Learning objectives <ul><li>To know the consequences of having faulty  heart valves </li></ul><ul><li>To know that coronar...
Faulty valves <ul><li>Occasionally, valves on the heart do not function properly </li></ul><ul><li>This causes several eff...
Dysfunction of the cardiovascular system <ul><li>There are 3 main dysfunctions of the cardiovascular system: </li></ul><ul...
Changes in Blood Pressure <ul><li>Condition: </li></ul><ul><ul><li>Blood pressure is the force exerted by the blood on the...
Changes in Blood Pressure <ul><li>Condition: </li></ul><ul><ul><li>Blood pressure naturally decreases as the blood vessel ...
Changes in Blood Pressure <ul><li>Causes: </li></ul><ul><ul><li>Genetic predisposition (family history of high blood press...
Changes in blood pressure <ul><li>Diagnosis: </li></ul><ul><ul><li>Blood pressure monitor – checking of the blood pressure...
Questions on coronary artery disease <ul><li>What is the CONDITION coronary artery disease? </li></ul><ul><li>List the CAU...
Coronary artery disease <ul><li>Condition: </li></ul><ul><ul><li>A blockage or narrowing of coronary arteries (the arterie...
Coronary artery disease <ul><li>Causes: the blockages can occur due to several reasons: </li></ul><ul><ul><li>Genetic pred...
Coronary artery disease <ul><li>Causes: the blockages can occur due to several reasons: </li></ul><ul><ul><ul><li>Age:  </...
Coronary artery disease (CAD) <ul><li>Symptoms </li></ul><ul><ul><li>Chest pain called angina: </li></ul></ul><ul><ul><ul>...
Coronary artery disease (CAD) <ul><li>Diagnosis: </li></ul><ul><li>By diagnostic imaging so that the heart and blood vesse...
Coronary artery disease (CAD) <ul><li>Diagnosis: </li></ul><ul><ul><li>MRI scan: magnetic resonance imaging </li></ul></ul...
Coronary artery disease (CAD) <ul><li>Diagnosis: </li></ul><ul><ul><li>CT scan: </li></ul></ul><ul><ul><ul><li>CT= compute...
Coronary artery disease (CAD) <ul><li>Diagnosis:  ECG – electrocardiogram </li></ul><ul><ul><li>ECG shows the electrical a...
Coronary artery disease (CAD) <ul><li>Diagnosis:  ECG – electrocardiogram </li></ul><ul><ul><li>Can show lots of different...
Coronary artery disease (CAD) <ul><li>Diagnosis: Coronary Catheterization (angiogram) </li></ul><ul><li>Under local anaest...
Coronary artery disease (CAD) <ul><li>Treatment </li></ul><ul><ul><li>Coronary artery bypass  graft (CABG) = heart bypass ...
Coronary artery disease (CAD)
Coronary artery disease (CAD) <ul><li>Treatment: CABG </li></ul><ul><ul><li>Can sort out more than one blockage and attach...
Coronary artery disease (CAD) <ul><li>Treatment </li></ul><ul><ul><li>Lifestyle changes: </li></ul></ul><ul><ul><ul><li>He...
Coronary artery disease (CAD) <ul><li>Risk factors for CAD </li></ul><ul><ul><li>Being male </li></ul></ul><ul><ul><li>Fam...
Heart attack <ul><li>Condition: </li></ul><ul><ul><li>Heart attack and myocardial infarction are essentially the same </li...
Heart attack <ul><li>Symptoms </li></ul><ul><ul><li>Uncomfortable pressure causing chest pain </li></ul></ul><ul><ul><li>P...
Heart attack <ul><li>Treatment  </li></ul><ul><ul><li>If a major coronary artery is affected then often the patient dies s...
Heart attack <ul><li>Treatment:  heart transplant </li></ul><ul><li>If a major part of the heart muscle has died or is not...
Heart attack <ul><li>Heart transplant procedure: </li></ul><ul><ul><li>A donor heart must be found – this must be from an ...
Heart attack <ul><li>Heart transplant – prevention of rejection: </li></ul><ul><ul><li>The patient  must be put on immunos...
Other Heart Treatments <ul><li>There are other treatments that can be used for other heart disorders such as misfiring of ...
