Signs and symptoms of heart disease depend on which condition you have. They can include pain in the chest, jaw, back, or arm, particularly on the left side; fainting, and an irregular heartbeat.
The treatment for heart disease depends on the cause. Some conditions may be treated with diet, drugs, procedures, and surgery. The life expectancy for a person with heart disease depends on the cause. Some are fatal.
The most devastating sign of coronary heart disease is abrupt, unexpected cardiac arrest. Cardiac arrest commonly occurs in people who have had previous heart attacks, but it may occur as the first symptom of heart disease.
Most people exhibit some symptoms or discomfort. Symptoms usually occur during exercise or activity because the heart muscle's increased demand for nutrients and oxygen is not being met by the blocked coronary blood vessel. Chest pain on exertion (angina pectoris), which may be relieved by rest.
More common symptoms of coronary heart disease include:
Silent ischemia is a condition in which no symptoms occur even though an electrocardiogram (ECG, or heart tracing) and/or other tests show evidence of ischemia. Arteries may be blocked 50% or more without causing any symptoms.
No one person usually has all of these symptoms.
Coronary heart disease is caused by any problem with the coronary arteries that keeps the heart from getting enough oxygen and nutrient-rich blood. Atherosclerosis is the most common cause of heart disease. Ischemia is the lack of sufficient blood so coronary heart disease is sometimes called ischemic heart disease.
Multiple risk factors cause coronary heart disease. The most common risk factors are heredity (coronary heart disease runs in the family); and high cholesterol (levels of cholesterol in the blood are above healthy levels).
Usually, the risk factors for heart disease involve:
There are many types of heart disease, which include:
Call your doctor if you notice any of these symptoms that suggest it may be angina:
Call your doctor if you have nausea, vomiting, or sweating; or palpitations or dizziness and you don't know the cause.
The most common symptoms of heart attacks are:
Call 911 or have someone take you immediately to a hospital emergency department if you have warning signs and symptoms of a heart attack.
Stress echocardiography is an alternative to the nuclear stress test. Many people prefer this test because it does not use a radioactive agent.
Echocardiography is a type of sonar that uses sound waves to bounce off walls and valves, creating an image of the heart as it beats.
The movements of the ventricular walls are compared during stress and at rest. Wall motion drops during stress if the coronary artery supplying that part of the heart has significant obstruction.
Like the other stress tests, the heart is stressed either by exercise on a treadmill or by administration of a drug.
Electron beam (ultrafast) CT scan (EBCT) is a noninvasive but somewhat controversial test. By measuring the amount of calcium deposited in the plaques of coronary arteries, it can detect blockages of only 10-20% of an artery, which may not show up in other tests.
Generally, such minor blockages are treated medically; lifestyle changes and risk factor modifications are recommended to prevent worsening of the blockage. Because elderly people frequently have calcium in their coronary arteries without significant narrowing, EBCT is of limited value in this age group. The advantage of EBCT comes in screening young people with one or more heart disease risk factors.
Coronary angiography by cardiac catheterization is the best way to evaluate coronary heart disease. You will go to a hospital or an outpatient catheterization lab (for same-day surgery). Under guidance of an X-ray camera, a long, thin plastic tube (catheter) is threaded into the opening of your coronary arteries from a blood vessel in either your groin (femoral artery) or your arm (radial artery).
Once the catheter reaches the coronary artery opening, it injects a small amount of iodine dye, which makes the coronary arteries visible on the X-ray screen. Pictures of the coronary arteries are then recorded in a computer for later review. The images show the diameter of the coronary arteries and any blockages narrowing them.
Coronary angiography is an invasive test. In experienced hands, the risk of complications is less than 1%; however, it is the only test that helps a cardiologist to determine precisely whether to treat you with bypass surgery, a less-invasive technique such as angioplasty or stent placement, or medications.
Coronary artery disease decreases blood supply to the heart from the blocked coronary artery. The lower blood flow may fail to meet the heart's demand for oxygen. Treatment aims to balance blood supply to the heart with heart oxygen demand, and prevent worsening of coronary heart disease.
Aspirin: When taken daily or every other day, aspirin reduces the risk of developing angina or heart attack by reducing the tendency of your blood to clot. It reduces the chance that a clot will form over a rupturing plaque in the coronary artery, a common underlying phenomenon in heart attack (myocardial infarction). Side effects of aspirin include ulcers or bleeding problems. Talk to your health-care professional before starting aspirin.
Beta-blockers: Beta-blockers decrease your heart rate and blood pressure, thus reducing your heart's demand for oxygen. Clinical trials have shown prevention of future heart attacks and sudden death.
