STUDENT ASSIGNMENT COVER SHEET

Academic Year 2019-2020

Semester 2

Program: PY

1) Shaher Yousef . 2) Ahmed Alashgar .

3) Ahmed Alshehri . 4) Abdulrahman Borham .
Student Name:
5) Fares Abrar .

1) 140097 . 2) 140110 .
3) 140236 . 4) 140348 .
Student ID Number:
5) 140214 .

Program Year/Level: B2
Course/Code: Humen Biology
Instructor Name: Dr. Hanan Hassan.
Assignment Title: Cardiovascular system
Deadline Date: 3\26\20
Date of Actual Submission: 3\26\20
Student Agreement:
I understand if my assignment is late, that 10% of the total assignment grade will be deducted if submitted
anytime within the five academic days following the due date. Later than this, I understand that I will
receive a zero on the assignment.

_
Student Signature: ___________________________________
Instructor Signature: __________________________________________
1. This cover sheet must be attached to the assignment.
2. Written assignments are to be submitted in soft copies (electronic) in Word.:
 Assignment

Student
Criteria Mark Comments
Mark
Research article contains table of
content and has a well informative 1
introduction.
Student did an excellent job of
communicating a very substantial body 3
of scientific information.
Research articles has list of citations
from different resources such as books 1
and scientific journals.
Team work: fair participation to the
1
assigned group.
Correct format and acceptable
2
percentage for plagiarism
Discussion: Student gave accurate and
logical answers for questions related to 2
topic
Total mark
10

Total mark :

Page 1
Table of Content:

ABSTRACT ................................................................................................................................... 3

INTRODUCTION......................................................................................................................... 4

CARDIOVASCULAR SYSTEM................................................................................................. 5

THE MAMMALIAN HEART ..................................................................................................... 5

Physiology and Anatomy of the Heart ........................................................................................ 5

Layers of the Heart Wall .......................................................................................................... 7

CIRCULATION OF THE HEART ............................................................................................ 8

The Pulmonary Circuit (Exchange of Gases) ............................................................................. 9

The Systemic Circulation ............................................................................................................. 9

Coronary Veins: ...................................................................................................................... 12

CORONARY ARTERY DISEASE ........................................................................................... 13

Acute Coronary Syndromes ....................................................................................................... 14

Symptoms..................................................................................................................................... 15

Diagnosis ...................................................................................................................................... 15

Treatment .................................................................................................................................... 18
Drugs ........................................................................................................................................ 18

Procedures to Restore and Improve Blood Flow ..................................................................... 20

Coronary Artery Bypass Surgery.............................................................................................. 20

Lifestyle and Home Remedies .................................................................................................... 20

REFERENCES............................................................................................................................ 22

Page 2
 Abstract
Blood always move within blood vessels and flows in a cycle, going around the body and to
the heart in a circle, which is known as a closed blood system. The heart is composed of four
chambers in total and the main function of the heart is to supply the body with blood. Coronary
arteries are branches of the aorta in the body and there are two coronary arteries, the right and
left coronary arteries and they both have specific functions. The heart is responsible of three
circulations which are the circulation through the heart, through the body and the coronary
circulation which supplies oxygenated blood and nutrients to the heart muscles. Coronary artery
disease (CAD) is one of the most common heart diseases caused due to atherosclerosis of the
coronary arteries. It can lead to acute coronary syndrome depending on how much the artery is
clogged. The key symptom of CAD is angina. After observing different factors, different
diagnostic tests are suggested to diagnose the disease. Treatment for coronary artery disease
mostly involves lifestyle changes such as quitting smoking and eating healthy food and if
necessary, drugs like cholesterol-modifying medications can be used. By decreasing and
reducing the amount of cholesterol in the blood the Beta blockers drug slows your heart rate and
decreases your blood pressure, which decreases your heart's demand for oxygen. Other certain
medical procedures like Angioplasty and stent placement (percutaneous coronary
revascularization) and coronary artery bypass surgery can also be used.

