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Saturday, June 28, 2008

What is heart disease?








Heart disease is a number of abnormal conditions affecting the heart and the blood vessels in the heart. Types of heart disease include:
Coronary artery disease (CAD) is the most common type and is the leading cause of heart attacks. When you have CAD, your arteries become hard and narrow. Blood has a hard time getting to the heart, so the heart does not get all the blood it needs. CAD can lead to:
Angina. Angina is chest pain or discomfort that happens when the heart does not get enough blood. It may feel like a pressing or squeezing pain, often in the chest, but sometimes the pain is in the shoulders, arms, neck, jaw, or back. It can also feel like indigestion (upset stomach). Angina is not a heart attack, but having angina means you are more likely to have a heart attack.
Heart attack. A heart attack occurs when an artery is severely or completely blocked, and the heart does not get the blood it needs for more than 20 minutes.
Heart failure occurs when the heart is not able to pump blood through the body as well as it should. This means that other organs, which normally get blood from the heart, do not get enough blood. It does NOT mean that the heart stops. Signs of heart failure include:
Shortness of breath (feeling like you can't get enough air)
Swelling in feet, ankles, and legs
Extreme tiredness
Heart arrhythmias are changes in the beat of the heart. Most people have felt dizzy, faint, out of breath or had chest pains at one time. These changes in heartbeat are, for most people, harmless. As you get older, you are more likely to have arrhythmias. Don't panic if you have a few flutters or if your heart races once in a while. If you have flutters AND other symptoms such as dizziness or shortness of breath (feeling like you can't get enough air), call 911 right away.

Do women need to worry about heart disease?
Do women of color need to worry about heart disease?


What can I do to prevent heart disease?
What does high cholesterol have to do with heart disease?
What do my cholesterol and triglyceride numbers mean?
How can I lower my cholesterol?
How do I know if I have heart disease?
What are the signs of a heart attack?
One of my family members had a heart attack. Does that mean I'll have one too?
Sometimes my heart beats really fast and other times it feels like my heart skips a beat. Am I having a heart attack?
Should I take a daily aspirin to prevent heart attack?
Does taking birth control pills increase my risk for heart disease?
Does using the birth control patch increase my risk for heart disease?
Does hormone replacement therapy (HRT) increase a woman's risk for heart disease?
See also...
Diabetes: Overview
Heart Healthy Eating
How to Talk to Your Doctor About Heart Disease and Heart Health
Menopause and Menopause Treatments
Obesity and Weight Loss
Physical Activity
Stress and Your Health




Heart Failure:





Everyone with heart failure should be recognised and offered appropriate evidence based care.
Literature search: Comprehensive systematic search to July 2002 plus selected update searches to December 2003 as advised by review groups
NICE guidelines have recently been published on the management of chronic heart failure in adults in primary and secondary carei. The guidelines include over 90 recommendations with algorithms for diagnosis and for pharmacological treatment. The following recommendations were identified as priorities for implementation:
Diagnosis
The basis for historical diagnoses of heart failure should be reviewed, and only patients whose diagnosis is confirmed should be managed in accordance with the guideline
Doppler 2D echocardiograhic examination should be performed to exclude important valve disease, assess the systolic (and diastolic) function of the (left) ventricle and detect intracardiac shunts
Treatment
All patients with heart failure due to left ventricular systolic dysfunction should be considered for treatment with an ACE inhibitor
Beta blockers licensed for use in heart failure should be initiated in patients with heart failure due to left ventricular systolic dysfunction after diuretic and ACE inhibitor therapy (regardless of whether or not symptoms persist)
Monitoring
All patients with chronic heart failure require monitoring. This monitoring should include:
a clinical assessment of functional capacity, fluid status, cardiac rhythm, and cognitive and nutritional status
a review of medication, including need for changes and possible side effects
serum urea, electrolytes and creatinine
Discharge
Patients with heart failure should generally be discharged from hospital only when their clinical condition is stable and the management plan is optimised
The primary care team, patient and carer must be aware of the management plan
Supporting patients and carers
Management of heart failure should be seen as a shared responsibility between patient and healthcare professional
i. Chronic heart failure: Management of chronic heart failure in adults in primary and secondary care. London: National Institute for Clinical Excellence, July 2003http://www.nice.org.uk/pdf/Full_HF_Guideline.pdf [full guideline]http://www.nice.org.uk/pdf/CG5NICEguideline.pdf [NICE guideline][accessed 22.12.03](Evidence based guideline – systematic literature search to 2002 for specific study types based on clinical questions set out by the technical team)


















Frequently Asked Questions
Call 1-866-344-0625For additional details about the PEERLESS-HF clinical research study and HeartNet™ device for the treatment of heart failure.

