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Cardiac output is homeostatically maintained throughout our lifetime so that it constantly meets

the needs of the body’s tissues. When the heart becomes damaged, such as after a heart attack, it
may not be able to maintain adequate flow. This causes blood pressure to fall, initiating homeostatic
feedback loops to try to bring blood pressure (and cardiac output) back to normal.

One way that the heart can become damaged is through a heart attack. This occurs when coronary
blood vessels, which supply the cells of the heart itself with oxygen and nutrients, become
significantly narrowed or completely blocked with a combination of plaque and thrombus (clot).
During a heart attack, cells lack oxygen, causing them to die. If enough heart muscle cells die, the
heart weakens so that it can’t pump as much blood, leading to the various negative effects
associated with this condition.

Congestive heart failure is another common condition affecting cardiac output. It may develop after
someone has a heart attack, or as a consequence of many other cardiac conditions. The problem
with congestive heart failure is that the heart muscle is weakened to the point that it doesn’t do a
good job pumping out the blood that is flowing into it (the blood flowing into the heart is called
venous return). In fact, one of the main feedback loops that regulates blood pressure does so by
adjusting the amount of blood in the body. This is because the more blood we have, the greater our
venous return, and the higher the cardiac output – assuming a healthy heart. With the weakened
heart associated with congestive heart failure, more venous return can actually lead to less cardiac
output. A lowered cardiac output decreases blood pressure, signaling the body to increase blood
volume, increasing venous return, and making cardiac output lower still. Because this loop
continually makes the problem with cardiac output and blood pressure worse, it is a positive
feedback loop – and not one we want to experience.

Homestasis - the body's ability to maintain normal function.

After having a heart attack the heart may not be able to continue to pump blood throughout the rest
of the body. The body requires circulating blood to deliver oxygenation, to take away waste
products, and to circulate other chemicals (hormones, etc) that are used to control systems (e.g.
maintain function) through the body. If the main pump fails then a substantial portion of the bodys'
functions fail - thereby upsetting homeostasis.

What is coronary heart disease?

The heart is a muscle, about the same size as an adult human fist. Blood is pumped from the heart to
the lungs, where it collects oxygen. This oxygen-rich blood is then pumped back to the heart and
then to organs throughout the body through arteries.

The blood then returns to the heart through the veins and is pumped to the lungs again. This is
called circulation.
Coronary arteries are the heart's network of blood vessels. They exist on the surface of the heart,
and they supply the heart muscle with oxygen. If the coronary arteries narrow, the supply of
oxygen-rich blood to the heart may become too low, especially during physical activity.

At first, this reduction in blood flow may not produce any symptoms, but as fatty deposits, or
plaques, build up in the coronary arteries, signs and symptoms may emerge

Treatment

Treatment options include inserting a small metal mesh to expand and support the artery.

CHD cannot be cured, but with today's technology, it can be managed effectively.

Treatment involves lifestyle changes, and possibly some medical procedures and medications.

Lifestyle recommendations include quitting smoking, eating a healthy diet, and exercising regularly.

Medications include:

Statins: These are the only medications demonstrated to have a positive impact on outcomes in
CHD, but if a person has another underlying cholesterol disorder, they may not work.

Low-dose aspirin: This reduces blood clotting, lowering the risk of angina or a heart attack.

Beta blockers: May be used to reduce blood pressure and heart rate, especially in a person who has
already had a heart attack.

Nitroglycerin patches, sprays, or tablets: These control chest pain by reducing the heart's demand
for blood by widening the coronary arteries.

Angiotensin-converting enzyme (ACE) inhibitors: These lower blood pressure and help to slow or
stop the progression of CHD.

Calcium channel blockers: This will widen the coronary arteries, allowing greater blood flow to the
heart, and reduce hypertension.

Surgery

Surgery can open or replace blocked arteries, if the blood vessels have become very narrow, or if
symptoms are not responding to medications:

Laser surgery: This involves making several tiny holes in the heart muscle, which encourage the
formation of new blood vessels.

Coronary bypass surgery: The surgeon uses a blood vessel from another part of the body to create a
graft that can bypass the blocked artery. The graft may come from the leg or an inner chest-wall
artery.
Angioplasty and stent placement: A catheter is inserted into the narrowed part of the artery. A
deflated balloon is passed through the catheter to the affected area. When the balloon is inflated, it
compresses the fatty deposits against the artery walls. A stent, or mesh tube, may be left in the
artery to help keep it open.

Rarely, a heart transplant may be carried out, if the heart is badly damaged and treatment is not
working.