Page 3
 Introduction
The cardiovascular system, also called the circulatory system or the vascular system, is a
system that comprises of the heart, blood vessels, and the blood. The main objective of the
cardiovascular system is to allow blood to circulate and to transport hormones, nutrients (like
amino acids and electrolytes), oxygen, cellular waste, and other materials to the entirety of the
body. The cardiovascular system includes the blood which is a fluid that contains plasma, red
blood cells, white blood cells, and platelets and also includes the heart, which is the main
organ of the cardiovascular system. The heart is a pumping muscle responsible for moving
blood and other materials throughout the body, and it is also responsible for protecting the
body from invading pathogens that cause diseases, as well as maintaining homeostasis by
regulating body temperature and pH. If the heart starts to stumble and weakens even for a
moment and cannot do its job properly, the cardiovascular system can get affected negatively.
Coronary arteries are an important part of the cardiovascular system that serves the heart
muscle by bringing oxygenated blood to the myocardium and other parts of the heart. These
arteries are sections from the aorta, and their location is above the aortic semilunar valve. The
coronary arteries are relatively narrow in width and so sometimes, it can get clogged. This
causes what is known as coronary artery disease. When this happens, oxygen and other
materials cannot reach the heart and eventually can cause heart attacks. Fortunately, this
disease has a treatment that can unclog the coronary artery and allow oxygen, glucose, and
nutrients to pass through to the heart.

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 Cardiovascular System

The Blood always flow within the Blood Vessels, and so the system is known as a closed
blood system. The blood (transport) systems are the blood vessels which are a system of
interconnecting tubes, the heart which is a muscular organ that pump blood through the vessels
to the whole-body parts, and blood which is composed of Plasma, Erythrocytes, Leucocytes
(Phagocytes and Lymphocytes) and Platelets. Things that are transported by the blood can be
Nutrients, Carbon Dioxide, Oxygen, Hormones, Urea, Antibodies and Heat. (1)

The Mammalian Heart

Physiology and Anatomy of the Heart

The heart is constructed entirely of living cells and cellular materials. The heart rests on the
diaphragm and near the midline of the Thoracic cavity. The Mediastinum is an anatomical region
that extends from the sternum to the vertebral column. The heart is enclosed and protected by the
Pericardium. The pericardium surrounds and anchors the heart, prevents it from overfilling with
blood. Pericardium membrane is made up of two main parts. The outermost layer is the fibrous
pericardium which is a loose-fitting sac of strong, hard fibrous connective tissue. The inner
serous pericardium is a thinner and more delicate membrane that forms a double layer around the
(2)
heart. Parietal Layer of the serous pericardium is attached to the fibrous pericardium. The

inner Visceral Layer (Epicardium) adheres to the surface of the heart. Between the parietal and
visceral pericardial membrane is a space called the Pericardial cavity or space. The pericardium
cavity contains a film of lubricating fluid that reduces friction and allows the heart and the
pericardium to glide smoothly against each other when the heart contracts and this fluid is known
(2)
as Serous Fluid. . The heart is divided into 4 chambers: 2 on the right-hand side and 2 on the

left-hand side. Each upper chamber is known as an atrium and each lower chamber is known as
ventricle. The 4 sections are known as: the right atrium; the right ventricle; the left atrium and
the left ventricle.

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 Blood comes into the heart by the atria, which are the smaller chambers, and is pumped
out by the larger ones — the ventricles. The septum separates the two upper chambers (the right
and left atria) and the two lower chambers (the right and left ventricles) of the heart. This is an
important function since the right side of the heart carries oxygen-poor blood from the
extremities to the heart, and the left side of the heart carries oxygenated blood that passes it
through veins. (3) Without the septum, the blood cannot be oxygenated. The tendons are
structures that are attached to the valves to stop them from going up to far when the ventricles
contract. Valves are one-way flow. They prevent the backflow of blood. There are valves that
separate the chambers of the heart. As the heart beats, the valves open and blood is pumped from
one chamber to another chamber.

