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What
is the Heart and what does it do?
The
heart is an organ that continuously pumps blood that carries oxygen
and nutrients to the body's tissues and organs. Oxygen and nutrients
are then removed from the blood by muscles and organs to produce
energy our bodies need in order to live. A heart pumps continuously
from before birth to the day of death without stopping. An adult
human heart may between 80,000 to 130,000 times a day, pumping 2,000-3,000
gallons of blood!
The
heart is a muscle and needs its own supply of blood, oxygen and
nutrients for the work it does. This blood flow is supplied by the
coronary arteries.
-
What
is Coronary Heart Disease (CHD)?
-
CHD
(also known as coronary artery disease or CAD) occurs when the coronary
arteries become narrowed or blocked. Most of the time such blockages
occur due to the presence of atherosclerosis. Narrowing along the
inner walls of coronary arteries occurs due to the accumulation
of cholesterol, fatty deposits and calcium deposits (called plaques).
This process is called atherosclerosis.
-
Myocardial ischemia (is-scheme-e-uh) occurs when certain
parts of the heart do not receive enough blood (oxygen) through
blocked or narrowed arteries. Heart muscle can withstand decreased
or absent blood flow for a period of time before damage to the effected
muscle is no longer reversible.
-
Myocardial
infarction (Heart Attack) occurs after blood flow to a part
of the heart has been blocked for a prolonged period of time (this
can vary from 30 minutes to several hours) causing permanent damage.
What
is angina?
- Angina
(say: ann-gi-na) is chest pain or discomfort that happens when
some part of the heart does not get enough blood (ischemia) to
carry the oxygen it needs. It is a common symptom of coronary
heart disease (CHD) , which occurs when vessels that carry blood
to the heart become narrowed and blocked.
-
Angina symptoms may include:
-
Pressing
or squeezing pain, usually in the chest under the breast bone,
but sometimes in the shoulders, arms, neck, jaws, or back. Chest
pain often steadily builds up over a period of minutes.
-
The
pain of angina may make you sweat or make it hard to catch your
breath.
-
Angina
is usually brought on by exertion. It is usually relieved within
a few minutes by resting or by taking prescribed angina medicine.
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Angina
usually occurs during physical activities like walking, sexual intercourse,
climbing stairs, exercising or doing housework. Other triggers include
smoking, alcohol, heavy meals,excessive heat or cold, emotional
stress and stimulant usage.
It
is important to mention that use of cocaine (blow, crack)or
methamphetamines (speed, crank, crystal meth) can cause angina and
even heart attacks in young healthy people without heart disease.
The cause is thought to be due to severe spasm of the coronary arteries.
Anemia (decreased number of red blood cells to carry oxygen) and
lung disease may also bring on angina.
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Are
there different types of angina ?
Some
people have angina that comes on with a certain level of exertion
and goes away easily. They may have this kind of angina for a
long time. This is called stable angina.
When
the pattern of angina changes a lot, it's called unstable angina.
This is a sign of danger. Unstable angina includes angina in someone
who hasn't had it before. It also includes more episodes of angina
with less exertion, or any angina that comes on during rest.
Another
sign of danger is chest pain that doesn't go away with rest or
after taking the medicine nitroglycerin. If you have chest pain
that doesn't go away, go to the emergency room right away. Emergency
Physicians and Nurses are trained to quickly recognize and treat
heart problems with the most effective therapies available.
Unstable
angina may be the first sign of a heart attack. If you get angina
pain, you should call 911since this is the fastest and safest
way to get to the Emergency Department. Paramedics can start treatment
before you get to the hospital.
Do
not go to your doctor's office or a clinic because they will not
be able to provide full testing or treatment for a heart attack.
If
symptoms are mild and you decide to take your own car, DO NOT DRIVE
YOURSELF.
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Does
every one with CHD get angina ?
Not
all cases of myocardial ischemia cause angina pain. Persons with
diabetes are more likely to experience "silent ischemia"
with no symptoms at all. Persons over age 70 often experience other
symptoms such as weakness, shortness of breath or "blacking out
spells" instead of angina. In some cases people may experience
heartburn or nausea due to myocardial ischemia. These symptoms are
sometimes called variant angina.
