Risk Factors for Heart Disease

What is a heart attack?
A heart attack is an event that results in permanent heart damage or death. It is also known as a myocardial infarction, because part of the heart muscle (myocardium) may literally die (infarction). A heart attack occurs when one of the coronary arteries becomes severely or totally blocked, usually by a blood clot. When the heart muscle does not obtain the oxygen-rich blood that it needs, it will begin to die. The severity of a heart attack usually depends on how much of the heart muscle is injured or dies during the heart attack.

What are possible consequences of a heart attack?
Depending upon the severity of both the attack and of the subsequent scarring, a heart attack can lead to any the following: heart failure, irregular heart rhythms (arrhythmias), cardiac arrest (which could lead to sudden cardiac death), cardiogenic shock (an often-fatal shock-like state) or death.

How is cardiac arrest different from a heart attack?
Each year approximately one million Americans experience a heart attack, making it the number-one cause of unexpected or sudden death among otherwise healthy adults. While many people use the two terms interchangeably, cardiac arrest is not the same as a heart attack. Cardiac arrest occurs when the heart actually stops beating and pumping blood, usually due to a malfunction in the heart's electrical system (ventricular fibrillation). The term "massive heart attack" is also mistakenly used to describe cardiac arrest, but they are not the same thing. A heart attack may lead to cardiac arrest, but these are separate events.

What are the common symptoms of a heart attack?
The classic symptom of a heart attack is chest pain that is unrelieved by rest and often spreads or radiates through the upper body to the arms, neck, shoulders or jaw. However, some patients may only experience chest pressure/discomfort, with or without other symptoms such as the following: shortness of breath, palpitations, fainting, fatigue, sweating or nausea. In contrast with men, women are more likely to feel fatigue or nausea prior to a heart attack. They also feel pain high in the abdomen and chest, and even in the back, neck or jaw. Whatever the nature of the pain, it does not have to be jarring or obvious for it to signal an impending heart attack. In fact, obvious pain is a better signal of an impending heart attack than discomfort or heartburn-like symptoms, which can be easily ignored or mistaken for indigestion.

What should you do if you think they might be having a heart attack?
As a general rule, it is better to be safe than sorry. If a heart attack is suspected and any of these symptoms are present, this may indeed be a sign of a serious lack of oxygen-rich blood supply to the heart. Emergency medical help should be sought immediately.
What are the risk factors for heart disease?
Risk factors for heart disease include: hypertension (high blood pressure), hyperlipidemia (high cholesterol), a family history of heart disease (particularly premature coronary artery disease), cigarette smoking, sedentary lifestyle and diabetes.

Risk Factors You Cannot Modify:

Family History
Your risk is higher if immediate family members have had coronary artery disease. Your risk is even higher if you are a man with a relative who died of a heart attack at an early age (under 70).

Age
The risk of developing coronary disease increases as you age.

Gender
Men under 50 have two to three times greater risk of heart attack than women of the same age. After menopause, however, women have the same risk as men.

Risk Factors You Can Modify:

Smoking
Smoking increases your risk of heart attack three to four times over non-smokers. Smoking can cause artery muscles to spasm, or contract, reducing blood flow to your heart.

High Blood Pressure
High blood pressure causes blood to press too hard against the walls of your arteries, damaging the arteries and promoting the development of atherosclerosis of the coronary arteries.

High Blood Cholesterol
Cholesterol is a fat substance found in foods of animal origin. High levels of cholesterol contribute to the formation of fatty buildup along the inside lining of the arteries, blocking the flow of blood.

High Triglycerides
Triglycerides are a fat found in the blood and are the end products of sugar breakdown that contributes to plaque formation. Limit your intake of sugars, starches and alcohol.

Diabetes
If you have diabetes, you are more than twice as likely to develop heart disease. Diabetes damages the artery walls and increases the risk of plaque formation. You can reduce, but not eliminate the risk of coronary artery disease by keeping your blood sugar levels normal and by controlling your cholesterol and triglycerides.

Excessive Alcohol and Caffeine Intake
Alcohol and caffeine can raise your cholesterol by raising the fat level in your blood. Try to limit your alcohol consumption. Small amounts of alcohol on a regular basis have been shown to decrease the risk of coronary disease. Limit caffeine beverages to two cups per day.

Obesity
Being overweight puts a direct strain on the heart. When you are overweight, your heart has to work harder to supply the extra tissues with blood. Many times, losing weight will decrease your cholesterol and lower your blood pressure.

Lack of Proper Exercise
A balance of rest, relaxation and activity are needed for a healthy body. A balanced exercise program is best with some exercise each day rather than a lot one day and none the next.

What causes coronary heart disease?
Coronary heart disease is caused when fatty plaques accumulate along the walls of the coronary arteries, narrowing them and thereby reducing blood flow to the heart. This process is referred to as atherosclerosis. Over time, the heart muscle, which is "starved" of oxygen and nutrients carried by the blood, begins to weaken, and parts of it may even die.