There are types of valves that include the atrioventricular valves (stops blood flowing from the
ventricles back to the atria). Bicuspid or Mitral Valves are 2 parts or flaps. The valves are
positioned between the left atrium and the left ventricles. Tricuspid Valves are positioned
between the right atrium and the right ventricles. The blood coming from the atria forces the
valves to open. The pulmonary valve and aortic valve are at the outlets of the right and left
ventricles, respectively. Pulmonary semi-lunar valve is located at the beginning of the pulmonary
artery and allows blood going to the lungs to flow out of the right ventricle but prevents it from
flowing back. Aortic semi-lunar valve is positioned at the beginning of the aorta and allows
blood to flow out of the left ventricle up into the aorta. There are two arteries that carry blood
away from the heart which is the Aorta and it is the largest artery branching from the left
ventricle and moving blood (at very high pressure) to the restof body parts. Pulmonary Artery is
the right and left pulmonary arteries branch off the main pulmonary trunk. It branches from the
right ventricle and moves blood to the lungs (at lower pressure). It divides into two arteries to
carry blood to the left and right side of the lungs. The largest vein in the human’s body are the
vena cava and it is consisted of two parts. One bringing deoxygenated blood downwards from
the head, arms and upper body called as superior vena cava, and the other bringing deoxygenated
blood upwards from the rest of the body is called inferior vena cava, to the right atrium.
Pulmonary Veins has two sides the right and the left pulmonary veins and it brings the

oxygenated blood back from the lungs to the heart into the left atrium. (2)

Page 6
 Figure 1.2 shows the types of valves
Figure 1.1 shows the anatomy of the heart

Layers of the Heart Wall

The walls of the heart consisted of three layers: The Epicardium (external layer), the
Myocar1dium (middle layer), and the Endocardium (inner layer).

The outer layer of the heart wall is the epicardium; covering of the heart composed of two layers
of fibrous tissue. (2) The outermost layer is called the visceral layer of the serous pericardium.
This thin outer layer of the heart wall is composed of the mesothelium and beneath it, there is a
delicate fibroelastic tissue and adipose tissue.The adipose tissue predominates and becomes
thickest over the ventricular surface, where it surrounds the major coronary and cardiac vessels
of the heart. The middle layer is the myocardium; muscle layer of each chamber of the heart and
composed of cardiac muscle tissue. The Cardiac muscle cells are in the wall of the heart. It
makes up the myocardium of the heart. Microscopically the cardiac muscles appear striated, and
the cells in it are joined end to end in the network of interconnected cells through junctions
called intercalated discs: they allow for rapid movement of ions and low electrical resistance this
allows propagation of stimuli through the heart wall. Unique characteristics of cardiac muscle
cells: branched + myogenic contraction. Cardiac Muscles circulate the blood and maintain blood
(hydrostatic) pressure. It forms cells known as the cardiocytes. These cells are short, branching
and a have single nucleus. Cardiac muscle is regulated by the pacemaker cells that are found in
the right atrium of the heart.

Page 7
The cardiac muscles are unconsciously involuntarily controlled, and it is responsible for the
pumping of the heart. The muscle fibers like those of striated skeletal muscle tissue are wrapped
and bundled with connective tissues sheaths composed of endomysium and perimysium. The
inner layer is the endocardium; a thin layer of smooth tissue lining each chamber of the heart and
covers also the valves of the heart. The smooth endothelial lining decreases the friction as blood
passes through the heart. The endocardium is continuous with the endothelial lining of the large
blood vessels attached to the heart.
Figure 1.3 shows the layer of the heart. Figure 1.4 shows the cardiac muscle.

Circulation of the Heart

The heart has two circulation appear in the figure. These circulations are the pulmonary
circulation and the systemic circulation. The blue arteries, veins and capillaries refer to the
pulmonary circulation. While the red color refers to the systemic circulation (4).

Figure 1.5

Page 8
The Pulmonary Circuit (Exchange of Gases)

It is the path that the blood flows through the lungs. First, the superior and the inferior
vena cava carry the deoxygenated blood from all parts of the body veins to the right atrium. Then
the blood will pass into the right ventricle through the tricuspid valve. Then the right ventricle
drives it into the pulmonary trunk through the pulmonary valve. The pulmonary trunk splits into
the right and left pulmonary arteries which has branches as they come close to the lungs. The
arterioles transmit blood to the pulmonary capillaries where the exchange between the CO2 and
O2 occurs (CO2 is released and O2 is picked up). Blood then goes to the pulmonary venules that
connect to the four pulmonary veins that pass into the left atrium. Blood that found in pulmonary
arteries is oxygen-poor - which means that the concentration of the CO2 is higher than the
concentration of O2 - but blood in the pulmonary veins is oxygen-rich so, it is wrong idea to

think that all arteries have blood with high oxygen level and all veins carry low oxygen blood (4).

