CONDITIONS

What Is Heart Disease

Heart disease is a wide-reaching term to describe a range of conditions that affect the heart.  The term “heart disease” is often used interchangeably with “cardiovascular disease.” Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack (a sudden and sometimes fatal blockage of blood flow to the heart), chest pain (angina) or heart failure (the inability of the heart to pump blood asit should).Other heart conditions, such as infections and conditions that affect your heart’s muscle, valves or beating rhythm, also are considered forms of heart disease.  Over 25 percent of all deaths in the United States are caused by heart disease. According to the Cleveland Clinic, heart disease claims more lives each year than the next 4 leading causes of death combined—cancer, chronic lower respiratory diseases, accidents, and diabetes mellitus.

There are dozens of heart diseases.  The following are the most common:

  • HYPERTENSION, or elevated blood pressure
  • Hypercholesterolemia, or HIGH CHOLESTEROL
  • ATRIAL FIBRILLATION, an abnormal rhythm of the heart
  • STROKE, or a decrease in blood supply to the brain
  • MYOCARDIAL INFRACTION (MI), or heart attack
  • CONGENITAL HEART DISEASE, which is a condition a person is born with
  • CORONARY ARTERY DISEASE, or a narrowing of the blood vessels which supply the heart muscle itself
  • CONGESTIVE HEART FAILURE, or an inability of the heart to pump blood throughout the body as it should

Risk Factors For Heart Disease

There are many risk factors that can increase your likelihood of developing heart disease.

These include:

  • Age.The older you are, the greater your risk of  developing heart disease is.
  • High blood pressure.
  • Certain chronic conditionssuch as thyroid problems, sleep apnea, diabetes, chronic kidney disease, lung disease or metabolic syndrome (a collection of symptoms that include excess body fat around the waist and high levels of blood sugar, cholesterol and blood pressure.
  • Drinking alcohol.For some people, drinking alcohol can trigger AF. Binge drinking may put you at an even higher risk. The federal Centers for Disease Control (CDC) defines binge drinking as the consumption of five or more drinks (for men) and four or more drinks (for women) in two hours. The National Institute on Alcoholism and Alcohol Abuse says women are more vulnerable to the effects of alcohol because they have less body water than men of similar weight, and so they absorb alcohol faster.
  • Obesity.The excess weight of obesity increases the stress load of all bodily organs, including the heart.
  • Family history.Heart disease tends to conglomerate in families.
  • Drug Use. Stimulants, like cocaine, and other illegal drugs can cause spasms in the heart muscle and arteries that leads to heart attack.
  • Stress. Stress can raise blood pressure and heart rate among other things, putting addition stress on your heart.
  • Physical Inactivity. The heart is a muscle, and like any other muscle in the body, it needs to be exercised. People who maintain an active lifestyle have a 45% lower risk of developing heart disease than those that do not.
  • Race. Certain heart conditions are more prevalent among specific populations. For example, African Americans and Hispanic populations are more likely to develop coronary artery disease (CAD).
  • Genetics. Congenital heart diseases are associated with many genetic conditions that are characterized by an addition or subtraction of chromosomes, including down syndrome, which is caused by an extra copy of the 21st chromosome.
  • High cholesterol. High levels of LDL cholesterol, also known as “bad cholesterol”, contribute to atherosclerosis, the hardening of artery walls that can lead to coronary artery disease.
  • Diabetes and Prediabetes. Individuals with diabetes are two to four times more likely to develop heart disease than non-diabetics.
  • Unhealthy diet. A poor diet can contribute to excess weight gain, high blood pressure, high cholesterol, and diabetes, all of which increase your risk of developing coronary artery disease.
  • Ethnicity. Hispanics and African Americans are at a higher risk of coronary artery disease.
  • Depression.  The exact effects of depression on heart health are unknown, however studies have shown that a large portion of patients with heart failure also are experiencing depressive symptoms. A 2011 study found that 35% of heart failure patients experienced depressive symptoms, 14% of which qualified for a major depressive disorder diagnosis.