What is a stroke?
When brain cells are deprived of their blood supply, a stroke or "brain attack" occurs. Without access to vital nutrients and oxygen, brain cells die. The effects of a stroke can vary widely depending on where it occurs in the brain, the severity of the attack, and the general health of the person. A minor stroke may not even be noticed, while a major one can cause crippling mental and physical disabilities or even death.

What are some of the high risk factors for stroke?
There is an increased risk if you have a family history of stroke or transient ischemic attacks (mini-strokes - also called TIA's). Also, more strokes occur in men. African-Americans have an increased risk of stroke, which in part is thought to be related to genetic factors. A high-fat diet, high blood pressure, exessive alcohol consumption, and being overweight all increase one's risk of having a stroke.

What is heart failure?
Heart failure occurs when the heart loses the ability to pump blood efficiently through the body. The seriousness of the condition depends on how much of the pumping capacity has been lost. Mild heart failure may have little effect on one's life, while severe heart failure interferes with even simple activities and often proves fatal.

What does a heart-healthy diet mean?
Heart-healthy means eating a diet that is low in sodium, cholesterol, and fat. Foods that best meet this requirement are whole grains, fruits, and vegetables. A diet high in sodium, fat and cholesterol is associated with higher blood pressure, increased weight, and elevated blood cholesterol levels, all of which increase the chances that atherosclerosis will occur. Atherosclerosis is the hallmark of coronary artery disease and consists of the build-up of fatty deposits on the inside of the artery walls.

The Diagnosis
If your doctor suspects that you have peripheral vascular disease or if you have symptoms of the disease, several tests are used to make a diagnosis. The following are diagnostic tests that your doctor may order:

Ankle Brachial Index (ABI)
The ABI is a simple non-invasive test that measures the ratio of the blood pressure in your ankle to that in your arm. This ratio may indicate a potential vascular problem.

Ultrasound Doppler Test
This non-invasive test uses sound waves to provide animage of the inside of the blood vessel to determine if a specific artery has plaque build-up.

The Angiogram
Before a final diagnosis is made, you may be asked to undergo an angiogram. A special dye is injected into the arteries under local anesthetic and x-rays are taken. The dye shows up on the x-rays, revealing the arteries and the presence of any narrowing or blockages. Your doctor will explain the risks and benefits of your treatment options and answer any questions you or your family may have.

Treatment Options
Treatment options for atherosclerotic disease include: medication, surgery and minimally invasive interventional procedures such as percutaneous transluminal coronary angioplasty (PTCA), percutaneous transluminal angioplasty (PTA), atherectomy, stent implantation and intravascular radiotherapy. The purpose of these treatments is to eliminate or reduce the symptoms you may have and, in the case of coronary artery disease, decrease your risk of heart attack.

Medications
Medications can be used alone or in combination with one of the treatments. While medications do not eliminate the narrowing of arteries, they can help improve the efficiency of the heart and reduce symptoms such as chest pain (angina), leg pain/ claudication and hypertension.

Bypass Surgery
In the case of coronary artery disease, Coronary Artery Bypass Graft Surgery (CABG), is performed by removing a portion of a small blood vessel from the leg or chest and sewing or “grafting” one end of the bypass to the aorta and the other end to the coronary artery beyond the narrowed area. Blood flows through the new grafted vessel to the heart muscle, “bypassing” or avoiding the blockage in the coronary artery.

Angioplasty
Angioplasty or percutaneous transluminal angioplasty (PTA) and percutaneous transluminal coronary angioplasty (PTCA) are techniques used to widen the narrowing in your artery without surgery. The basic idea of angioplasty is to position a catheter with a small inflatable balloon on the end within the narrowed section of the artery. Inflation of the balloon catheter causes the balloon to push outward against the narrowing and surrounding wall of the artery. This process reduces the narrowing until it no longer interferes with blood flow. The balloon is then deflated and removed from the artery.

Stent Implantation
A stent is a small, latticed, metal scaffold that is introduced into your blood vessel on a balloon catheter. Stents are used for treatment of new lesions or blockages and in areas where restenosis (plaque build-up after treatment) has occurred. The doctor maneuvers the catheter into the blocked artery and inflates the balloon. The stent expands against the vessel wall as the balloon is inflated. Once the balloon has been deflated and withdrawn, the stent stays in place permanently, holding the blood vessel open and improving blood flow.

Intravascular Radiotherapy
Stent placement may reduce the possibility of restenosis but does not prevent its occurrence. Intravascular Radiotherapy is a recent advancement in the treatment of coronary artery disease that has been shown to reduce the occurrence of restenosis. Both beta and gamma radiation are therapeutic options that have shown positive results in clinical trials.

Atherectomy
Directional Coronary Atherectomy (DCA) is a technique by which a catheter with a small mechanically-driven cutter shaves the plaque and stores it in a collection chamber. The plaque is then removed from the artery when the device is withdrawn. Mechanical rotational atherectomy is a technique that uses a diamond-shaped burr that rotates and shaves the plaque into tiny particles, which then pass through the circulatory system.

What is cardiac rehabilitation?
Cardiac rehabilitation is a comprehensive program consisting of monitored exercise, health education and support. It helps people who are recovering from or experiencing a heart problem return to an active life.