Shopping on line can be easy, simple and save you lots of money. It can also take a lot of your time, frustrate you, and result in unwanted purchases. Now the same can be said for regular high street shopping, but with the vast opportunity presented by the Internet it will pay you to spend a few minutes reading this and understanding how to better optimize your Coronary Heart Disease shopping experience:

1. Compare - without doubt the biggest advantage that the Coronary Heart Disease offers shoppers today is the ability to compare thousands of Coronary Heart Disease at a time. This is a great thing, but not necessarily all the time! Too much can be daunting at times so take advantage of the great comparison sites and where possible let them do the hard work for you.

2. Research - if it has been said it will be on the internet. Ignorance is no longer a justifiable reason for buying the wrong thing. Take the time to research in detail everything that you could possible want to know about

3. Testimonials - don't know anybody that has bought a Coronary Heart Disease? Wrong! If the Coronary Heart Disease is good the internet will let you know. Use the Internet as a friend and get testimonials before you buy.

4. Questions - Got a question about Coronary Heart Disease then search the Forums, FAQ's, Blogs etc. Don't be afraid to ask .....

5. Reputation - Never heard of the company selling Coronary Heart Disease? Don't worry, no reason why you should know every company in the world, but you know someone that does! Use the internet to find out what people are saying about Coronary Heart Disease and build up a picture of their reputation for sales, returns, customer service, delivery etc.

6. Returns - still worried that even after all of the above your Coronary Heart Disease wont be what you want? Check out the returns policy. There is so much competition now that someone, somewhere is bound to offer the terms that you are comfortable with.

7. Feedback - happy with your Coronary Heart Disease then let people know, after all you are depending on others people input in your buying decision, so why not give a little back.

8. Security - check for the yellow padlock on the Coronary Heart Disease site before you buy, and the s after http:/ /i.e. https:// = a secure site

9. Contact - got a question about Coronary Heart Disease, or want to leave a comment then check out the sites contact page. Reputable companies have them and respond.

10. Payment - ready to pay for your Coronary Heart Disease, then use your credit card or PayPal! Be aware of companies that don't accept them, there may be genuine reasons but given the huge amount of choice you have when buying online there is no reason at all not to buy via credit card or PayPal.

{{DiseaseDisorder infobox | Name = Coronary heart disease | ICD10 = I20-I25 | ICD9 = {{ICD9|410-->-{{ICD9|414-->, {{ICD9|429.2--> | -->Coronary heart disease (CHD), also called coronary artery disease (CAD), ischaemic heart disease, atherosclerosis heart disease, is the end result of the accumulation of atheroma within the walls of the Coronary circulation that supply the myocardium (the muscle of the heart) with oxygen and nutrients. While the symptoms and signs of coronary heart disease are noted in the advanced state of disease, most individuals with coronary heart disease show no evidence of disease for decades as the disease progresses before the first onset of symptoms, often a "sudden" myocardial infarction, finally arise. After decades of progression, some of these atheroma may rupture and (along with the activation of the blood clotting system) start limiting blood flow to the cardiac muscle. The disease is the most common cause of cardiac arresthttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1835183, and is also the most common reason for death of men and women over 20 years of age.According to present trends in the United States, half of healthy 40-year-old males will develop CHD in the future, and one in three healthy 40-year-old women.http://circ.ahajournals.org/cgi/content/full/115/5/e69/TBL3179728 According to the Guinness Book of Records, Northern Ireland is the country with the most occurrences of CHD.

Overview Atherosclerotic heart disease can be thought of as a wide spectrum of disease of the heart. At one end of the spectrum is the asymptomatic individual with atheromatous streaks within the walls of the coronary arteries (the arteries of the heart). These streaks represent the early stage of atherosclerotic heart disease and do not obstruct the flow of blood. A coronary angiogram performed during this stage of disease may not show any evidence of coronary artery disease, because the lumen of the coronary artery has not decreased in calibre.

