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Heart Disease Essentials

Guest Author - A. Maria Hester, M.D.

Coronary artery disease (CAD) is the leading killer of men and women in America. All tissues in the body need oxygen to survive, and the heart is no exception. Coronary arteries supply the heart with its needed blood supply.

In coronary artery disease, thick patches of fatty tissue, called plaques, form on the inside walls of the coronary arteries. As plaques thicken, the arteries narrow and blood flow is compromised. Acute coronary syndrome (ACS) is a potentially life-threatening complication of CAD. Typically in ACS a blood clot forms on top of an unstable plaque and leads to an abrupt decrease in blood flow to the heart. If severe, a heart attack may ensue.

What are the symptoms?

In classic ACS, the patient experiences crushing chest tightness, which may radiate to the neck, jaw, shoulders, or arms. Common accompanying symptoms may include shortness of breath, profuse sweating, heart racing, dizziness, nausea, or vomiting.

However, studies suggest many patients who suffer a heart attack do not have classic symptoms and may not experience any chest pain at all! Women are more likely than men to have an atypical presentation and purely have symptoms such as shortness of breath, dizziness, weakness, fainting, abdominal pain, or even cardiac arrest.

How is it diagnosed?

Typically, a patient tells her doctor about symptoms that are concerning for a potential diagnosis of CAD, and the doctor orders diagnostic tests, beginning with a basic EKG. Depending on the level of suspicion, the physician may then order a cardiac stress test, which gives far more information about the presence or absence of CAD.

A normal resting EKG only means that during the few seconds that the EKG machine is recording, there is no evidence of decreased blood flow to the heart. It does NOT rule out CAD, but it does give valuable information in many instances. For example, if you are having severe chest pain while the EKG is recording, and the EKG is completely normal, the likelihood that the chest pain is due to CAD is relatively low, and your doctor will likely consider other causes of chest pain.

In addition, your overall risk profile, the way you describe your pain, and your physical exam findings play a large role in determining how many tests your doctor orders before she feels very comfortable that your symptoms are not related to heart disease. For example, a thin 45 year old woman with no medical problems who runs 12 miles each week, never smoked, and has no family history of heart disease is far less likely to have CAD than a sedentary, overweight 75 year old woman with high blood pressure, diabetes, and high cholesterol, who smokes 2 packs of cigarettes each day. Therefore, the diagnostic workup will likely vary considerably in these two ladies who see the same doctor with the same symptoms.

How it is treated?

Depending on the severity of CAD and the overall risk involved, treatment can range from cardiac bypass surgery to medical management, which simply means reducing the risk of progression by lifestyle changes and medication. For instance, smoking cessation, optimal blood pressure control, or taking cholesterol-lowering medications can go a long way in optimizing outcome and minimizing future risk of a heart attack.

What is my risk for developing CAD?

Several factors increase your risk of developing CAD, including:
High blood pressure
Diabetes mellitus
Cigarette smoking
Family history of CAD
Sedentary lifestyle
A bad cholesterol profile

How can I protect myself?

Risk factor modification is key to preventing CAD, or living longer with it. Talk to your doctor about your current risk factors and how you can lower your risk.
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Content copyright © 2015 by A. Maria Hester, M.D.. All rights reserved.
This content was written by A. Maria Hester, M.D.. If you wish to use this content in any manner, you need written permission. Contact Patricia Villani, MPA, PhD for details.


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