Heart pacemaker <ul><li>If the SA node does not function correctly then the heart cannot pump blood efficiently. </li></ul...
Pacemaker
Detailed treatments for CAD <ul><li>Cholesterol-lowering medications.  By decreasing the amount of cholesterol in the bloo...
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Presentation: Dysfunctions of the cardiovascular system

  1. 2. Learning objectives <ul><li>To know the consequences of having faulty heart valves </li></ul><ul><li>To know that coronary artery disease, heat attacks and changes in blood pressure are dysfunctions of the cardiovascular system </li></ul><ul><li>To know the treatment and diagnosis for coronary artery disease, heart attack and a change in blood pressure </li></ul>
  2. 3. Faulty valves <ul><li>Occasionally, valves on the heart do not function properly </li></ul><ul><li>This causes several effects of the body: </li></ul><ul><ul><li>backflow of blood occurring: </li></ul></ul><ul><ul><ul><li>If this occurs between the right ventricle and pulmonary artery then not enough blood gets to the lungs so cant get oxygen </li></ul></ul></ul><ul><ul><ul><li>If this occurs between the left ventricle and aorta then not enough oxygenated blood gets to cells </li></ul></ul></ul><ul><ul><li>Poor pressure for pumping blood </li></ul></ul><ul><ul><li>Fainting/collapsing </li></ul></ul><ul><ul><li>Cold hands and feet </li></ul></ul><ul><ul><li>Low blood pressure </li></ul></ul>
  3. 4. Dysfunction of the cardiovascular system <ul><li>There are 3 main dysfunctions of the cardiovascular system: </li></ul><ul><ul><li>Change in blood pressure </li></ul></ul><ul><ul><li>Coronary artery disease </li></ul></ul><ul><ul><li>Heart attack </li></ul></ul>
  4. 5. Changes in Blood Pressure <ul><li>Condition: </li></ul><ul><ul><li>Blood pressure is the force exerted by the blood on the walls of the blood vessels </li></ul></ul><ul><ul><li>High blood pressure is called HYPERTENSION and this is when the blood pressure significantly greater than the average blood pressure </li></ul></ul><ul><ul><ul><li>Average : 120 / 80 mm/Hg (millimetres of mercury) </li></ul></ul></ul><ul><ul><ul><ul><li>Said as 120 over 80 </li></ul></ul></ul></ul><ul><ul><ul><li>High blood pressure: 140 / 90 mm/Hg </li></ul></ul></ul><ul><ul><li>The top (first) number is the systolic pressure. This is the pressure in the arteries when the heart contracts. </li></ul></ul><ul><ul><li>The bottom (second) number is the diastolic pressure. This is the pressure in the arteries when the heart rests between each heartbeat. </li></ul></ul>
  5. 6. Changes in Blood Pressure <ul><li>Condition: </li></ul><ul><ul><li>Blood pressure naturally decreases as the blood vessel get smaller </li></ul></ul><ul><ul><ul><li>E.g. The highest blood pressure is found in the arteries and the lowest in the veins (capillaries are variable) </li></ul></ul></ul>
  6. 7. Changes in Blood Pressure <ul><li>Causes: </li></ul><ul><ul><li>Genetic predisposition (family history of high blood pressure) </li></ul></ul><ul><ul><li>Lifestyle: </li></ul></ul><ul><ul><ul><li>Smoking </li></ul></ul></ul><ul><ul><ul><li>Alcohol </li></ul></ul></ul><ul><ul><ul><li>Diet </li></ul></ul></ul><ul><ul><ul><li>Stress </li></ul></ul></ul><ul><li>Symptoms: rarely causes symptoms </li></ul><ul><ul><li>Severe hypertension can cause: </li></ul></ul><ul><ul><ul><li>Headache </li></ul></ul></ul><ul><ul><ul><li>Sleepiness </li></ul></ul></ul><ul><ul><ul><li>Confusion </li></ul></ul></ul><ul><ul><ul><li>Coma </li></ul></ul></ul>
  7. 8. Changes in blood pressure <ul><li>Diagnosis: </li></ul><ul><ul><li>Blood pressure monitor – checking of the blood pressure regularly </li></ul></ul><ul><li>Treatment: </li></ul><ul><ul><li>Lifestyle changes: </li></ul></ul><ul><ul><ul><li>not smoking </li></ul></ul></ul><ul><ul><ul><li>drinking less </li></ul></ul></ul><ul><ul><ul><li>avoiding fatty foods </li></ul></ul></ul><ul><ul><ul><li>Avoiding foods with lots of salt in </li></ul></ul></ul><ul><ul><li>Drugs to: </li></ul></ul><ul><ul><ul><li>lower blood pressure if it is 140/90 mmHg or higher. </li></ul></ul></ul><ul><ul><ul><li>lower your cholesterol level </li></ul></ul></ul>