Over a period of many years, these streaks increase in thickness. While the atheromatous plaques initially expand into the walls of the arteries, eventually they will expand into the lumen of the vessel, affecting the flow of blood through the arteries. While it was originally believed that the growth of atheromatous plaques was a slow, gradual process, recent evidence suggests that the gradual buildup may be complemented by small plaque ruptures which cause the sudden increase in the plaque burden due to accumulation of thrombus material.

image of a coronary artery (left), with color coding on the right, delineating the lumen (yellow), external elastic membrane (blue) and the atherosclerotic plaque burden (green). As the plaque burden increases, the lumen size will decrease.Atheromatous plaques that cause obstruction of less than 70 percent of the diameter of the vessel rarely cause symptoms of obstructive coronary artery disease. As the plaques grow in thickness and obstruct more than 70 percent of the diameter of the vessel, the individual develops symptoms of obstructive coronary artery disease. At this stage of the disease process, the patient can be said to have ischemic heart disease. The symptoms of ischemic heart disease are often first noted during times of increased workload of the heart. For instance, the first symptoms include exertional Angina pectoris or decreased exercise tolerance.

As the degree of coronary artery disease progresses, there may be near-complete obstruction of the lumen of the coronary artery, severely restricting the flow of oxygen-carrying blood to the myocardium. Individuals with this degree of coronary heart disease typically have suffered from one or more myocardial infarctions (heart attacks), and may have signs and symptoms of chronic coronary ischemia, including symptoms of Angina pectoris at rest and flash pulmonary edema.

A distinction should be made between myocardial ischemia and myocardial infarction. Ischemia means that the amount of oxygen supplied to the tissue is inadequate to supply the needs of the tissue. When the myocardium becomes ischemic, it does not function optimally. When large areas of the myocardium becomes ischemic, there can be impairment in the relaxation and contraction of the myocardium. If the blood flow to the tissue is improved, myocardial ischemia can be reversed. Infarction means that the tissue has undergone irreversible death due to lack of sufficient oxygen-rich blood.

An individual may develop a rupture of an atheromatous plaque at any stage of the spectrum of coronary heart disease. The acute rupture of a plaque may lead to an acute myocardial infarction (heart attack).

Pathophysiology Limitation of blood flow to the heart causes ischemia (cell starvation secondary to a lack of oxygen) of the myocardial cells. When myocardial cells die from lack of oxygen, this is called a myocardial infarction (commonly called a heart attack). It leads to cardiac muscle damage, cardiac muscle death and later scarring without cardiac muscle regrowth.

Myocardial infarction usually results from the sudden occlusion of a coronary artery when a plaque ruptures, activating the clotting system and atheroma-clot interaction fills the lumen of the artery to the point of sudden closure. The typical stenosis of the lumen of the coronary artery before sudden closure is typically 20%, according to clinical research completed in the late 1990s and using IVUS examinations within 6 months prior to a myocardial infarction. High grade stenosis as such exceeding 75% blockage, such as detected by Cardiac stress test, were found to be responsible for only 14% of acute myocardial infarctions the rest being due to plaque rupture/ spasm. The events leading up to plaque rupture are only partially understood. Myocardial infarction is also caused, far less commonly, by spasm of the artery wall occluding the lumen, a condition also associated with atheromatous plaque and CHD.

CHD is associated with Tobacco smoking, obesity, hypertension and a chronic sub-clinical lack of vitamin C. A family history of CHD is one of the strongest predictors of CHD. Screening for CHD includes evaluating homocysteine levels, High density lipoprotein and Low density lipoprotein (cholesterol) levels and triglyceride levels.

Angina Angina pectoris that occurs regularly with activity, upon awakening, or at other predictable times is termed stable angina and is associated with high grade stenosis of the heart artery. The symptoms of angina are often treated with nitrate preparations such as Glyceryl trinitrate (pharmacology), which come in short-acting and long-acting forms, and may be administered transdermally, sublingually or orally. Many other more effective treatments, especially of the underlying atheromatous disease, have been developed.

