What is Coronary Artery Disease?

A narrowing or blockage of your coronary arteries, known medically as coronary artery disease, is typically brought on by the accumulation of fatty material known as plaque. Heart disease, ischemic heart disease, and coronary artery disease are other names for the condition.(Clinic, 2022)

The Heart

 

  • The size of your fist would roughly describe the heart muscle. It beats about 70 times each minute and pumps blood all over your body.
  • The blood travels to your lungs, where it absorbs oxygen, after leaving the right side of the heart.
  • Once it has returned to your heart, the oxygen-rich blood is circulated through a system of arteries to the body’s organs.
  • Veins carry the blood back to your heart, where it is then pumped to your lungs once more. Circulation is the term for this action.
  • The coronary arteries, a network of blood vessels on the surface of the heart, provide the heart with its own supply of blood. (nhs.uk, 2022)

Coronary arteries

 

The blood vessels known as the coronary arteries are what feed your heart muscle with oxygen-rich blood to keep it pumping. Your heart muscle is directly above the coronary arteries. There are four major coronary arteries are:

  • The right coronary artery.
  • The left coronary artery.
  • The left anterior descending artery.
  • The left circumflex artery.

Atherosclerosis is the root cause of coronary artery disease. Plaque accumulation inside of your arteries is known as atherosclerosis. Cholesterol, fatty compounds, waste materials, calcium, and the clotting agent fibrin make up plaque. Your arteries shrink and harden as plaque builds up on their walls. Your arteries may get blocked or damaged by plaque, which will restrict or halt blood flow to your heart muscle. Your heart cannot receive the oxygen and nutrients it needs to function correctly if it does not receive enough blood. Ischemia is the name of this condition. Angina, or chest pain from inadequate blood flow to the heart muscle, can cause discomfort or pain in the chest. You also run the danger of having a heart attack. (Clinic, 2022)

Coronary heart disease can occasionally be “silent,” which means you may not notice any signs until you have a heart attack or another issue. Because of this, coronary heart disease may be challenging to identify before a problem arises. Additionally, it explains why heart disease prevention is so crucial.

Symptoms of a heart attack

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The following signs of a heart attack or other abrupt heart condition include:

  • Angina, or chest pain from the heart, can occasionally be brought on by physical exercise and can feel like pressure, squeezing, indigestion, burning, or tightness. Usually beginning behind the breastbone, the pain or discomfort may also radiate to the arms, shoulders, chin, mouth, or back.
  • Cold sweats
  • Dizziness
  • Light-headedness
  • a feeling of indigestion or nausea
  • Neck ache
  • Breathlessness, especially when do heavy activity
  • Sleep disruptions
  • Weakness

Compared to men, women are less likely to have chest pain during a heart attack. They are more prone to feel:

  • Dizziness
  • Extreme fatigue
  • Nausea
  • Chest pressure or constriction
  • Stomach ache

Additionally, you could get abrupt heart problem symptoms including neck pain, shortness of breath, or chest pain that improves with rest but worsens with activity. As the coronary arteries continue to get more constricted due to plaque formation, these symptoms could worsen. A heart attack may be indicated by chest pain or discomfort that does not go away, occurs more frequently, occurs while you are resting, or persists.(Nhlbi.nih.gov, 2022)

Risk Factors

 

The most common cause of coronary heart disease (CHD) is an accumulation of fatty deposits (atheroma) on the walls of the arteries surrounding the heart (coronary arteries).

The arteries become more constricted as a result of atheroma buildup, which reduces blood flow to the heart muscle. Atherosclerosis is the name of this process.

You have a much higher chance of acquiring atherosclerosis if you:

  • Being overweight or obese, having a family history of CHD (the risk is higher if you have a male relative under the age of 55 or a female relative under the age of 65 with CHD), and being obese are additional risk factors for developing atherosclerosis

Smoking

 

A significant risk factor for coronary heart disease is smoking. Nicotine and carbon monoxide (from smoking) both stress the heart by causing it to beat more quickly. They also raise your chance of developing blood clots.

Other compounds in cigarette smoke can cause furring of the arteries by harming the lining of your coronary arteries. Your risk of heart disease is greatly increased by smoking.