Prevention

Controlling blood cholesterol levels reduces the risk of CHD. Being physically active, limiting alcohol
intake, avoiding tobacco, and consuming a healthy diet with reduced sugar and salt can all help.

People with CHD or diabetes should ensure they control these conditions by following the doctor's
recommendations.

Risk factors

Smoking increases the risk. Tobacco can:

Increase inflammation and cause more cholesterol to deposit in coronary arteries.

A woman who smokes 20 cigarettes a day is six times more likely to develop CHD than a woman
who has never smoked.

Men who smoke regularly are three times more likely to develop CHD compared with men who
have never smoked.

The following factors increase the risk:

As people age the risk increases.

Men are more likely to develop CHD, although the risk for women is still significant, especially
after menopause.

Having a parent who developed CHD before the age of 60 years increases the risk of developing it.

Uncontrolled hypertension, or high blood pressure, causes arteries to thicken and narrow, reducing
blood flow.

High blood cholesterol increases the chance of plaque building up, and this makes atherosclerosis
more likely.

Lack of exercise increases the risk, as does poor diet, including consumption of processed meat,
trans fats, and fast foods.

Long-term emotional and mental stress have been linked with damage to arteries.
Components of metabolic syndrome, such as diabetes type II and obesity, are linked to a higher risk
of developing CHD.

Some risk factors are not lifestyle-related. These may include:

High levels of homocysteine, an amino acid produced by the body. Studies have linked it to a higher
incidence of CHD.

High levels of fibrinogen, a blood protein involved in the blood clotting process. Excess levels may
encourage the clumping of platelets, resulting in the formation of clots.

High levels of lipoprotein have been associated with a higher risk of cardiovascular disease and
CHD.

Diagnosis

Physical examination, medical history and a number of tests can help to diagnose CHD including:

Electrocardiogram (ECG): This records the electrical activity and rhythms of the heart.

Holter monitor: This is a portable device that the patient wears under their clothes for 2 days or
more. It records all the electrical activity of the heart, including the heartbeats.

Echocardiogram: This is an ultrasound scan that checks the pumping heart. It uses sound waves to
provide a video image.

Stress test: This may involve the use of a treadmill or medication that stresses the heart.

Coronary catheterization: A dye is injected into the heart arteries through a catheter that is
threaded through an artery, often in the leg or arm, to the arteries in the heart. An X-ray then
detects narrow spots or blockages revealed by the dye.

CT scans: These help the doctor to visualize the arteries, detect any calcium within fatty deposits
that narrow coronary arteries, and to characterize other heart abnormalities.

Nuclear ventriculography: This uses tracers, or radioactive materials, to show the heart chambers.
The material is injected into the vein. It attaches to red blood cells and passes through the heart.
Special cameras or scanners trace the movement of the material.

Blood tests: These can measure blood cholesterol levels, especially in people who are over 40 years
old, have a family history of heart or cholesterol-related conditions, are overweight, and have high
blood pressure or another condition, such as an underactive thyroid gland, or any condition which
may elevate blood levels of cholesterol.

Treatments for coronary heart disease include heart-healthy lifestyle changes, medicines, medical
procedures and surgery, and cardiac rehabilitation. Treatment goals may include:
Lowering the risk of blood clots forming (blood clots can cause a heart attack)

Preventing complications of coronary heart disease

Reducing risk factors in an effort to slow, stop, or reverse the buildup of plaque

Relieving symptoms

Widening or bypassing clogged arteries

Heart-Healthy Lifestyle Changes

Your doctor may recommend heart-healthy lifestyle changes if you have coronary heart disease.
Heart-healthy lifestyle changes include:

Heart-healthy eating

Maintaining a healthy weight

Managing stress

Physical activity

Quitting smoking

Heart-Healthy Eating

Your doctor may recommend heart-healthy eating, which should include:

Fat-free or low-fat dairy products, such as fat-free milk

Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week

Fruits, such as apples, bananas, oranges, pears, and prunes

Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans

Vegetables, such as broccoli, cabbage, and carrots

Whole grains, such as oatmeal, brown rice, and corn tortillas

When following a heart-healthy diet, you should avoid eating:

A lot of red meat

Palm and coconut oils


Sugary foods and beverages

Two nutrients in your diet make blood cholesterol levels rise:

Saturated fat—found mostly in foods that come from animals

Trans fat (trans fatty acids)—found in foods made with hydrogenated oils and fats, such as stick
margarine; baked goods, such as cookies, cakes, and pies; crackers; frostings; and coffee creamers.
Some trans fats also occur naturally in animal fats and meats.

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