For risk factors for specific conditions, visit the following pages:

  • HYPERTENSION
  • HIGH CHOLESTEROL
  • ATRIAL FIBRILLATION
  • STROKE
  • HEART ATTACK OR MYOCARDIAL INFRACTION (MI)
  • CONGENITAL HEART DISEASE          
  • CORONARY ARTERY DISEASE
  • CONGESTIVE HEART FAILURE

Diagnosing Heart Disease

If your doctor suspects you may have heart disease, he or she may conduct several of the following diagnostic tests:

  • Sphygmomanometer Test, which measures blood pressure.According to guidelines, a normal blood pressure is less than 120/80 mm Hg. Hypertension is blood pressure that is greater than 140/90. For people over age 60, high blood pressure is defined as 150/90 or greater. 
  • Blood Test. Cholesterol screening measures your level of high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and triglycerides (a type of fat in your blood). A small sample of blood will be drawn from your arm and sent to be analyzed in a laboratory. Your doctor will tell you if you should fast) before your blood test. If you aren’t fasting when the blood sample is drawn, only the values for total cholesterol and HDL cholesterol will be usable. That’s because the amount of LDL (bad) cholesterol level and triglycerides can be affected by what you’ve recently consumed. Your test report will show your cholesterol level in milligrams per deciliter of blood (mg/dL). Your doctor will interpret your cholesterol numbers based on other risk factorssuch as age, family history, smoking and high blood pressure.
  • Electrocardiogram (ECG). An ECT uses small sensors (electrodes) attached to your chest and arms to record electrical signals as they travel through your heart. According to the National Heart, Blood and Lung Institute (NHLBI), the electrical signals originate in a group of cells called the sinus node or sinoatrial (SA) node. The SA node is located in the right atrium, the upper right chamber of the heart.  In a normal adult heart at rest, the SA node sends an electrical signal to begin a heartbeat 60 to 100 times a minute.
  • Holster monitorThis portable ECG device is carried in your pocket or worn on a belt or shoulder strap. It records your heart’s rhythms for 24 hours.
  • Event recorder. This portable ECG device is intended to monitor your heart activity over a few weeks to a few months. You activate it only when you experience symptoms.
  • Echocardiogram. Sound waves are used to produce a video image of your heart.
  • Chest X-rayThis can help your doctor see the condition of your lungs and heart.
  • Physical examinationYour doctor will ask you or a family member what symptoms you’ve been having, when they started and what you were doing when they began. Your doctor then will evaluate whether these symptoms are still present, ask about your medications and possible head injuries, as well as your personal and family history of heart disease. Your doctor will also check your blood pressure and use a stethoscope to listen to your heart and to listen for a whooshing sound (bruit) over your neck (carotid) arteries, which may indicate atherosclerosis (a buildup of plaque in your arteries). Your doctor may also use an ophthalmoscope to check for signs of tiny cholesterol crystals or clots in the blood vessels at the back of your eyes.
  • Computerized tomography (CT) scanThis scan uses a series of X-rays from a variety of angles to create a detailed cross-sectional image of your brain.
  • Magnetic resonance imaging (MRI). This test uses powerful radio waves and magnets to get hundreds of images of your brain. Unlike a CT scan, an MRI doesn’t use radiation.
  • Carotid ultrasound. Sound waves create detailed images of the inside of the carotid arteries in your neck. This test shows buildup of fatty deposits (plaques) and blood flow in your carotid arteries.
  • Cerebral angiogram. Your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin, and guides it through your major arteries and into your carotid or vertebral artery. Then he or she injects a dye into your blood vessels to make them visible under X-ray imaging. This procedure gives a comprehensive view of arteries in your brain and neck.
  • Echocardiogram. An echocardiogram uses sound waves to create detailed images of your heart and can find a source of clots in your heart that may have traveled to your brain and caused your stroke.
  • Angiogram (coronary catheterization). In this test, a liquid dye is injected into the arteries through a long tube known as a catheter. The dye settles on plaque buildup in the artery and reveals the buildup on an x-ray image.
  • Exercise stress test. Stress tests typically involve running on a treadmill or pedaling on a stationary bike while hooked up to an ECG machine. This can help doctors understand how your heart responds to stress and what is the best long term course of treatment for you. 