Angina that changes in intensity, character or frequency is termed unstable. Unstable angina may precede myocardial infarction, and requires urgent medical attention. It is treated with morphine, oxygen, intravenous nitroglycerin, and aspirin. Interventional procedures such as angioplasty may be done.

Risk factors The following are confirmed independent risk factors for the development of CAD, in order of decreasing importance:
  • Hypercholesterolemia (specifically, serum LDL concentrations)
  • tobacco smoking
  • Hypertension (high systolic pressure seems to be most significant in this regard)
  • Hyperglycemia (due to diabetes mellitus or otherwise)
  • Type A personality . Added in 1981 as an independent risk factor after a majority of research into the field discovered that TABP's were twice as likely to cause CHD than any other personality type.
  • Hereditary differences in such diverse aspects as lipoprotein structure and that of their associated receptors, homocysteine processing/metabolism, etc.


    • Significant, but indirect risk factors include:

    Prevention Coronary heart disease is the most common form of heart disease in the Western world. Prevention centers on the modifiable risk factors, which include decreasing cholesterol levels, addressing obesity and hypertension, avoiding a sedentary lifestyle, making healthy dietary choices, and smoking cessation. There is some evidence that lowering uric acid and homocysteine levels may contribute. In diabetes mellitus, there is little evidence that blood sugar control actually improves cardiac risk. Some recommend a diet rich in omega-3 fatty acids and vitamin C. The World Health Organization (WHO) recommends "low to moderate alcohol intake" to reduce risk of coronary heart disease.http://www.who.int/nutrition/topics/5_population_nutrient/en/index12.html

    An increasingly growing number of other physiological markers and homeostatic mechanisms are currently under scientific investigation. Among these markers are low density lipoprotein and asymmetric dimethylarginine. Patients with CHD and those trying to prevent CHD are advised to avoid fats that are readily oxidized (e.g., saturated fats and trans-fats), limit carbohydrates and processed sugars to reduce production of Low density lipoproteins while increasing High density lipoproteins, keeping blood pressure normal, exercise and stop smoking. These measures limit the progression of the disease. Recent studies have shown that dramatic reduction in LDL levels can cause mild regression of coronary heart disease.

    Exercise Separate to the question of the benefits of exercise; it is unclear whether doctors should spend time counseling patients to exercise. The U.S. Preventive Services Task Force (USPSTF), based on a systematic review of randomized controlled trials, found 'insufficient evidence' to recommend that doctors counsel patients on exercise. However, the American Heart Association, based on a non-systematic review, recommends that doctors counsel patients on exercise http://www.ngc.gov/summary/summary.aspx?ss=15&doc_id=5360&string=#s23

    Preventive diets It has been suggested that coronary heart disease is partially reversible using an intense dietary regimen coupled with regular cardio exercise.





    The consumption of trans fat (commonly found in hydrogenated products such as margarine) has been shown to cause the development of endothelial dysfunction, a precursor to atherosclerosis.

    Aspirin Aspirin, in doses of less than 75 to 81 mg/d, can reduce the incidence of cardiovascular events. The U.S. Preventive Services Task Force 'strongly recommends that clinicians discuss aspirin chemoprevention with adults who are at increased risk for coronary heart disease'. The Task Force defines increased risk as 'Men older than 40 years of age, postmenopausal women, and younger persons with risk factors for coronary heart disease (for example, hypertension, diabetes, or smoking) are at increased risk for heart disease and may wish to consider aspirin therapy'. More specifically, high-risk persons are 'those with a 5-year risk ≥ 3%'. A risk calculator is available.http://www.med-decisions.com/

