Images Of So-Called "Plaque" Inside An Artery
Karl Note: The below is a very traditional explanation of heart disease and heart attacks. This is what literally millions of people have been told is the truth. It is a bold thing to go against thousands of doctors, and deny the truth held dear by millions of Americans about the number one killer in society. Read with care -- the truth may upset you!
Coronary Heart Disease
The heart is a muscular organ that pumps blood to the body at an average of 72 times per minute. Oxygen and nutrients serve as a fuel supply to the pump and is carried to it in the form of blood that flows through the coronary arteries. Thus, the coronary arteries serve as fuel pipe lines to the heart muscle.
The three
major coronary arteries (LAD or left
anterior descending , circumflex
and right coronary arteries) and their
respective branches each supply a designated
portion
of
the heart, as follows:
The left anterior descending or LAD coronary artery supplies blood to the the front (anterior) portion of the heart and the septum (muscle partition that separates the left and right ventricles).
The circumflex supplies the back (posterior) portion of the left ventricle,
The right coronary artery supplies the bottom (inferior) portion of the ventricle and also the right ventricle in 90% of cases. In the other 10%, the circumflex sends a branch to the inferior wall of the left ventricle.
Coronary arteries have muscle fibers within its wall. By contracting the muscle the artery can reduce blood flow, while relaxing the muscle increases flow. In this way, the coronary arteries can regulate blood flow to different portions of the heart.
Occasionally, the muscle within a coronary artery may go into spasm and markedly reduce blood flow to the heart muscle. This condition is known as coronary spasm. Typically, the chest discomfort of coronary artery spasm occurs at rest, and usually during the early morning hours. When the spasm is relieved (spontaneously or with the use of medications), the blood vessel goes back to its normal appearance and function. A temporary decrease in blood supply can cause chest discomfort while a persistent decrease can result in permanent muscle damage or a heart attack.
Atherosclerosis is by far he commonest
cause of coronary artery blockage. Unlike
coronary spasm which creates a temporary
blockage, atherosclerosis results in a
fixed blockage. Occasionally,
atherosclerosis may be accompanied by
coronary spasm. The diagrams below show the
various stages of progression of
atherosclerosis and development of coronary
artery blockages. The round picture on the
left of each illustration is a
cross-sectional view of the coronary artery,
while the picture on the right is a
longitudinal section at the same level.
The inner lining of the normal
coronary artery is smooth and free of
blockages or obstructions.
However,
as we get older, lipids or fatty substances
(cholesterol and triglycerides) are deposited
as fatty streaks. The streaks are only
minimally raised and thus do not produce any
obstruction or symptoms.
Patients with one or more risk factors for
coronary artery disease are susceptible
to the increased buildup of fatty layers,
known as atheroma (pronounced
athe-a-roma). This buildup of material
begins to encroach upon the inner channel and
starts to interfere with the free flow of
blood through the coronary artery.
Major risk factors for developing coronary artery disease include:.
-
Hyperlipidemia (high cholesterol level, particularly the "bad" component known as LDL)
-
High blood pressure
-
Diabetes
-
Cigarette smoking
-
Strong family history of coronary artery disease (CAD).
Male
gender, obesity, age above 50 years, lack of
exercise, stress and tension can also
predispose to the development of
atherosclerosis.
The deposit of atheroma within the inner
lining of arteries is called
atherosclerosis (pronounced
ath-row-sklee-rosis). It is estimated
that 1/3 rd of adult Americans develop some
form of CAD.
Significant atherosclerosis may be
confined to the coronary arteries or may be
associated with blockages within the arteries
of the neck and those supplying blood to the
lower limbs (legs).
As
atherosclerosis progresses, fibers begin to
grow into and around the fatty layers of
atheroma, causing the blockage to harden and
turn into a plaque (pronounced plak).
The enlarging plaque increases the
encroachment into the inner channel of the
coronary artery. When the channel is reduced
by more than 50% (of the diameter) the artery
may become obstructed enough to decrease
blood flow to the heart muscle during times
of increased need (exercise, emotional
stress, etc.). During such times, the blood
pressure and heart rate are both elevated and
increase the need of oxygen and nutrients by
the heart muscle.
The imbalance between the supply and
demand of oxygen can cause chest discomfort
(tightness, fullness, heaviness or pain) in
the center of the chest and /or over the left
breast). This is known as
angina(pronounced an-ji-na)
or angina pectoris. When the
coronary artery blockage is severe enough to
completely cut off the supply of oxygen and
nutrients to the heart muscle, a heart
attack can result. However,
atherosclerosis may maintain a stable pattern
for several years or even decades if the
plaques grow slowly or remain relatively
stationary. These patients may not notice
worsening of angina during the time of
stability and are said to have
stable angina
In
other cases, plaques within the inner lining
of the coronary artery may develop a slight
crack or rupture.. Note that the rupture
involves only the surface and does not go
through the wall of the artery. It is similar
to a superficial crack on the plaster of a
swimming pool lining and blood does not
escape out of the artery. Plaque rupture
stimulates the production of blood clots
that tries to seal off the superficial crack.
The clot also gets into the crack and causes
it to rise and further obstruct the channel
of the artery. The sudden increase in the
obstruction caused by the raised ruptured
plaque and associated clot can transform a
mild blockage into a critical one within a
matter of hours. The decrease in blood flow
to the heart muscle is severely reduced and
the patient begins to have severe and
prolonged chest pain that occurs at rest and
may even awaken him or her from a sound
sleep. This is known as
unstable angina.
If the clot does not fully close off the
channel of the artery (as in the example
above) enough blood flow is maintained to the
heart muscle and a heart attack may not
develop if appropriate and prompt treatment
is employed.
However,
the clot may continue to grow in many cases.
This can completely fill the open channel of
the artery and cutoff blood flow to the part
of the heart muscle that it is supplying.
Without oxygen and nutrients, the patient
suffers from a
heart attack and the involved heart
muscle can get permanently damaged. The good
news is that there are several forms of
treatment that can get rid of the blood clot
and restore flow across the artery. However,
this can only be employed if the patient is
rushed to the emergency room of the nearest
hospital. Every minute counts in salvaging
heart muscle.
Coronary artery blockages and heart attacks
may also be seen in patients who use "Crack"
cocaine. This is becoming the commonest cause
of heart attacks in young adults who are
treated in emergency rooms in the USA
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