Symptoms of Heart Disease

The following symptoms may be signs of heart disease:

  • Severe headache
  • Fatigue or confusion
  • Vision problems
  • Chest pain
  • Difficulty breathing
  • Irregular heartbeat
  • Blood in the urine
  • Pounding in your chest, neck, or ears
  • Dizziness
  • Anxiety
  • Weakness
  • Faintness or confusion
  • Fatigue when exercising
  • Sweating
  • Chest pain or pressure (This is an emergency. Call 911)

For symptoms of specific heart conditions, visit the following pages:

  • HYPERTENSION
  • HIGH CHOLESTEROL
  • ATRIAL FIBRILLATION
  • STROKE
  • HEART ATTACK OR MYOCARDIAL INFRACTION (MI)
  • CONGENITAL HEART DISEASE          
  • CORONARY ARTERY DISEASE
  • CONGESTIVE HEART FAILURE

Prognosis

Over 25 percent of all deaths in the United States are caused by heart disease. However, if treated properly, heart disease patients should be able to live comfortably with most conditions.

For the prognosis of specific heart conditions, visit the following pages:

  • HYPERTENSION
  • HIGH CHOLESTEROL
  • ATRIAL FIBRILLATION
  • STROKE
  • HEART ATTACK OR MYOCARDIAL INFRACTION (MI)
  • CONGENITAL HEART DISEASE          
  • CORONARY ARTERY DISEASE
  • CONGESTIVE HEART FAILURE

Living With Heart Disease

No matter what is causing your heart’s health to be compromised, there are things you can do to improve it:

  • Stop smoking. An estimated 20% of all deaths due to heart disease are directly linked to smoking.
  • Keep your blood pressure and cholesterol under control. People with high blood pressure and cholesterol are at an elevated risk for heart disease. About 50% of ischemic strokes (caused by a blockage of the artery to the brain) are caused by high blood pressure.
  • Manage your weight. About one in three American adults is obese (weighing at least 20 percent above the “suggested” weight for their height), which doubles their risk for coronary artery disease (CAD) at a given age.
  • Engage in regular cardiovascular exercise. Exercise helps the heart work more efficiently, reducing blood pressure, raising HDL cholesterol, decreasing the tendency of blood to form clots, moderating stress, helping the body use insulin, and helping people maintain a healthy weight. Sedentary people who begin a regular program of exercise reduce their risk of a heart attack by 35 to 55 percent. Low-intensity activities, such as gardening or walking, if done regularly and over the long term, can decrease the risk of heart attack. Speak with your doctor about the right routine for you.
  • If you have diabetes, keep your blood sugar levels under control. People with diabetes are twice as likely to have a heart attack or stroke. 
  • Eat a healthy diet. Opt for high fiber foods such as fruits, vegetables, and whole grains, as well as omega-3 oils such as cold-water fish and salmon), and mono- and polyunsaturated fats. But limit saturated fats and avoid trans fats, often found in fried foods, processed foods, and commercial baked goods.
  • Limit salt. The American Heart Association recently reduced the amount of salt recommended for everyone to just 1,500 mg a day, which is about two-thirds of a teaspoon.
  • Control stress.
  • Tame alcohol intake. There’s a growing consensus that light to moderate alcohol consumption–that is, two drinks or less a day for a man, one drink for a woman (a drink is defined as 12 oz. of beer, 4 oz. of wine, or 1.5 oz. of 80-proof spirits) can help prevent heart attacks. However, drinking more than that can increase the risk of heart attack and stroke.
  • Educate yourself about your condition so that you can know as much as you can about heart disease. This will help ensure you are getting the best treatment available, as well as train you to recognize any potentially harmful side effects or disease progression. 