The Systemic Circulation

It is the circuit of vessels providing oxygenated blood to the tissues of the body and
picking up the deoxygenated blood - blood with low concentration of O2-from the tissues of the
body. In the systemic circuit the left ventricle of the heartpumps blood across the aorta and
arteries that divides to form the arterioles and across the capillaries, where the blood reaches an
equilibrium with the interstitial fluid, and then passes through the venules into the veins. The
venae cava will return the blood to the right atrium of the heart. Pressure in the arterial systems
responsible of maintaining systemic blood flow (5). When the blood return to the right side of the
heart it will be deoxygenated blood because cells have taken much of the O2 and provided CO2
to the blood. At this point, the blood is ready to another path to the lungs (6).

Coronary Artery
Nutrients cannot diffuse fast enough from blood in the four chambers of the heart to deliver all
the layers of cells that make up the heart wall. Because of that the myocardium has its own
network of blood vessels which is the coronary or cardiac circulation. The coronary arteries
branch from the aorta and encircle the heart like a crown encircles the head. The coronary
arteries are squeezed shut. So, when the heart contracts, little blood flows in it, but when the
heart relaxes the high pressure of blood in the aorta pumps blood through the coronary
arteries, into capillaries, and letter into coronary veins (2).

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 There are two coronary arteries, the left main coronary artery which is also called the left
main trunk has two branches, the circumflex artery and left anterior descending artery (LAD).
Right Coronary Artery (RCA) branches into the Right marginal artery and posterior descending
artery. (16)
Coronary arteries are epicardial (above the epicardium) and microvascular which is close
to the endocardium. The ostia of the left and right coronary arteries are located above the aortic
valve. The right coronary artery is anterior of the heart and posterior surface of the heart and
posterior interventricular. The left coronary artery is superior and posterior to the right coronary
and anterior of the heart.(7)

The Coronary Circulation

The left atrium and the posterior wall of the left ventricle are supplied withoxygenated blood by
the circumflex branch which runs posteriorly. While the interior interventricular branch moves in
the direction of the apex of the heart and supplies the nutrients to the anterior walls of the
ventricles and the interventricular septum. In the other hand, the right coronary artery supplies
the right atrium and then splits into two branches which are the marginal branch and the posterior
interventricular branch. The marginal branch provides the lateral walls of the right atrium and
right ventricle with the oxygenated blood. While the posterior wall of both ventricles supplied
with oxygenated blood by posterior interventricular branch(8). The myocardium has many
anastomoses _which are connections of arteries that supply the same area of the body_ that
connect branches of given coronary arteries. They provide by-passes for arterial blood if the
main route becomes obstructed. So, the heart muscle may receive enough oxygen even though
one of its coronary arteries is partly blocked (2). The circulation is shown in figure (1.6)

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 Figure 1.6

Coronary Veins:

Coronary venous flow happens through diastole and systole, and the coronary venous
system empties the myocardium of oxygen-depleted blood. The coronary venous system controls
the arterial system (9).

After blood delivers through the arteries of the coronary circulation, it runs into capillaries,
where it brings oxygen and nutrients to the heart muscle and take up carbon dioxide and wastes,
and then travels into coronary veins. Most of the deoxygenated blood from the myocardium
empties into an enormous vascular sinus in the coronary sulcus that is on the posterior surface of
the heart known as the coronary sinus. The deoxygenated blood in the coronary sinus drains into
the right atrium. The basis tributaries transmitting blood into the coronary sinus are the
following: Great cardiac vein which is in the anterior interventricular sulcus and empties the
regions of the heart provided by the left coronary artery. Middle cardiac vein that is found in the
posterior interventricular sulcus empties the parts of the heart that are supplied by the posterior
interventricular branch of the right coronary artery.

