Coronary heart disease is the commonest cause of the cardiovascular disability and death. This pathological state includes Arteriosclerotic coronary artery disease and Ischaemic heart disease.
The heart functions as the pumping station for the supply of blood to the whole body, whereas coronary arteries, which come out of the aorta, supply the blood and feed the heart muscles themselves. The main coronary arteries lie on the surface of the heart, and small arteries penetrate into the cardiac muscle mass. The left coronary artery supplies mainly the anterior part of the left ventricle, whereas the right coronary artery supplies most of the right ventricle as well as the posterior part of the left ventricle.
The resting coronary blood flow in the human being averages approximately 225 ml per minute, which is about 4 to 5 percent of the total cardiac output. During extra work period the heart increases its cardiac output as much as four to five folds, and it pumps the blood against a higher than normal arterial pressure. Consequently the work output of the heart under severe conditions may increase as six to eight fold. The coronary blood flow also increases four to five fold to supply the extra nutrients needed by the heart.
Coronary artery disease (CAD) is a condition in which the heart muscle receives an inadequate amount of blood because of an interruption of its blood supply. Depending on the degree of interruption, symptoms can range from a mild chest pain to a full-scale heart attack. Generally, the symptoms manifest themselves when there is about a 75 percent narrowing of coronary artery lumen. The underlying causes of CAD are many and varied. Two of the principal ones are atherosclerosis and coronary artery spasm.
Atherosclerosis (sometimes called ‘hardening of the arteries’) is a situation characterized by a thickening of the arterial wall with (i) large number of smooth-muscle cells and (ii) deposits of cholesterol and other substances in the portion of the vessel wall closest to the lumen. The mechanism that initiates this thickening is not clear, but it is known that cigarette smoking, high plasma cholesterol concentration, hypertension, diabetes and several other factors increase the incidence and the severity of the atherosclerotic process.
The extra muscle cells and various deposits in the wall bulge into the lumen of the vessel and increase resistance to flow. This is usually progressive, often leading ultimately to complete occlusion. Acute coronary occlusion may occur because of (i) sudden formation of blood clot on the roughened vessel surface, (ii) the breaking off of a fragment of blood clot or fatty deposit that then lodges downstream, completely blocking a smaller vessel, or (iii) a profound spasm of the vessel, smooth muscle.
Coronary artery spasm is a condition in which the smooth muscle of a coronary artery undergoes a sudden contraction, resulting in vaso-constriction. It typically occurs in individuals with atherosclerosis and may result in chest pain during rest, chest pain during exertion,-.„ffeart attacks and sudden death. Although tfcc caCts’es of coronary artery spasm are not well known, smoking, stress and alcoholism are said to be the triggerirt agents.
Preksha — Yoga management
Shat kriyas – Jal neti
Yogic exercises – Of neck and chest
Asanas – Hridyastambhasana, Pawan muktasana, Vajrasana and Shashankasana
Pranayama – Nadi shodhan and Ujjayai pranayama
Kayotsarga – 40 minutes, twice a day
Preksha – (i) Deergha shwas preksha, (ii) Meditate with full concentration of mind on heart and coronary arteries
Anupreksha – Contemplation of fearlessness
Life style change – To adopt a stressfree habit, try to remain happy and cheerful, and to get completely away from smoking and drinking.
Dietary recommendations-
• Diet should be light, avoid meat, excessive protein, milk and dairy products, oil and excessive spices.
• These may be replaced with whole grains, fresh fruits and vegetables.
• Overeating should be avoided.
• Meal timing should be fixed.