Screening

Most heart diseases and risk factors contributing to heart diseases are screened for at regular physicals. The American Heart Association stresses the importance of regular screening for cardiovascular disease. American heart association volunteer and director of William Beaumont Hospital in Royal Oak, Michigan, Barry A. Franklin, Ph. D., said on the matter, “Regular cardiovascular screening is important because it helps you detect risk factors in their earliest stages. This way, you can treat the risk factor with lifestyle changes and pharmacotherapies, if appropriate, before it ultimately leads to the development of cardiovascular disease.”

Your doctor will most likely check the following:

  • Blood pressure. High blood pressure is one of the most common precursors to cardiovascular disease. If it is found early, appropriate medications can help reduce the risk of cardiovascular disease due to high blood pressure.
  • Body mass index (BMI). A BMI of 25 or above is considered to be overweight, and a BMI above 30 indicates obesity.
  • Waist circumference. A large waist circumference is indicative of fat accumulation around the midsection, which significantly raises an individual’s risk of heart disease.
  • Diet. Your doctor will most likely ask you about your diet. If your diet is high in red meats, fats, and processed foods, he or she will most likely recommend a change to include more whole grains, fatty fish, and vegetables. A diet high in red meat, fats, and processed foods can cause high cholesterol and eventually atherosclerosis (hardening of the arteries).
  • Exercise. Your doctor will ask about your exercise regimen and may suggest more or less activity based on the limitations of your heart and body.
  • Smoking and drug use. Your doctor will ask about smoking and drug use, which can add significantly to the risk of heart disease. If you do smoke or use drugs, your doctor will be able to help you find the right pathway to quit.
  • Heart rate/heartbeat. Your doctor will conduct a physical exam, listening to your heart beat and taking your heart rate. Some doctors may wish to perform a regular electrocardiogram (ECG) which can help detect irregularities in the heart’s electrical activity. ECGs are recommended

If your doctor suspects you have a heart disease after a thorough examination, he or she may conduct several diagnostic tests to arrive at a diagnosis.

Prevention

For healthy people, the following steps have been shown to help prevent or reduce the risk factors for heart disease. Keep in mind that reducing one risk factor may help reduce others:

  • Quit smoking. An estimated 20% of deaths due to heart disease in the United States are linked directly to smoking.
  • Reduce your blood cholesterol.For every 1 percent reduction in high blood cholesterol, there’s a 2 to 3 percent decline in the risk of heart attack.
  • Avoid or control hypertension. For every one-point reduction in diastolic blood pressure, there’s a 2 to 3 percent decline in the risk of heart attack.
  • Stay active. Exercise helps the heart work more efficiently, reducing blood pressure, raising HDL cholesterol, decreasing the tendency of blood to form clots, moderating stress, helping the body use insulin, and helping people maintain a healthy weight. Sedentary people who begin a regular program of exercise reduce their risk of a heart attack by 35 to 55 percent. Low-intensity activities, such as gardening or walking, if done regularly and over the long term, can decrease the risk of heart attack.
  • Maintain a healthy weight. About one in three American adults is obese (weighing at least 20 percent above the “suggested” weight for their height), which doubles their risk for CAD at a given age. Obesity also increases the risk for hypertension, and high blood cholesterol.
  • Avoid or control diabetes. Type 2 diabetes (non-insulin-dependent), is an important risk factor for heart disease.  According to the American Heart Association, heart disease and stroke are the number one cause of death for patients with type 2 diabetes, and adults with type 2 diabetes are two to four times more likely to have heart disease than those who do not. 
  • Consider a drink a day. There’s a growing consensus that light to moderate alcohol consumption–that is, two drinks or less a day for a man, one drink for a woman (a drink is defined as 12 oz. of beer, 4 oz. of wine, or 1.5 oz. of 80-proof spirits) can help prevent heart attacks. However, drinking more than that can increase the risk of heart attack and stroke.
  • Take low-dose aspirin. The recommended regimen–a baby aspirin (81 milligrams) daily or half a regular aspirin (160 milligrams) very other day–can lower the risk of heart attack by about one-third by reducing the ability of platelets in the blood to stick together and thus form a clot. Aspirin can have side effects and isn’t right for everyone, so consult with your doctor.

