Coronary artery disease

Coronary artery disease (CAD), also known as ischemic heart disease (IHD), is a group of diseases that includes: stable angina, unstable angina, myocardial infarction, and sudden cardiac death. It is within the group of cardiovascular diseases of which it is the most common type. A common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Occasionally it may feel like heartburn. Usually symptoms occur with exercise or emotional stress, last less than a few minutes, and get better with rest. Shortness of breath may also occur and sometimes no symptoms are present. The first sign is occasionally a heart attack. Other complications include heart failure or an irregular heartbeat.
Coronary heart disease (CHD) is the leading cause of death for both men and women now days in the world. According to present trends, half of healthy 40-year-old men will develop CAD in the future, and one in three healthy 40-year-old women. About 1 in 6 men and 1 in 10 women die from CHD.
CHD generally affects more men than women, although from the age of 50 the chances of developing the condition are similar for both sexes.
CHD is also called as Ischemic heart disease or IHD.
Angina a typical type of chest pain, is the main symptoms of CHD. However, not everyone has the same symptoms and some people may not have any symptoms or sign before CHD is diagnosed. It is essentially a clinical syndrome of characteristic chest pain produced by increased work of the heart. It is usually relieved by rest. In most cases, it is manifested in front of the chest and mostly over the sternum. It may spread towards the left or right side of the chest. The pain radiates towards the left side very often. It may spread to the arms, neck, jaws and even the upper part of the abdomen. The left shoulder and the left arm are very often affected. The common man calls it heart disease. In Ayurveda it is known as Hridroga. It is of several types depending upon the characteristic features of the pain. If the pain is acute, pricking and of shifting nature, this is usually known as Vataja hridroga. If it is associated with burning sensation, heat, or excessive sweating then it is called Pittaja hridroga. In kaphaja Hridroga, the pain is usually very mild and it is associated with heaviness, nausea, vomiting and cough.
The heart
The heart is a muscular organ about the size of one’s fist. It pumps blood around your body and beats approximately 70-72 times a minute. After the blood leaves the right side of the heart, it goes to the lungs for its purification from where it picks up oxygen then comes back to the left side of the heart from where it is then pumped to the body’s organs through a network of arteries. The blood returns to your heart through veins before being pumped back to your lungs again. This process is called circulation.
What causes coronary heart disease?
Coronary heart disease is the term that describes the deposition of fats like thick and viscous like material called cholesterol inside the vessels, which ultimately leads to the narrowing of the vessels. Technically this deposition process of fats substance or cholesterol inside the vessels is called atherosclerosis or atherosclerotic changes. With these changes inside the vessels the free flow of the blood gets hampered and the heart get devoid of the oxygen. This whole process lead to the event of heart attack. With not enough oxygen to the heart, there may be chest pain (angina pectoris), heart attack (myocardial infarction), or even death. Cholesterol build up is the most common cause of heart disease, and it happens so slowly that you are not even aware of it.
Blood cholesterol plays an important part in deciding a person’s chance or risk of getting coronary heart disease (CHD). The higher the blood cholesterol level, the greater is the risk.
A high blood cholesterol level is not the only thing that increases your chance of getting heart disease.
There are certain other factors such as:
Age, Sex, Family history of early heart disease and Individual’s personality can play the role.
Other factors include:
Cigarette smoking, High blood pressure, Elevated serum cholesterol, Diabetes, Obesity, Physical inactivity and Stress. The more risk factors you have, the greater is your chance of heart disease.
Atherosclerosis can be caused by lifestyle factors and other conditions, such as:
• smoking
• high cholesterol
• high blood pressure (hypertension)
• diabetes

Diagnosis:
The diagnosis of the CHD requires:
Complete medical and family history, Lifestyle and habits, Some blood or lab tests.
Further tests may be needed to confirm a diagnosis of CHD, that includes:
• ECG
• 2D Echo
• TMT
• Magnetic resonance imaging (MRI)
• CT scan
• coronary angiography
For symptomatic patients, stress echocardiography can be used to make a diagnosis for obstructive coronary artery disease. The use of echocardiography, stress cardiac imaging, and/or advanced non-invasive imaging is not recommended on individuals who are exhibiting no symptoms and are otherwise at low risk for developing coronary disease.
The diagnosis of coronary disease underlying particular symptoms depends largely on the nature of the symptoms.
The first investigation is an electrocardiogram (ECG/EKG).

Signs and symptoms
A typical type of Chest pain commonly called as Angina, is the commonest sign and symptom which the patient feels initially. Along with pain there is heaviness of chest with huge discomfort. Stress also contributes to have attack of angina which can stay for few minutes and relieves when you are stress free. Apart from that patient may experience, Shortness of breath, as there is poor supply to the heart, it is not able to pump back enough blood which causes shortness of breath. Sometimes this condition gets so much worst when there will be no supply at all to heart. This condition results in Heart attack.

Treatment:
Till early eighties, it was widely believed that heart disease was virtually irreversible. This meant that once developed, the disease ran a progressive course until the coronary arteries were completely blocked. But recent studies have proven beyond doubt that not only it is possible to stall the process of artery blockage but also the blockage can be really reversed. This implies that through measures other than surgery, it is quite possible to increase the blood flow to the areas of the heart that receive less than adequate blood supply due to clogging of the coronary arteries.
Ayurveda, aims to treat the root cause of the disease. A real cure for this disease is only possible if we adopt a holistic approach as the one advocated in Ayurveda. There are some very effective natural treatments for regulating the problem and strengthening the heart.