  8. 9. Questions on coronary artery disease <ul><li>What is the CONDITION coronary artery disease? </li></ul><ul><li>List the CAUSES of coronary artery disease </li></ul><ul><li>What are the SYMPTOMS? </li></ul><ul><li>How can it be DIAGNOSED? </li></ul><ul><li>What TREATMENTS are available? </li></ul><ul><li>What are the RISK FACTORS? </li></ul>
  9. 10. Coronary artery disease <ul><li>Condition: </li></ul><ul><ul><li>A blockage or narrowing of coronary arteries (the arteries that supply the heart with oxygen and glucose) </li></ul></ul><ul><ul><li>This leads to the heart muscle not receiving enough oxygen and a build up of carbon dioxide so it cant respond to exercise demands </li></ul></ul>
  10. 11. Coronary artery disease <ul><li>Causes: the blockages can occur due to several reasons: </li></ul><ul><ul><li>Genetic predisposition (family history of high blood pressure) </li></ul></ul><ul><ul><li>Lifestyle: </li></ul></ul><ul><ul><ul><li>Diet </li></ul></ul></ul><ul><ul><ul><ul><li>Fat/cholesterol deposits in the arteries from fatty food which reduces the size of the lumen (space inside the artery) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>This restricts blood flow therefore blood pressure is increased. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>This is known as atherosclerosis. </li></ul></ul></ul></ul><ul><ul><ul><li>Smoking – increases blood pressure and fat deposits </li></ul></ul></ul><ul><ul><ul><li>Alcohol – excessive intake increases blood pressure </li></ul></ul></ul><ul><ul><ul><li>Stress – puts strain on heart making it beat quicker </li></ul></ul></ul>
  11. 12. Coronary artery disease <ul><li>Causes: the blockages can occur due to several reasons: </li></ul><ul><ul><ul><li>Age: </li></ul></ul></ul><ul><ul><ul><ul><li>fat/cholesterol builds up due to years of eating </li></ul></ul></ul></ul><ul><ul><ul><ul><li>arteries lose collagen and elasticity causing walls to become rigid and preventing blood from flowing smoothly. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>This increases blood pressure </li></ul></ul></ul></ul>
  12. 13. Coronary artery disease (CAD) <ul><li>Symptoms </li></ul><ul><ul><li>Chest pain called angina: </li></ul></ul><ul><ul><ul><li>dull ache or pressure spreading to the arms (especially left arm), neck, or back due to blood being force through blockage/narrow part of artery </li></ul></ul></ul><ul><ul><ul><li>brought on by exertion e.g. Walking briskly </li></ul></ul></ul><ul><ul><li>Shortness of breath </li></ul></ul><ul><ul><li>Indigestion </li></ul></ul><ul><ul><li>Can be symptomless </li></ul></ul>
  13. 14. Coronary artery disease (CAD) <ul><li>Diagnosis: </li></ul><ul><li>By diagnostic imaging so that the heart and blood vessels can be seen </li></ul><ul><ul><li>Chest X rays – outline of structure can be seen and changes detected </li></ul></ul><ul><ul><li>Coronary angiography </li></ul></ul><ul><ul><ul><li>patient injected with an opaque medium into the blood </li></ul></ul></ul><ul><ul><ul><li>This shows up on X rays so that blood flow can be seen </li></ul></ul></ul><ul><ul><ul><li>Better than just x rays as shows soft tissues which normal x rays don’t </li></ul></ul></ul>
