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CAD Term Paper


The Cardiovascular System
The cardiovascular system, also known as the circulatory system is an essential organ system that supports life. Its main purpose is to circulate blood throughout the body. This allows the blood to carry nutrients and oxygen to the cells, and remove waste that accumulate in those cells. The circulator system is a closed system made up of veins and arteries. Blood flows away from the heart within the arteries, whilst the flow is reversed in veins which resupplies the heart with blood.

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The heart is one of the major components of the cardiovascular system. It is an organ that has the ability to pump blood throughout the entire body. It achieves this through muscular contractions initiated by electrical pulses that travel through the heart. The conductive pathway associated to the heart beat consist of the SA node (pacemaker), AV node, bundle of his, and the Purkinje fibers. The right side of the heart is connected to the pulmonary pathway that produces oxygenated blood. The left side of the heart pumps which is connected to the systemic pathway pumps oxygenated blood to the entire body. The systemic pathway is also used in returning that blood back to the heart. The two sides of the heart are divided by a layer of tissue called the septum. The heart is a muscular organ that works independently from the nervous system. The heart consists of four chambers where the lower two are considered as ventricles, and the upper two are atria. The heart consists of the endocardium which is the inner most layer, the myocardium which is the middle layer, and pericardium which is the thick outer layer in which the heart rests.

The blood that is pumped from the heart travels through arteries into smaller arterioles, and then into arterial capillaries. These capillaries directly connect to the venous capillaries, which then leads onto the venules and veins. The largest veins that supply the heart with blood are called the superior and inferior Vena Cava. The blood itself consists of water, erythrocytes, leukocytes, and platelets. Additionally, it may have any material that is being transported from one location to another.

CAD – What is it?
Coronary artery disease (CAD) is the largest cause of death in both men and women throughout the United States of America. It is also the most common form of heart disease. The cause of CAD is widely thought to be the buildup of plaques inside the arteries that supply blood to the heart muscles. Plaques consisting of materials such as cholesterol grow within arteries, gradually narrowing the cross section of the artery allowing less blood to flow through. Such a buildup of material within the arteries is known as atherosclerosis. Due to the thinning of the arteries the targeted muscles in the heart will be supplied with a lower volume of blood, oxygen, and nutrients. Therefore, the health of such muscles deteriorate over time as the plaque progresses in development. In some cases, a blood clot can occur at a ruptured plaque which will impede the flow of the blood through the arteries completely. In this case the muscles can be damaged to a great extent due to complete oxygen deprivation. Such damage might also be irreversible, as the related tissue may die through starvation. CAD can lead to heart failure, in which case the heart muscles are weakened, or to arrhythmias, where the normal beat of the heart is altered.

The chest pain associated with CAD related muscle damage is known as angina. This pain which could be similar to indigestion, is accompanied by a feeling of pressure or squeezing within the heart. CAD related pain is not specific to the heart, but can be felt by other areas of the upper body. CAD associated narrowing of the arteries are also known as cardiac ischemia.

What can cause CAD
CAD is broadly associated with an unhealthy lifestyle which can lead to high Low Density Lipoprotein (LDL) cholesterol levels. CAD is thought to begin early in human lives where the initial signs of plaque formation can be detected in the early to mid-teenage years. A considerable amount of scientific literature suggests that developing healthy lifestyle habits, such as healthy eating, weight management, and regular exercise can help slow the progressing of CAD, and ultimately prevent heart attacks.

CAD is also connected to age, high blood pressure, family history of the disease, and smoking. This suggests that cholesterol deposition rates within the arteries is not the only causative event. Persons with high blood pressure might have a heart attack sooner than a person with a normal blood pressure, even when both of them have similar plaque builds. Family history is significant in determining the chance of plaque depositing and hardening within an artery. Therefore, CAD diagnosis must consider multiple factors in determining what is the main cause, hence the best treatment to prevent heart failure, angina, and arrhythmia. In addition to the obvious heart pain or angina, shortness of breath can also indicate CAD. Persons become short of breath when the heart is weakened by CAD, and is unable to pump an adequate amount of oxygen containing blood to other organs and muscles.

CAD can also be influenced with either form of diabetes. Both forms of the disease if left untreated are known to significantly contribute towards the development of CAD. Further to its influence of CAD diabetes also may contribute towards neuropathy, nephropathy, eye damage (retinopathy), skin/mouth conditions, and even complications during pregnancy.

Diagnosing CAD can prevent heart attacks
The early diagnosis of CAD is important for the effective treatment of the disease. However, this process is complex, and relies on multiple diagnostic tests for a true diagnosis. The diagnosis usually starts at a routine visit to a physician, where based on the family history and general health of the patient a recommendation to a heart specialist may be done. Heart specialist or cardiologists are more knowledgeable about the exact mechanisms of CAD, and are equipped with the necessary tools to conduct a thorough investigation of the patient.