Nitroglycerin: This medication reduces chest pain both by decreasing your heart's oxygen demand and by dilating the coronary arteries, increasing the oxygen supply. Sprays or tablets placed under your tongue are designed to be taken when you need instant relief from angina. Long-acting nitroglycerin tablets or skin patches work slowly over many hours.
Calcium channel blockers (CCBs): Calcium channel blockers dilate the coronary arteries to improve blood flow. They also reduce blood pressure, and slow heart rate.
ACE inhibitors: Angiotensin-converting enzyme (ACE) inhibitors work by dilating blood vessels, increasing blood flow. They recently have been shown to reduce the numbers of cardiac events, heart attacks, and deaths in people with coronary heart disease, unrelated to their blood pressure lowering effect. Therefore, additional beneficial tissue effects on blood vessels and heart muscle is thought to occur. They are immensely useful in people with diabetes and those with weakened heart muscles.
Statins: Statin drugs work by reducing the amounts of lipids (cholesterol and other fats) in your blood. This changes the inner lining of the blood vessels so plaques are less likely to form or get large. They slow or stop the progression of coronary heart disease and also deter repeat heart attacks.
Clinical trials have shown beneficial effects immediately after a heart attack or threatened heart attack, even before the fat lowering effect is maximal, meaning they stabilize the plaque. Examples include atorvastatin (Lipitor), pravastatin (Pravachol), simvastatin (Zocor), lovastatin (Mevacor), and rosuvastatin (Crestor).
When angina symptoms worsen despite medications, you may need an invasive procedure in the cardiac catheterization lab to clear the blocked artery. These procedures are performed by a cardiologist, not a cardiac surgeon, and have fewer complications.
Coronary angioplasty (PTCA): This procedure is similar to coronary angiography (cardiac catheterization or a dye study to visualize the inside of coronary arteries) but is therapeutic as well as diagnostic. A similar but sturdier tube (guide catheter) is inserted into an artery in your groin or arm, and a hair-thin guide wire is threaded through it into your coronary artery. A much thinner catheter is threaded over the guide wire into the blocked artery. This thinner catheter has a tiny balloon at the end.Once the balloon is positioned at the blockage, the balloon is inflated to widen your artery and improve blood flow. The plaque is still there, just flattened against the wall of the artery. The balloon catheter is then withdrawn. PTCA, stands for its full formal name: percutaneous (through the skin) transluminal (through the hollow center of the blood vessel) coronary angioplasty.
Stents: A stent is a small, sieved, coil-like metallic tube or scaffold mounted over a balloon. The balloon is inflated at the blockage, which expands the stent. The balloon is then withdrawn, but the stent stays in place, keeping the artery from narrowing again. Like arteries treated with angioplasty alone, arteries treated with a stent can eventually close up again. The stent is a longer lasting solution for many people.
Surgery for coronary heart disease is reserved for people whose disease is either severe or is not improved or stabilized by medication and other less invasive therapies.
Coronary artery bypass grafting (CABG): This is the standard operation for blockages of coronary arteries. If multiple coronary arteries are blocked, or if the left main artery shows significant blockage, bypass surgery is usually the best treatment choice. The blocked parts of the arteries are detoured or bypassed with blood vessels "harvested" from your chest (internal mammary), arm (radial artery), or a leg (saphenous vein). During the surgery, the heart is stopped temporarily and you are connected to a machine called a bypass pump that takes over the functions of the heart. These operations are very successful and have a low rate of complications.
Off-pump bypass surgery: Sometimes surgeons can perform open heart surgery without using a bypass pump and while the heart is beating. The procedure causes fewer side effects than the standard procedure, but it is not feasible in all situations.
Minimally invasive coronary bypass (MINI-CABS): If just your front or right coronary arteries need bypass, a surgeon may replace the blocked artery with an artery from the leg.
Regular follow-up visits with your health-care professional are essential. Coronary heart disease is a chronic (long-term, ongoing), relentlessly progressive disease. Reducing risk factors may only slow its pace. Even angioplasty or bypass surgery only reduces the severity of the symptoms. It does not cure the disease. It often comes back and gets worse, requiring further treatment for people with previous heart attacks or bypass, especially if the person has not corrected the abnormal risk factors.
Usually, your doctor or health-care professional will monitor you for any new symptoms or signs of disease progression (periodic physical exams and ECGs or stress tests). Silent ischemia (periodic treadmill or radionuclide stress tests or stress echocardiography).
Your doctor will monitor your progress in risk reduction and how well treatment is working. Keep track of your own numbers. This is your life. Monoriting includes:
Your doctor will monitor how well your medications, making adjustments as necessary. Side effects of medications will also be monitored and treated if necessary.
