Understanding Heart Disease

Heart disease is actually a broad term used for a wide variety of diseases of the heart and blood vessels such as coronary artery disease, heart rhythm disorders called arrhythmias and defects of the heart present at birth, also called congenital heart defects.

To clarify, when we use the term heart disease on The Heart Foundation website, we are primarily referring to coronary artery disease, also called coronary heart disease or cardiovascular disease.  This is a condition in which plaque, which is made up of fat, cholesterol, calcium and other substances in the blood, builds up inside the coronary arteries which supply oxygen-rich blood to the heart muscle. Informational Resources

This plaque build-up is called atherosclerosis.  A plaque can grow large enough to reduce or completely block blood flow through an artery.  More frequently, a plaque may rupture, causing a blood clot to form that either blocks the artery or breaks off and travels somewhere else in the body causing a blockage at another site.  When the blockage takes place in a blood vessel that feeds the heart, the result is a heart attack or, depending on the severity, Sudden Cardiac Death.

If the plaque build-up or blood clot resulting from the plaque rupture occurs in the carotid arteries on either side of the neck, this is called Carotid Artery Disease and can result in a stroke.  Peripheral Arterial Disease is when the major arteries that supply blood to the legs, arms or pelvis are obstructed.  If blood flow to any of these areas of the body is reduced or blocked, numbness, pain and sometimes dangerous infections such as gangrene can occur.

It is important to be familiar with the anatomy of the heart and how it functions in the body to truly understand heart disease.  Click here to view the video Cedars-Sinai Heart Center Anatomy of the Heart.

Heart Attack Symptoms

Symptoms of a heart attack or myocardial infarction can vary greatly from person to person, but in order to help you identify a possible heart attack, we have listed some of the most common symptoms below:

• Approximately 2 out of every 3 people who have heart attacks experience chest pain, shortness of breath or fatigue a few days or weeks before the attack.
• A person with angina (temporary chest pain) may begin to find that it takes less and less physical activity to trigger the pain.  Any change in the pattern of angina should be taken very seriously and brought to the attention of your physician.
• During a heart attack, a person may feel pain in the middle of the chest which can spread to the back, neck, jaw or arms.  The pain may also be felt only in the back, neck, jaw or arms rather than the chest.
• A person having a heart attack may have gas-like pain or pressure in the stomach area which is often mistaken for indigestion. The pain is similar to angina, but it is usually more severe, longer lasting and does not improve with rest or a nitroglycerin pill.
• It is important to note that approximately 1 out of every 3 people who have heart attacks do not feel any chest pain.  Many of these are women, non-Caucasian, older than 75, have heart failure or diabetes or have had a stroke.
• Nausea & vomiting which are sometimes mistaken for food poisoning or the stomach flu
• Lightheadedness or dizziness
• Shortness of breath, especially in older people
• Feelings of restlessness, sweatiness, anxiety or a sense of impending doom
• Bluishness of the lips, hands or feet
• Heavy pounding of the heart or abnormal heart rhythms
• Loss of consciousness (This can be the first symptom of a heart attack!)
• Disorientation resembling a stroke may occur in older people.
• Also, older people, especially women, will often take longer to admit they are not well and to request medical assistance.

Helping a Victim of a Heart Attack

Half of the deaths from heart attack occur in the first 3 or 4 hours after the onset of symptoms, so it is important to know and recognize the warning signs.

• If you think that you or someone in your presence is having a heart attack, call 911 IMMEDIATELY!  Every minute you delay can result in more damage to the heart muscle.
• Having the victim chew an aspirin after the ambulance has been called may help reduce the size of the blood clot.

Helping a Victim of Sudden Cardiac Death

• Call 911 IMMEDIATELY!
• Begin cardiopulmonary resuscitation or CPR.  CPR can double or triple a cardiac arrest victim’s chances of survival. 
• Utilize an automated external defibrillator (AED) if one is available.  Follow the instructions provided by the unit.  Many public places such as airports and shopping malls now have AEDs.  Brain death begins in only 4 to 6 minutes after cardiac arrest, but it is often reversible if treated within a few minutes with defibrillation, or an electric shock to the heart, as from an AED, to restore a normal heartbeat.

The chances of survival for a victim of Sudden Cardiac Death drop by 7 to 10 percent with every minute that passes without CPR and defibrillation, and very few attempts at resuscitation succeed after 10 minutes, so the key is to ACT QUICKLY!

