Heart Disease
February 2007
Heart disease is the leading cause of death in America, taking
over 650,000 lives a year. Since February is Heart Month, it’s a
good time to be sure you’re taking good care of your heart.
Your Heart
Although it’s no bigger than your clenched fist, your heart beats more
than 100,000 times a day. To pump the blood that nourishes all parts of your
body, your heart muscle needs its own supply of oxygen-rich blood. Your heart’s
blood flows through the coronary arteries. Blockages in these arteries
cause coronary
artery disease (CAD).
Who Gets CAD?
CAD strikes about 13 million Americans. But some people are more vulnerable
than others. For example, men develop CAD about 10 years before women. Here
is a list of the major CAD risk factors:
Symptoms
A strong squeezing pressure deep in the center of the chest or off to the
left side is typical of CAD. The pain can radiate to the neck and jaw or the
shoulder and arms, particularly on the left. Sweating, nausea, dizziness, lightheadedness,
an erratic pulse, or shortness of breath may also occur.
CAD can be tricky. Many other conditions can cause similar symptoms, but some
patients have unusual complaints or none at all. Silent CAD is most common
in women and in diabetic people.
When the pain of CAD comes on after predictable stress (such as exercise,
strong emotion, or exposure to cold) and is relieved by rest or nitroglycerin (see
below), it is called stable angina.
But if the pain starts without obvious cause or if it persists, it may represent unstable angina or
a heart
attack, which are medical emergencies.
Early treatment of unstable angina and heart attacks is crucial. It’s
your job to call your doctor or 911 if there is any chance you are having a
heart attack. Doctors would much rather see a false alarm than a tragedy that
could have been prevented.
Diagnosis
Your doctor will ask if you’ve had symptoms of heart disease and if
CAD runs in your family. Next, your doctor will check your blood pressure and
examine your heart and circulation. You’ll also be tested for cardiac
risk factors.
If your doctor suspects CAD, you’ll need additional tests. Here are
some of the most important ones:
- Electrocardiogram
(EKG). The EKG records the electrical activity of your heart.
- Stress tests. While you walk on a treadmill, doctors monitor
your EKG. In some cases, you’ll be given a tiny amount of a radioactive
chemical to produce nuclear images of your heart.
- Echocardiography. Sound waves are beamed at your heart to
measure its size and pumping capacity and to evaluate the heart’s valves.
- Computed tomography (CT scanning). One type measures the
calcium in plaques; another produces pictures of the coronary arteries.
- Coronary angiography. Doctors thread a tiny plastic catheter
(tube) into the coronary arteries, then inject a dye so x-rays can show blockages.
- Blood tests. During heart attacks, some heart cells die,
leaking their contents into the blood. Doctors measure troponin and creatine
phosphokinase (CPK) levels to learn if a heart attack has occurred.
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Prevention and Treatment: Lifestyle
Avoid tobacco in all its forms, including secondhand smoke.
Eat right. Cut down on saturated fat and cholesterol by limiting
meat, whole dairy products, and eggs. Avoid the trans fats in stick
margarine, fried foods, and many snack and “junk” goods. Favor
olive and canola oils. Eat lots of fish. Load up on whole grain products instead
of refined grains and simple sugars. Eat lots of fruits and vegetables. Cut
down on sodium (salt). If you enjoy alcohol and can drink responsibly, have
one or two drinks a day, but not more.
See the PEC brochure ‘Good
Eating for Good Health’ for details.
Stay active. People with CAD need medical clearance and guidance,
but most can—and should—spend at least 30 minutes a day walking,
biking, or doing other forms of moderate exercise.
Control your weight. If you need to reduce, cut down on the
calories you eat and boost the calories you burn with exercise.
Reduce stress. Anger, depression, and social isolation can
be heart breaking.
Treatment: Medication and Supplements
Since no two patients are alike, your doctor will decide what’s best
for you. Here are some major options:
Supplements. Most patients with CAD should take fish oil
capsules to get 1 g of omega 3 fats a day. A daily multivitamin is also reasonable.
Aspirin helps prevent artery-blocking blood clots. Unless
there is a specific reason not to take aspirin (such as ulcers, bleeding, or
allergies), every patient with CAD should take 81 mg (one “baby aspirin”)
a day. And if you think you may be having a heart attack, you should chew and
swallow an aspirin tablet even before you call 911.
Anti-clotting drugs. In selected cases, your doctor may prescribe
drugs such as clopidogrel and warfarin.
Nitrates are used to relieve and prevent angina.
Beta-blockers help prevent repeat attacks and angina.
Angiotension-converting enzyme inhibitors help the heart
heal after a heart attack.
Calcium-channel blockers can help prevent angina.
Cholesterol-lowering drugs. Most CAD patients need medication,
such as a statin drug, to achieve their goals.
Treatment: Revascularization
Although many patients with CAD respond very well to lifestyle therapy and
medication, many others benefit from angioplasties or
bypass operations that restore blood flow to the heart.
Living with CAD
CAD is a serious illness. Your doctor will arrange the tests you need, but
your job is just as important: follow a heart-healthy lifestyle, take your
medication as directed, and report any symptoms promptly. It’s a lifelong
process, but it will help keep the beat of life strong and steady.
For more information about heart disease, symptoms, diagnosis, treatments,
and risk factors, visit the following links:
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