  14. 15. Coronary artery disease (CAD) <ul><li>Diagnosis: </li></ul><ul><ul><li>MRI scan: magnetic resonance imaging </li></ul></ul><ul><ul><ul><li>scan of the heart producing high quality images </li></ul></ul></ul><ul><ul><ul><li>Is used to assess the progress of coronary artery bypass graft </li></ul></ul></ul><ul><ul><ul><li>May eventually replace or coronary angiography </li></ul></ul></ul><ul><ul><ul><li>The patient lies inside a large, cylinder-shaped magnet. </li></ul></ul></ul><ul><ul><ul><li>Radio waves are sent through the body. This makes nuclei in the body's atoms move </li></ul></ul></ul><ul><ul><ul><li>As they move back into place they send out radio waves of their own. </li></ul></ul></ul><ul><ul><ul><li>The scanner picks up these signals and a computer turns them into a picture. </li></ul></ul></ul>
  15. 16. Coronary artery disease (CAD) <ul><li>Diagnosis: </li></ul><ul><ul><li>CT scan: </li></ul></ul><ul><ul><ul><li>CT= computer tomography </li></ul></ul></ul><ul><ul><ul><li>Take images of a heart beat </li></ul></ul></ul><ul><ul><ul><li>Good but a long waiting list to have the scan </li></ul></ul></ul>
  16. 17. Coronary artery disease (CAD) <ul><li>Diagnosis: ECG – electrocardiogram </li></ul><ul><ul><li>ECG shows the electrical activity of the heart so it shows the pathway starting from atria - SAN, bundle of His, purkinje fibres and finishing at ventricles contracting etc </li></ul></ul><ul><ul><li>The electrical impulses are recorded on a piece of paper </li></ul></ul><ul><ul><li>A typical trace shows: </li></ul></ul><ul><ul><ul><li>P wave - atria contracting </li></ul></ul></ul><ul><ul><ul><li>QRS complex - ventricles contracting </li></ul></ul></ul><ul><ul><ul><li>T wave – ventricles relaxing </li></ul></ul></ul>
  17. 18. Coronary artery disease (CAD) <ul><li>Diagnosis: ECG – electrocardiogram </li></ul><ul><ul><li>Can show lots of different things: </li></ul></ul><ul><ul><ul><li>Irregular heat beat rhythm – faster (tachycardia) or slower (bradycardia) than normal </li></ul></ul></ul><ul><ul><ul><li>Bigger or smaller time intervals in between waves can indicate heart abnormalities </li></ul></ul></ul><ul><ul><ul><li>Can show where a ‘misfire’ occurs </li></ul></ul></ul><ul><ul><ul><li>Problems with the chambers </li></ul></ul></ul><ul><ul><ul><li>Problems with thickening of the ventricle muscle or other heart muscle disorders </li></ul></ul></ul>
  18. 19. Coronary artery disease (CAD) <ul><li>Diagnosis: Coronary Catheterization (angiogram) </li></ul><ul><li>Under local anaesthetic, a small cut is made in a artery to the heart </li></ul><ul><li>A liquid dye is injected into the arteries of the heart through a long, thin, flexible tube (catheter) that is threaded through an artery. </li></ul><ul><li>The arteries then become visible on X-ray and videotape, showing areas where coronary arteries may be blocked. </li></ul><ul><li>The catheter may also be used to push open a blocked artery, a procedure called an angioplasty </li></ul>
  19. 20. Coronary artery disease (CAD) <ul><li>Treatment </li></ul><ul><ul><li>Coronary artery bypass graft (CABG) = heart bypass </li></ul></ul><ul><ul><ul><li>Restores normal function by providing a new route for blood to flow to the heart bypassing the blocked coronary artery </li></ul></ul></ul><ul><ul><ul><li>Procedure: </li></ul></ul></ul><ul><ul><ul><ul><li>Cut a length of vein usually from the leg </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Cut at the one end of the blocked coronary artery so that there is a ‘blockage free’ end </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Attach one end of the new vein to the cut end to the ‘blockage free’ end of the coronary artery </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Attach the other end of the new vein to the artery allowing blood to flow freely </li></ul></ul></ul></ul>
  20. 21. Coronary artery disease (CAD)
