Hear About Heart Disease

Introduction

Some 7 million Americans suffer from coronary heart disease
(CHD), the most common form of heart disease.
This type of heart disease is caused by a narrowing
of the coronary arteries that feed the heart.

CHD is the number one killer of both men and women
in the U.S. Each year, more than 500,000
Americans die of heart attacks caused by CHD.

Many of these deaths could be prevented because CHD is
related to certain aspects of lifestyle. Risk factors for
CHD include high blood pressure, high blood cholesterol,
smoking, obesity, and physical inactivity--
all of which can be controlled.

Although medical treatments for heart disease have come
a long way, controlling risk factors remains the key
to preventing illness and death from CHD.

Who Is at Risk for CHD?

Risk factors are conditions that increase your risk of developing
heart disease. Some can be changed and some cannot.
Although these factors each increase the risk of CHD,
they do not describe all the causes of the disease;
even with none of these risk factors, you might still develop CHD.

Controllable
Uncontrollable
High blood pressure
Gender
High blood cholesterol
Heredity (family history of CHD)
Smoking
Age
Obesity
Physical Activity
Diabetes
Stress*
* Although stress may be a risk factor for CHD,
scientists still do not know exactly how
stress might be involved in heart disease.

What Is CHD?

Like any muscle, the heart needs a constant supply of oxygen
and nutrients that are carried to it by the blood
in the coronary arteries. When the coronary arteries become
narrowed or clogged and cannot supply enough blood to the heart,
the result is CHD. If not enough oxygen-carrying blood
reaches the heart, the heart may respond with pain called angina.
The pain is usually felt in the chest or sometimes
in the left arm and shoulder. (However, the same inadequate blood
supply may cause no symptoms, a condition called silent angina.)

When the blood supply is cut off completely, the result
is a heart attack. The part of the heart that
does not receive oxygen begins to die,
and some of the heart muscle may be permanently damaged.

What Causes CHD?

CHD is caused by a thickening of the inside walls
of the coronary arteries. This thickening, called
atherosclerosis, narrows the space through which blood can flow,
decreasing and sometimes completely cutting off the
supply of oxygen and nutrients to the heart.

Atherosclerosis usually occurs when a person has
high levels of cholesterol, a fat-like substance,
in the blood. Cholesterol and fat,
circulating in the blood, build up on the
walls of the arteries. The buildup narrows
the arteries and can slow or block
the flow of blood. When the level of
cholesterol in the blood is high, there is a greater
chance that it will be deposited onto the artery walls.
This process begins in most people during childhood
and the teenage years, and worsens as they get older.

In addition to high blood cholesterol, high blood pressure
and smoking also contribute to CHD. On the average,
each of these doubles your chance of developing heart disease.
Therefore, a person who has all three risk factors is
eight times more likely to develop heart disease
than someone who has none. Obesity and physical
inactivity are other factors that can lead to CHD.

Overweight increases the likelihood of developing high blood
cholesterol and high blood pressure, and physical inactivity
increases the risk of heart attack. Regular exercise,
good nutrition, and smoking cessation are key
to controlling
the risk factors for CHD.

What Are the Symptoms of CHD?

Chest pain (angina) or shortness of breath may be the
earliest signs of CHD. A person may feel heaviness, tightness,
pain, burning, pressure, or squeezing, usually behind the breastbone
but sometimes also in the arms, neck, or jaws.
These signs usually bring the patient to a doctor
for the first time. Nevertheless, some people have
heart attacks without ever having any of these symptoms.

It is important to know that there is a wide range
of severity for CHD. Some people have no symptoms at all,
some have mild intermittent chest pain, and some have mild
intermittent chest pain, and some have more pronounced and
steady pain.Still others have CHD that is severe enough
to make normal everyday activities difficult.

Because CHD varies so much from one person to another,
the way a doctor diagnoses and treats CHD will also vary a lot.

The following descriptions are general guidelines to
some tests and treatments that may or may not be used,
depending on the individual case.

Are There Tests for CHD?

There is no one simple test--some or all of
the following procedures may be needed. These diagnostic
procedures are used to establish CHD, to determine
its extent and severity, and to rule
out other possible causes of the symptoms.

After taking a careful medical history and doing a
physical examination, the doctor may use some
tests to see how advanced the CHD is.
The only certain way to diagnose and
assess the extent of CHD is coronary
angiography (see below); other tests can
indicate a problem but do not show exactly where it is.

An examination for CHD may include the following tests:

An electrocardiogram (ECG or EKG) is a graphic record
of the electrical activity of the heart
as it contracts and rests.

Abnormal heartbeats and some areas of damage,
inadequate blood flow, and heart enlargement
can be detected on the records.

A stress test (also called a treadmill test or exercise ECG)
is used to record the heartbeat during exercise.
This is done because some heart problems only show
up when the heart is working hard.
In the test, an ECG is done before,
during, and after exercising on a treadmill;
breathing rate and blood pressure may be
measured as well. Exercise tests are useful
but are not completely reliable; false positives
(showing a problem where none exists) and false negatives
(showing no problem when something is wrong) are fairly common.

