Heart Disease

Aug 23, 2017

This is the first part of a two part series on heart disease. We will first discuss Coronary Artery Disease ( CAD). Next month Congestive Heart Failure (CHF) will be presented. Causes, signs and symptoms, diagnosis, medical therapies, and procedures that restore blood flow to the heart will be examined. CAD occurs when the arteries that bring blood, O2 and nutrients become damaged. Cholesterol- containing deposits (plaques) and inflammation are the  usual causes of CAD. Over time these plaques build up and cause narrowing of the arteries. This leads to decreased blood flow and, in some cases, symptoms such as chest pain (angina), shortness of breath, profuse sweating and fatigue. A complete blockage causes a myocardial infarction ( MI- heart attack). Some people can have no symptoms and suffer a major heart attack as the first awareness that they have heart disease.        The damage to the coronary arteries is caused by smoking, HTN (high blood pressure), elevated cholesterol ( especially the bad kinds- LDL and VLDL ), diabetes ,and a sedentary lifestyle (couch potato). Once damage has occurred, fatty cholesterol-laden plaques accumulate at the site of injury (atherosclerosis) and cause various degrees of blockage.The blood platelets that clump at the site of injury can form a clot that further blocks the artery.    
Risk factors include age, male sex (women over sixty-five have similar risk), smoking, elevated cholesterol, HTN, diabetes, obesity, sleep apnea, and family history. If a man has a father or brother with significant CAD, or MI under fifty-five he needs to undergo a full cardiac evaluation even without any signs or other risk factors. Sometimes these risk factors are additive. If you are obese,smoke,and have HTN, you are more at risk to be diabetic,and that raises your risk of CAD many fold. Complications of severe CAD and/or MI are angina, heart failure due to damaged heart muscle which is to weak to pump blood effectively, and abnormal heartbeats due to decreased blood flow to the heart’s electrical system.
Diagnosis includes an EKG (electrocardiogram), which can show patterns of decreased blood flow (ischemia) and previous heart attacks ( MI). Sometimes people have had heart attacks and don’t even know it!). A Holter monitor is a 24 hour recording of the EKG which can show heart changes during exertion or stress. It is the size of an iPod. A cardiac echocardiogram( a type of sonogram) can show the heart in real time motion and is used with an exercise stress test to detect signs of weakened heart motion. This can mean decreased blood flow and a poorly functioning heart. The gold standard of diagnosis is a cardiac catheterization. This procedure involves injecting a dye that is seen  in real time showing if the coronary arteries are blocked or open. The dye is injected in vein in the arm or leg and circulates to the heart.
The treatment of CAD consists of lifestyle changes, medications,and possible medical procedures to restore the flow of blood to the heart. The most important lifestyle change involves quitting smoking. Smoking is responsible for CAD, lung cancer, COPD (emphysema), and decreased wound healing. Diet has serious consequences, but one should not go overboard with drastic changes. These are not sustainable in the long term. Plans like weight-watchers, which allow you to eat almost anything in moderation work best. The only food best avoided is most fast-food, since it is loaded with saturated fats and salt. Beginning a low impact exercise program of walking 30 minutes per day.Losing the weight will take stress off of the heart and decrease blood pressure and , sometimes, blood sugar as well. Any form of meditation will lower stress levels which is great for the heart.
Medications that lower cholesterol have greatly reduced the incidence of CAD. Drugs such as statins lower the LDL ( “bad cholesterol”)and raise the HDL (“good cholesterol”). This can decrease the size of plaques in the artery. A baby aspirin (81mg) can prevent platelets from sticking to damaged arteries causing clots that block blood flow. People need to discuss which drugs are right for them.
Procedures that restore blood flow through coronary  arteries are used in the most severe blockages. This consists of passing a deflated balloon attached to a thin tube through the blockage and is then inflated to compress the blockage. Sometimes a stent is left in place releasing medication to keep the artery open. This is called angioplasty.
CAD is a condition with multiple causes and solutions. Even a bad family history can be significantly improved by early monitoring and timely intervention.