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 Also, there is a small cardiac vein in the coronary sulcus empties the right atrium and
right ventricle. Anterior cardiac veins remove the blood from the right ventricle and open
immediately into the right atrium (2). The coronary veins are shown in figure (1.7)

Figure 1.7

Coronary Artery Disease

Coronary artery disease (CAD), the most common form of heart disease is the narrowing
or blockage of the coronary arteries caused by atherosclerosis. (10)

Figure 2.2
Figure 2.1

Atherosclerosis called the hardening or clogging of the arteries is the buildup of plaques
that is cholesterol and fatty deposits in the inner walls of the arteries. The deposition of plaques
in the coronary arteries restricts blood flow to the heart muscle by either clogging the artery or
causing abnormal artery tone and function. Without sufficient blood supply, the heart is deprived
of oxygen and vital nutrients it requires for proper functioning.

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This can cause chest pain called angina. If the blood supply is cut off or energy demand of the heart
muscle is not satisfied it can also cause the heart attack. A complete blockage in a coronary artery is
called a total coronary occlusion or if its more than three-month-old then a chronic total occlusion.
Stenoses, or narrowing, of the main coronary artery and an adjoining side branch vessel is called a
bifurcation blockage or lesion. Sometimes, the blood clot breaks, restoring the blood supply, but in
other cases, when the blood clot blocks the blood supply to the heart muscle it can cause one of the
three serious conditions, called Acute coronary syndromes. (10) (11)

Acute Coronary Syndromes

There are three types of coronary artery disease, depending upon the location of the blockage,
the length of the time that blood flow is blocked and the amount of damage that occurs the type
is determined. These conditions are life threatening and require direct medical attention. (12)

Unstable Angina
It is a change from stable angina. Angina may be occurring more frequently, more easily
at rest, more severe, or long lasting. It can be relieved with oral medication, but it is unstable and
may lead to a heart attack. (12)

Heart attack: Non-ST segment elevation myocardial infraction (NSTEMI)

This heart attack, or myocardial infarction, does not show changes on an
electrocardiogram (ECG). The damage that occurred to the heart muscle can be known by
chemical markers in the blood. However, the extent of the damage is relatively small as the
blockage may be partial or temporary. (12)

Heart Attack: ST Segment Elevation Myocardial Infarction (STEMI)

This heart attack or MI is the result of sudden blockage in blood supply. It shows changes on the
ECG as well as in the levels of chemical markers in the blood as it affects a large area of the
heart muscle. (12)

Figure 2.3

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Symptoms
The most common symptom is chest pain, angina also called angina pectoris.

Angina along with some other symptoms can also be signs of a heart attack like

• Discomfort or pain in the upper parts of the body like the arms, left shoulder, back,
neck, jaw, or stomach.

• Shortness of breath or difficulty in breathing.

• Cold sweat

• Loss of appetite, indigestion, or feeling choked

• Nausea

• Extreme weakness, light-headedness, dizziness or anxiety

• Irregular or rapid heartbeats (13)

Diagnosis

The cardiologist can diagnose the disease as coronary artery disease after checking the
symptoms, medical history, and risk factors, performing physical exams and diagnostic tests. (14)

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The diagnostic tests include:

Electrocardiogram (ECG)
It is the recording of the electricity or the electric signals that travel through the heart.
An ECG can reveal traces of a previous attack or an attack that can take place.
Certain abnormalities can indicate insufficient blood supply to the heart. (14)

Figure 2.4

Echocardiogram
It produces images of the heart using sound waves. It is used to analyze whether all the
parts of the heart wall are functioning properly to the heart’s pumping activity.

Figure 2.5

Page 15
Stress Test
If symptoms appear while exercising, the patient is told to exercise during the ECG, this
is known as an exercise stress test.

The stress test can be performed using an echocardiogram as well. In some cases, the test can be
performed using medication to stimulate the heart.

The nuclear stress test is another type of stress test that helps measure blood flow to the heart
muscle at rest and during stress. It is like an exercise stress test but with additional images to the
ECG. In this test, a tracer along with special cameras are injected to detect the areas of the heart
receiving less blood supply. (14)

Figure 2.6

Cardiac catheterization and Angiogram

To have a view of the blood flow in the heart, a special dye is injected into the coronary
arteries, this is known as an angiogram. The dye is injected through a procedure called cardiac
catheterization in which it is introduced into the arteries of the heart by a long, thin, flexible tube
(catheter). The dye highlights narrow spots and blockages on the X-ray images. (14)