High blood pressure

 

Your heart is strained by high blood pressure (hypertension), which can cause CHD. 

High cholesterol

 

The liver produces cholesterol from the saturated fat in your diet. Although it is necessary for healthy cells, having too much of it in the blood might cause CHD.

High lipoprotein (a)

 

Lipoprotein (a), also referred to as LP(a), is a kind of fat produced by the liver, just like cholesterol. It is a known risk factor for atherosclerosis and cardiovascular disease.

Your parents pass on to you a portion of their LP(a) gene. Although screening is advised for those at moderate or high risk of developing cardiovascular disease, it is not regularly measured.

Lack of regular exercise

 

Fatty deposits can accumulate in your arteries if you don’t exercise.

A heart attack may result from a blockage in the arteries that carry blood to your heart. A stroke can occur if the arteries supplying blood to your brain are compromised.

Diabetes

 

Diabetes, which can more than double your chance of having CHD, may result from excessive blood sugar levels.

Diabetes can cause the lining of blood vessels to thicken, which can impede blood flow, which can result in CHD.

Thrombosis

 

A blood clot in an artery or vein is known as a thrombosis.

A coronary artery thrombosis inhibits the blood flow from getting to the heart muscle. Typically, a heart attack results from this.(nhs.uk, 2022)

Screening for coronary heart disease

 

Heart disease can be a silent illness, which means that symptoms may not appear until a significant health issue, such as a heart attack. It’s crucial to get frequent check-ups so that your doctor can assess your risk and suggest healthy lifestyle adjustments to fend against heart disease.

If you do not have any risk factors, you should begin screening tests and risk assessments for coronary heart disease around the age of 20. Children who have risk factors, such as obesity, inactivity, or a family history of heart disease, may require screening.

To assist you to minimise your risk of coronary heart disease, your doctor may advise preventative treatments such as lifestyle changes that promote heart health.

 To screen for the condition.your doctor will

  • Assess risk factors to determine your likelihood of having coronary heart disease toorder
  • To determine whether you have high blood pressure, check your blood pressure measurements.
  • Measure your waist circumference and body mass index to determine whether you are an unhealthy weight.
  • Order blood tests to determine whether you have diabetes, high blood triglycerides, or high blood cholesterol.

The screening process typically takes place at a healthcare provider’s office, but it can also take place at health fairs, pharmacies, and other locations. At the doctor’s office, a hospital, or a lab, blood samples may be taken.

Before the blood tests, find out if you need to fast (not consume any food or liquids other than water).

Diagnostic tests and procedures

 

Your healthcare practitioner may request tests to determine whether you have coronary heart disease if you exhibit signs of the condition. Additionally, it’s possible that your doctor will request blood tests to evaluate your levels of proteins, sugar, lipoproteins, triglycerides, cholesterol, and other markers of inflammation.

  • An electrocardiogram (EKG or ECG): ECG analyses the heartbeat to determine whether it is normal or irregular. Additionally, an EKG documents the frequency and timing of electrical signals that go through the heart.
  • A coronary calcium scan:A coronary calcium scan quantifies the calcium content of your coronary artery walls. This exam is a particular kind of cardiac CT scan. Coronary calcium scans can also be used to determine the risk of coronary heart disease in non-smokers or persons who smoke.
  • Stress testsStrain tests Verify the heart’s response to physical stress. To make your heart work hard and beat quickly during a stress test, you either pedal a stationary bike or walk or run on a treadmill. Your doctor may prescribe medication to make your heart work as hard as it would during exercise if a medical condition prohibits you from exercising. While you exercise, your ECG and maybe echocardiography or CT scan will be examined to look for signs of decreased blood flow to your heart muscle.
  • Cardiac MRI (magnetic resonance imaging): Magnetic resonance imaging (MRI) of the heart can identify any tissue damage or issues with blood flow in the heart or coronary arteries. It can aid your doctor in the diagnosis of nonobstructive or obstructive coronary artery disease as well as coronary microvascular disease. Cardiac MRI can also assist in interpreting the findings of other imaging examinations.
  • Cardiac positron emission tomography (PET) scanning:Cardiovascular positron emission tomography (PET) screening evaluates blood flow into the heart tissues and through the tiny coronary blood channels. A nuclear heart scan of this kind can identify coronary microvascular disease.
  • Coronary angiography:The coronary angiography procedure reveals the coronary arteries’ interiors. Your doctor will use a process known as cardiac catheterization to insert the dye into your coronary arteries. If other tests indicate that you are likely to have coronary artery disease, this procedure is frequently utilized. Your doctor will employ coronary angiography with guidewire technology to help navigate to the smaller spaces in order to diagnose coronary microvascular disease.
  • Coronary computed tomographic angiography:Instead of invasive cardiac catheterization, coronary computed tomographic angiography is a non-invasive imaging procedure that uses CT scanning to reveal the interior of your coronary arteries.(Nhlbi.nih.gov, 2022)