Nuclear scanning is sometimes used to show damaged
areas of the heart and expose problems with
the heart's pumping action. A small amount of radioactive
material is injected into a vein,
usually in the arm. A scanning camera records
the nuclear material that is taken up by heart muscle
(healthy areas) or not taken up (damaged areas).

Coronary angiography (or arteriography) is a
test used to explore the coronary arteries.
A fine tube (catheter) is put into an artery
of an arm or leg and passed through
the tube into the arteries of the heart.
The heart and blood vessels are then
filmed while the heart pumps. The picture
that is seen, called an angiogram or
arteriogram, will show problems such
as a blockage caused by atherosclerosis.

How Is CHD Treated?

CHD is treated in a number of ways,
depending on the seriousness of the disease.
For many people, CHD is managed with
lifestyle changes and medications. Others with
severe CHD may need surgery. In any case,
once CHD develops, it requires lifelong management.

What Kind of Lifestyle Changes Can Help a Person with CHD?

Although great advances have been made in treating
CHD, changing one's habits remains the single most
effective way to stop the disease from progressing.

If you know that you have CHD, changing your
diet to one low in fat, especially saturated
fat, and cholesterol will help reduce high
blood cholesterol, a primary cause of atherosclerosis.
In fact, it is even more important to keep
your cholesterol low after a heart attack to help
lower your risk of having another one.
Eating less fat should also help you lose weight.
If you are overweight, losing weight
can help lower blood cholesterol and
is the most effective lifestyle way to
reduce high blood pressure, another
risk factor for atherosclerosis and heart disease.

People with CHD can also benefit from exercise.
Recent research has shown that even moderate amounts
of physical activity are associated with lower
death rates from CHD. However, people with
severe CHD may have to restrict their exercise
somewhat. If you have CHD, check with your doctor
to find out what kinds of exercise are best for you.

Smoking is one of the three major risk factors for CHD.
Quitting smoking dramatically lowers the risk of a
heart attack and also reduces the risk of a second
heart attack in people who have already had one.

What Medications Are Used to Treat CHD?

Medications are prescribed according to the nature
of the patient's CHD and other problems.
The symptoms of angina can generally be
controlled by "beta-blocker" drugs that decrease
the workload on the heart, by nitroglycerine
and other "nitrates" and by
"calcium-channel blockers" that relax
the arteries, and by other classes of drugs.
The tendency to form clots is reduced
by aspirin or by other platelet inhibitory and anticoagulant drugs.

Beta-blockers are given to decrease the
recurrence of heart attack. For those with
elevated blood cholesterol that is unresponsive to dietary
and weight loss measures, cholesterol-lowering
drugs may be prescribed, such as lovastatin,
colestipol,cholestyramine, gemfibrozil, and niacin.
Impaired pumping function of the heart may
be treated with digitalis drugs or ACE inhibitors.
If these is high blood pressure or fluid
retention, these conditions are also treated.

Ask your doctor which medication you are taking,
what it does, and whether there are any
side effects. Knowing more about this will help you
stick to the schedule that has been prescribed for you.

What Types of Surgery Are Used to Treat CHD?

Many patients can control CHD with lifestyle changes
and medication. Surgery may be recommended
for patients who continue to have frequent
or disabling angina despite the use of
medications, or people who are found to have
severe blockages in their coronary arteries.

Coronary angioplasty or balloon angioplasty begins
with a procedure similar to that described
under angiography. However, the catheter positioned
in the narrowed coronary artery has a tiny
balloon at its tip. The balloon is inflated and
deflated to stretch or break open the
narrowing and improve the passage for blood flow.
The balloon-tipped catheter is then removed.

Strictly speaking, angioplasty is not surgery.
It is done while the patient is awake
and may last 1 to 2 hours. If angioplasty
does not widen the artery or if complications
occur, bypass surgery may be needed.

In a coronary artery bypass operation,
a blood vessel, usually taken from the leg or chest,
is grafted onto the blocked artery,
bypassing the blocked area. If more
than one artery is blocked, a bypass
can be done on each. The blood can
then go around the obstruction
to supply the heart with enough
blood to relieve chest pain.

Bypass surgery relieves symptoms of heart
disease but does not cure it.
Usually you will need to make a number of
changes in your lifestyle after the operation.
If your normal lifestyle includes smoking,
a high-fat diet, or no exercise,
changes are advised.

Several experimental catheter-surgical procedures
for unblocking coronary arteries are under
study; their safety and effectiveness
have not yet been established. They include:
Atherectomy, a procedure in which surgeons shave off
thin strips of the plaque
blocking the artery and remove these strips.

Laser angioplasty; instead of using
a balloon to open up the blocked artery,
doctors insert a catheter with a laser tip
that burns or breaks down the plaque.

Insertion of a stent, a metal coil that
can be permanently implanted in a narrowed
part of an artery to keep it propped open.

For further information contact:

National Heart Lung, and Blood Institute (NHLBI)
Information Center
P.O. Box 30105
Bethesda MD 20824-0105
Acknowledgement:
U.S. Department of Health and Human Services
Public Health Service
National Institutes of Health
The National Heart, Lung, and Blood Institute
NIH Publication No. 93-2265

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