Figure 2.7

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Cardiac catheterization and Angiogram
To have a view of the blood flow in the heart, a special dye is injected into the coronary
arteries, this is known as an angiogram. The dye is injected through a procedure called cardiac
catheterization in which it is introduced into the arteries of the heart by a long, thin, flexible tube
(catheter). The dye highlights narrow spots and blockages on the X-ray images. (14)

Heart Scan
Calcium deposits in the arteries can narrow them and cause coronary artery disease, they
can be seen using computerized tomography (CT) technologies. A CT coronary angiogram can
be used to generate images of the heart arteries in which a contrast dye is injected intravenously
during the CT scan. (14)

Figure 3.1

Treatment

If diagnosed with Coronary artery disease (CAD), it is important to reduce or control the
risk factors and seek treatment to lower the chances of heart attack or stroke. Treatment depends
on a lot of thing like current health condition, risk factors, and overall wellbeing. (15)

Treatment for coronary artery disease most of the time involves lifestyle changes and, if
necessary, drugs and certain medical procedures.
Drugs

Different type of drugs can be used to treat coronary artery disease, including:

Page 17
• Cholesterol-modifying medications: by decreasing or reducing the amount
ofcholesterol in the blood, especially low-density lipoprotein (LDL, or the "bad") cholesterol,
these drugs decrease the primary material that deposits on the coronary arteries. A range of other
medications can also be prescribed, including statins, niacin, fibrates and bile acid sequestrants.

• Aspirin:a daily dose of aspirin or other types of these drugs can help improvesymptoms of
chest pain by making the blood thinner. This can decrease the tendency of your blood to clot,
which may help prevent obstruction of your coronary arteries.

If you have had a heart attack, aspirin can help prevent future attacks. There are some cases
where aspirin isn't appropriate. For example, when there is a bleeding disorder, or an alternative
blood thinner is being, so the doctor must be consulted before starting to take aspirin.

• Beta blockers:these drugs slow down the heart rate and decrease the bloodpressure, which
decreases heart's demand for oxygen. If there is history of a heart attack, beta blockers reduce the
risk of future attacks.

• Calcium channel blockers: these drugs may be used with beta blockers if betablockers
alone are not effective or instead of beta blockers if they cannot be used. These drugs may help
improve the symptoms of chest pain.

• Nitroglycerin: Nitroglycerin tablets, sprays and patches can help in controllingchest pain
by temporarily dilating the coronary arteries and reducing the heart's demand for blood.

• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II

receptor blockers (ARBs) drug: these similar drugs reduce blood pressure and also may
helpprevent progression of coronary artery disease. (15)

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Procedures to Restore and Improve Blood Flow

Sometimes more aggressive treatments are needed there are some options:

Angioplasty and stent placement ( percutaneous coronary revascularization )

In this procedure, a long thin tube (catheter)is inserted into the narrowed part of the artery. The
wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is
then inflated, compressing the deposits against your artery walls.

A stent is often left in the artery to help keep it open. Most stents gradually release medication to
help keep the arteries open. (15)

Coronary Artery By pass Surgery

In this surgery a graft bypass is created in the blocked coronary arteries by using a vessel from
another part of your body. That helps and allows blood to flow around the blocked or narrowed
coronary artery. Because this requires open-heart surgery, it is mostly reserved for cases of
multiple narrowed coronary arteries. (15)

Lifestyle and Home Remedies

Lifestyle changes can help prevent or slow the progression of coronary artery disease by doing:

• Stop Smoking: smoking is a major and main risk factor for coronary artery disease.Nicotine
makes the blood vessels narrower and forces the heart to work very harder, also carbon
monoxide reduces oxygen in blood and damages the lining of the blood vessels. Therefore,
quitting is one of the best ways to reduce and prevent the risk of a heart attack.

• Control Blood Pressure: check blood pressure at least every two years. Make more-frequent
measurements if the blood pressure is higher than normal or there is a history of heart disease.
Optimal blood pressure is less than 120 systolic and 80 diastolic (The normal rate), as measured
in millimeters of mercury (mm Hg).

Page 19
• Keep a Check of Cholesterol: take a baseline cholesterol test when in 20s and afterthat at
least every five years. For example, (8, p8) If the test results are not within good desirable
ranges, it is recommended to perform more-frequent measurements (8, p8). Most people should
aim for an LDL cholesterol level below 130 milligrams unit per deciliter (mg/dL), or 3.4
millimoles per liter (mmol/L).

