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Heart Disease

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CONDITIONS

Brief Review of Coronary Artery Disease

The coronary arteries supply blood to the heart muscle. Because the heart muscle is continuously working at a high level, and thus requires a continuous supply of oxygen and nutrients, any obstruction of the coronary arteries leads to problems almost immediately.

The most common cause of coronary artery disease is atherosclerosis. Atherosclerosis is a chronic, progressive disease of the arteries in which "plaques" made up of cholesterol deposits, calcium, and abnormal cells develop on the inner lining of the arteries.

Atherosclerosis

The top artery shows a normal lumen, or opening. The bottom artery illustrates what happens to the lumen when atherosclerotic plaques form in the arterial wall.

These plaques cause a gradual, progressive narrowing of the lumen of the artery, and thus make blood flow through the artery progressively more difficult.

"Angina" refers to the symptoms a patient experiences any time the heart muscle is not getting enough blood flow through the coronary arteries. Angina is usually perceived as a discomfort (often a pressure-like pain) in or around the chest, shoulders, neck or arms.

"Stable angina" is angina that occurs in a nearly predictable fashion, that is, with exertion or after a big meal. Stable angina generally indicates that a stable atherosclerotic plaque is present in one of the coronary arteries, causing a partial obstruction of that artery. When the patient is at rest, the partially obstructed artery is able to meet the needs of the cardiac muscle. But when exertion occurs (or some other stress that causes increased cardiac work,) the obstruction prevents an adequate increase in blood flow to the muscle, and angina is experienced. Thus, stable angina implies a fixed, stable atherosclerotic plaque.

"Unstable angina" is angina that occurs sporadically, or unpredictably, or at rest. There is no particular pattern to unstable angina. Unstable angina implies the existence of an unstable plaque, one that has partially ruptured, or in which blood clots may be forming and breaking off, so that the lumen of the artery is not fixed, but is changing. Patients with unstable angina have a high incidence of total occlusion of the coronary artery, and thus a high incidence of heart attacks.
A myocardial infarction, or heart attack, occurs when a coronary artery becomes completely occluded, so that the heart muscle supplied by that artery dies. A heart attack, therefore, is death of heart muscle. The consequences of a myocardial infarction depend largely on how much heart muscle has died. A small heart attack is one in which only a small portion of the heart muscle dies. A large heart attack is one in which a large portion of heart muscle dies.

Blockages in the coronary arteries

Arterial narrowings in the LAD and circumflex arteries threaten to cause myocardial infarctions with substantial muscle loss.

Most heart attacks are now felt to be due to a sudden rupture of an atherosclerotic plaque, and subsequent clotting off of the artery. If patients come under medical attention within a few hours of the onset of a heart attack, the size of the heart attack can be greatly reduced by administering "clot-busting" drugs, or by performing an immediate angioplasty to open up the occluded blood vessel.

After a heart attack, the remaining heart muscle "remodels" itself. The damaged heart tends to dilate, and can lead to a dilated cardiomyopathy. If the heart attack is relatively large, heart failure can develop immediately, or over the next several months. Heart muscle that has been damaged due to coronary artery disease can become quite prone to developing ventricular tachycardia or ventricular fibrillation. In fact, sudden death is extremely common in people who have survived heart attacks, and all these patients should be assessed for the propensity to develop lethal arrhythmias.

Preventing heart attacks is largely a matter of retarding the development of atherosclerotic plaques in the coronary arteries. This is done thorough smoking cessation, weight control, maintaining an active lifestyle, and cholesterol control.

After atherosclerotic heart disease has set in, the blood flow to the heart muscle can be improved by means of angioplasty, stenting, or coronary artery bypass surgery. Drugs used for coronary artery disease - beta blockers and nitrates - do not appreciably increase blood flow to the heart muscle. Instead, these drugs reduce the oxygen demand of the heart muscle.

Much research is being conducted to find non-invasive ways to halt the progression of coronary artery disease, or even to reverse it. The use of statin drugs and of antioxidants has attracted the most attention.

SYMPTOMS

Symptom Checker

Symptoms often associated with heart disease:

Abdominal pain, abnormal pulsation, angina, anxiety, appetite loss, balance problems, breathing problems, chest pain or discomfort, cough, cyanosis (bluish skin discoloration), depression, dizziness, dyspnea, edema, fainting, fast heart beat, fever, headache, hemoptysis (coughing blood, irregular heart beat, jaw pain , lightheadedness, memory, problems, muscle cramps or spasm, numbness and tingling, palpitations, shortness of breath, skipped beats, squatting (in toddlers), swelling, syncope, tachycardia (fast heart beat, vertigo, weakness, weight gain, weight loss .

Cardiovascular Disease Risk Factors

Two of the major independent risk factors for cardiovascular disease are high blood pressure and high blood cholesterol.

About 90% of middle-aged Americans will develop high blood pressure in their lifetime, and over 70% of people with high blood pressure do not have it under control. A 12-13 point reduction in blood pressure can reduce heart attacks by 21%, strokes by 37%, and all deaths from cardiovascular disease by 25%.
Over 80% of those who have high blood cholesterol do not have it under control. A 10% decrease in total blood cholesterol levels may reduce the incidence of coronary heart disease by as much as 30%.
A key strategy for addressing these risk factors is to educate the public and health care practitioners about the importance of prevention. Current guidelines recommend that all adults have their blood pressure checked regularly and their blood cholesterol levels checked every 5 years. Systems changes are also needed to help practitioners adhere to guidelines for treating patients with or at risk for heart disease and stroke, such as prescribing beta-blockers and aspirin. Preventive actions can help people at any level of blood pressure or cholesterol to reduce their risk.

People also need to be educated about the signs and symptoms of heart attacks and stroke and the importance of calling 911 quickly. Forty-seven percent of heart attack victims and about the same percentage of stroke victims die before emergency medical personnel arrive.

Other important risk factors for heart disease and stroke-such as diabetes, tobacco use, physical inactivity, poor nutrition, and overweight and obesity-need to be addressed through lifestyle changes and appropriate use of medications.

About Stroke

A stroke or cerebrovascular accident occurs when the blood supply to the brain is cut off (an ischemic stroke) or when a blood vessel bursts (a hemorrhagic stroke). Most strokes are of the ischemic type. Without oxygen, brain cells begin to die. Death or permanent disability can result. High blood pressure, smoking, and having had a previous stroke or heart attack increase a person's chances of having a stroke.

Stroke is the third leading cause of death in the United Sates. In 2001, stroke killed 163,538 people, accounting for about 1 of every 14 deaths in the United States. According to the American Heart Association, about 700,000 people in the United States suffer a stroke each year (about 500,000 first attacks and 200,000 recurrent attacks). Four million Americans who have survived a stroke are living with impairments and 15 to 30 percent are permanently disabled. The American Heart Association also estimates that stroke cost about $51.2 billion in both direct and indirect costs in 2003 in the United States alone.

With timely treatment, the risk of death and disability from stroke can be lowered. It is very important to know the symptoms of a stroke and act in time.

Know the Signs and Symptoms of a Stroke

Signs of a Stroke

The National Institute of Neurological Disorders and Stroke notes these major signs of stroke:

Sudden numbness or weakness of the face, arms or legs
Sudden confusion or trouble speaking or understanding others
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, or loss of balance or coordination
Sudden severe headache with no known cause
If you think someone is having a stroke, you should call 911 immediately.

About Heart Attack

If the blood supply to the heart is cut off, a heart attack results. Cells in the heart muscle that do not receive enough oxygen-carrying blood begin to die. The more time that passes without treatment to restore blood flow, the greater the damage to the heart. Having high blood pressure or high blood cholesterol, smoking, and having had a previous heart attack, stroke or diabetes can increase a person's chances of developing heart disease and having a heart attack.

According to the American Heart Association, about 700,000 Americans will have an initial heart attack and another 500,000 will have a recurrent heart attack in 2004.Almost half of people who have a heart attack will die from it. According to a CDC report, almost half of the cardiac deaths in 1999 occurred before emergency services and hospital treatment could be administered.

It is important to recognize the signs of a heart attack and to act immediately by calling 911. A person's chance of surviving a heart attack is increased if emergency treatment is administered as soon as possible.

CDC's Public Health Efforts: CDC currently funds health departments in 32 states and the District of Columbia to develop, implement, and evaluate cardiovascular health promotion, disease prevention, and control programs and to eliminate health disparities. The programs emphasize the use of education, policies, environmental strategies, and system changes to address heart disease and stroke in various settings and to ensure quality of care. For more information, visit http://www.cdc.gov/cvh/stateprogram.htm.

Know the Signs and Symptoms of a Heart Attack

The National Heart Attack Alert Program notes these major signs of a heart attack:

Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes, or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain.

Discomfort in other areas of the upper body. Can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach.

Shortness of breath. Often comes along with chest discomfort. But it also can occur before chest discomfort.

Other symptoms. May include breaking out in a cold sweat, nausea, or light-headedness.

If you think that you or someone you know is having a heart attack, you should call 911 immediately.

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