A heart-to-heart about HF:



Whether you know it as heart failure, congestive heart failure or HF, chances are you know how debilitating the symptoms of heart failure can be: being constantly tired or fatigued, chest pain, weight gain caused by fluid retention, swelling (edema) in your legs and shortness of breath may diminish your quality of life.
If you’ve been diagnosed with heart failure, you’re not alone. According to the National Institutes of Health, about 5 million Americans have heart failure.
Advances in medical technology mean that new investigational devices and therapies for the treatment of heart failure may be available. One of these is the HeartNet™ procedure.
If lifestyle changes and medications such as beta blockers, diuretics and ACE inhibitors have not controlled your heart failure symptoms, you might be eligible to participate in the PEERLESS-HF clinical research study
You can start by taking a short online evaluation that will let you know if you could be a candidate for the study*, or you can call our toll-free, nurse-staffed information line at 1-866-344-0625 to find out more about the clinical research study and the investigational device.









Medical Protection for Seniors - 24 hours/7 days a week Call (800) 815 - 5922

In a Home fall emergency, a senior usually can not reach the telephone. She or He may lay on the floor for hours or days, disconnected from any help. This injury can become life threatening.

A simple press of a button will instantly activate Life Alert's small base unit located in the house. This small base unit will immediately communicate with our Central Monitoring Station, initiating amplified two-way voice communication between the senior and our emergency operators. If there is no voice response, we will call a neighbor to check on the senior. If needed, we will also contact the authorities: Paramedics, Fire Department or Police.





Alternative Names:



Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD
Causes
Coronary heart disease is usually caused by a condition called atherosclerosis, which occurs when fatty material and a substance called plaque builds up on the walls of your arteries. This causes them to get narrow. As the coronary arteries narrow, blood flow to the heart can slow down or stop, causing chest pain (stable angina), shortness of breath, heart attack, and other symptoms.
Coronary heart disease (CHD) is the leading cause of death in the United States for men and women. According to the American Heart Association, more than 15 million people have some form of the condition.
Men in their 40s have a higher risk of CHD than women. But, as women get older, their risk increases so that it is almost equal to a man's risk. See: Heart disease and women
Many things increase your risk for CHD. Bad genes (heredity) can increase your risk. You're more likely to develop the condition if someone in your family has had it -- especially if they had it before age 50. Your risk for CHD goes up the older you get.
The following factors also increase your risk of CHD:
Diabetes
High blood pressure
High LDL "bad" cholesterol
Low HDL "good" cholesterol
Menopause
Not getting enough physical activity or exercise
Obesity
Smoking
Higher-than-normal levels of inflammation-related substances may also increase your risk for a heart attack. Such substances include C-reactive protein and fibrinogen. Increased levels of a chemical called homocysteine, an amino acid, are also linked to an increased risk of a heart attack.
Symptoms »



Symptoms may be very noticeable, but sometimes you can have the disease and not have any symptoms.
Chest pain or discomfort (angina) is the most common symptom. You feel this pain when the heart is not getting enough blood or oxygen. How bad the pain is varies from person to person.
There are two main types of chest pain:
Atypical chest pain -- often sharp and comes and goes. You can feel it in your left chest, abdomen, back, or arm. It is unrelated to exercise and not relieved by rest or a medicine called nitroglycerin. Atypical chest pain is more common in women.
Typical chest pain -- feels heavy or like someone is squeezing you. You feel it under your breast bone (sternum). The pain usually occurs with activity or emotion, and goes away with rest or a medicine called nitroglycerin.
Adults with typical chest pain have a higher risk of CHD than those with atypical chest pain.
Other symptoms include:
Shortness of breath



Heart attack -- in some cases, the first sign of CHD is a heart attack In-Depth Symptoms »
Exams and Tests »
Many tests help diagnose CHD. Usually, your doctor will order more than one test before making a definite diagnosis.
Tests may include:
Electrocardiogram (ECG)
Exercise stress test
Echocardiogram
Nuclear scan
Coronary angiography/arteriography
Electron-beam computed tomography (EBCT) to look for calcium in the lining of the arteries -- the more calcium, the higher your chance for CHD
Coronary CT angiography
Magnetic resonance angiography In-Depth Diagnosis »





