Medical Tutorial

Heart Disease Guide

"Heart Disease Guide"

"Heart Disease Guide"What Is Heart Disease?

The topic of heart disease usually centers on heart attacks but there are many other problems that can compromise heart functions, injure the heart tissues, or cause heart disease. Most of the major problems include coronary artery disease, heart failure, arrhythmias, and cardiomyopathy.

What Is a Heart Attack?

A heart attack occurs when a coronary artery becomes blocked (usually in a coronary artery by a blood clot) resulting in loss of the blood supply to an area of heart tissue. Loss of the blood supply can quickly damage and kill heart tissue; quick treatments in the emergency department and/or the catheterization suite have reduced deaths from heart attacks in recent years but still more than a million individuals have a heart attack each year in all over the world.

Symptoms of a Heart Attack

Warning signs of a heart attack include the following:

  • Chest pain
  • Pain that may spread to the back, arms, neck, and jaw
  • Shortness of breath
  • Nausea, vomiting
  • Rapid or irregular heartbeats
  • Other symptoms such as weakness, anxiety, indigestion, and heartburn may occur

Some individuals may have only one or two symptoms

Heart Attack Symptoms in Women

Heart attack symptoms in some women may differ from those usually seen in men. For example, many women may have predominant symptoms of heartburn, malaise, heart beat abnormalities (heart flutters), cough, and loss of appetite. Ignoring such symptoms may cause treatment delays and more damage to heart tissue.

Coronary Artery Disease Signs

Coronary artery disease (CAD) occurs when plaque, a sticky substance, narrows or partially obstructs coronary arteries (like sticky material stopping up a straw) and can result in reduced blood flow. This reduced blood flow may cause chest pain (angina), a warning sign of potential heart problems such as a heart attack.

Inside a Heart Attack

Plaque in coronary (and other) arteries maybe hard or firm on the outside but soft, mushy, and sticky on the inside. If the hard shell-like area cracks open, then blood components exposed to the sticky areas collect and can form a blood clot and quickly block most or all of the blood flow through the artery. The heart tissue downstream from the clot then suffers from lack of blood and becomes damaged or dies.

Call 911 When Symptoms Occur

If you or an individual develop symptoms of a heart attack, do not delay getting medical help. Call 911. Do not drive yourself or others to a hospital as 911 emergency medical services (EMS) personnel can begin basic treatment immediately. Delaying care can result in increased heart damage or death.

Sudden Cardiac Death

Sudden cardiac death occurs when the heart’s regular electrical signals become erratic and cause the heart muscle to contract and relax irregularly which results in the inability of the heart to pump blood. Unless this situation is quickly altered by CPR and/or a restoration of organized electrical activity occurs that allows the heart to function as a blood pump (done by an electrical shock from a defibrillator), death can occur in a few minutes.

Arrhythmia: Erratic Heart Beat

Normal heartbeats that pump blood rely on regular electrical impulses. Irregular electrical impulses, termed arrhythmias, can alter, reduce, or even stop the heart’s ability to pump blood. If a person notices their heartbeat is abnormal (fast, slow, or irregular), they should seek medical care if the arrhythmia persists or causes chest pain.


Cardiomyopathy is a disease that causes changes in the heart muscle that reduce the heart’s ability to pump blood and usually leads to chronic heart failure. Other conditions (high blood pressure and heart valve disease) may be associated with cardiomyopathy.

Heart Failure

Heart failure means that over time, the heart’s pumping action cannot meet or “fails” the body’s demand for blood. For example, heart failure patients have difficulty doing work or climbing stairs. Most people develop heart failure due to heart muscle damage from coronary artery disease (CAD) and heart attacks that can weaken the heart muscle. Over time, hearts with heart failure enlarge and may pump faster to try and meet the body’s demand for blood. Heart failure does not mean the heart stops functioning. It means there is a failure in an aspect of its function.

Congenital Heart Defect

A congenital heart defect is a defect in the development of the heart as an organ that is usually first noticed at birth although some are not found until adulthood. There are many types of congenital heart defects and a few need no treatment but others may need surgical repair. Congenital heart defects put those patients at higher risk to develop arrhythmias, heart failure, heart valve infections, and other problems. However, this risk can be reduced by specialized treatments.

Testing: Electrocardiogram (EKG)

The heart’s electrical activity can be seen with an EKG (also termed ECG or electrocardiogram). EKGs are tests that provide important information to the physician about the heart rhythm, damage to the heart, or a heart attack, and may provide several other important pieces of information or clues to the patient’s condition. In addition, EKGs can be compared to past and future EKGs to see changes in the heart’s electrical activity.

Testing: Stress Test

A stress test measures the ability of a person’s heart to respond to the body’s demand for more blood during stress (exercise or work). A continual measurement of the heart’s electrical activity (a continual EKG or rhythm strip) is recorded along with the heart rate and blood pressure as a person’s stress (exercise) is gradually increased on a treadmill. The information helps to show how well the heart responds to the body’s demands and may provide information to help diagnose and treat problems.

Testing: Holter Monitor

A Holter monitor is similar to a stress test (see previous slide) but it is worn for 1 or 2 days and provides a continual EKG-like recording of the
heart’s electrical activity during those days. Most doctors will ask the patient to keep a logbook of the time they do certain activities (for example, walking a mile starting at 7:20 AM and ending at 7:40 AM) and list any symptoms (for example, “experienced shortness of breath or rapid irregular heartbeats at 7:35 AM”). The Holter monitor’s recordings can then be examined when certain symptoms occur.

