CORONARY HEART DISEASE

Coronary heart disease (CHD) is the most common form of heart disease and the single most important cause of premature death in Europe, the Baltic states, Russia, North and South America, Australia and New Zealand. By 2020 it is estimated that it will be the major cause of death in all regions of the world.

In the UK (population 59 million), 1 in 3 men and 1 in 4 women die from CHD, an estimated 330 000 people have a myocardial infarct each year and approximately 1.3 million people have angina. The death rates from CHD in the UK are amongst the highest in Western Europe (more than 140 000 people) but are falling, particularly in younger age groups; in the last 10 years CHD mortality has fallen by 42% among UK men and women aged 16-64.

Disease of the coronary arteries is almost always due to atheroma and its complications, particularly thrombosis; the common clinical manifestations and pathological correlates of CHD are shown in Box 18.53. Occasionally, the coronary arteries are involved in other disorders such as aortitis, polyarteritis and other connective tissue disorders.

18.53 CORONARY HEART DISEASE: CLINICAL MANIFESTATIONS AND PATHOLOGY

Clinical problem	Pathology
Stable angina	Ischaemia due to fixed atheromatous stenosis of one or more coronary arteries
Unstable angina	Ischaemia caused by dynamic obstruction of a coronary artery due to plaque rupture with superimposed thrombosis and spasm
Myocardial infarction	Myocardial necrosis caused by acute occlusion of a coronary artery due to plaque rupture and thrombosis
Heart failure	Myocardial dysfunction due to infarction or ischaemia
Arrhythmia	Altered conduction due to ischaemia or infarction
Sudden death	Ventricular arrhythmia, asystole or massive myocardial infarction