The Basics

 

Coronary artery disease:  Anatomy and definitions

 

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“Prevention of a heart attack  is  better than cure, so it's prevention, prevention, prevention."

 

To implement prevention one needs to understand  disease. To prevent heart attacks one needs to understand coronary artery disease. Coronary artery disease in young people comes from risk factors: genetics, lifestyle measures smoking, unhealthy diet , lack of exercise and stress. This genetic predisposition and poor lifestyle interaction can lead to diabetes, obesity, hypertension, high cholesterol which accelerates the development of coronary artery disease.To tackle prevention we need to develop an early lifestyle management strategy.Your lifestyle strategy will be unique to your body but will have common evidence based principles. Results will be seen  up to 4 weeks once conditioning and remodelling occurs. This is a biopsychosocial approach.

 

The following needs to be understood: Biological and Psychosocial 

 

Biological:  Diet, the body and exercise.

1. Diet: Metabolic processing of food, manufacturing of cholesterol, the mediterreanean diet      2. Understand the effects of  exercise on  your body structure and circulation, exercise  limitations, degree of obesity  and  age.  Everyone can do some exercise to varying degrees from getting on and off a chair to running a marathon.

 

 Psychosocial: 

1. Psychological - Staying determined and focussed on your objective mind/ brain interaction- yoga meditation/ tai chi/psychologist 

2. Social commitment-  joining people with the same intentions and goals,  exercise classes, personal trainers, exercise buddies, gym lif

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So start here:

 

1. Genetics: You can't change your  genes but you can modify its expression. A healthy lifestyle which includes exercise and diet can produce translational proteins that will block or modify gene expression. Look at your family history ,it will try to predict your risk.

2. Understand your body and your current risk factors i.e. what is the level of obesity, cholesterol,  disordered eating.  Discuss your heart attack risk  with your doctor (as a percentage % using the framingham risk calculator). 

3. Establish your wellness needs and develop your master plan for a healthy lifestyle. Use this throughout your life with adjustments for age, injury and illness. The lifestyle plan will largely include diet and exercise. Commitment to this requires mental balance and strength.

 

Understanding the basic anatomy of the heart and circulation

Consider the heart as a pump and the coronary arteries as small hose pipes.  The coronary arteries supply blood and oxygen to the heart muscle to keep the pump working.

 

Blockages (cholesterol and calcium plaques) occur  inside the  coronary arteries and can lead to heart attacks. These plaques require “plumbing”  ( angiogram, stents and balloon angioplasty) to unblock them.

 

The heart is a muscular pump made up of the left ventricle (LV  - main chamber) and the right ventricle(RV). The left and right atria are less important  from a heart attack point of view. They have only a small amount of heart muscle.

 

The LV  pumps blood and oxygen to the brain and vital organs (kidneys, liver, gut), muscles and bones.

 

The right ventricle pumps blood to the lungs to receive oxygen and release carbon dioxide (CO2).

 

The coronary arteries supply blood , oxygen and nutrition to the LV and RV. They arise from the aorta and run over the surface of the heart.  Small branches penetrate the heart muscle to deliver oxygen and nutrition for the pump to work.

 

Below is the information you must know.

 

1. There are   4 main coronary arteries supplying blood to the heart muscle :  LMS (left main stem), LAD (left anterior descending artery most serious and commonest), LCx  (left circumflex) and  RCA (right coronary artery).The left main stem bifurcates (divides) into the LAD (left anterior descending artery) l and LCx (left circumflex artery). These arteries supply blood to the front of the heart and the left side. The RCA (right coronary artery) supplies blood to the right ventricle  of the heart and the undersurface  of the left ventricle.

2. The most significant  (commonest) affected artery is the LAD since it controls the blood supply to 70-80% of the heart muscle (myocardium)

3. Blockages (Plaques) in any of these arteries are  significant.  The bigger and longer the artery the more significant the blockage. There are high risk and low risk plaques.

 

Lifestyle management plan to prevent  blockages (plaques)

 

The prevention and management of obesity (linked to diet and disordered eating)  is crucial to the prevention of heart disease across the spectrum. Heart attack is no exception. Obesity,   Type 2 Diabetes, Hypertension (high Blood Pressure) and  Hypercholesterolemia constitute the Metabolic Syndrome.The metabolic syndrome causes high risk plaques which lead to heart attacks especially if they smoke. This predisposes a person to developing blockages (cholesterol related plaque inside the arteries). These plaques break open to cause a blood clot which blocks the flow in the artery causing a heart attack. A heart attack (myocardial infarction) is where the blood  clot stops the heart muscle from receiving oxygen. These plaques need to be detected early, especially vulnerable (high risk) plaques. High risk plaques (TCFA- Thin cap fibroatheroma) have a high cholesterol and lipid (fat) content.

 

The development of this plaque requires endothelial dysfunction (a defect in the internal lining of a coronary artery caused by abnormal genetics, smoking, diabetes etc). These defects take up cholesterol and fat from the blood and form plaques inside the artery.

 

Obesity

Dietary control and disordered eating patterns control obesity. The higher the BMI the higher the risk. BMI in excess of 35 kg/sqm is severe obesity. The more obese the person the higher percentage body fat and visceral fat (tummy fat). Fat (lipid or adipose tissue) is manufactured and stored via Insulin which is the main storage hormone of the body. Insulin is present in the beta cells of the pancreas in the upper mid section of the abdomen. 
 

Obese patients have a larger pancreas, with more storage hormone (Insulin) in the betacells on standby. The pancreas and Insulin  is the key to weight loss. A small pancreas with less beta cells  and less insulin on standby is the goal and key to weight loss. I don't believe weight loss is a” mind over matter”phenomenon. In my opinion it's the “mind over pancreatic function.” The recommended diet is the mediterreanean diet to prevent heart disease. It has the most evidence in reducing the risk of heart attack.

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Want to see the recommendations, full diet and exercise plan as well as take courses for a more scientific background and evidence based information?

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Join the club today

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Membership includes:

Recommendations to reduce insulin activity and prevent fat storage, including full exercise and scientific dietary recommendation 

You'll be able to connect with the Doctor, ask questions, learn module by module, take quizzes and more.

 

Here's an example of some of the courses you'll get access to. Improve your medical knowledge about heart disease to impact your life from a real expert:

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• 101 The Basics

• 102: 102 Heart attacks and blockages

• 103 Symptoms , signs and diagnosis of a heart attack

• 104 Prevention of heart attacks

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