Testing: Chest X-ray

Chest X-rays are used to provide the doctor with a view of both the heart and lungs to help determine if any abnormalities are present. These two X-rays show a relatively normal heart on the left. In the right X-ray, an enlarged heart (mainly the left ventricle) is easily seen and suggests the heart’s main pumping chamber is not functioning normally.

Testing: Echocardiogram

An echocardiogram is a real-time moving picture of a functioning heart made by using sound waves (ultrasound) to generate images. Echocardiograms use the same noninvasive technology used to examine the fetus during pregnancy. It can show how well heart chambers and heart valves are functioning, before and after treatments, as well as other features.

Testing: Cardiac CT

Specialized cardiac computerized tomography (CT) scans or cardiac CTs can provide detailed 3-D images of the heart. The images can be manipulated to look for calcium buildup (plaque) in coronary arteries or provide images of such internal structures of the heart such as the valves. The information can provide information about several heart disease problems.

Testing: Cardiac Catheterization

Cardiac catheterization is a technique that may provide both diagnostic information and therapeutic methodology during one procedure. The technique is invasive. A thin tube is placed in a blood vessel in the leg or arm and threaded into the heart and into the opening of a coronary artery. Dye is put into the tube and goes into the artery. A special X-ray machine images the dye that can show narrowing or blockage of the artery. The same tube may be used with special tips to open the coronary artery by angioplasty (small balloon is inflated) or used to place a wire mesh (stent) that expands to hold the artery open.

Living With Heart Disease

Most types of heart disease are chronic but slowly progressive. They begin with minor symptoms that often slowly worsen and require long-term medical treatment. In many patients when the heart begins to fail, such symptoms as fatigue, shortness of breath, ankle swelling, fluid retention, and other symptoms may become refractory to treatments. Lifestyle changes may become necessary (for example, home oxygen, limited activity) or even surgery or a heart transplant may be needed for
the patient.

Treatment: Medicines

Advances in medicines that can help reduce the symptoms and slow the damage of heart disease have helped the majority of heart disease patients. Drugs are available to do the following:

  • Lower blood pressure
  • Lower heartbeat rates
  • Lower cholesterol levels to reduce plaque
  • Help stabilize abnormal heart rhythms
  • Reduce or prevent clotting in coronary arteries
  • Improve the pumping ability of a person’s heart with heart disease

Treatment: Angioplasty

Other treatments for heart disease involve special techniques as previously mentioned — angioplasty and stent placement. A thin catheter or tube is placed in a coronary artery and is threaded through an obstruction like a clot. A balloon is inflated and pushes aside the obstruction. The balloon is then deflated leaving the artery unblocked thus allowing good blood flow. Often, after angioplasty, an expandable mesh tube is then inserted, expanded, and then reinforces the artery
and keeps it from collapsing.

Treatment: Bypass Surgery

Some patient’s coronary arteries are not good candidates for angioplasty and/or stents. Such patients may benefit from another treatment technique termed bypass surgery. Bypass surgery occurs when a surgeon removes a blood vessel from one part of the body (chest, legs, or arms) and uses it to connect one open part of a coronary artery to another open part thus bypassing the area that has blocked blood flow. Often the surgeon may need to bypass more than one artery.

Who Is at Risk for Heart Disease?

Although men (even at a younger age) have a higher risk for heart disease than women, heart disease is still the number one killer of both sexes. People with a family history, who smoke, and who are obese have a higher risk of developing heart disease.

Risk Factors You Can Control

Common risk factors for heart disease include elevated cholesterol, high blood pressure, diabetes, and lack of physical activity. These risk factors can be reduced by making healthy lifestyle choices and by medications. A doctor can help you with your choices and medications.

Smoking Increases Risk

Smoking increases a person’s risk for heart disease from 2 to about 4 times greater than nonsmokers. People who do not smoke but are exposed to second-hand smoke are at greater risk for heart disease. Although over 135,000 people die each year from heart disease related to smoking, it is never too late to quit smoking because once you quit, your risk of heart disease begins to drop almost immediately.

Life After a Heart Attack

If a person suffers a heart attack, it is still possible to develop a healthy lifestyle. Many doctors recommend that their patients participate in a cardiac rehab program and learn how to avoid cigarettes, develop a healthy diet, and to become more active. All of these changes may help a person’s heart recover and function better.

Heart Disease Prevention

Heart disease prevention and risk reduction is possible by living a healthy lifestyle. Basic components of a healthy lifestyle are as follows:

  • Never smoke or stop smoking cigarettes
  • Eat a nutritious diet (many vegetables and fruits, less fats, sugars, and meats)
  • Get at least 30 minutes of exercise almost every day
  • Avoid alcohol or consume no more than 1 drink per day for women and no more than 2 drinks per day for men
  • If needed, achieve medical control of diabetes, high blood pressure, and cholesterol

Encourage friends and family to help you do the above (maybe they could benefit from your good example)

Your Heart and Diet

As mentioned in previous slides, a major key to preventing, recovering from, and slowing heart disease is a heart-healthy diet. Most heart doctors recommend vegetables, fruits, whole grains, and legumes as basic foods to get good heart health. Plant oils, nuts, and seeds may help reduce cholesterol levels while eating fish about twice a week is a good source of protein without the fats found in red meat. While heart disease is treatable by many methods, prevention or healing by reasonable lifestyle changes seems to be one of the best ways to handle this widespread health problem.

Courtesy: Charles Patrick Davis, MD, PhD

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