Conditions
ANGINA
What is angina?
Angina (angina pectoris) refers to a temporary chest pain that is caused by not enough blood getting to the heart. It may be a feeling of tightness, heaviness, dull discomfort, numbness, burning, pressure, or crushing pain that is usually felt behind the breastbone. It can also spread to the arms, neck, and jaw. Angina is often brought on by exercise, eating, or stress. Not all chest pain is that of angina; only your doctor can make the proper diagnosis.
How long does it last?
In most cases an attack will last for less than five minutes, but can range from less than 30 seconds to more than 30 minutes. You will learn to recognize your own pattern – that is, when attacks are likely to occur, how long they will last, and what kind of pain you will feel. If your pattern of pain changes, you should notify your doctor.
When are you likely to have an attack of angina?
Anginal usually occurs when your heart has to work harder like when you climb uphill, eat a big meal, go out in very hot or cold weather, or react to stress. This can be caused by atherosclerosis which is the buildup of fatty deposits within the arteries. This narrows the space through which the blood can flow. It can also be caused by Vasospasm which is a spasm (sudden contraction) of one of the coronary arteries that causes it to narrow temporarily. A spasm can occur at any time in some patients, even when they are at rest. This type of angina is called variant or vasospastic angina.
Is an anginal attack the same as a heart attack?
No – an angina attack is not a heart attack. In a heart attack a portion of the heart receives little or no oxygen for a longer period of time. Without oxygen, that portion of the heart muscle dies. If angina is untreated a heart attack could happen. Be sure to contact your physician if your angina attacks begin to occur more often, are brought about by less strenuous activities than usual, your angina attacks last for a longer time, or feel different in any other way.
How can you tell if you are having heart attack?
The symptoms of a heart attack are usually stronger than those of angina. Signs that a person is having a heart attack and should get emergency attention include: pain lasting more than 30 minutes, sweating, nausea, shortness of breath, severe anxiety, fatigue. Most people who suffer a fatal heart attack do so because they did not get help soon enough. So, if you think you are having a heart attack, call an ambulance, or get to a hospital immediately. Do not hesitate to seek help; it is always better to be safe than sorry.
Can angina be treated?
Yes. Several types of medication are available to treat angina such as oral nitroglycerin tablets, nitroglycerin ointments or pads, beta-blockers or calcium antagonist. In addition, you can make changes in your life-style to control various risk factors. With proper treatment and good living habits, you should experience fewer, less painful attacks, or even no attacks at all. You doctor will prescribe the treatment that is appropriate for you. It is very important for you to stop smoking. A program of moderate exercise, under your doctor's guidance, can make your heart stronger and enable it to use oxygen more efficiently.
WHAT IS A HEART ATTACK?
A heart attack occurs when the blood supply to part of the heart muscle itself – the myocardium – is severely reduced or stopped. The medical term for heart attack is myocardial infarction. The reduction or stoppage happens when one or more of the coronary arteries supplying blood to the heart muscle is blocked. This is usually caused by the buildup of plaque (deposits of fat-like substances), a process called atherosclerosis. The plaque can eventually burst, tear or rupture, creating a "snag" where a blood clot forms and blocks the artery. This leads to a heart attack. A heart attack is also sometimes called a coronary thrombosis or coronary occlusion. If the blood supply is cut off more than a few minutes, muscle cells suffer permanent injury and die. This can kill or disable someone, depending on how much heart muscle is damaged. Sometimes a coronary artery temporarily contracts or goes into spasm. When this happens the artery narrows and blood flow to part of the heart muscles decreases or stops. We're not sure what causes a spasm. A spasm can occur in normal-appearing blood vessels as well as in vessels partly blocked by atherosclerosis.
HEART ATTACK SYMPTOMS & WARNING SIGNS
IF YOU THINK YOU'RE HAVING A HEART ATTACK, CALL 9-1-1- OR YOUR EMERGENCY MEDICAL SYSTEM IMMEDIATELY.
Some heart attacks are sudden and intense but most heart attacks start slowly, with mild pain or discomfort. Often people affected aren't sure what's wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:
CHEST DISCOMFORT: Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
DISCOMFORT IN OTHER AREAS OF THE UPPER BODY: Symptoms can include pain or discomfort in one or both arms, the back, jaw or stomach.
SHORTNESS OF BREATH: This feeling often comes along with chest discomfort. But it can occur before the chest discomfort.
OTHER SIGNS: These may include breaking out in a cold sweat, nausea or lightheadedness. If you or someone you're with has chest discomfort, especially with one or more of the other signs, don't wait longer than a few minutes (no more than 5) before calling for help. Call 9-1-1…get to a hospital right away. Calling 9-1-1 is almost always the fastest way to get lifesaving treatment. Emergency medical services staff can begin treatment when they arrive – up to an hour sooner than if someone gets to the hospital by car. The staff are also trained to revive someone whose heart has stopped. You'll also get treated faster in the hospital if you come by ambulance.
WHAT IS ARRHYTHMIA?
An arrhythmia is a change in the rhythm of your heartbeat. When the heart beats too fast, it's called tachycardia. When it beats too slow, it's called bradycardia. Arrhythmia can also mean that your heart beats irregularly (skips a beat or has an extra beat). At some time or another, most people have felt their heart race or skip a beat. These occasional changes can be brought on by strong emotions or exercise. They usually are not a cause for alarm. Arrhythmias that occur more often or cause symptoms (see the box below) may be more serious and need to be discussed with your doctor.
WHAT ARE THE SYMPTOMS OF ARRHYTHMIA?
Palpitations or rapid thumping in your chest, feeling tired or lightheaded, passing out, shortness of breath.
WHAT CAUSES AN ARRHYTHMIA?
The heart has 4 chambers. The walls of the heart contract to push blood through the chambers. The contractions are controlled by an electrical signal that begins in the heart's natural "pacemaker" (called the sinoatrial node). The rate of the contractions is influenced by nerve impulses and hormones in the blood. A problem in any of these can cause an arrhythmia. Minor arrhythmias may be caused by excessive alcohol use, smoking, caffeine, stress or exercise. The most contractions is influenced by nerve impulses and hormones in the blood. A problem in any of these can cause an arrhythmia. Minor arrhythmias may be caused by excessive alcohol use, smoking, caffeine, stress or exercise. The most common cause of arrhythmias is heart disease, particularly coronary artery disease, abnormal heart valve function and heart failure. However, arrhythmias can occur for no known reason.
IS AN ARRHYTHMIA SERIOUS?
In most people, arrhythmias are minor and are not dangerous. A small number of people, however, have arrhythmias that are dangerous and require treatment. Arrhythmias are also more serious if you have other heart problems. In general, arrhythmias that start in the lower chambers of the heart (called the ventricles) are more serious than those that start in the upper chambers (called the atria).
WHAT ARE SOME OF THE TYPES OF ARRHYTHMIAS?
Atrial fibrillation. The heart beats too fast and irregularly. This type of arrhythmia requires treatment and can increase your risk of stroke.
Paroxysmal atrial tachycardia. The heart has episodes when it beats fast, but regularly. This type of arrhythmia may be unpleasant but is usually not dangerous.
Ectopic beats. The heart has an extra beat. Treatment usually is not needed unless you have several extra beats in a row.
Ventricular tachycardia and ventricular fibrillation. The heart beats too fast and may not pump enough blood. These types of arrhythmias are very dangerous and need immediate treatment.
WHAT'S THE TREATMENT?
Treatment depends on the type of arrhythmia you have. Some mild arrhythmias require no treatment. Other arrhythmias can be treated with medicines. An artificial pacemaker: An electronic device placed under the skin on the chest. It helps the heart maintain a regular beat, especially when the heart beats too slowly. Cardiac defibrillation (very brief electric shock): Can be used to stop an abnormal rhythm and restore a normal one. Surgery: Can correct certain types of arrhythmias. For example, arrhythmias caused by coronary artery disease may be controlled by bypass surgery. When an arrhythmia is caused by a certain area of the heart, sometimes that part of the heart can be destroyed or removed.
CONGESTIVE HEART FAILURE
Congestive Heart Failure Is a term used to describe any condition in which the heart is unable to adequately pump blood.
SIGNS AND SYMPTOMS:
When the left ventricle cannot adequately pump blood out of the left atrium, or when one or more of the heart valves becomes leaky or stenotic, blood can "back up" into the lungs. When this happens, the lungs become congested with fluid, making it difficult to breathe and interfering with the movement of oxygen from the lungs into the blood stream. This can result in shortness of breath (dyspnea) with exertion, waking up at night short of breath. Because the heart is not pumping enough blood to the muscles of the body, some patients become fatigued easily and feel weak all the time. Swelling (edema) of the feet, ankles, legs and sometimes the abdomen are other common symptoms.
TREATMENT
Lifestyle Modifications
Diet: Intake of salt causes the body to retain fluid, which can worsen the symptoms of heart failure. Patients with congestive heart failure should therefore restrict their dietary intake of salt to no more than 2 to 3 grams daily. Rarely, patients also may have to restrict the amount of fluids they consume.
Alcohol: Alcohol can adversely impact the heart. Patients with congestive heart failure generally should limit their alcohol intake to one drink a day. When heart failure is believed to be due to excess alcohol consumption, absolute abstinence from alcohol consumption is mandatory.
Exercise: When there are only mild symptoms of heart failure, regular exercise may help to prevent overall decline in fitness and improve energy level and exercise capacity. Recommended exercise might include taking brisk walks or using a stationary bike 3 to 4 times a week for 20 to 30 minutes. Heavy lifting and extreme exertion are not recommended.
Medications: A variety of medications that improve symptoms, decrease the need for hospitalizations, and even prolong life are available to treat patients with congestive heart failure.
Mechanical Devices and Surgery: Occasionally, patients whose heart failure symptoms persist after all forms of medical therapy may require insertion of a special device to assist the heart. An intra-aortic balloon pump (IABP) is a device that is inserted through an artery in the groin and then placed within the aorta (the main artery of the body). Basically, an IABP is a large, inflatable balloon that is expanded and deflated, in coordination with each heart beat, by a pump that rapidly pushes and then removes a gas into and out of the inserted balloon. This beat by a pump that rapidly pushes and then removes a gas into and out of the inserted balloon. This decreases the amount of work that the heart performs and increases the flow of blood throughout the body. A left ventricular assist device (LVAD) is a complex pump that is implanted in the body to assist the left ventricular in pumping blood. Heart transplant surgery is reserved for the most severely ill heart failure patients. Such patients have disabling symptoms and often require repeated or continuous hospitalization.
ATRIAL FIBRILLATION
Atrial fibrillation is an abnormality of the heart rhythm in which chambers of the heart no longer contract in an organized manner. Heart rate often becomes irregular and may be very fast, producing palpitations. Atrial fibrillation can lead to symptoms of heart failure (shortness of breath, edema, palpitations) and chest pains, and when left untreated, occasionally can lead to stroke.
Signs and Symptoms: As atrial fibrillation develops, the patient may be unaware of any symptoms. It may be discovered incidentally, when the patient or doctor at some point happens to notice that the patient's heart beat is no longer regular. Sometimes, the development of shortness of breath or of fatigue compels a patient to seek medical attention. Unfortunately, some do not see a doctor until they have suffered a stroke.
Complications: The most devastating complication of atrial fibrillation occurs when a blood clot forms in the left atrium, travels to the left ventricle, and is pumped to the brain. When a blood clot lodges in one of the arteries supplying the brain with blood, it can block blood flow to that part of the brain and cause a stroke. Strokes can be severe and can cause permanent paralysis of part of the body, speech impairment, and even death. Unfortunately, stroke can occur at any time and, usually without warning.
Treatment of atrial fibrillation is complex and depends on whether the patient is currently experiences symptoms, how long the patient has been in atrial fibrillation, the overall health of the patient, and the size and function of the heart's chambers.
STABLE PATIENTS
In stable patients, several general approaches may be taken. Those who are experiencing palpitations can be treated with certain medications that "slow" conduction of electrical impulses through the AV node and down into the ventricles. Cardioversion through medication although long term treatment with Warfarin may decrease the chances of having a stroke, it is generally felt that a more ideal approach to prevent stroke is to try to "convert" the heart rhythm from atrial fibrillation back into sinus rhythm. Not every patient can be successfully converted back into sinus rhythm. These patients include those who have been in atrial fibrillation for a long period of time and those who are found to have a very enlarged (dilated) atria.
UNSTABLE PATIENTS
In unstable patients, those experiences severe shortness of breath, chest pains, or lightheadedness due to low blood pressure, it may be necessary to "shock" the heart into sinus rhythm. Cardioversion is used to attempt to convert the patient with atrial fibrillation back into sinus rhythm by electrically shocking the heart. During this procedure, the patient is usually sedated, or put to sleep, through intravenous infusion of one of several short-acting medications. Special pads or paddles are then applied to the chest and increasing energy levels of electrical charge are produced in an attempt to shock the heart back into sinus rhythm. Although the shocks can cause significant discomfort, most patients are asleep during the procedure and remember little, if anything, about the experience afterward.
STROKE
A stroke happens when a part of the brain experiences a problem with blood flow. This disruption in blood flow cuts off the supply of oxygen to the cells in that part of the brain, and these cells begin to die. Damage to the brain can cause loss of speech, vision, or movement in an arm or a leg, depending on the part of the brain that is affected. Stroke is the major form of cerebrovascular disease, or CVD, a term that sometimes is used interchangeably with stroke.
There are two main types of stroke:
Stroke caused by a blockage in the artery supplying blood to a particular region of the brain. This is the most common type of stroke. Stroke caused by bleeding within the brain. In addition, some people experience brief warning signals that a major stroke is going to happen in the future. The medical term to describe these symptoms is transient ischemic attack or TIA. Sometimes called "mini-strokes," TIA's are exactly like a stroke. A stroke that damages the right side of the brain will affect the left side of the body.
Stroke caused by blocked blood flow: About 85% of all strokes happen because not enough blood gets to the brain. Blood flow stops when an artery carrying blood to the brain becomes blocked. The technical name for this type of brain attack is cerebral infarction. It is also called ischemic stroke. "Ischemic" refers to a condition caused by a decreased supply of oxygenated blood to a body part. The blockage can be caused either by a blood clot that forms in an artery in the brain, or by a blood clot formed elsewhere in the body that travels through the blood stream to the brain. If this clot becomes stuck in an artery in the brain, a stroke can result. Clots are more likely to form in arteries that are damaged by atherosclerosis.
In ischemic stroke, one of two major arteries is usually involved:
The carotid artery (most commonly involved site).
The basilar artery.
Stroke Caused By Bleeding In The Brain
The other 15% of strokes happen when an artery carrying blood to the brain bursts suddenly. The bursting can happen because of a weak spot in the wall of an artery called an aneurysm. This type of brain attack is called a hemorrhagic stroke.
What are "mini-strokes"?
A "mini-stroke" is exactly like a stroke, but it lasts only a short time and leaves no disability. The term for this event is transient ischemic attack or TIA.
A TIA happens when a blood clot clogs an artery temporarily, cutting off blood flow and, consequently the supply of oxygen to cells. But the difference between a TIA and a stroke is that, with TIA, the blood clot dissolves on its own and blood flows is restored before permanent damage to the brain can occur.
HEART DISEASE
Heart disease describes a variety of disorders and conditions that can affect the heart. The most common type of heart disease is coronary heart disease (CHD), also called coronary artery disease. The word "coronary" means crown, and it is the name given to the arteries that circle the heart like a crown. The coronary arteries supply the heart muscle with oxygen and nutrients. Coronary heart disease develops when one or more of the coronary arteries that supply the blood to the heart become narrower than they used to be. This happens because of a buildup of cholesterol and other substances in the wall of the blood vessel, affecting the blood flow to the heart muscle.
Deposits of cholesterol and other fat-like substances can build up in the inner lining of these blood vessels and become coated with scar tissue, forming a bump in the blood vessel wall known as plaque. Plaque build-up narrows and hardens the blood vessel, a process called atherosclerosis, or hardening of the arteries. Eventually these plaque deposits can build up to significantly reduce or block blood flow to the heart.
Many people experience chest pain or discomfort from inadequate blood flow to the heart, especially during exercise when the heart needs more oxygen. Without an adequate blood supply, heart muscle tissue can be damaged.
Although we typically think atherosclerosis as a disease of old age, the process begins as early as childhood, making prevention of coronary heart disease a priority for everyone.
It's not easy to tell if you have coronary heart disease, since the disease rarely causes symptoms in its early stages. That is why it's important to see your physician regularly and evaluate your diet and lifestyle habits. Your physician can detect early warning signs of CHD, such as high blood pressure or high cholesterol levels.
When you have your blood pressure taken, your health care provider is measuring the pressure, or tension, that blood exerts on the walls of the blood vessels as it travels around the body. In a healthy person, this pressure is just enough for the blood to reach all the cells of the body, but not so much that it strains blood vessel walls.
Blood pressure is measured in millimeters of mercury (mm HG).
A typical normal blood pressure is 120/80 mm Hg or "120/80." The first number represents the pressure when the heart contracts. The second number represents the pressure when the heart reflexes. Blood pressure greater than 140/90 mm Hg is considered high.
Generally, blood pressure will go up at certain times – for instance, if you smoke a cigarette, win the lottery, or witness a car crash – and will return to normal when the stressful or exciting event has passed.
But when blood pressure is high all the time, the continuous increased force on blood vessel walls can damage blood vessels and organs, including the heart, kidneys, eyes and brain.
The medical term for high blood pressure is hypertension.
Although high blood pressure can nearly always be brought down to safe levels, your doctor cannot do it alone. You need to become a partner in your own care.
What Are The Guidelines For Treating High Blood Pressure?
Treatment for high blood pressure consists of lifestyle modifications and drug therapy.
Cholesterol is a waxy, fat-like substance that is made in the body by the liver. Cholesterol forms part of every cell in the body and serves many vital functions. Our bodies need cholesterol to:
Maintain healthy cell walls, make hormones (the body's chemical messengers), make vitamin D, make bile acids, which aid in fat digestion.
High levels of cholesterol in the blood can clog blood vessels and increase the risk for heart disease in animal-based foods such as meat and dairy products. In addition to making cholesterol, we also get a small percentage of our body's cholesterol from the foods we eat. Only animal-based foods such as meat, eggs, and dairy products contain cholesterol. Plan foods such as fruits, vegetables, and grains do not contain cholesterol.
Cholesterol Testing
All adults should have their blood cholesterol level measured at least once every 5 years. If your blood cholesterol level is:
Below 180 – your blood cholesterol level is ideal
180-199 – your blood cholesterol level is acceptable
200-219 – your blood cholesterol is borderline high
220 or higher – your blood cholesterol level is too high
If your total blood cholesterol level is greater than 200 (and especially if it is over 220), you should have another test to see what type of cholesterol is high.
If your HDL cholesterol level (the good kind) is:
Under 35 – it is too low
36-50 - it is unacceptable.
Over 50 – it is ideal.
If your LDL cholesterol level (the bad kind) is:
130 or less – it is ideal
130 to 159 – it is borderline high
160 or greater – it is too high
You should also have your blood level of another type of fat – triglycerides – measured at the same time you have your blood cholesterol levels checked. High blood triglyceride levels can also increase risk for heart disease. Fortunately, these levels can be quickly lowered with weight control and more exercise.
