe pain and longer, so that the body was soaked with cold sweat. If not handled properly, can lead to death.
CHD risk factors can be divided into two major categories, namely the risk factors can be reduced, repaired or modified, and risk factors of a natural or can not be prevented. Risk factors that can not be changed are age (over 40 years), gender (men are more at risk) and family history. Modifiable risk factors, including smoking, dyslipidemia, lack of movement, obesity, diabetes mellitus, stress, infections, and disorders of the blood (fibrinogen, factor of thrombosis, and so on). Therefore, some businesses actually could be done to reduce these risk factors, such as a healthy diet, consuming more soluble fiber, regular exercise and regular, and smoking cessation.
Alternative Therapies
Developing coronary heart disease treatment options suitable technological progress. Generally divided into therapy with drugs, coronary angioplasty (PTCA) and coronary bypass surgery (CABG). Drug PFS form antiangina drug (nitrates, beta blockers, calcium channel blockers), is useful for reducing the oxygen consumption of heart muscle and increase coronary blood flow by expanding blood vessels.
Efficacious diuretics increase spending on salt and water through urine, thus reducing the amount of fluid in the circulation as well as lowering blood pressure. Digitalis medication serves to add strength contraction of heart muscle, which improves the function of the heart. The drug is often used also as antiarrhythmics (anti-heart rhythm disorders).
Antihypertensive medication, working blood vessels dilate / relax arterial smooth muscle. The most popular are antiplatelet drugs (aspirin), works to thin the blood.
Recent research has shown giving a statin (cholesterol lowering drugs) via the oral after a heart attack can reduce the mortality rate to 34 percent per year. Anti-inflammatory effects of this drug has the ability to strengthen the protective layer of plaque, stabilize plaque, and can even reduce the constriction. Unfortunately until now there has been no single drug that can destroy the blockage / plaque on which the cause of CHD.
High Risk
In high-risk patients, medications are often inadequate, so there are only two ways to overcome this obstruction, ie, coronary angioplasty and coronary bypass surgery. The action is only performed if the blockage exceeds 50 percent of coronary artery lumen diameter by angiography examination. Coronary angioplasty is an intervention method to improve early blood vessels with the use of balloons to open clogged blood vessels. This action can reduce the death rate to 36 percent. This therapy was first introduced by Dr. Andreas Gruentzig in 1977.
At that time, still done with a very simple tool. Technological developments, especially in the field of catheters, balloons, and new medical devices such as stents, drugs, x-rays, and the ability of the operator, the more popularizing this therapy. Actions performed in the catheterization laboratory that resembles an operating room. The patient was laid on the table and associated with cardiac rhythm monitoring tools on an ongoing basis. After local anesthesia, a catheter is then inserted into the artery through the groin or wrist. Through the catheter was inserted another catheter having a balloon on the end and be directed to the heart with the help of the monitor. When it reaches the blocked artery, the balloon was developed to remove plaque, so that the heart again obtained in a normal blood supply.
PTCA is considered less risky and requires only a brief treatment (1-2 days) in hospital. In the world today is more than 1 million cases per year. The weakness of the risk of narrowing again (restenosis) of up to 50 percent of the diameter of the lumen in the same place over a period of 3-6 months.
Experts continue to examine ways to overcome this problem. Various classes of drugs such as corticosteroids, cytostatic, lowering fat, high-dose vitamin E, and others have tried. But it failed because of restenosis is local. The medicine must be provided locally through a catheter with two methods, namely gamma rays or beta radiation intrakoroner. Constraints are limited facilities and the side effects that may arise.
Another method is to coat the stent (a kind of metal frame that serves as a buffer to keep blood vessels open) with drugs to prevent the growth of new tissue, such as Sirolimus and Paclitaxel. Drugs released slowly when the stent was removed and the drug reacts with plaque, thus inhibited cell growth, even stopped.
This method could reduce restenosis rates to 5 percent and in patients with diabetes mellitus even reached 10 percent, and proven to be safe because no systemic side effects encountered. Still, research continues to proceed because this method is still not perfect.
Coronary angioplasty imposed severe coronary lesions and involves a lot of blood vessels at high risk of re-narrowing and even blockage. After all the action repeated angioplasty, especially if you need a lot of stents, also requires a high cost.
It may be that the cost of angioplasty ended up bigger than surgery and ultimately the patient also must be sent to the operating table, accompanied by higher risk.
In such circumstances, the choice of coronary bypass surgery would be more profitable than the original. Surgery is also more favorable in patients with stricture located in the position left main coronary artery, diabetes mellitus and patients with decreased cardiac function.
Heart surgeon perform installation artery bypass (bypass) in coronary artery narrowing / blockage by using general anesthesia. Bypass material can be taken from the leg veins, blood vessels below the chest or the arm. This technique first introduced to Dr. Rene Favoloro at Cleveland Clinic, USA in 1969. Currently more than 300 000 operations have been conducted in the U.S. each year. Unfortunately, new blood vessels grown (graft) is not always guaranteed trouble-free. It may be that in the course of time, graft narrowing / clog, requiring repeat angioplasty or surgery.
Risk was decreased with increasing experience, drug discovery and development of technology. The death rate ranges between 1-2 percent. In fact, in the heart of a large central / famous, can reach below 1 percent.
Now also known as off pump bypass surgery, namely heart surgery without using the help of heart lung machine. Planting graft performed on the heart is still beating (beating heart). This technique can reduce operating costs, shorten hospitalization and reduce trauma, and complications from surgery. However, the benefits still require long-term evaluation.
Selection of CHD therapy depends on several things, such as location and character of the narrowing, the number of blood vessels involved, cardiac function, presence of comorbidities, age, and also the cost. Each measures proven to improve patient life expectancy and quality of CHD. Concerns risks of each intervention can be understood, but the risk was far smaller than ever before.
Decision-making type of action by doctors who treat people objectively and wisely it is necessary to provide the largest possible benefits of therapy for patients with CHD. Of course these actions need to be also accompanied by improvements in lifestyle, ie implementing a healthy diet, low cholesterol diet, exercising regularly, and avoid stress.
Yanto Sandy Tjang,
Doctors Cardiac Surgeon at the Heart Center North Rhine Westphalia Bad Oeynhausen / Ruhr University of Bochum, Germany. You have read Alternative Therapy Coronary Heart Disease