Cardiologists may use a range of tests that include electrocardiograms, stress testing, echocardiograms, chest x-rays, blood tests, coronary angiographs, and even cardiac catheterization in order to diagnose the extent of CAD.

An electrocardiogram is useful in defining the heart rate of the patient under normal conditions by recording the strength and timing of electrical signals passing through the heart. In contrast a stress test might be beneficial to the cardiologist as it shows how well the heart is pumping blood under stress conditions. The inability for the heart to keep up with a stressful situation is a big indicator of CAD. The cardiologist may also use tools such as echocardiograms in order to image the heart through sound waves. Through this method the specialist is able to define where the CAD is located within the heart. Blood tests tend to be taken throughout the process of diagnosis and treatment for CAD, as it complements the other tests by indicating the levels of good and bad fat within the body. Finally, coronary catheterization allows for the diagnostic team to distribute a special dye within the hearts coronary arteries, and subsequently image the area through a process known as angiography.

Treatment of CAD – Is prevention better than the cure?
The treatment of CAD is completely dependent on the extent of damage that has occurred to the heart muscles and coronary arteries. A treatment set up might include adjustments to lifestyle, medication, surgery, and cardiac rehabilitation.

Lifestyle changes. Lifestyle changes may be recommended at the earliest stages of CAD or even before any symptoms are detected. Doctors such as physicians might ask a patient to achieve a suitable body mass index according to the patient’s height, and ethnic background. Most CAD patients are recommended multiple methods of achieving healthy weights, such as through healthy eating habits, or by following a regular exercise routine. Some patients see benefits when they limit the amount of LDL cholesterol that is consumed per meal, whilst others might see the same benefits by reducing the amount of saturated and trans fats that they consume. In addition to lowering the amount of fats that are consumed, management of sodium intake is essential for healthy heart function. Similarly reducing or even avoiding alcohol intake, and smoking can have a marked effect on heart health.

Exercise is widely known to be associated with good health. A patient who is committed towards treating CAD might take up light to moderate exercise in order to better regulate the fats in their body, and lose weight. Exercise is also linked with lowering stress due to endorphin release. This is directly beneficial for the patient as stress is a factor that can lead to CAD. Therefore, patients that endeavor to maintain a healthy lifestyle by eating well and exercising regularly have significantly lower chance of CAD.

Medication. Lifestyle changes require the patients to commit to a different routine than what might be comfortable, and hence does not always take place. Patients who do not change their unhealthy lifestyles might progress to a noticeable stage of CAD in a short period of time. Such patients as well as those who have a family history of the disease are usually prescribed medication that helps reduce the amount of LDL cholesterol and triglycerides from the body. It is important to note that some preexisting conditions may require substances such as triglycerides to be given to the patient. Such treatments may in fact have a detrimental effect on cardiac health, and as such might be stopped, or lowered in order to treat CAD. Other medicines that can help treat CAD include blood thinners that lower the risk of heart attacks, especially in the case of high blood pressure. In addition to medicines directly related to the heart, medication might also factor in preexisting conditions such as diabetes that can contribute to CAD.

Medical Procedures and Surgery. Once a diagnosis confirms that a patient’s heart is affected by CAD, and if the extend of the disease is significant, interventional therapies are recommended. There are two major interventions that are used currently in order to treat mid-late stage CAD. As CAD prevents normal blood flow through a coronary artery, the intervention must re-establish healthy blood flow. This can be achieved by either reopening the artery through a process known as Percutaneous Coronary Intervention, where a flexible tube known as a stent is inserted into the blocked area. If the CAD has affected multiple sites of the same artery then stenting might not be feasible, and instead a complete bypass of that artery may be needed. Therefore, a process known as Coronary Artery Bypass is conducted by opening up the chest and grafting new arteries onto the heart. This process is significantly riskier than stenting as it is considered a major surgery.

Cardiac Rehabilitation. Cardiac rehab is a complex process involving many different healthcare specialist, such as doctors, nurses, dieticians, physiotherapists, and counselors. The process involves educating the patient on why he or she has developed CAD, and what measures might be needed in order to reduce the risk of a heart attack in the future. Cardiac rehab programs are usually implemented by the primary healthcare facility at which the patient is first treated or diagnosed. Most patients benefit from such programs as their progress is closely monitored by a specialist team over a long period of time. Patients also tend to form good lifestyle habits through such programs which provide lifelong benefits. Such patients are also more likely to pass on their knowledge and experiences to other who might be at risk of CAD, thus improving the general wellbeing of the population.

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