  21. 22. Coronary artery disease (CAD) <ul><li>Treatment: CABG </li></ul><ul><ul><li>Can sort out more than one blockage and attach more veins e.g. Double heart bypass, triple heart bypass </li></ul></ul><ul><ul><li>Advantages </li></ul></ul><ul><ul><ul><li>Oxygen can get to all parts of heart </li></ul></ul></ul><ul><ul><ul><li>Heart beat is stronger </li></ul></ul></ul><ul><ul><ul><li>Pain and angina goes away </li></ul></ul></ul><ul><ul><ul><li>Live longer </li></ul></ul></ul><ul><ul><li>Disadvantages </li></ul></ul><ul><ul><ul><li>Danger of heart surgery as the patient has to be placed on a heart lung machine </li></ul></ul></ul><ul><ul><ul><li>Full function cannot be replaced </li></ul></ul></ul><ul><ul><ul><li>The graft can rupture – burst open and cause internal bleeding and death </li></ul></ul></ul>
  22. 23. Coronary artery disease (CAD) <ul><li>Treatment </li></ul><ul><ul><li>Lifestyle changes: </li></ul></ul><ul><ul><ul><li>Healthier diet </li></ul></ul></ul><ul><ul><ul><ul><li>avoid fatty foods especially saturated (animal) fat to prevent fat depositing in the coronary arteries and prevention of obesity </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Avoid foods with high levels of salt </li></ul></ul></ul></ul><ul><ul><ul><li>Stop smoking to try to decrease blood pressure and prevent more fat deposits </li></ul></ul></ul><ul><ul><ul><li>Limit alcohol intake to help with reducing blood pressure </li></ul></ul></ul><ul><ul><ul><li>Avoid stress! </li></ul></ul></ul>
  23. 24. Coronary artery disease (CAD) <ul><li>Risk factors for CAD </li></ul><ul><ul><li>Being male </li></ul></ul><ul><ul><li>Family history </li></ul></ul><ul><ul><li>Smoking </li></ul></ul><ul><ul><li>High alcohol intake </li></ul></ul><ul><ul><li>High levels of fat in the diet </li></ul></ul><ul><ul><li>High blood pressure </li></ul></ul><ul><ul><li>Obesity </li></ul></ul><ul><ul><li>Inactivity </li></ul></ul>
  24. 25. Heart attack <ul><li>Condition: </li></ul><ul><ul><li>Heart attack and myocardial infarction are essentially the same </li></ul></ul><ul><ul><li>It is when the heart muscle dies and so cannot beat any longer </li></ul></ul><ul><ul><li>This means that blood cannot be pumped around the body </li></ul></ul><ul><li>Causes: </li></ul><ul><ul><li>Occurs due to a blockage in the coronary arteries: </li></ul></ul><ul><ul><ul><li>Coronary artery disease </li></ul></ul></ul><ul><ul><ul><li>Coronary thrombosis (blood clot in the coronary artery) </li></ul></ul></ul>
  25. 26. Heart attack <ul><li>Symptoms </li></ul><ul><ul><li>Uncomfortable pressure causing chest pain </li></ul></ul><ul><ul><li>Pain spreading to the shoulders, neck or arms especially left arm </li></ul></ul><ul><ul><li>Light headedness, fainting, sweating, nausea or shortness of breath. </li></ul></ul><ul><ul><li>Anxiety, nervousness and/or cold, sweaty skin. Paleness or pallor. </li></ul></ul><ul><ul><li>Increased or irregular heart rate. </li></ul></ul><ul><li>Diagnosis </li></ul><ul><ul><li>Any technique that diagnoses CAD </li></ul></ul>
  26. 27. Heart attack <ul><li>Treatment </li></ul><ul><ul><li>If a major coronary artery is affected then often the patient dies so there is no treatment </li></ul></ul><ul><ul><li>However, if it is not a major coronary artery then the patient can be treated and live </li></ul></ul><ul><ul><li>Can treat a heart attack by removing the blockage so same treatments as CAD often work </li></ul></ul>
  27. 28. Heart attack <ul><li>Treatment: heart transplant </li></ul><ul><li>If a major part of the heart muscle has died or is not functioning properly then the only option would be to replace it </li></ul><ul><li>Donor = is the person who has donated the heart (dead!) </li></ul><ul><li>Recipient = is the person who is receiving the heart </li></ul><ul><li>So the donor heart is put into the recipient </li></ul>
