Heart disease affects 14 million Americans. It kills more than 600,000 Americans and more than 7 million people worldwide each year, making it the No. 1 cause of death in the United States and abroad. To raise awareness of this important disease, February has been designated American Heart Month.
We are born with clean, smooth, elastic coronary arteries; healthy blood vessels that supply oxygen and nutrition to our heart muscles. As we age, these arteries become less elastic (sometimes referred to as "hardened") and can become clogged with atherosclerotic plaque, which is made up of fatty, calcified and/or scarred tissue. This can cause heart disease, where insufficient blood gets to the heart muscles.
As you may expect, increased demands on the heart from exercise or other stresses may cause this insufficient blood supply to become critical and cause symptoms of angina. An acute blockage, often from a "plug" of platelets on top of this chronic narrowing of these arteries, can cause a heart attack.
Some people have "silent ischemia," where they either do not have symptoms or have subtle symptoms that they do not recognize. These patients may not be aware they have had a problem until chronic symptoms (such as exercise intolerance) develop, or until an abnormal electrocardiogram or other abnormal test is noted.
People symptomatic from ischemic heart disease can experience a wide spectrum of symptoms such as chest pain/discomfort/pressure (described very differently by different people), arm pain, lower jaw pain, upper abdominal pain, shortness of breath with/without any pain, palpitations, lightheadedness, diaphoresis, and/or other non-specific symptoms such as weakness, nausea and others. The acute onset of symptoms that may be attributed to heart disease should result in an immediate call to 911.
There are many risk factors for developing heart disease. Advancing age and a family history of heart disease cannot be averted. Male sex may be another non-modifiable risk factor. However, it is possible to reduce your risk of developing heart disease by minimizing modifiable risk factors. This can be done by:
- Stopping smoking.
- Reducing exposure to second-hand smoke
- Controlling certain medical conditions such as high blood pressure, high cholesterol and diabetes through diet, exercise and/or medications.
- Exercising regularly.
- Maintaining a healthy body weight.
- Avoiding drug abuse.
- Avoiding stress.
- Others - check with your doctor.
In an acute flare-up - a possible heart attack - tests will include an ECG, blood test, chest X-ray and maybe others.
People who have higher risk of coronary heart disease or who develop symptoms possibly suggestive of chronic heart disease may need to undergo testing to evaluate the extent of suspected disease, which may include:
- Stress tests (whether exercise, radionuclide or echocardiography), where the response of the heart to intentionally induced increased workload is evaluated.
- Angiography, where dye is injected and the arteries visualized to see if they are patent.
- Newer tests, such as ultrafast CT scans.
Treatment of heart disease is aimed at improving the flow of blood to the muscles of the heart. This may include:
- Medications, diet and exercise to control diseases that contribute to heart disease, such as diabetes, high cholesterol and high blood pressure.
- Medications to minimize build-up of plaque such as aspirin and/or other anti-platelet agents.
- Other medications to open up the coronary arteries or to decrease the heart workload, such as nitroglycerin, beta blockers, ACE inhibitors, calcium channel blockers and/or others.
- Minimally invasive procedures such as angioplasty and/or placement of stents to keep the arteries open.
- Coronary artery bypass grafting surgery to bypass the blocked arteries.
Everyone should be aware of their risks for developing heart disease and should discuss ways to minimize these risks with their healthcare provider. They should also be aware of possible symptoms that can come from a heart attack, and should seek immediate care if they develop such symptoms.
Jeff Hersh, Ph.D., M.D., F.A.A.P., F.A.C.P., F.A.A.E.P., can be reached at DrHersh@juno.com.
author: Dr. Jeff Hersh