More than 15 million Americans with coronary artery disease are living with the disease. The number one killer of Americans, heart disease takes various forms.
Coronary artery disease involves narrowing of the coronary arteries that supply blood to the heart. When a clot forms on plaque deposits that are narrowing the passage, the result is a heart attack.
Angina is chest pain that occurs when the heart needs more oxygen than its getting. This is usually caused by a partial blockage of a coronary artery. When the angina is stable, it can be controlled with short periods of rest and medication. When episodes of pain are more frequent, more painful and less likely to be relieved by rest and medication–a condition known as unstable angina–a heart attack may be imminent.
Congestive heart failure refers to a weakening of the heart’s pumping action, caused by injury or disease that can lead to a dangerous buildup of fluids in the lungs, ankles or elsewhere in the body.
According to data from the 2005 Behavioral Risk Factor Surveillance System, 19.6 percent of Americans 65 and older have had a heart attack or are diagnosed with angina or congestive heart failure.
When early manifestations such as high cholesterol and high blood pressure are included, a substantial portion of the population, young and old, is living with heart disease.
For either of these early conditions, required behavioral changes include regular exercise, a heart-healthy diet, weight control and avoidance of cigarette smoke, both first- and second-hand. Patients should also monitor both cholesterol and blood pressure carefully and take prescribed medications.
Even with normal cholesterol and blood pressure, however, some individuals suffer a heart attack or discover that they have angina. At this point, the need for dramatic lifestyle changes becomes critical.
Angina occurs because constriction of coronary arteries prevents normal blood flow to the heart. The pain can be triggered by anything that causes the heart to work harder–physical activity, emotional stress, cold weather, a big meal. To relieve angina attacks, many patients are prescribed nitroglycerin to carry with them at all times and to place under the tongue at the time of an attack. They shouldn’t limit physical activity or exercise because of fear of a heart attack, but to respect angina and rest until the symptoms subside.
Patients also can keep a diary to help them discover when their angina tend to occur—maybe after climbing more than one flight of stairs without stopping, walking faster than usual or when under a great deal of emotional stress. They should avoid combining triggers–such as hurrying to get to a car when the weather is especially cold.
When angina becomes difficult to control, many patients undergo balloon angioplasty or coronary artery bypass graft surgery to restore normal blood flow through coronary arteries. These procedures are also used as emergency treatment for a heart attack.
Either a heart attack or a heart procedure is emotionally and physically traumatic. Nevertheless, doctors like to get patients up and moving around as soon as possible. Cardiac rehabilitation typically starts in the hospital, and most doctors recommend or prescribe it after the return home.
Regular supervised exercise strengthens the heart and reduces the risk of a future heart attack. It’s also good treatment for congestive heart failure. According to one study, heart attack patients who attended cardiac rehabilitation had a 50 percent increased chance of being alive three years later compared to those not participating.
Unfortunately, many Americans living with heart disease–whatever the form or severity–fail to heed the advice about what they should or shouldn’t do. Many even become lax about taking their prescribed medications. In an era when treatment options were severely limited, our grandparents had heart attacks and died early. But today, if those with coronary artery disease are careful about following treatment plans, they can enjoy fairly normal lives for many years.
Two Leaders, One Leading Heart Care Team. The Marshfield Clinic and Ministry Health Care heart care team is a cooperative effort by two leading health care organizations working together as a single leading team. For over 90 years, this has enabled the team to deliver the very highest level of care available in the region. It is the heart care team chosen more often than any other local program, treating more of the most complex cases and conducting more research into leading edge heart care treatments. The team is made up of primary care physicians, cardiologists, cardiovascular surgeons, researchers, and other physicians and staff located at 41 hospitals and clinics. Log on to www.oneheartcareteam.org to learn more.
"I am happy to be able to bring our Heart Care to our patients in their own community," stated Marshfield Clinic Cardiologist Richard Reinhart, MD. "This offers access to the combined expertise of our institutions for our patients in their home towns. If needed, direct access is provided to any additional evaluation or treatment in our heart center at Saint Clare’s Hospital in Weston or Saint Joseph’s Hospital in Marshfield."
For more information about the Heart Care Team in your area, including second opinions, call 800-888-4755.
REFERENCES:
David Danar, “December 2003: A look back and at the year ahead,” Medscape Family Medicine/Primary Care, December, 2003.
Joel E. Dimsdale, “Psychological stress and cardiovascular disease,” Journal of the American College of Cardiology, May, 2008.
The Johns Hopkins White Papers, “Coronary heart disease,” 2008.
Isabella Kardys, et al, “C-reactive protein and risk of heart failure. The Rotterdam Study,” American Heart Journal, December, 2006.
Elizabeth Kohlway, “New almanac confronts the high costs of chronic disease,” Nation’s Health, August, 2008.
Theresa A. McDonagh, “Challenges in advanced chronic heart failure: drug therapy,” Future Cardiology, September, 2008.
