The risk of heart disease is serious. Heart disease and strokes kill more than 800,000 Americans each year and cost $445 billion each year, according to the Department of Health and Human Services. Heart disease can affect our ability to work or to enjoy every day activities and those with heart disease have a higher risk of early death.
The good news is that heart disease can be prevented or the risk reduced. By making healthy choices, like quitting smoking (or never starting), and lowering the amount of salt and trans fats we consume we become heart healthy. We CAN live a heart healthy lifestyle by beginning with small steps and building upon a foundation of knowledge and understanding. Change may be easier than you think – even fun!
There is no current American Medical Association (AMA) approved screening test for coronary disease. Diagnosing heart disease depends on the patient’s symptoms and their risk factors. Symptoms of a heart attack typically last longer than 5 minutes and can include:
- 1. Chest pain
- 2. Discomfort in the upper body, including the arms, back, neck or jaw
- 3. Stomach pain
- 4. Shortness of breath
- 5. Nausea
- 6. Breaking out in a cold sweat
- 7. Dizziness
A heart attack is the result of coronary arteries (the arteries that feed the heart nutrition and oxygen) becoming suddenly blocked by a blood clot. When dealing with acute cardiac events, time is crucial. The sooner a person arrives at the hospital, the sooner appropriate treatment can begin. If you have any of the above symptoms and think you may be having a heart attack, seek medical attention immediately.
If medical attention is not immediately available, aspirin is the easiest and most important medicine available for a heart attack. Chewing 4 baby aspirin (81mg each) is the quickest way to get life-saving medicine into the bloodstream. (Persons with severe allergic reactions to aspirin should not take any medicine prior to going to the emergency room.)
If evaluation in the ER shows that a heart attack is occurring, the patient is taken immediately to a cardiac catheterization lab. Most hospitals in NY and LI have cardiac catheterization labs and can provide emergency cardiac angioplasty and stent placement (ballooning and opening of the closed artery.) The angioplasty/stent procedure is most effective if done as soon as possible after the first symptom occurs. Therefore, the sooner a patient arrives in the emergency room, the greater their chances are for recovery of heart muscle function.
When evaluating for underlying coronary disease some basic testing is often done, including a complete history and physical. Your physician will measure your height and weight, take a family history of cardiovascular disease, ask whether you smoke, and record your blood pressure. An electrocardiogram (ECG) is a snapshot of the electrical circuit pattern of your heart and a baseline is important as this pattern should not change over time. With active heart disease, there will be recognizable changes in the ECG. Blood work will focus on sugar and cholesterol levels. Your physician may then order one of the following cardiac specific diagnostic tests:
Holter Monitor: Patients who complain of palpitations, syncope (passing out) or have an irregular heartbeat on an ECG, may undergo monitoring of the heart rhythm with a 24 Hour Holter. This test helps doctors diagnose abnormalities of the electric pattern of the heart.
A Plain Stress Test: A test where you have an ongoing ECG while you walk on a treadmill. This test can clarify symptoms, evaluate blood pressure response to exercise, and determine if the ECG is normal. Women typically have minor baseline ECG abnormalities and interpreting mild changes from this baseline during a stress ECG is difficult.
A Nuclear Stress Test: Incorporates a plain stress test but a nuclear tracer is given via an intravenous line to estimate the blood flow to the heart from the coronary vessels. This is a much more sensitive test for heart disease when the plain stress test is inconclusive.
Echocardiography: This is a sonogram of the heart and looks at heart structure, function, and heart valve problems. A stress echocardiogram compares a resting echocardiogram to an echocardiogram taken following intensive exercise (typically walking on a treadmill). The two sets of images are then compared to determine if the walls of the exercising heart are beating equally compared to resting heart motion.
Cardiac CT Angiography: Also known as 64 slice CT, it is a diagnostic only, very fast CAT scan using IV dye. The CT camera will take pictures of the heart to look for potential blockages of the coronary arteries.
Cardiac Catheterization: Better known as an angiogram, this may need to be done if severe narrowing is suspected because of a CTA, positive stress test or persistent symptoms. This can only be done in a hospital. It is an invasive test that uses a catheter to inject dye right into the coronary arteries. This test has the benefit of being both diagnostic and therapeutic which allows for the opening of blockages at the time of the procedure. If a vessel needs to be opened, a balloon and stent are deployed into the narrow part of the artery.
Common Medications Used in Heart Disease:
Beta-blockers: These are the medicines that end in “lol” like metoprolol, Toprol, atenolol, or carvedilol. These act to lower blood pressure and lower heart rate. The most common side effect from beta-blockers is fatigue, decreased libido, and worsening of depression. They are contraindicated in patients with asthma and COPD.
Ace inhibitors: These are the medicines that end in “pril” like monopril, enalapril, fosinopril, or ramipril. These medications lower blood pressure. They help the heart maintain its shape after a heart attack so it pumps more efficiently. The most common side effect is a dry cough or a tickle in the back of the throat. A very rare but serious side effect is angioedema, which is swelling of the tongue and throat.
ARB’s: These are the “artans” like valsartan (Diovan), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis). These are the “daughter” compounds of the ACE inhibitors. They lower blood pressure but do not lead to the annoying side effect of dry cough. Up until recently, they were not generic and much more expensive than ACE inhibitors.
Statins: – atorvastatin (Lipitor), simvastatin (Zocor), pravastatin (Pravachol), or rosuvastatin (Crestor) – lower bad cholesterol and have been clearly shown to decrease the risk of coronary artery disease. These can cause muscle aches and rarely serious complications of liver toxicity or muscle breakdown. They should be taken at night and never taken with GRAPEFRUIT juice. They should be used with caution with certain antibiotics. Liver tests must be followed regularly while on these medications.
Fibrates: fenofibrate – (Tricor), gemfibrizol (Lopid) lower triglycerides primarily and side effects include gallstones, muscle weakness, GI upset.
Niacin: (Vitamin B3): Niaspan is beneficial because it can lower triglycerides and raise HDL. It can cause symptoms of flushing an therefore it should be taken with a small amount of food and 1 hour after aspirin. Niacin can lead to increased risk of gout attacks and can worsen sugars.
Aspirin: is an antiplatelet agent that was shown to prevent cardiac events including heart attacks and strokes.
Plavix:is also an antiplatelet agent and is most often used after a patient has a stent. It is also used for patients post mini-stroke or with peripheral arterial disease. For patients receiving a stent this medicine SHOULD NEVER BE stopped without contacting your cardiologist. The most common side effect is painless bruising. Rare allergic reaction such as diffuse skin rash can occur. If you experience this, you should contact your physician immediately.
Nitrates: isosorbide dinitrate or isosorbide mononitrate (Isordil and Imdur) act to keep the coronary artery vessels relaxed so they stay dilated. The most common side effects are headaches and low blood pressure.
As you can tell, evaluating coronary disease is a difficult and complicated process. The above articles are not meant to inform you about all the aspects of coronary disease. Instead, our goal is to increase your understanding of this problem so that you can speak to your physician with more confidence about this disease. If you have any questions on cardiac disease, please do not hesitate to make an appointment with your primary care physician or cardiologist.