  28. 29. Heart attack <ul><li>Heart transplant procedure: </li></ul><ul><ul><li>A donor heart must be found – this must be from an individual who has been pronounced dead </li></ul></ul><ul><ul><li>The donor heart must be kept chilled in saline </li></ul></ul><ul><ul><li>The recipient of the heart has to be tissue-typed to see if the heart is compatible with them </li></ul></ul><ul><ul><li>The chest is opened and the patient is placed on a heart lung machine as most of diseased heart is taken out but all major blood vessels are left intact </li></ul></ul><ul><ul><li>The new heart is put in and attached to the major blood vessels </li></ul></ul><ul><ul><li>The patient must be put on immunosuppressant drugs to stop the body rejecting the new heart which means that they are susceptible to infection </li></ul></ul>
  29. 30. Heart attack <ul><li>Heart transplant – prevention of rejection: </li></ul><ul><ul><li>The patient must be put on immunosuppressant drugs to stop the body rejecting the new heart </li></ul></ul><ul><ul><li>People on immunosuppressant drugs are susceptible to infection as it is stopping the immune system from working properly </li></ul></ul><ul><ul><li>If they did not have these drugs then the body would see the new heart as ‘foreign’ and attack and destroy it. </li></ul></ul>
  30. 31. Other Heart Treatments <ul><li>There are other treatments that can be used for other heart disorders such as misfiring of the heart – irregular heart beats e.g. having a pacemaker fitted. </li></ul>
  31. 32. Heart pacemaker <ul><li>If the SA node does not function correctly then the heart cannot pump blood efficiently. </li></ul><ul><li>The SA node is a pacemaker meaning that it sets the pace of the heart beat and allows it to maintain its rhythm </li></ul><ul><li>If this is not functioning correctly then an artificial pacemaker can be fitted </li></ul><ul><li>To do this, an insulated wire is put into a major vein with an electrode in the heart muscle itself </li></ul><ul><li>The battery end is located just under the skin e.g.. in abdomen or collar bone </li></ul><ul><li>Batteries can easily be replaced as easy to get to. </li></ul>
  32. 33. Pacemaker
  33. 34. Detailed treatments for CAD <ul><li>Cholesterol-lowering medications. By decreasing the amount of cholesterol in the blood, especially LDL (the &quot;bad&quot; form of cholesterol), these drugs decrease the primary material that deposits on the coronary arteries. Examples include statins, niacin, fibrates and bile acid sequestrants. </li></ul><ul><li>Aspirin. This common over-the-counter medication may be recommended as an anti-platelet, which thins the blood, and as an anti-coagulant, which reduces the tendency for blood to clot and block a coronary artery, causing a heart attack. Other anti-platelet drugs or anti-coagulants may be prescribed as well. </li></ul><ul><li>Beta-blockers. These drugs help make the heart's job of pumping blood easier by relaxing the heart, slowing its rhythm, decreasing blood pressure and lowering the heart's demand for oxygen. They include metoprolol, atenolol and propranolol. </li></ul><ul><li>Nitroglycerin. This drug, as a tablet, spray or skin patch, helps relieve chest pain (angina) by opening narrowed blood vessels and improving blood flow to the heart muscle. The patient may also receive nitrates, a longer-lasting form of nitroglycerin. </li></ul><ul><li>Calcium channel blockers. These medications help to open coronary arteries to increase blood flow to the heart muscle. They can also help reduce high blood pressure. </li></ul><ul><li>ACE inhibitors (angiotensin converting enzyme inhibitors). Similar to beta-blockers, these help lower blood pressure and make the heart's job of pumping blood easier. In addition, ACE inhibitors have shown significant benefits for patients in recovering from a heart attack. They include ramipril, lisinopril, enalapril and captopril. </li></ul><ul><li>Vitamins. Folic acid, B-6 and B-12 are vitamins that help to decrease homocysteine in the blood. Homocystiene has been associated with accelerated clogging of the arteries (atherosclerosis). In specific situations, some patients may be prescribed L-arginine or Omega-3 fatty acids. </li></ul>

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