Miriam E. Nelson, et al, “Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association,” Medicine and Science in Sports and Exercise, August, 2007.
“Prevalence of heart disease–United States, 2005,” MMWR, March, 2007.
Marian Sandmaier, “Your Guide to Living Well with Heart Disease,” NIH publication No. 06-5270, November, 2005.
Additional Heart Information
Managing Heart Disease
The number one killer of both men and women in the United States, coronary artery disease is a chronic condition that usually starts early in life. Although there’s no cure, there are ways to manage the symptoms.
- Know your risk factors–smoking, family history, age, high blood pressure and high cholesterol–and make changes in those that are within your control.
- Recognize the symptoms and contact your doctor if you feel pain or tightness in your chest or have shortness of breath during physical activity.
- See your doctor regularly for checkups and monitor your own cholesterol and blood pressure.
- Take the medications your doctor prescribes and follow well known recommendations for diet, exercise, weight control and avoidance of cigarette smoke.
[SOURCE: “Heart disease: living with heart disease,” WebMD Medical Reference from The Cleveland clinic, edited by Cynthia Dennison Haines, M.D., October 1, 2005]
Will an Aspirin a Day Keep the Doctor Away?
Should you take a baby aspirin a day to lower your risk of heart disease? The answer is maybe, but only if your doctor tells you to.
Because of its antiplatelet effect, daily aspirin is often prescribed as preventive medicine to persons who have had a heart attack, stroke, balloon angioplasty or heart bypass surgery. Persons in the middle of a heart attack are usually given aspirin to chew in the ambulance on the way to the hospital. One recent large study found that aspirin may help prevent a first heart attack in women age 65 and over.
Aspirin, however, has side effects, and the FDA has not approved it as a preventive measure for persons who have never had a heart attack, stroke or heart procedure.
[SOURCE: Marian Sandmaier, “Your Guide to Living Well with Heart Disease,” NIH publication No. 06-5270, November, 2005]
Feel Down? Get Help
Persons who have suffered a heart attack or have had a heart procedure are frequently bothered by symptoms of depression. About one in five patients has major depression while many others battle the blues.
Research has demonstrated that patients who get treatment for their depression fare better in battling their heart disease.
[SOURCE: Marian Sandmaier, “Your Guide to Living Well with Heart Disease,” NIH publication No. 06-5270, November, 2005]
Healthier Lifestyle, Better Treatment Equals Fewer Deaths
Thanks largely to better treatment and a healthier lifestyle, the age-adjusted death rate from heart disease declined by about 50 percent between 1980 and 2000. That’s about 349,000 fewer deaths.
Treatment advances included the use of clot-dissolving medications and angioplasty for the emergency treatment of heart attacks and the use of preventive and maintenance therapies such as aspirin, cholesterol-lowering statins and ACE inhibitors.
Lifestyle measures included lower smoking rates and better control of cholesterol and blood pressure through medications, diet and exercise.
[SOURCE: New England Journal of Medicine, June 7, 2007]
Get Yearly Flu Shots
Even if you’ve successfully managed your heart risk factors all year, a case of the flu can increase your risk of a fatal heart attack.
A study of about 35,000 Russian adults who died between 1993 and 2000 found a 30 percent increased risk of death from a heart attack during flu outbreaks. Fewer than three percent of those who died had received a yearly flu shot.
Flu makes the heart more vulnerable because of widespread inflammation that is capable of rupturing plaque deposits in arteries. The stress of the illness also increases the heart’s workload.
[SOURCE: European Heart Journal, May, 2007]
It’s Never Too Late Too Quit Smoking
Both smoking and exposure to second-hand smoke are major risk factors for heart disease. The toxins in cigarette smoke damage blood vessels and start a process of inflammation that leads to atherosclerosis (hardening or narrowing of arteries).
Cutting back on smoking is not enough. One large study found that even persons who cut their smoking in half showed no decrease in their risk of a heart attack.
Quitting, however, can make a major difference, and one study found that even smokers hospitalized for a heart attack or severe heart disease were less likely to have a heart attack or be hospitalized again over the next two years if they quit smoking.
[SOURCE: “Is it ever too late to quit smoking?” The Johns Hopkins White Papers, “Coronary heart disease,” 2008]
For more information log on to www.oneheartcareteam.org
Two Leaders, One Leading Heart Care Team. The Marshfield Clinic and Ministry Health Care heart care team is a cooperative effort by two leading health care organizations working together as a single leading team. For over 90 years, this has enabled the team to deliver the very highest level of care available in the region. It is the heart care team chosen more often than any other local program, treating more of the most complex cases and conducting more research into leading edge heart care treatments. The team is made up of primary care physicians, cardiologists, cardiovascular surgeons, researchers, and other physicians and staff located at 41 hospitals and clinics. For more information about the Heart Care Team, including second opinions, call 800-888-4755.