How to Reduce Your Risk

1. Choose a Heart Healthy Lifestyle.
   • Engage in regular moderate aerobic exercise for at least 30 minutes five days a week or more vigorous workouts at least 20 minutes three times a week.
   • Adopt a diet low in salt, saturated and transfats and high in unsaturated fats (fish, avocado, etc.) like the Mediterranean Diet.
   • Maintain a normal body weight with caloric adjustment.
   • Take fish oil supplements.
   • Avoid smoking and recreational drug use.
   • Imbibe no more than ½ to 1 alcoholic beverage per day.
2. Know and review your risk factors with a trusted physician.
3. Your physician may recommend medications to control cholesterol, hypertension and diabetes.
4. High-risk individuals should consider taking a daily aspirin.
5. Avoid hormone replacement unless you have severe menopausal symptoms.
6. In selected cases, it may be necessary to conduct non-invasive or even invasive tests to determine the nature and severity of the heart disease.
7. Sometimes angioplasty/stenting or even bypass surgery may be needed if you have severe and symptomatic arterial blockage.
8. Learn CPR.

Age

Heart disease can occur at any age. However, four out of five people who die from coronary heart disease are aged 65 or older. The risk of stroke doubles with each decade after the age of 55.

Gender

Men and women are equally at risk for heart disease, but women tend to get coronary artery disease an average of 10 years later than men. The risk for women increases as they approach menopause and continues to rise as they get older. Death rates from heart disease and stroke for women are twice as high as those for all forms of cancer.

Family History (Heredity)

Presence of heart disease in a parent or sibling, especially at a young age, increases your risk of developing heart disease.

Smoking

Smokers are twice as likely to suffer heart attacks as non-smokers, and they are more likely to die as a result. Smoking is also linked to increased risk of stroke.  The nicotine and carbon monoxide in tobacco smoke damages the cardiovascular system. Passive smoking may also be a danger. 46 million Americans (25 million men and 21 million women) smoke.  Women who smoke and take the oral contraceptive pill are at particularly high risk of heart disease and stroke.

Cholesterol

The higher the blood cholesterol level, the higher the risk of coronary heart disease, particularly if it is combined with any of the other risk factors. Diet is one cause of high cholesterol – others are age, sex and family history. High levels (over 100 mg/dl) of LDL (low-density lipoprotein), or “bad cholesterol”, are dangerous, and low levels (under 40 mg/dl in men and under 55 mg/dl in women) of HDL (high-density lipoprotein), or “good cholesterol”, increase the risk of heart disease and stroke. High levels (over 150 mg/dl) of triglycerides (another type of fat), in some, may also increase the risk of heart attack and stroke.Nearly 40 million Americans have high cholesterol levels.

High Blood Pressure

High blood pressure (over 140/90 mmHg and over 130/80 mmHg in diabetics) increases the risk of heart attack, stroke, aneurysm, and kidney damage. When combined with obesity, smoking, high cholesterol or diabetes, the risk increases several times. High blood pressure can be a problem in women who are pregnant or are taking high-dose types of oral contraceptive pill. 72 million Americans over age 20 have high blood pressure.

Physical Inactivity

Failure to exercise (walking or doing other moderate activities for at least 30 minutes five days a week or more vigorous workouts at least 20 minutes three times a week) can contribute to an increased risk of coronary heart disease as physical activity helps control weight, cholesterol levels, diabetes and, in some cases, can help lower blood pressure.

Obesity

People who are overweight are more likely to develop heart disease and stroke, even if they have none of the other risk factors. Excess weight causes extra strain on the heart; influences blood pressure, cholesterol and levels of other blood fats – including triglycerides; and increases the risk of developing diabetes. 66% of Americans over age 20 are obese.

Alcohol

Small amount of regular alcohol consumption (1/2 to 1 drink per day for women and 1-2 drinks per day for men) can reduce risk of heart disease. However, drinking an average of more than one drink a day for women or more than two drinks a day for men increases the risk of heart disease and stroke because of the effect on blood pressure, weight and levels of triglycerides – a type of fat carried in the blood. Binge drinking is particularly dangerous.

Drug Abuse

The use of certain drugs, particularly cocaine and amphetamines, has been linked to heart disease and stroke.  Cocaine can cause abnormal heartbeat which can be fatal while heroin and opiates can cause lung failure. Injecting drugs can cause an infection of the heart or blood vessels.

Diabetes

The condition seriously increases the risk of developing cardiovascular disease, even if glucose levels are under control. More than 80% of diabetes sufferers die of some form of heart or blood vessel disease.

Previous Medical History

People who have had a previous heart attack or stroke are more likely than others to suffer further events.

Stress, Depression, Anger/Hostility

Stress, depression, and negative emotions have also been linked to an increased risk of heart disease.