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Is
all chest pain "angina?"
Not all
chest pain is from the heart, and not all pain from the heart is angina.
For example, if the pain lasts for less that 30 seconds or if it goes
away during a deep breath, after drinking a glass of water, or by
changing position, it is NOT likely to be angina and should not cause
concern. But prolonged pain, unrelieved by rest and accompanied by
other symptoms may signal a heart attack.
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Will
angina cause a heart attack?
An episode of angina is not a heart attack. Angina pain means that
some of the heart muscle in not getting enough blood temporarily--for
example, during exercise, when the heart has to work harder. The pain
does NOT mean that the heart muscle is suffering irreversible, permanent
damage. Episodes of angina seldom cause permanent damage to heart
muscle.
In contrast, a heart attack occurs when the blood flow to a part of
the heart is suddenly and permanently cut off. This causes permanent
damage to the heart muscle. Typically, the chest pain is more severe,
lasts longer, and does not go away with rest or with medicine that
was previously effective. It may be accompanied by indigestion, nausea,
weakness, and sweating. However, the symptoms of a heart attack are
varied and may be considerably milder.
When
someone has a repeating but stable pattern of angina, an episode of
angina does not mean that a heart attack is about to happen. Angina
means that there is underlying coronary heart disease. Patients with
angina are at an increased risk of heart attack compared with those
who have no symptoms of cardiovascular disease, but the episode of
angina is not a signal that a heart attack is about to happen.
In
contrast, when the pattern of angina changes--if episodes become more
frequent, last longer, or occur without exercise--the risk of heart
attack in subsequent days or weeks is much higher. A person who has
angina should learn the pattern of his or her angina--what causes
an angina attack, what it feels like, how long episodes usually last,
and whether medication relieves the attack. If the pattern changes
sharply or if the symptoms are those of a heart attack, one should
get medical help immediately by calling 911.
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How
is angina or CHD diagnosed?
The
symptoms you describe to your doctor will help your doctor decide
if you need to have your heart tested. Your doctor will also consider
if you have any conditions that can increase your chance of heart
disease. These conditions include high blood pressure, diabetes, smoking,
or a high cholesterol level, and menopause in women. If you have family
members who have had heart disease at a young age (under 50), your
chance of developing heart disease is higher.
An
electrocardiogram, sometimes called an EKG, is a simple test that
can show if your heart has been damaged by a previous heart attack.
The EKG can also show if your angina is caused by your heart, if the
EKG is done while you are having chest pain. This test may be normal,
even in the presence of coronary artery disease, in some people. This
is especially true if pain is not present when the EKG is done.
The
next step after an EKG may be a stress test. Often, this test is done
while you walk on a treadmill. Or it can be done with medicines that
put stress on the heart. Your doctor will look at your EKG to see
if it's abnormal when you exercise. This is analogous to taking a
car on a test drive at highway speeds to see how the engine performs
versus testing it in idle (a resting EKG).
Your
doctor may also have x-rays of the heart taken before and after you
exercise. Special chemicals (radioisotopes such as thallium) are injected
into a vein during maximal exercise and taken up by normal heart muscle.
A radioactivity counter and computer measure the radioisotope distribution
to different parts of the heart (a "picture" is taken).
Differences in radioisotope concentration and in the rates at which
the radioisotopes disappear indicate unequal blood flow. These pictures
can show if an area of the heart is short of blood during exercise.
If this is so, it may mean that the arteries supplying blood to your
heart are blocked.
The
most accurate (as well as most invasive) way to assess the presence
and severity of coronary disease is a coronary angiogram, an x-ray
of the coronary artery. A long thin flexible tube (a "catheter") is
threaded into an artery in the groin or forearm and guided to the
heart. Dye is injected into the arteries around the heart. X-rays
are taken. If any of the arteries that supply the heart are blocked,
the x-rays will show it. These blockages can cause angina and put
you at risk of a heart attack.
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What
are the treatments for heart disease?