Complications of coronary artery disease

 

The following other cardiac diseases can develop from coronary artery disease:

If you adhere to your cardiologist’s recommended course of action, you can lower your risk of having certain cardiac diseases.

Prevention of Coronary Artery Disease

 

While there are steps you may take to reduce your risk of developing coronary artery disease, it is not entirely preventable. This is due to the fact that there are two categories of risk factors: those that can be modified and those that cannot (modifiable).

Older age, male gender, a family history of heart disease, and genetic risk factors are among the non-modifiable risk factors. For more information, go to the section of this article that addresses the issue of “who gets coronary artery disease”.

However, you can change a lot of risk factors. Most of them involve modifying your way of life, such as quitting smoking, losing weight if you’re overweight, controlling your blood pressure and cholesterol levels, and managing your diabetes. For other examples, see “lifestyle changes” under the therapy part of this article.

Remember that your risk of developing heart disease increases the more risk factors you have. Fortunately, by taking charge of your modifiable risk factors, you may decide to help yourself and lower your chance of disease.(Clinic, 2022)

Unani Medicine

 

Approximately 2000 plants have been identified as herbs effective for treating cardiovascular issues in the traditional medical system. Research studies that have helped people with disorders like CVDs—CAD, hyperlipidemia, connected comorbidities, ischemic heart disease, etc.—have also produced extensive data. For example, Hypericum perforatum, Plantago major, and Matricaria chamomilla have been made lawful in France, and St. John’s wort and ginseng root have been made legal in Germany for the treatment of cardiovascular issues. Numerous countries have reported extensive use of herbs for the treatment of CAD, including Stephania tetrandra, Crtageus spp., Ginkgo biloba, Leonurus cardiaca, Aconitum spp., Citrus paradisi, Hypericum perforatum, Ginseng, Ephedra sinica, and Stephania tetrandra.

The active components of herbal remedies have been isolated and then commercially employed for medication compositions. For instance, some herbal remedies that have been utilized all over the world to treat CAD and other CVD’s include digitoxin from foxglove (Digitalis purpurea), ephedrine from ma-huang (Ephedra sinica), reserpine from snakeroot (Rauwolfia serpentina), salicin from willow bark (Salix alba), and others. (Kumar et al., 2020)

ARJUN (Terminalia arjuna)

 

Parts used

 

Fruit, Stem bark, Leaf, Bark, Ashes.

Actions

 

Stem bark: astringent, tonic, febrifuge. Fruit: tonic, expectorant.

Uses

 

Stem bark:illnesses of the heart as cardiac tonic, biliary affection, and sores.

Fresh leaf juice: ear ache.

Fruit: sore throat, cough, dyspepsia.

Chemical Constituents

 

The active ingredients in terminalia are tannins, oligomeric proanthocyanidins (OPCs), flavonoids (arjunone, arjunolone, luteolin), gallic acid, ellagic acid, triterpenoid saponins (arjunic acid, arjunolic acid, arjungenin, arjunglycosides), calcium, magnesium, zinc, and copper.

Mechanisms of Action

 

The flavonoids in the bark of Terminalia arjuna are extremely abundant. The flavonoids arjunolone, flavones, bicalein, quercetin, kempferol, and pelorgonidin have all been found in the bark of this plant. There is sufficient proof to conclude that bioflavonoids, by their ability to scavenge free radicals, decrease endothelial activation, increase endothelium generated nitric oxide activity, and prevent platelet aggregation. They may also lessen the risk of thrombosis and inhibit cyclooxygenases. High dietary flavonoid consumption is thought to be negatively correlated with the risk of coronary artery disease (CAD). The positive effects of Terminalia arjuna on CAD may be due to the plant’s high flavonoid concentration.