(8, p9) If there are other risk factors for heart disease, the target LDL cholesterol maybe below
100 mg/dL (2.6 mmol/L).

• Keep Diabetes Under Control: for diabetic patients, a tight blood sugarmanagement may
help reduce the risk of heart disease.

• Get Moving: doing exercise has good effect on helps achieve and maintain ahealthy weight
and control diabetes, elevated - high-cholesterol and high blood pressure, all risk factors for
coronary artery disease. With the doctor's recommendation, aim for about 150 minutes a week of
moderate physical activity. For example, try to walk for about 30 minutes on most or all days of
the week.

• Participate in Cardiac Rehabilitation: if surgery is obligatory it is suggested towork

hard and to participate in cardiac rehabilitation that means a program of education, counseling
and exercise training that is designed to help improve your health.

• Eat Healthy Foods:a heart-healthy diet, such as the Mediterranean diet, thatemphasizes
on plant-based healthy foods, such as fruits, vegetables, whole grains, legumes and nuts and is
low in saturated fat, cholesterol and sodium can help in controlling weight, blood pressure and
cholesterol. Eating one or two servings of fish per week is also beneficial.

• Maintain a Healthy Weight: being overweight that is more than normal, increasesthe risk
of coronary artery disease. Losing even just a small amount of percentage of your current weight
can help reduce risk factors for coronary artery disease.

• Manage Stress:reduce stress as much as possible it is good for health. Practicehealthy

techniques for controlling and managing stress, such as muscle relaxation and deep breathing. (15)
Page 20
References

(1) Mary Jones and Geoff Jones(2009), IGCSE Biology Coursebook,

Second Edition, Cambridge.

(2) Gerard J. Tortora and Bryan Derrickson(2011), Principle of Anatomy

and Physiology
th
Maintenance and Continuity of the Human Body. 13 Edition,
Volume 2, International Student Version.

(3) Mary Jones, Richard Fosbery, Jennifer Gregory, and Dennis

Taylor(2014), Cambridge International AS and A Level. Biology
Coursebook,( Fourth Edition).cambridge university press.

(4) Sylvia S. Madder and Michael Windelspecht(2014), Human Biology,

Fourteenth Edition, , Appalachian State University.

(5) The Editors of Encyclopedias Britannica, ENCYCLOPÆDIA

BRITANNICA. https://www.britannica.com/science/systemic-circulation
(6) , Ph.D. Miller and Levine(2006),Prentice Hall Biology 1145 pages.
(7) http://www.vhlab.umn.edu/atlas/coronary-arteries/left-
coronary-artery/index.shtml
(8) Jardins, T. D. (2012), Cardiopulmonary Anatomy & Physiology (6th
ed.). USA: Delmer, Cengage learning.
(9) Hutchins G, Moore G, Hatton E (1986) Arterial-venous relationships in the
human left ventricular myocardium, Anatomic basis for countercurrent
regulation of blood flow. Circulation 74:1195-1202
(10) Coronary Artery disease. (n.d.). Retrieved March 4, 2019, from
https://www.ottawaheart.ca/sites/default/files/uploads/coronary-artery-disease-
patient-guide.pdf

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(11) Coronary Artery disease. (n.d.). Retrieved March 4, 2019, from
https://my.clevelandclinic.org/health/diseases/16898-coronary-artery-disease

(12) CAD: Acute Coronary Syndrome. (n.d.). Retrieved March 4, 2019, from

https://my.clevelandclinic.org/health/diseases/16713-cad-acute-coronary-syndrome

(13) Coronary Artery disease Symptoms. (n.d.). Retrieved March 4, 2019, from

https://my.clevelandclinic.org/health/symptoms/16821-coronary-
artery-disease-symptoms

(14) Coronary Artery disease. (2018, May 16). Retrieved March 4, 2019, from
https://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/diagnosis-
treatment/drc-20350619

(15) Coronary artery disease - Diagnosis and treatment - Mayo

Clinic/Mayoclinic.org https://www.mayoclinic.org/diseases-conditions/coronary-
artery-disease/diagnosis-treatment/drc-20350619

(16) https://my.clevelandclinic.org/health/articles/17063-coronary-arteries
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