Complementary and Alternative Treatment

Supplements. The following list of supplements is offered by the University of Maryland Medical Center; always check with your cardiologist or primary doctor before adding supplements to your regimen for treating and preventing heart failure. Many people with heart conditions take multiple medications, including blood-thinning medications, blood pressure medications, and others. the supplements below may interact with these (and other medications) and may not be right for people with certain medical conditions.

  • Magnesium is particularly important for maintaining a normal heart rhythm and is often used by physicians to treat irregular heartbeat (arrhythmia). People with heart failure are often at risk for developing an arrhythmia. In addition, some diuretics (water pills) may cause your body to lose too much magnesium.
  • Carnitine. Early studies show L-carnitine supplements may reduce your chances of developing heart failure after a heart attack and improve exercise capacity if you already have heart failure.
  • Coenzyme Q-10. Several research studies suggest that CoQ10 supplements can help reduce swelling in the legs, enhance breathing by reducing fluid in the lungs, and increase exercise capacity in people with heart failure.
  • Creatine is a naturally occurring amino acid (protein building block) found mainly in muscles. In a few studies of people with heart failure, injections of creatine (in addition to standard medical care) provided improvement in heart function and ability to exercise compared to those who received placebo.
  • Vitamin B1 (Thiamine may be related to heart failure in several ways. First, low levels of thiamine can contribute to the development of heart failure. On the flip side, people with severe heart failure can lose a significant amount of weight, including muscle mass (called cachexia), and become deficient in many nutrients, including thiamine. In addition, diuretics (water pills) can cause your body to lose too much thiamine..
  • Amino acids. A few small studies suggest these amino acids might be helpful for heart failure, but more research is needed:
    • Arginine (needed for the body to make nitric oxide, which helps blood flow)
    • Taurine (helps heart muscle contract)

Stress reduction practices. Since stress is associated with heart disease, it’s prudent to try techniques to help reduce it. The following methods have been shown to reduce stress in some people:

  • Meditation
  • Yoga, Tai’ Chi, and other forms of moderate exercise such as walking
  • Deep breathing
  • Visualization
  • Biofeedback

When To Contact A Doctor

Call your doctor if:

  • Are still experiencing an irregular heart rate
  • You are not responding to treatment
  • Feel heart palpitations
  • Have periods of unexplained lightheadedness, dizziness, or confusion.
  • Experience an episode of fainting, or you come close to fainting for no apparent reason
  • Have shortness of breath that gets worse with exercise

Call 911 if you are experiencing the symptoms of a HEART ATTACK which include:

  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
  • Lightheadedness or sudden weakness.
  • A fast or irregular heartbeat.

Call 911 if you are experiencing the symptoms of a STROKE which include:

  • Numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
  • Vision changes.
  • Trouble speaking.
  • Confusion or trouble understanding simple statements.
  • Problems with walking or balance.
  • Severe headache that is different from past headaches.

Questions For A Doctor

You will probably have different questions to ask your doctor depending on your heart condition. Be open about all your concerns. If you’re having difficulty focusing, bring along a friend or family member. Below you’ll find general questions you might want to ask your doctor about heart disease as suggested by the American Heart Association.

QUESTIONS ABOUT MEDICATION

  • What is the name of the medicine?
  • Is this the brand or generic name?
  • What is the medicine supposed to do?
  • What happens if I miss a dose of my medicine?
  • How will I know that my medication is working?
  • What are the risks of taking this medication?
  • What are the risks of NOT taking this medication?

QUESTIONS ABOUT DIET

  • What kinds of foods should I eat?
  • What kinds of foods should I avoid?
  • Should I restrict my calories or fat intake to a certain level?
  • What are some cooking tips that I should follow?
  • What do I need to know about eating out?
  • Do I need to see a nutritionist or dietitian?
  • Are there any groups in the community that can help me with my nutrition goals?
  • How can I control the portions? How much salt may I eat?

QUESTIONS ABOUT EXERCISE

  • Can I exercise?
  • Can I play sports?
  • What are the best types of activities for me?
  • How much activity do I need?
  • Can I have sex?