The bark of Terminalia arjuna has yielded a range of tannins in addition to flavonoids. Tannins have been shown to relax arterial segments that have been precontracted by norepinephrine and increase nitric oxide production. It’s possible that tannins have a role in the Terminalia arjuna bark’s purported hypotensive effects. The inotropic effect of Terminalia arjuna is assumed to be mediated by saponin glycosides, whilst vascular strengthening and free radical antioxidant activity are provided by flavonoids and OPCs. Two novel cardenolide cardiac glycosides were just recently identified from Terminalia arjuna’s root and seed. These cardenolides primarily increase the force of cardiac contraction by elevating intracellular sodium and calcium levels.

Ischemic Heart Disease/ Coronary Artery Disease

 

Numerous groups of researchers have thoroughly examined the effectiveness of Terminalia arjuna therapy in treating ischemic stroke and ischemic heart disease, establishing its anti-ischemic potential.

A randomized, double-blind, crossover design was used to administer Terminalia arjuna (500 mg 8 hourly), isosorbide mononitrate (40 mg/day), or a matching placebo for one week at a time, separated by at least a three-day washout period. The participants were 58 males with chronic stable angina (NYHA class II-III) and evidence of provable ischemia on treadmill exercise test. At the conclusion of each therapy, they completed clinical, biochemical, and treadmill exercise evaluations, which were compared over the course of the three therapy periods.In comparison to placebo therapy, patients with stable angina who were exercising on a treadmill while experiencing provocable ischemia responded better to a 500 mg dose of Terminalia arjuna bark extract. The extract was well tolerated, and these advantages were comparable to those shown with isosorbide mononitrate (40 mg/day) therapy. During Terminalia arjuna medication, no notable adverse effects were reported.

ZAFRAN (Crocus sativus)

 

The Crocus sativus flowering plant, often known as zafran or saffron, is a member of the crocus family. It is frequently used in the manufacture of numerous foods and cosmetics as a spice, coloring, and flavoring agent. It is indigenous to Greece and Iran. The plant’s stigmas are mostly employed for medicinal purposes. It functions as an expectorant, antispasmodic, and aphrodisiac. Additionally, it is used to treat cholera, dysentery, jaundice, and sleeplessness. It is regarded as a heart and nervous system tonic.

Chemical constituents

 

Crocetin, commonly known as “crocetin” or “crocetin I,” is one of the carotenoids found in Crocus sativus stigmas. Other glycosidic forms of crocetin include digentiobioside (also known as “crocin”), glucoside, gentioglucoside, and diglucoside.

Other significant elements of saffron include the monoterpene aldehydes picrocrocin and its deglycosylated derivative safranal (dehydrocyclocitral), which are generated in saffron during drying and storage and are accountable for the spice’s bitter flavor and scent, respectively.

Saffron was also found to include anthocyanins, flavonoids, vitamins (particularly riboflavin and thiamine), amino acids, proteins, carbohydrates, mineral matter, gums, and other chemical components. Crocin, one of the components of saffron extract, is primarily accountable for its pharmacological effects.

Mechanism of action

 

Crocin may shield cells from oxidative stress because it scavenges free radicals, particularly superoxide anions. Crocin helps protect the hepatocytes from toxins and in the cryoconservation of sperm. It might help treat neurological illnesses because of its potent antioxidant activity.

Its secondary metabolites and their derivatives are what give it its antioxidant properties (safranal, crocetin, dimethyl crocetin).

Safranal’s antioxidant activity is inferior to that of the carotenoids found in saffron. However, the saffron spice has a substantial antioxidant activity due to the synergistic action of all the bioactive components. In this ligand-polynucleotide combination, the antioxidant activity of saffron chemicals can shield DNA and tRNA from damaging chemical reactions.