Prevention
is the best treatment. The best way to prevent coronary artery disease
is to control high blood pressure, diabetes or a high cholesterol
level and, if you smoke, to stop smoking. Whether you have these conditions
or not, maintaining a healthy diet, a healthy weight and a regular
exercise program can help you avoid coronary artery disease. Hormone
replacement therapy with a medicine called estrogen also may help
prevent coronary artery disease in women after menopause.
If
you already have coronary artery disease, controlling blood pressure,
diabetes and cholesterol and quitting smoking are important to keep
the problem from getting worse. A healthy diet, a healthy weight and
a moderate, regular exercise program are also important in people
with coronary artery disease.
Medication
- Most people with heart disease need to take medicine. This medicine
may include one aspirin every day. This treatment has been shown to
reduce the chance of having a second heart attack in people who have
already had one. Medicines called beta blockers, **calcium channel
blockers and nitrates also help relieve angina.
Angina
is often controlled by drugs. The most commonly prescribed drug for
angina is nitroglycerin, which relieves pain by widening blood vessels.
This allows more blood to flow to the heart muscle and also decreases
the work load of the heart. Nitroglycerin is taken when discomfort
occurs or is expected. Doctors frequently prescribe other drugs, to
be taken regularly, that reduce the heart's workload. Beta blockers
slow the heart rate and lessen the force of the heart muscle contraction.
**Calcium
channel blockers, although effective in reducing the frequency and
severity of angina attacks may result in a higher overall death rate
in patients with underlying coronary artery disease (especially in
people with a prior heart attack). This is documented in shorter acting
calcium channel blockers (those taken more than once a day). Not enough
information is currently available for longer acting calcium channel
blockers. The use of calcium channel blockers, particularly
ones that must be taken more than once a day have been discouraged
in patients with coronary artery disease .
Calcium
channel blockers may still indicated for persons having high blood
pressure without coronary artery disease or certain heart arrhythmias.
If you are taking a calcium channel blocker and have had a prior heart
attack or have been diagnosed with angina please consult your doctor!
Angioplasty
is a treatment for heart disease. Angioplasty uses a tiny balloon
to push open the blocked arteries around the heart. The balloon is
inserted the same way that a cardiac catheterization is done, through
a long thin tube inserted in an artery in the arm or leg. A stent,
which is a small metal tube, might be put into the artery, where the
blockage was, to keep the artery open longer.
Surgery
- Another treatment for angina is bypass surgery. Veins or arteries
from the legs or breast bone are sewn into the arteries of the heart
to bring blood past a blockage and increase the blood flow to the
heart. Bypass is usually done when angioplasty isn't possible or when
your doctor feels that the results would be better with bypass surgery
than with angioplasty.
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What
are side effects of heart disease treatment ?
Each
of the medicines prescribed for heart disease, just like most medicines,
may have side effects. Aspirin may cause upset stomach. The nitrates
may cause hot flushes and headaches. Beta blockers cause fatigue and
sexual dysfunction in some patients. Calcium channel blockers may
cause constipation and leg swelling. These are some of the more common
side effects of these medicines. Most patients don't have side effects
from these medicines. If you have side effects after taking a medicine,
tell your doctor.
Every
medical procedure, such as angioplasty or bypass surgery, has a potential
risk. The major risks can include heart attack, stroke or even death.
These possibilities are rare. Most patients do very well with these
procedures. After an angioplasty, you can expect to return to your
previous activity level, or even a better activity level, within a
few days. It takes longer to recover from bypass surgery.
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Which
treatment is right for me?
First
you need to understand how serious your heart disease is and the treatment
choices you have. For less serious heart disease, you and your doctor
may consider medicine with or without angioplasty. As heart disease
becomes more serious, the choice of treatment includes bypass surgery.
If you have a more severe case of heart disease, you and your doctor
will consider which procedure will help you live a longer and better
quality life. The factors that affect this decision differ with each
patient.
Once
you have heart disease, does it ever go away?
If you have heart disease, you need to work with your doctor to manage
your risk factors and to monitor your condition. Heart disease doesn't
go away, but with proper treatment you can live longer and feel better.
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