Treatment of CHD or IHD includes
Lifestyle changes: That includes all the things which help in reversing all the factors that leads to ill health
Preventions: Prevention is by eating a healthy diet, regular exercise, maintaining a healthy weight or ideal weight according to BMI and not smoking.
Management: This include:
Sodhana chikitsa or Panchakarma therapy, for the cleansing or detoxification purpose. If the condition of the patient is not acute or if there is not any emergency that one can go for sodhana or purification method under panchakarma. Preferably vamana karama and virechana karma are indicated. Also urhu basti is indicated.
Shamana aushadies or oral medication: This includes:
Nourishment: This is very important to nourish the damaged tissues and cells of the heart and the arteries, and to prevent the from free radicles through the effective anti oxidants. Herbal medicines like Amlaki or Indian gooseberry is an excellent anti-oxidant that can help to prevent arterial damage as well as nourishing the heart tissue. Amlaki can help boost the immune system also.
Increased circulation: Main cause of heart problems or can say heart attack, is hardening, inflammation or congestion of the arteries, which leads to restricted blood flow as well as excessive pressure on the heart muscle and tissue. Arjuna or Terminalia arjuna is one of Ayurveda’s magical herbs for strengthening the cardiac muscle, reducing arterial congestion and lowering blood pressure. It also helps in dissolving the clots in the blood and thus effective in reducing the plaques.
Reduce Blood fats and high cholesterol: main cause of the pathogenesis of the disease since from the beginning to the progressive stage is high cholesterol levels in the blood. Triphala Guggulu like combinations are well known to tackle the situations arised from the situations like high cholesterol levels in the blood or other fats also.
Relaxation: As the stress, anxiety and worries also contributes the problem of CHD OR IHD, it become very necessary to cure these things also effectively so that the condition be tackled delicately. For this herbs like Brahami ( bacopa monerie) or Ashwagandha ( withamnia somniferra) are quite effective. These are the wonder herb for reducing tension in the body and mind as well as strengthen the heart muscle.
Dietary suggestions: Eat a nourishing diet that is devoid of all processed foods, poor quality dairy, poor quality oils, hydrogenated oils. Increase the intake of foods that are excellent for the heart. Use garlic, turmeric, ginger and saffron. Include whole grains, pulses and foods high in essential fatty acids.
A diet high in fruits and vegetables decreases the risk of cardiovascular disease. Vegetarians have a lower risk of heart disease, possibly due to their greater consumption of fruits and vegetables. High fiber diet also lowers the risk of cardiovascular diseases. The consumption of trans fat (commonly found in hydrogenated products) has been shown to cause a precursor to atherosclerosis and increase the risk of coronary artery disease.
Lifestyle: Practising light aerobic exercise and regular relaxation through warm ups, yoga, pranayams and asanas. Ayurveda would recommend some nourishing yoga practices, such as the dynamic ‘Sun Salutation’ as well as daily breathing practices (Pranayama). Ayurveda suggests exercising within your own limitations and does not encourage excessive exercise that leaves you tired. Yoga is exercise that leaves you energised and fitter.
A very common cause of heart diseases is mental stress. Regular practice of yoga and Pranayama (breathing exercises) reduces stress levels also, meditation has been scientifically proven to prevent as well as cure heart diseases.
Ayurveda considers the functions of heart and mind inter-linked. Disturbance in one affects the other. Therefore, patients having heart disease are advised to get relaxed from anxiety, worry, excessive sexual intercourse and other worries.

Ayurvedic medicines can provide a complementary role in managing the disease. During an acute attack of pain, especially in cases of angina, Ayurvedic medicines like:
Brihat Vat Chintamani
Laxmi Vilas Rasa
Shrung Bhasma can be taken beneath the tongue. These protect the heart, decrease the pain, and improve the tone of the heart muscles.
Following an acute attack, the same remedies can be given again to reduce damage. Other helpful medicines include

  • Prabhakar vati
  • Nagarjuna abhrak
  • Lasunadi vati
  • Arjuna choorna
  • Arjunarista
  • Punarnavadi mandoora
  • Puanrnavasava
  • Mukta pisti
  • Jaharmohra pisti
  • Akik pisti

These medicines help reduce fatty deposits in the blood vessels and reduce blood pressure, blood cholesterol, and atherosclerosis. Studies demonstrate that powdered stem bark of Terminalia arjuna modifies coronary risk factors such as hypertension, obesity, and diabetes.
In addition, the following remedies might be of assistance:
• Commiphora mukul ( guggulu )shows significant ability to reduce cholesterol and triglycerides.
• Emblica officinalis ( amla )reduces serum cholesterol levels.
• Ocimum sanctum ( tulasi )reduces hypertension and stress.
• Trigonella foenum-graecum (fenugreek) possibly decreases blood glucose levels.
• Withania somnifera ( ashwagandha )possesses anti-inflammatory, anti-stress, anti-oxidative, and rejuvenating properties.
Zinziber officinale (Ginger) tends to decrease platelet aggregation.

Risk factors
Coronary artery disease has a number of well determined risk factors. The most common risk factors include:
• Smoking
• Family history
• Hypertension
• Obesity
• Diabetes
• Poor diet
• Excessive alcohol
• Lack of exercise.
Other risks include depression and Stress. The underlying mechanism involves atherosclerosis of the arteries of the heart.
Prevention
Up to 90% of cardiovascular disease may be preventable if established risk factors are avoided. Prevention involves:
• Exercise
• Decreasing obesity
• Treating hypertension
• A healthy diet
• Decreasing elevated cholesterol levels
• Stopping smoking.
Medications and preventive measures are equally effective. High levels of physical activity reduce the risk of coronary artery disease by about 25%.
In diabetes mellitus, there is little evidence that very tight blood sugar control improves cardiac risk although improved sugar control appears to decrease the risks of triopathies ( nephropathy, retinopathy, neuropathy).