Effect on coronary artery disease

 

Human volunteers received 50 mg of saffron dissolved in 100 ml of milk twice a day, and the considerable reduction in lipoprotein oxidation susceptibility in CAD patients suggests that saffron may have antioxidant potential.(Arman and Mahtab, 2013)

An overview of Several Common Herbs used in Ayurveda therapy or all Together to treat CAD

 

Scientific name

Common Name

Family

Ethnopharmacological use

Convallaria majalis

Lilly of the valley

Asparagus

Coronary Artery Disease, Congestive Heart Failure

Selenicereus grandiflorus

Night

blooming cereus

Cactaceae

Coronary Artery Disease, Congestive Heart Failure

Storphantus preussi

Strophanthus

Apocynaceae

Coronary Artery Disease, Congestive Heart Failure

Fumaria officinalis

Fumitory

Papaveraceae.

Coronary Artery Disease, Congestive Heart Failure

Digitalis purpurea

Foxglove

Plantaginaceae

Coronary Artery Disease, many Cardiovascular diseases

Khamiras Used in Cardiac Disorders

In the Unani system of medicine, the term “Khamira” refers to a fermented dessert that was initially popularized by the Hakeem of the Mogul era. Khamira is a form of semi-solid Majoon that is manufactured by combining a base (Qiwam) of sugar or sugar with honey with a Joshandah (decoction) of herbal or powdered medications. In addition to herbal substances, medications of animal and mineral origin are also combined, either by creating an aqua solution or a micro-fine powder.

To treat heart disorders, a unique class of pharmacological compositions has been developed. They are known as Kameera formulations. They are specifically intended to treat heart problems including cardiac failure, among others.(Ansari and Nazir, 2014)

Khamiraah Jaat which commonly used by Unani Physicians for Amraz-e-Qalb:

  1. Khamira Aabresham Sada
  2. Khamira Gaozaban Sada
  3. Khamira Gaozaban Ambari
  4. Khamira Gaozaban Ambari Jadwar Ood Saleeb wala
  5. Khamira Zamarrud
  6. Khamira Khas
  7. Khamira Gaozaban Ambari Jawahar Wala
  8. Khamira Aabresham Sheerah Unnab Wala
  9. Khamira Aabresham Ood Mastagi Wala
  10. Khamira Sandal Sada
  11. Khamira Sandal Tursh Warq-e-Tila Wala
  12. Khamira Marwareed Ba Nuskha Khas
  13. Khamira Marwareed Ba Nuskha Kalan
  14. Khamira Marwareed
  15. Khamira Yaqoot
  16. Khamira Yashab
  17. Khamira Zehar Mohra (Ahmad et al., 2010)

AHMAD, S., REHMAN, S., AHMAD, A. M., SIDDIQUI, K. M., SHAUKAT, S., KHAN, M. S., KAMAL, Y. & JAHANGIR, T. 2010. Khamiras, a natural cardiac tonic: An overview. Journal of Pharmacy and Bioallied Sciences, 2, 93.

ANSARI, K. A. & NAZIR, S. 2014. Cardio protective drugs in Unani medicine: A review. The Pharma Innovation Journal, 3, 67-69.

ARMAN, R. S. & MAHTAB, A. S. 2013. Unani drugs in the management of cardiovascular diseases: A review on pharmacological studies on Arjun and Zafran. Int. J. Res. Ayurveda Pharm, 4, 463-467.

CLINIC, C. 2022. Coronary Artery Disease: Causes, Symptoms, Diagnosis & Treatments [Online]. Cleveland Clinic. Available: https://my.clevelandclinic.org/health/diseases/16898-coronary-artery-disease [Accessed 07/19/22].

KUMAR, P., GOVINDASAMY, K., KUMARESAN, G. & RAJ, N. S. 2020. A Critical Review on Traditional Medicines, Ayurvedic Herbs and fruits in Treatment of Cardiovascular Diseases. Research Journal of Pharmacy and Technology, 13, 3480-3484.

NHLBI.NIH.GOV. 2022. Coronary Heart Disease – Symptoms | NHLBI, NIH [Online]. Available: https://www.nhlbi.nih.gov/health/coronary-heart-disease/symptoms [Accessed 07/19/22].

NHS.UK. 2022. Coronary heart disease [Online]. Available: https://www.nhs.uk/conditions/coronary-heart-disease/#:~:text=Coronary%20heart%20disease%20is%20the,furred%20up%20with%20fatty%20deposits. [Accessed 07/19/22].

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