( By Dr. Natoobhai J.Shah & Dr. Sailesh N. Shah )

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a-Forces Of Invasion And Defence

In order to maintain the health of the coronary arterial system, there is a constant interplay between the forces of invasion and the natural forces of defence. Recent advances in molecular and cellular biology have shed new light on the maintenance of the "internal mileu" of the coronary circulation.

Maintenance of arterial health is maintained by a constant system of check and balances involving factors such as :

  1. Arterial Endothelium
  2. Circulating blood corpuscles with other blood products
  3. Arterial dilation or spasm.

The endothelium - The innermost coat of the arterial wall is formed by a lining of endothelial cells. It is this surface which comes into direct contact with blood stream. The endothelial cells are constantly active and secrete their own chemical substances for local protection.

The Endothelium, in fact, is known as the " Gate Keeper ". The endothelium maintains its structural integrity and does not allow cholesterol to enter into it. When the endothelium becomes sick along with loss of harmony between blood corpuscles and blood products, the cholesterol gets oxidized. The oxidized cholesterol is toxic enough to further damage the " gate keeper cells. " The modified cholesterol gets entry through weak endothelial cells to start its gradual deposits under the cell surface. This starts the core of atheroma. What actually causes endothelial cell sickness and what are the factors to bring about this disequilibrium is still not understood. It is quite possible that certain environmental factors known as " Risk Factors" play a harmful role. The common risk factors would include faulty diet, lack of physical activity, mental stress with a fast tempo of life, tobacco in any form, high blood pressure, diabetes and a family or genetic history. On the other hand, our body has its own In-built natural protective or defensive forces. IN point of fact, the biggest doctor for prevention, or self recovery is our bodies own In-built forces. The professional doctor only comes second and he too tries to derive help from the existing natural forces. As of now these forces are still not fully understood and need ongoing research.

There are some negative forces which can play havoc with the flow of blood by causing narrowing of the passage of coronary arteries. The known negative forces are :

  1. Cholesterol when oxidized to form its deposits
  2. Endothelial cell sickness loosing its protectiveness
  3. Blood viscosity with change in the behaviour of its corpuscles
  4. Coronary artery spasms or defective dilation
  5. A few European workers suggest some association with infection by respiratory chlamydia group of organism.

At present this is highly controversial.

Opposing the above, are In-built natural body defence forces which can constantly defend, repair or adjust. Some of them are :

  1. Healthy Endothelial cells - known as "gate -keeper " cells.
  2. Mini but multiple collaterals or side channels ( Fig. 2.3)
  3. High density cholesterol - so called "good cholesterol."
  4. Protective platelet factors producing artery dilations.
  5. Natural blood anticoagulation systems.
  6. Coronary artery dilation through various mechanisms from nervous system, platelets, endothelium etc.

It can be surmised from above that against the forces of destruction or disease, our own body is provided with forces to defend, repair or even adjust. These normal body potentials should not be overlooked or neglected. Some more detail about various factors are discussed through out the book. It is important to realize that our coronary arteries though used as supply tubes to the heart muscle should never be compared to those nonliving rigid pipe lines such as used in our own buildings or factories. Our coronary arteries are living, active, elastic and can proliferate. Each structure in our coronary artery is ever vigorous to challenge the blockages from disease processes. It secretes several local chemical substances and enzymes for counteraction.

Some factors in our blood also play an important role normally against but, surprisingly at times in favour of the disease process. The ever flowing blood contains certain components such as platelets, white cells and also certain substances such as thrombin, fibrinogen, antithrombin and fibrinolytic. Normally through their actions and counteractions , the blood thickness is kept at its ideal optimum for smooth flow, through the arteries. Due to reasons, known and unknown the flow balance can be disturbed so as to lead to poor organ supply or perfusion. In an acute situation a blood clot may form to partially or totally block the supply of oxygen and other nutrients to affected areas that are dependent on that particular arterial supply line. The natural defence forces would try to provide blood and nutrients to the deprived areas by proliferation of side channels or " collaterals." The state of the organs health would depend on the competence and excellence of blood collaterals along with the natural thinning of blood. If these forces fail in spite of counteractive forces, a state of arterial and organ disease develops. Similar scenario can occur with the heart which receives oxygen and nutrients from the system of coronary arteries. They are the main supply channels for the musculature of heart. The partial or complete blockage of a coronary artery can result in a spectrum of diseases known as coronary heart disease. These include Angina, unstable angina,myocardial infarction, sudden death, complex heart irregularities, and congestive heart failure. How do such diseases start, how to recognize their presence and how to manage them will be discussed further.

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