    Regarding healthy women, the more recent Women's Health Study randomized controlled trial found statistical significance benefit from aspirin in the reduction of cardiac events; however there was a statistical significance reduction in stroke. Subgroup analysis showed that all benefit was confined to women over 65 years old. In spite of the statistical significance benefit for women < 65 years old, recent Clinical practice guideline by the American Heart Association recommend to 'consider' aspirin in 'healthy women' {{DiseaseDisorder infobox | Name = Coronary heart disease | ICD10 = I20-I25 | ICD9 = {{ICD9|410-->-{{ICD9|414-->, {{ICD9|429.2--> | -->Coronary heart disease (CHD), also called coronary artery disease (CAD), ischaemic heart disease, atherosclerosis heart disease, is the end result of the accumulation of atheroma within the walls of the Coronary circulation that supply the myocardium (the muscle of the heart) with oxygen and nutrients. While the symptoms and signs of coronary heart disease are noted in the advanced state of disease, most individuals with coronary heart disease show no evidence of disease for decades as the disease progresses before the first onset of symptoms, often a "sudden" myocardial infarction, finally arise. After decades of progression, some of these atheroma may rupture and (along with the activation of the blood clotting system) start limiting blood flow to the cardiac muscle. The disease is the most common cause of cardiac arresthttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1835183, and is also the most common reason for death of men and women over 20 years of age.According to present trends in the United States, half of healthy 40-year-old males will develop CHD in the future, and one in three healthy 40-year-old women.http://circ.ahajournals.org/cgi/content/full/115/5/e69/TBL3179728 According to the Guinness Book of Records, Northern Ireland is the country with the most occurrences of CHD.

    Overview Atherosclerotic heart disease can be thought of as a wide spectrum of disease of the heart. At one end of the spectrum is the asymptomatic individual with atheromatous streaks within the walls of the coronary arteries (the arteries of the heart). These streaks represent the early stage of atherosclerotic heart disease and do not obstruct the flow of blood. A coronary angiogram performed during this stage of disease may not show any evidence of coronary artery disease, because the lumen of the coronary artery has not decreased in calibre.

    Over a period of many years, these streaks increase in thickness. While the atheromatous plaques initially expand into the walls of the arteries, eventually they will expand into the lumen of the vessel, affecting the flow of blood through the arteries. While it was originally believed that the growth of atheromatous plaques was a slow, gradual process, recent evidence suggests that the gradual buildup may be complemented by small plaque ruptures which cause the sudden increase in the plaque burden due to accumulation of thrombus material.

    image of a coronary artery (left), with color coding on the right, delineating the lumen (yellow), external elastic membrane (blue) and the atherosclerotic plaque burden (green). As the plaque burden increases, the lumen size will decrease.Atheromatous plaques that cause obstruction of less than 70 percent of the diameter of the vessel rarely cause symptoms of obstructive coronary artery disease. As the plaques grow in thickness and obstruct more than 70 percent of the diameter of the vessel, the individual develops symptoms of obstructive coronary artery disease. At this stage of the disease process, the patient can be said to have ischemic heart disease. The symptoms of ischemic heart disease are often first noted during times of increased workload of the heart. For instance, the first symptoms include exertional Angina pectoris or decreased exercise tolerance.

    As the degree of coronary artery disease progresses, there may be near-complete obstruction of the lumen of the coronary artery, severely restricting the flow of oxygen-carrying blood to the myocardium. Individuals with this degree of coronary heart disease typically have suffered from one or more myocardial infarctions (heart attacks), and may have signs and symptoms of chronic coronary ischemia, including symptoms of Angina pectoris at rest and flash pulmonary edema.

    A distinction should be made between myocardial ischemia and myocardial infarction. Ischemia means that the amount of oxygen supplied to the tissue is inadequate to supply the needs of the tissue. When the myocardium becomes ischemic, it does not function optimally. When large areas of the myocardium becomes ischemic, there can be impairment in the relaxation and contraction of the myocardium. If the blood flow to the tissue is improved, myocardial ischemia can be reversed. Infarction means that the tissue has undergone irreversible death due to lack of sufficient oxygen-rich blood.