The American Heart Association recommends that maximum calories from fat be less than 30% of total calories in any meal.
Smoking: Smoking is the single best change you can make to prevent heart disease. Quitting can be difficult, so seek your health-care professional's help. Passive smoking (breathing in tobacco smoke), smoking cigars, or chewing tobacco are equally dangerous to your health.
Physical activity: Exercise helps to lower your blood pressure, increase your level of good cholesterol (HDL), and control your weight. Try to complete an endurance exercise of at least 30 minutes, 3-5 times a week. But just brisk walking alone will improve cardiovascular survival. Exercise can include walking, swimming, biking, or aerobics. Before beginning an exercise program, talk to your health-care professional.
Obesity: Excess weight puts extra strain on your heart and blood vessels by increasing blood pressure, plus frequently associated with diabetes, high cholesterol and triglycerides, and low HDL. A high-fiber, low-fat diet and regular exercise can help you lose weight and keep it off. Fad diet programs may be unsafe. Seek your health-care professional's advice before starting any weight loss program. Don't rely on drugs to lose weight. Certain medicines used for weight loss-for example, Fen-Phen-have been associated with dangerous heart valve damage and other serious medical conditions in some users.
High blood pressure: If you have high blood pressure, your health-care professional should treat it aggressively. Proper diet, low salt intake, regular exercise, reduction in alcohol intake, and weight reduction are of paramount importance. If your health-care professional prescribes medications, take them faithfully.
Diabetes: Diabetes causes blockage and hardening (atherosclerosis) of blood vessels everywhere in the body, including coronary arteries. Controlling diabetes significantly reduces coronary risk.
Viagra and coronary heart disease: If you intend to use sildenafil (Viagra) for erectile dysfunction, contact your doctor to make sure it is safe for you. If you have a significant coronary blockage, angina or heart attack may occur with use of Viagra. Also, you must avoid taking nitroglycerin in any form-pill, patch, or spray-within 48 hours of taking Viagra. Using Viagra with nitroglycerin may cause dangerously low blood pressure.
If you have coronary heart disease, following the recommendations of your health-care professional is very important if you wish to improve your condition or prevent it from getting worse. If you notice any change in your condition, you may need further diagnosis or treatment.
The most important ways to reduce the risk of heart disease are in your control, not the control of your health-care professional. Lifestyle changes are the most powerful way to prevent heart disease from getting worse or of reducing the risk of getting heart disease in the first place. The phenomenal drop in the heart disease death rate over the past 30 years has been due more to reducing risk factors than to advances in treatment.
Eat a heart-healthy diet: This is the most important step you can take in lowering your risk.
Lower your fat intake: Calories from fat should be less than 30% of your total calorie intake every day. This translates to less than 60 grams of fat per day for an adult.
Lower your blood cholesterol to the recommended level, especially the LDL cholesterol: This keeps plaque from building up within your coronary arteries.
Engage in regular exercise: This can reduce your risk of heart disease. Exercise strengthens the heart, makes it more efficient, and lowers your blood pressure and bad cholesterol (LDL), yet raises you good cholesterol (HDL). Check with your health-care professional before beginning an exercise program. The American Heart Association recommends at least 30 minutes of exercise 3-5 times a week.
Quit smoking: This also provides a very striking benefit. After only 3 years of not smoking, your risk of heart disease drops to that of a nonsmoker. Your health-care professional can help you quit smoking by providing guidance on changing your behavior. Certain medications have been shown to help some people quit smoking.
Control high blood pressure and diabetes: If you have diabetes, keep your blood sugar under control every day. You should know the value of your HbA1c, a measure of how your blood sugar is controlled; it should be less than 7.0.
Take a low-dose aspirin daily: This can reduce your risk of heart attack. With aspirin, there is some risk of bleeding, so ask your health-care professional before taking aspirin daily.
No scientific clinical trial in humans has shown a beneficial effect of vitamins on the heart.
Note that hormone replacement therapy (HRT) was used for many years to prevent coronary heart disease and heart attack in women who had gone through menopause. Replacing certain hormones was thought to provide a heart-protective effect enjoyed by women before menopause. A research study that ended in 2002 found, however, that women who took HRT actually had higher rates of heart disease and stroke than women who did not take HRT. HRT is no longer recommended for prevention of heart disease.
Heart healthy foods include:
Recovery from coronary heart disease depends on many factors, including the following:
Call 911 or go to your nearest Urgent Care or Emergency Department if you have angina, unstable angina, or a heart attack.
Classic symptoms of a heart attack may include:
The chest pain may be described as tightness, fullness, a pressure, or an ache. Unfortunately, many people do not have these classic signs. Other signs and symptoms of heart attack may include:
