Everything You Need to Know About Heart Disease
Table of Contents
Types of Heart Disease
Signs and Symptoms
Signs and Symptoms in Women
Living with Heart Disease
When to See a Doctor
Heart disease is the leading cause of death for both men and women in the United States. In fact, it accounts for one in every four deaths. Furthermore, someone has a heart attack every 40 seconds in the United States and more than one person dies from a heart disease-related incident every minute.
Lastly, the Centers for Disease Control and Prevention (CDC) estimates heart disease costs the health care system almost $200 billion per year. This includes costs for health care services, medications, and lost productivity.
Types of Heart Disease
Heart disease is a term that encompasses a variety of ailments that affect your heart. People often interchange heart disease with cardiovascular disease.
The main types of heart disease include:
- Hardening of the arteries (atherosclerosis) causing narrowing or blockage of the heart’s arteries (coronary artery disease [CAD]);
- Heart rhythm disturbances (arrhythmias);
- Heart failure (congestive heart failure [CHF]);
- Heart valve problems (valvular heart disease);
- Heart muscle problems (cardiomyopathy);
- Heart irregularities present at birth (congenital heart defects), and;
- Heart infections, which can be caused by bacteria, viruses, or parasites.
Out of the above, the most common type of heart disease is CAD.
Signs and Symptoms
The most common symptom of heart disease is chest pain or angina. Angina may be described as discomfort, heaviness, tightness, pressure, aching, burning, or squeezing sensation in your chest. It is often mistaken for indigestion or heartburn. Angina may also be felt in the shoulders, arms, neck, throat, jaw, or back.
Other symptoms of heart disease may include:
- Shortness of breath;
- Rapid or irregular heartbeats (palpitations);
- A fast heartbeat (tachycardia);
- Profuse sweating (diaphoresis), and;
- Weakness, fatigue, and dizziness.
Signs and Symptoms in Women
The signs and symptoms of heart disease in women deserve special mention, as their experience is often different than that of men. On average, these signs and symptoms occur about 10 years later in women. As such, they may easily be confused with other conditions, such as depression, menopause, and anxiety.
It has been reported that women are more likely to experience symptoms unrelated to angina, such as anxiety, sleep disturbances, and unusual fatigue. Furthermore, almost 80 percent of women reported experiencing these symptoms for at least one month before their heart attack occurred.
There are several risk factors for heart disease. Some of the risk factors are controllable while other risk factors are uncontrollable.
The CDC estimates that 47 percent of Americans have at least one risk factor for heart disease. Most doctors agree that the key risk factors for heart disease are high blood pressure, high cholesterol, and smoking. Both high cholesterol and smoking increase your risk of developing heart disease by two-fold, respectively.
On top of these key factors, established risk factors for the development of heart disease include:
- Diabetes: People with diabetes are two to four times more likely to die from heart disease.
- Family History: This is especially concerning if it involves a first-degree male relative under 55 years old or female relative under 65 years old.
- Poor Diet: In particular, this is a diet high in fat, salt, sugar, and cholesterol.
- Depression: Adults with this psychiatric disorder have a 64 percent greater risk of developing CAD.
Being overweight, lack of exercise, and excessive alcohol use are other risk factors of heart disease.
The American Heart Association recommends some specific screening tests for heart disease that should begin at age 20. The exception being tests for blood glucose, which should begin at age 40 or 45.
Fasting cholesterol levels should be checked every four to six years. Your doctor may choose to check these levels more frequently if you are at increased risk for heart disease.
After age 40, your doctor should also use an equation to calculate your 10-year risk of experiencing a heart attack or stroke.
Blood pressure should be monitored at least once every two years if it is less than 120/80 mm Hg. If it is above 120/80 mm Hg, your doctor may choose to check it more often.
Body Mass Index and Waist Circumference
Body mass index (BMI) and/or waist circumference should be monitored at every health care visit.
A BMI of 25 to 29.9 kg/m2 defines overweight, while greater than or equal to 30 kg/m2 defines obesity. A waist circumference greater than 35 inches in women or greater than 40 inches in men increases your risk for heart disease.
Considering diabetes can increase your risk of developing heart disease, it is beneficial to get tested for it.
In fact, the United States Preventive Services Task Force recommends that overweight or obese adults obtain screening for type 2 diabetes between the ages of 40 and 70. If the results are normal, they should repeat the test every three years. Meanwhile, the American Diabetes Association recommends that adults start annual screening for type 2 diabetes at age 45.
If your fasting blood glucose is greater than or equal 126 mg/dL on more than one occasion, you have diabetes. Alternatively, your doctor may pursue a diagnosis through an A1C test, as a level greater than or equal to 6.5 percent defines diabetes.
The cornerstone of heart disease prevention is to address the controllable risk factors in an effort to reduce your risk of developing the disease. Fortunately, there are many things you can do to reduce your chances of getting heart disease. With meticulous execution, you can reduce your chances by as much as 80 percent.
Many interventions aimed at the prevention of heart disease entail the control of medical conditions or lifestyle factors that contribute to the disease. These include:
- Blood Pressure: If your blood pressure is above 120/80 mm Hg, it is important to get regular screenings and investigate ways to control your blood pressure.
- Cholesterol: You should strive to keep your cholesterol and triglyceride levels under control; some individuals require medications, such as statins, to control these parameters.
- Risk of Diabetes: If you have prediabetes or full-blown diabetes, it is important to get appropriate screenings and manage your blood sugar levels; most doctors agree on a goal A1C of less than seven percent.
Living with Heart Disease
In addition to the screenings and prevention measures mentioned above, lifestyle changes have the potential to further slash your risk of heart disease.
Diet and Exercise
A good place to start is with eating a well-balanced, heart-healthy diet. This diet should minimize your intake of saturated fats, sodium, and sugar and maximizes your intake of whole grains, fruits, and vegetables.
In addition to changing your diet, you should strive to get moderate exercise for at least 150 minutes per week.
With proper nutrition and regular exercise, you should be able to maintain a healthy weight — a BMI of 18.5 to 24.9 kg/m2 — to combat obesity or being overweight.
Other changes in lifestyle that may help prevent heart disease include:
- Limiting Alcohol Intake: Men should have no more than two alcoholic drinks per day, while women should not have more than once per day.
- Avoiding and/or Quitting Smoking: If you smoke and want to quit, you should speak with your doctor about the many smoking cessation aids available.
- Reducing Stress: Since stress can increase your blood pressure, it can trigger a heart attack, as well as spur detrimental coping behaviors, such as smoking, overeating, or heavy drinking.
- Getting Adequate Sleep: Sleep deprivation raises your risk of high blood pressure, obesity, and diabetes — which are all risk factors of heart disease.
When to See a Doctor
Many people with heart disease might believe that their symptoms are indigestion or heartburn, which is not always the case.
It is best to call your doctor if:
- You begin to feel new symptoms of heart disease, or;
- Your usual symptoms become more frequent or severe.
It is best to call 911 if:
- Chest pain is accompanied by symptoms such as shortness of breath, heart palpitations, dizziness, fast or irregular heartbeat, nausea, or profuse sweating;
- You’re still feeling chest pain after taking three doses of nitroglycerin at five-minute intervals or after 15 minutes as you may be having a heart attack.
Emergency health care personnel may tell you to chew an aspirin. This could prevent a blood clot from forming or getting larger in size in the arteries of your heart.
There is no one single test used to diagnose heart disease.
The process starts with your doctor talking to you about your medical history. They will ask you about:
- Your symptoms;
- How long you have had them;
- What you are doing when you get them, and;
- What makes them better or worse.
Genetics can play a role in heart disease. As a result, your doctor will inquire about your family history of heart disease.
Next, your doctor will perform a thorough physical examination looking for any signs of heart disease. There will be special emphasis on the cardiovascular exam. During this exam, the doctor will be looking for the following signs:
- Heart murmurs;
- Abnormal sounds in their arteries called bruits;
- An abnormal heart rhythm
- Uncontrollably high blood pressure;
- Swelling in lower extremities;
- Abnormal lung sounds, and;
- Troubled breathing.
After your doctor takes a careful medical history and a thorough physical examination, blood tests are usually the next step in the evaluation of heart disease. Screening tests, such as fasting cholesterol levels and fasting blood glucose, are a good start, as well as tests for kidney, liver, and thyroid function.
A special blood test called C-reactive protein (CRP) may be recommended. CRP is a marker for inflammation. As such, elevated levels of CRP correlate with high levels of inflammation — and an increased risk for heart attack. Another special blood test called B-type natriuretic peptide may be used to rule in or rule out CHF.
If your preliminary evaluation identifies signs of heart disease or if you have specific risk factors for CAD, your doctor may also recommend one or more of the following non-invasive diagnostic tests for heart disease:
- Electrocardiogram: Also known as ECG or EKG; this test measures the electrical activity in your heart and can be used to diagnose irregularities, such as abnormal heartbeats, damage to heart muscle, decreased blood flow in the heart’s arteries, and heart enlargement.
- Echocardiogram: This test uses sound waves to provide information about the heart’s size, shape, and movement.
- Stress Test: Also known as an exercise stress test or exercise ECG; this test is especially useful for the diagnosis of CAD.
- Holter Monitor: This test provides a continuous 24- to 48-hour ECG and is especially useful for the diagnosis of heart rhythm disturbances.
- Cardiac Computed Tomography: Also known as a CT scan; this test is done for calcium scoring.
- Cardiac Magnetic Resonance Imaging: Also known as an MRI.
If your physical exam, blood tests, and non-invasive tests are inconclusive with regard to heart disease, your doctor may recommend the following invasive procedures:
- Cardiac Catheterization and Coronary Angiography: Your cardiologist inserts a thin tube called a catheter into an artery in the groin and advances it up into the heart where a dye is injected giving detailed X-ray images of the heart’s blood vessels; this test, known as a coronary angiography, is especially useful for diagnosing blood flow problems and blockages in the coronary arteries.
- Electrophysiology Study: During this test, electrodes are attached to your heart through a catheter, electrical impulses are sent through it, and how the heart responds to these impulses is recorded.
- Intracoronary Ultrasound: This test uses a catheter to create a picture of the coronary arteries, showing the thickness of the arteries and any blockages in blood flow.
Heart disease is a major cause of disability and causes many potentially fatal complications if left untreated.
Three of the most common complications of heart disease are:
- Heart Failure: Occurs when the heart cannot pump enough blood to meet your body’s needs.
- Heart Attack: Occurs when the coronary arteries are narrowed or blocked — usually as a result of atherosclerosis — cutting off blood supply to the heart muscle and causing irreparable damage
- Stroke: Occurs when the arteries to your brain are narrowed or blocked, cutting off the blood supply to the brain, which is a medical emergency.
Other complications of heart disease may include the following:
- Aneurysm: This refers to a bulge in the wall of an artery and may cause life-threatening internal bleeding if it ruptures.
- Peripheral Arterial Disease: This complication usually occurs in the lower extremities as a consequence of atherosclerosis and is characterized by decreased blood flow leading to leg pain when walking.
- Pulmonary Embolism: This complication is similar to a stroke, but the blocked blood vessel is in the lungs instead of the brain, which is also a life-threatening medical emergency.
- Atrial Fibrillation: This complication is characterized by the upper chambers of the heartbeat erratically; it is one of the most commonly diagnosed heart arrhythmias.
- Sudden Cardiac Arrest: This complication is characterized by the sudden, unexpected loss of heart function, breathing, and consciousness and can be fatal if not treated immediately.
Treatment for heart disease largely depends on the type of heart disease you have as well as how far it has advanced. For instance, if you have a heart infection, you’ll likely be given antibiotics as part of your treatment.
The overarching goal for the treatment of heart disease is to prevent complications and/or progression of the disease. In general, the treatment of heart disease usually includes lifestyle changes, medications, and medical procedures or surgery.
Lifestyle changes that help treat heart disease include:
- Eating a low-fat, low-sodium diet;
- 150 minutes per week of regular exercise
- Avoiding and/or quitting smoking;
- Limiting alcohol use to no more than two drinks per day for men and no more than one drink per day for women.
Medications may be necessary to treat your heart disease.
You may be prescribed angiotensin-converting enzyme (ACE) inhibitors if you have high blood pressure, heart failure, or have had a heart attack. Examples of ACE inhibitors include benazepril (Lotensin), ramipril (Altace), and captopril (Capoten).
If you can’t tolerate ACE inhibitors, you may have to take angiotensin II receptor blockers (ARBs) instead. Examples of ARBs include losartan (Cozaar), olmesartan (Benicar), and valsartan (Diovan).
If you are at high risk of heart disease, your doctor may prescribe anticoagulants — also known as “blood thinners” — to prevent heart attack, stroke, or pulmonary embolism. Examples of anticoagulants include enoxaparin (Lovenox), heparin, and warfarin (Coumadin).
Additionally, antiplatelet drugs may be prescribed to prevent a future heart attack or if you have an arrhythmia. Examples of antiplatelet agents include aspirin, clopidogrel (Plavix), and prasugrel (Effient).
Beta-blockers slow down your heart rate, causing it to beat less forcefully. This can be useful for treating high blood pressure and heart failure, as well as preventing future heart attacks. Examples of beta-blockers include metoprolol (Lopressor), labetalol (Trandate), and propranolol (Inderal).
Calcium channel blockers (CCBs) work by causing your blood vessels to relax and causing your heart to beat less forcefully. This may be useful for the treatment of high blood pressure, chest pain, and arrhythmias. Examples of CCBs include amlodipine (Norvasc), diltiazem (Cardizem), and nifedipine (Procardia).
Digoxin may be prescribed if you have heart failure or arrhythmia.
If you have high cholesterol and/or coronary atherosclerosis, your doctor may prescribe statins to combat these ailments. Examples of statins include atorvastatin (Lipitor), rosuvastatin (Crestor), and pravastatin (Pravachol).
Finally, you may have to take nitrates if you have chest pain or heart failure. Examples of nitrates include nitroglycerin (Nitrostat), isosorbide dinitrate (Isordil), and isosorbide mononitrate (Monoket).
Surgery or invasive procedures are sometimes needed to treat heart disease, especially CAD.
If you have one or two blockages in your coronary arteries, you may be a candidate for a cardiac stent. Combined with angioplasty, stents are designed to keep arteries open, thereby improving previously diminished blood flow.
If you have more than two blockages in your coronary arteries, you may be a candidate for open-heart surgery, which is also referred to as coronary artery bypass grafting (CABG). This is a major surgery that detours blood flow around your blockages.
Although heart disease is the single largest killer of men and women in the United States, there are things you can do to affect its outcome. It would be in your best interest to subscribe to a heart-healthy diet, get moving, quit smoking, and control your blood pressure, cholesterol, and blood sugar.