Heart Disease - A Comprehensive Overview - What You Need to Know
by Dr. C.H. Weaver M.D. 2/2020
There are several types of heart conditions that are considered forms of heart disease. The most common type of heart disease in the United States is coronary artery disease (CAD)—a condition that can cause a heart attack, angina, heart failure, and arrhythmias.
According to the Centers for Disease Control and Prevention, heart disease is the leading cause of death for both men and women in the United States. Heart disease can run in families, either due genetic factors, common environmental and lifestyle factors, or a combination of the two.
Coronary artery disease is caused by build-up of plaque, or cholesterol deposits, in the coronary arteries—the arteries that supply blood to the heart. Plaque build-up can lead to a process called atherosclerosis, where the arteries begin to narrow and the heart doesn’t get enough blood. Eventually, CAD can lead to a weakened heart muscle, an irregular heartbeat, or heart failure. When heart failure occurs, the heart can’t effectively pump blood.
The following are conditions that can be caused by CAD:
Heart attack: The death of or damage to a section of the heart muscle; caused by reduced blood supply to the heart.
Angina: Chest pain or discomfort caused by inadequate blood supply to the heart; sometimes pain also occurs in shoulders, arms, neck, jaw, or back
Heart Failure: Also called congestive heart failure or chronic heart failure; the heart has not stopped but cannot pump as much blood as the body needs
Arrhythmias: Irregular heartbeats; may be abnormally fast or slow; can be serious and require immediate treatment, such as ventricular fibrillation.
Heart Disease In Depth
- Stress and Heart Health
- Heart Health at Every Age
- Unmasking the Genetics of Early Heart Disease
- Have a Healthy Heart
Common risk factors for heart disease include inactivity, obesity, high blood pressure, cigarette smoking, high cholesterol, and diabetes. Fortunately, these risk factors can often be managed with lifestyle changes and medical treatment. Basically, this means that by keeping your blood cholesterol levels and blood pressure within in a normal range, maintaining a healthy weight, not smoking, and understanding your risk for diabetes or managing the condition if you do have it, you are taking important steps to reduce your risk of heart disease and its serious consequences. And because heart disease appears to run in families, if you do have a family history of the condition, it’s important to avoid lifestyle choices like smoking and poor diet that can further increase your risk.
Some people have no symptoms of CAD until they experience a heart attack. Because a heart attack may be the first sign that you have a heart condition, it’s very important to know the symptoms of a heart attack. Also know that a heart attack requires immediate treatment; you should call 9-1-1 right away if you experience any of these symptoms.
According to the CDC, the symptoms of a heart attack include:
- Pain or discomfort in the jaw, neck, or back
- Feeling weak, light-headed, or faint
- Chest pain or discomfort
- Pain or discomfort in the arms or shoulders
- Shortness of breath
If you or someone you know is experiencing the symptoms of a heart attack, call 9-1-1 immediately.
Treating a heart attack as soon as possible can limit damage to the heart. When a heart attack occurs, blood supply to the heart is cut off, reducing oxygen supply to the heart muscles. As a result, cells in the heart muscle begin to die. Therefore, getting emergency treatment to restore blood flow to the heart as soon as possible is needed in order to limit damage.
Testing and Diagnosis
Several tests as well as information about your family’s history of heart disease can help you and your doctor determine your risk for CAD. Your doctor may start by checking your blood pressure, cholesterol levels, and blood glucose. If you are at high risk, additional testing can be used to diagnose CAD.
Tests for CAD include:
- ECD or EKG (also known as an electrocardiogram)—a test to measure your heartbeat
- Echocardiogram—an ultrasound image of the heart
- Exercise stress test—tests how well your heart works when it must pump blood
- Chest X-ray—image of the heart, lungs, and other organs in the chest
- Cardiac catheterization—examines inside of arteries for damage; uses a thin, flexible tube, which is threaded through an artery in the groin, neck, or arm
Diet and Exercise
Diet and Nutrition
A healthy diet can help prevent or manage several risk factors associated with heart disease. Namely, by avoiding certain foods and eating more of others, you may be able to maintain healthy cholesterol levels and blood pressure as well as prevent excess weight gain—steps that can lower your risk of heart disease or prevent current heart disease from becoming worse.
According to the American Dietetic Association, a heart-healthy diet includes foods that are:
- Low in saturated fat and trans fats (avoid meats, dairy products, deep-fried, processed foods that are high in saturated fats, and fried and unprocessed foods that contain trans fats)
- High in omega-3 fatty acids (such as fish and olive oil)
- High in fiber (such as whole grains, fruits, and vegetables)
- Low in salt and sugar
Excessive alcohol use should also be avoided. It may increase blood pressure and blood levels of triglycerides (fats), which are risk factors for heart disease and atherosclerosis, respectively.
Regular exercise can help control risk factors for heart disease including obesity, high blood pressure, and diabetes and can help maintain healthy cholesterol levels.
The American Heart Association suggests at least 150 minutes per week (or 30 minutes per day, five days per week) of moderate exercise. Another suggestion is 75 minutes per week of vigorous exercise. You can also combine vigorous and moderate activities. If you’re not able to complete a 30-minute period of activity, the American Heart Association recommends breaking sessions down into two or three 10- to 15-minute segments per day.
