Coronary heart disease (CHD)

By Pari Verma

Around 695,000 people in the USA die from coronary heart disease, this surmounts to 1 in 4
deaths being caused by heart disease (CDC, 2019). CHD is an extremely dangerous and
common disease that affects millions. It is caused by fatty deposits and is mostly observed in
unhealthy individuals. There are several risk factors and demographics that affect the chances
of having CHD. This can be very detrimental as it can lead to heart attacks and several other
dangerous outcomes. This is why there are several advised treatments and cures for CHD such
as medication, surgery and angioplasty however they have their respective economic and
ethical implications.

CHD is an illness that involves the buildup of fatty deposits

(plaque) in the lumen of an artery which hence decreases the
diameter of the artery, causing the flow of blood to be restricted or
stopped (NHS, 2020 ). The blockage in an artery can be caused
either by atherosclerosis or thrombosis. Atherosclerosis is the build
of cholesterol in the diameter of the artery. Thrombosis is when a
blood clot forms in the artery which prevents blood from passing
through it (NHS,2020). This causes that area of the body to not
receive oxygen and nutrients for energy.
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There are several risk factors of CHD including: diabetes, obesity, smoking, high blood
pressure, age, a diet high in cholesterol, fats or salt and genetic disposition. Diabetes and high
blood pressure can increase the probability of formation of a thrombus as blood flowing at
higher pressure is more likely to rupture the plaque and cause a thrombus to form. Over 80%
of people that suffer from CHD are either overweight or obese (PubMed, 2017). Obesity can
cause muscular hypertrophy making the heart function poorly. Moreover obesity and a diet
high in salt can cause hypertension therefore increasing the strain on the heart. Chemicals in
cigarette smoke increase the formation of blood clots hence promoting thrombosis. Many
individuals have a family history of heart diseases, this makes them more likely to suffer from
CHD genetically. Men and older people have more chances of having CHD as hormones and
aging are also risk factors (NCBI, 2019).
Blockages in arteries caused by CHD prevent several cardiac tissues from receiving nutrients;
this causes the tissue to die and suffer from damage as it is unable to carry out aerobic
respiration to continue functioning. Therefore a symptom of CHD is breathlessness as the
body is trying to make up for the lack 0f oxygen in the body’s circulatory system. This can
cause angina which is a sharp chest pain, and eventually can
lead to the heart’s functionality being completely halted
alternatively, a heart attack or cardiac arrest. Angina is an
uncomfortable sensation and is often accompanied by
tightness in the neck or jaw (NHS, 2020). When arteries
become completely blocked, the lack of oxygen can cause
permanent damage to the cardiac tissues. This damage
prevents the heart from being able to pump blood/ beat
and causes a cardiac arrest/heart attack. Alternatively, heart
failure is when the heart is unable to pump blood due to it
taking on a lot of stress to pump through the narrowed
arteries and becoming weak.

The high number of deaths caused by CHD can be reduced by taking preventative measures
that reduce its risk. Firstly, exercise as it helps physical well-being, when someone works out it
maintains a healthy weight which reduces the risk of developing high blood pressure.
Moreover regular exercise helps train the heart’s muscles and strengthen it to decrease the
probability of heart failure as your heart will be well trained to pump more and at higher
pressure. A healthy diet low in saturated fats, cholesterol and salt would be helpful as
saturated fats and cholesterol can lead to thrombosis and plaque and salt can cause
hypertension. Lastly, reducing alcohol consumption and smoking can directly reduce the
chances of developing CHD as both are risk factors.

When a person develops CHD, there are medications and medical/surgical procedures that
can be used to cure it or reduce the chances of suffering from it. Medications such as aspirin
are advised as the first line of defense and doctors also recommend them as precautionary.
Aspirin is blood thinner which reduces the probability of heart attacks as it prevents the
formation of clots and promotes blood flow (Medlineplus, 2020). However aspirin isethically
questionable to prescribe as a daily medication as it has several side effects that can affect a
person’s wellbeing. Side effects include: Diarrhoea, nausea, vomiting, itching, rashes and
stomach pain (Medlineplus, 2020). When atherosclerosis has already developed in a person’s
arteries, the next step is a minor surgical procedure known as an angioplasty. This involves a
tube inserted into a person’s arterial
network which detects blockages by
flushing the arteries with a special dye
which indicates what part of the artery is
blocked. When this area is identified, a
balloon is pushed through the tubing and
inflated to expand the blocked lumen and
a stent. This expansion is temporary and
the artery requires a stent which is a
mesh-like cylindrical instrument inserted
into the artery to keep it open and allow
blood to flow. Lastly if the case gets
(Azuravascularcare, 2019) severe and there is no way to salvage the
artery; a by-pass surgery is done. A by-pass surgery involves the surgeon ignoring the blocked
blood vessel and instead re-routing the blood flow to the area that wasn’t receiving blood
through another artery from another part of the body. This way there is no need to interfere
with the blocked blood vessel and instead another one is diverted to redirect blood flow.
These 2 surgical procedures are effective against severe cases of CHD but they have economic
drawbacks. They are expensive and for people that don't have life insurance or free provided
healthcare, it would be financially straining. The average cost of by-pass surgery in the U.S
was $30,000-$200,000 and the average cost of an angioplasty was $32,200 (livelyme,
2020)(chicagotribune, 2020). This may prevent people from receiving a life saving surgery and
may force people to suffer from heart attacks.

After carefully assessing the severity of CHD and its implications, we can deduce that this
disease is very prevalent and affects millions of people. The cures for CHD have their own
drawbacks such as its side effects or financial incapacitation; however, this disease must be
cured because it can easily lead to death. This is why the government and health ministry of
each individual country must take into consideration these factors and the severity of CHD in
order to best provide their citizens with opportunities to receive medical procedures and
advice to help cure it.
 Works cited:
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https://www.verywellhealth.com/coronary-artery-disease-symptoms-1745924.
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2019, https://livelyme.com/blog/the-costs-of-bypass-surgery/.
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https://www.cdc.gov/heartdisease/facts.htm.
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