    An individual may develop a rupture of an atheromatous plaque at any stage of the spectrum of coronary heart disease. The acute rupture of a plaque may lead to an acute myocardial infarction (heart attack).

    Pathophysiology Limitation of blood flow to the heart causes ischemia (cell starvation secondary to a lack of oxygen) of the myocardial cells. When myocardial cells die from lack of oxygen, this is called a myocardial infarction (commonly called a heart attack). It leads to cardiac muscle damage, cardiac muscle death and later scarring without cardiac muscle regrowth.

    Myocardial infarction usually results from the sudden occlusion of a coronary artery when a plaque ruptures, activating the clotting system and atheroma-clot interaction fills the lumen of the artery to the point of sudden closure. The typical stenosis of the lumen of the coronary artery before sudden closure is typically 20%, according to clinical research completed in the late 1990s and using IVUS examinations within 6 months prior to a myocardial infarction. High grade stenosis as such exceeding 75% blockage, such as detected by Cardiac stress test, were found to be responsible for only 14% of acute myocardial infarctions the rest being due to plaque rupture/ spasm. The events leading up to plaque rupture are only partially understood. Myocardial infarction is also caused, far less commonly, by spasm of the artery wall occluding the lumen, a condition also associated with atheromatous plaque and CHD.

    CHD is associated with Tobacco smoking, obesity, hypertension and a chronic sub-clinical lack of vitamin C. A family history of CHD is one of the strongest predictors of CHD. Screening for CHD includes evaluating homocysteine levels, High density lipoprotein and Low density lipoprotein (cholesterol) levels and triglyceride levels.

    Angina Angina pectoris that occurs regularly with activity, upon awakening, or at other predictable times is termed stable angina and is associated with high grade stenosis of the heart artery. The symptoms of angina are often treated with nitrate preparations such as Glyceryl trinitrate (pharmacology), which come in short-acting and long-acting forms, and may be administered transdermally, sublingually or orally. Many other more effective treatments, especially of the underlying atheromatous disease, have been developed.

    Angina that changes in intensity, character or frequency is termed unstable. Unstable angina may precede myocardial infarction, and requires urgent medical attention. It is treated with morphine, oxygen, intravenous nitroglycerin, and aspirin. Interventional procedures such as angioplasty may be done.

    Risk factors The following are confirmed independent risk factors for the development of CAD, in order of decreasing importance:
  • Hypercholesterolemia (specifically, serum LDL concentrations)
  • tobacco smoking
  • Hypertension (high systolic pressure seems to be most significant in this regard)
  • Hyperglycemia (due to diabetes mellitus or otherwise)
  • Type A personality . Added in 1981 as an independent risk factor after a majority of research into the field discovered that TABP's were twice as likely to cause CHD than any other personality type.
  • Hereditary differences in such diverse aspects as lipoprotein structure and that of their associated receptors, homocysteine processing/metabolism, etc.


    • Significant, but indirect risk factors include:

    Prevention Coronary heart disease is the most common form of heart disease in the Western world. Prevention centers on the modifiable risk factors, which include decreasing cholesterol levels, addressing obesity and hypertension, avoiding a sedentary lifestyle, making healthy dietary choices, and smoking cessation. There is some evidence that lowering uric acid and homocysteine levels may contribute. In diabetes mellitus, there is little evidence that blood sugar control actually improves cardiac risk. Some recommend a diet rich in omega-3 fatty acids and vitamin C. The World Health Organization (WHO) recommends "low to moderate alcohol intake" to reduce risk of coronary heart disease.http://www.who.int/nutrition/topics/5_population_nutrient/en/index12.html

    An increasingly growing number of other physiological markers and homeostatic mechanisms are currently under scientific investigation. Among these markers are low density lipoprotein and asymmetric dimethylarginine. Patients with CHD and those trying to prevent CHD are advised to avoid fats that are readily oxidized (e.g., saturated fats and trans-fats), limit carbohydrates and processed sugars to reduce production of Low density lipoproteins while increasing High density lipoproteins, keeping blood pressure normal, exercise and stop smoking. These measures limit the progression of the disease. Recent studies have shown that dramatic reduction in LDL levels can cause mild regression of coronary heart disease.

    Exercise Separate to the question of the benefits of exercise; it is unclear whether doctors should spend time counseling patients to exercise. The U.S. Preventive Services Task Force (USPSTF), based on a systematic review of randomized controlled trials, found 'insufficient evidence' to recommend that doctors counsel patients on exercise. However, the American Heart Association, based on a non-systematic review, recommends that doctors counsel patients on exercise http://www.ngc.gov/summary/summary.aspx?ss=15&doc_id=5360&string=#s23

    Preventive diets It has been suggested that coronary heart disease is partially reversible using an intense dietary regimen coupled with regular cardio exercise.





    The consumption of trans fat (commonly found in hydrogenated products such as margarine) has been shown to cause the development of endothelial dysfunction, a precursor to atherosclerosis.

    Aspirin Aspirin, in doses of less than 75 to 81 mg/d, can reduce the incidence of cardiovascular events. The U.S. Preventive Services Task Force 'strongly recommends that clinicians discuss aspirin chemoprevention with adults who are at increased risk for coronary heart disease'. The Task Force defines increased risk as 'Men older than 40 years of age, postmenopausal women, and younger persons with risk factors for coronary heart disease (for example, hypertension, diabetes, or smoking) are at increased risk for heart disease and may wish to consider aspirin therapy'. More specifically, high-risk persons are 'those with a 5-year risk ≥ 3%'. A risk calculator is available.http://www.med-decisions.com/

    Regarding healthy women, the more recent Women's Health Study randomized controlled trial found statistical significance benefit from aspirin in the reduction of cardiac events; however there was a statistical significance reduction in stroke. Subgroup analysis showed that all benefit was confined to women over 65 years old. In spite of the statistical significance benefit for women < 65 years old, recent Clinical practice guideline by the American Heart Association recommend to 'consider' aspirin in 'healthy women'

    Coronary heart disease Introduction - Health encyclopaedia - NHS ...
    Narrowing of the coronary arteries that supply blood to the heart ... The heart. The heart is a muscle that is about the size of your fist. It pumps blood around your body and ...

    Coronary heart disease Diagnosis - Health encyclopaedia - NHS Direct ...
    Narrowing of the coronary arteries that supply blood to the heart ... A number of different tests are used to diagnose heart related problems including:

    Coronary heart disease - Questions to ask - Questions
    If you are diagnosed with coronary heart disease, you will need to prevent the factors that will lead to a progression of the disease'

    Understanding coronary heart disease
    Introduction page to guide on coronary heart disease (CHD). ... Print options and next steps. Print an information prescription containing all the facts you need on Coronary heart ...

    Coronary heart disease - Introduction - NHS24 Health Library
    Health Information and Self Care Advice for Scotland. nhs24.com provides comprehensive up-to-date health information and self care advice for people in Scotland.

    Scotland's Health on the Web - Coronary Heart Disease
    National Coronary Heart Disease Website. The CHD website will be incorporated under the new Heart Scotland website, due to be released later this year.

    Coronary heart disease statistics 2004
    This is the twelfth edition of Coronary heart statistics produced by the British Heart Foundation. It is divided into 13 chapters. The first two chapters on mortality and morbidity ...

    Coronary Heart Disease Statistics 2007
    This is the fifteenth edition of Coronary Heart Disease Statistics produced by the British Heart Foundation. It is divided into 13 chapters. The first two chapters on mortality and ...

    Coronary Heart Disease
    meta_description}. ... An annual update on Coronary Heart Disease (CHD) and Cerebrovascular Disease.

    Coronary Heart Disease
    meta_description}. ... ISD Scotland collects data on the number of patients treated for Coronary Heart Disease, and the procedures they receive. This together with data on deaths ...

     

    Coronary Heart Disease



     
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