You may choose the type of physical activity that you enjoy and that accommodates your abilities. Keep in mind that aerobic exercise (such as walking, swimming, or bicycling) can benefit the heart, whereas strength training (lifting weights) will contribute to stamina and bone health.
Always talk with your doctor before beginning any type of exercise program or making changes to your current routine.
Treatment for CAD can lower your risk of having a heart attack, as well as prevent an existing heart condition from worsening. Consult your doctor about medications to treat CAD risk factors, including high cholesterol, high blood pressure, irregular heartbeat, and low blood flow. Surgical procedures to help restore blood flow to the heart are also recommended for some.
In addition to medical approaches to treating CAD, you can also take steps in your daily life to improve your heart health. Options you may discuss with your doctor include eating a healthy diet, getting regular exercise, and not smoking.
Medications are available to treat CAD and related conditions. As well, people who have had heart attacks will likely be prescribed medication that they will take for the rest of their lives. Your healthcare team will determine which medication or combinations are best for you.
The following are examples of types of medications prescribed for cardiac conditions:
- Anticoagulants: Also called “blood thinners,” these drugs decrease the ability of the blood to clot (they don’t actually thin the blood, however). Anticoagulants can prevent clots from forming in the blood vessels or prevent existing clots from becoming larger. They may be prescribed to prevent stroke.
- Antiplatelet Agents: These medications are prescribed for people who have had a heart attack, unstable angina, a stroke, or other cardiac conditions. They are used to prevent blood clots.
- Angiotensin-converting Enzyme (ACE) Inhibitors: These medications are used to treat cardiovascular conditions including high blood pressure and heart failure. They work by expanding blood vessels and lowering levels of the chemical angiotensin II to allow the heart to work more efficiently.
- Angiotensin II Receptor Blockers: These drugs may be prescribed to treat high blood pressure and heart failure. They work by lowering levels of angiotensin II to keep it from affecting the heart and blood vessels, which keeps blood pressure from rising.
- Beta Blockers: These medications are used to lower blood pressure, treat chest pain, and may be included in therapy for arrhythmias. Beta blockers are also prescribed to lower the risk of future heart attacks among patients who have had a heart attack. They work by slowing down the rate and force of the heartbeat, which also lowers blood pressure.
- Diuretics: Diuretics increase urination in order to rid the body of excess fluid and sodium. They help lower blood pressure and can reduce edema, or swelling, from build-up of excess fluid in the body.
- Vasodilators: Also known as nitrates, these medications are used to relieve angina, or chest pain. They relax the blood vessels and increase the supply of blood and oxygen to the heart and reduce its workload.
- Statins: Statins are used to lower blood cholesterol levels, or, specifically, to lower “bad” LDL cholesterol and triglyceride levels and raise “good” HDL levels.
Surgery for heart disease and related conditions includes life-saving procedures performed in the event of a heart attack as well as procedures to treat and prevent other cardiovascular complications.
The following are examples of cardiac surgeries and procedures:
- Angioplasty: This procedure is used to increase blood flow through a blocked artery. It can relieve chest pain and reduce the risk of a heart attack or stroke. Angioplasty involves special tubing, which is threaded up through the coronary artery. A deflated balloon is attached to the tubing; the balloon is inflated to expand the blocked areas and restore blood flow.
- Atherectomy: This procedure is similar to angioplasty but uses a rotating shaver instead of a balloon. The shaver cuts away plaque from the artery to increase blood flow.
- Stent Procedure: A stent is used during angioplasty. The stent itself is a wire mesh tube that props open the artery. Following angioplasty, the stent stays in the artery permanently.
- Bypass Surgery: A bypass treats blocked arteries by creating news passages for blood to flow to the heart muscle. To do so, veins or arteries are taken from other parts of the body and used to reroute blood around the clogged artery. A bypass can relieve angina and reduce the risk of a heart attack.
- Implantable Medical Devices: Devices that can be surgically implanted to treat cardiovascular conditions include:
- Left Ventricular Assist Device—a battery-operated pump-type device that helps the heart pump blood when it can’t work effectively on its own
- Pacemaker—a device that sends electrical impulses that help the heart beat at a regular rhythm; used when heartbeat is too fast, too slow, or irregular
- Implantable Cardioverter Defibrillator—a device that is implanted into the heart tissue; sends electrical shocks, detects the heart’s rhythm, and “paces” heart (restores normal rhythm as needed); can prevent sudden cardiac death in at-risk patients
Living with Heart Disease
Living with heart disease—and enjoying the best possible quality of life—will involve working with your healthcare team to make sure that you are getting appropriate treatment. As well, it’s important that you follow your doctor’s advice, take medications as prescribed, and make healthy lifestyle choices that will protect your heart health and overall well-being. Understanding your risks and how to manage them can help you enjoy long-term health.
If you’ve had a heart attack, work with your healthcare team to take steps to prevent another heart attack and other related conditions such as a stroke, kidney disorders, and peripheral arterial disease. Talk with your doctor about programs designed to help you make heart-healthy lifestyle changes. Steps may include medication, diet, regular exercise, stopping smoking, and managing stress. Your doctor may also recommend that you make changes in your everyday activities; this may involve work, travel, sex, and exercise.