Treatment depends on your symptoms and how severe the disease is.
If you have coronary artery disease that does not cause symptoms, you can be treated with either medicine or angioplasty with stenting. Recent studies show that medicine and angioplasty with stenting have equal benefits. Angioplasty with stenting does not help you live longer, but it can reduce angina or other symptoms of CHD.
Angioplasty with stenting, however, can be a life-saving procedure if you are having a heart attack.
Medications used to treat CHD include:
ACE inhibitors to lower blood pressure
Blood thinners (antiplatelet drugs) to reduce your risk of blood clots
Beta-blockers to lower heart rate, blood pressure, and oxygen use by the heart
Calcium channel blockers to relax arteries, lowering blood pressure and reducing strain on the heart
Diuretics to lower blood pressure
Nitrates (such as nitroglycerin) to stop chest pain and improve blood supply to the heart
Statins to lower cholesterol
Procedures to treat and diagnose CHD are called percutaneous coronary interventions, or PCIs. Angioplasty and stenting are types of PCIs. Other types include:
Coronary atherectomy
Coronary radiation implant or coronary brachytherapy
Coronary brachytherapy delivers radiation into the coronary arteries. This treatment is only for patients who have had a stent-related problems.
Surgeries used to treat CHD include:





Lifestyle changes are very important. Your doctor may tell you to:
Avoid or reduce the amount of salt (sodium) you eat
Eat a heart healthy diet -- one that is low in saturated fats, cholesterol, and trans fat
Get regular exercise and maintain a healthy weight
Keep your blood sugar strictly under control if you have diabetes
Stop smoking In-Depth Treatment »
Outlook (Prognosis)
Everyone recovers differently. Some people can maintain a healthy life by changing their diet, stopping smoking, and taking medications exactly as the doctor prescribes. Others may need medical procedures such as angioplasty or surgery.
Although everyone is different, early detection of CHD generally results in a better outcome.
Possible Complications





Sudden death
When to Contact a Medical Professional
If you have any of the risk factors for CHD, set up an appointment with your doctor to discuss prevention and possible treatment.
If you have angina, shortness of breath, or symptoms of a heart attack, immediately contact your health care provider, call the local emergency number (such as 911), or go to the emergency room.
Prevention »



See your health care provider regularly. Tips for preventing CHD or lowering your risk of the disease:
Avoid or reduce stress as best as you can.
Don't smoke.
Eat well-balanced meals that are low in fat and cholesterol and include several daily servings of fruits and vegetables.
Get regular exercise. If your weight is considered normal, get at least 30 minutes of exercise every day. If you are overweight or obese, experts say you should get 60 to 90 minutes of exercise every day.
Keep your blood pressure, blood sugar, and cholesterol under control.
Moderate amounts of alcohol (1 glass a day for women, 2 for men) may reduce your risk of cardiovascular problems. However, drinking larger amounts does more harm than good.
If you have one or more risk factors for coronary heart disease, talk to your doctor about possibly taking an aspirin a day to help prevent a heart attack or stroke. Low-dose aspirin therapy may be prescribed if the benefit is likely to outweigh the risk of gastrointestinal side effects.
New guidelines no longer recommend hormone replacement therapy, vitamins E or C, antioxidants, or folic acid to prevent heart disease.In-Depth Prevention »


References »
Mosca L, Banka CL, Benjamin EJ, et al. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update. Circulation. 2007; Published online before print February 19, 2007.
Smith SC Jr, Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute. Circulation. 2006 May 16;113(19):2363-72. Erratum in: Circulation. 2006 Jun 6;113(22):e847.
Boden WE, O'rourke RA, Teo KK, et al. Optimal Medical Therapy with or without PCI for Stable Coronary Disease. N Engl J Med. 2007 Mar 26; [Epub ahead of print].
American Heart Association. Heart Disease and Stroke Statistics — 2007 Update. Dallas, Texas: American Heart Association; 2007.


National Heart, Lung, and Blood Institute (NHLBI)Phone Number(s): (301) 592-8573Internet Address: http://www.nhlbi.nih.gov/index.htm

National Cholesterol Education ProgramNational Heart, Lung, and Blood Institute (NHLBI)Internet Address: http://www.nhlbi.nih.gov/about/ncep/

National High Blood Pressure Education ProgramNational Heart, Lung, and Blood Institute (NHLBI)Internet Address: http://www.nhlbi.nih.gov/about/nhbpep/index.htm

Act In Time to Heart Attack Signs CampaignNational Heart Attack Alert ProgramNational Heart, Lung, and Blood Institute (NHLBI)Phone Number(s): (301) 592-8573Internet Address: http://www.nhlbi.nih.gov/actintime/

The Heart TruthNational Awareness Campaign for Women about Heart DiseaseNational Heart, Lung, and Blood Institute (NHLBI)Internet Address: http://www.nhlbi.nih.gov/health/hearttruth/index.htm

American Heart AssociationPhone Number(s): (800) 242-8721Internet Address: http://www.americanheart.org/

WomenHeartPhone Number(s): (202) 728-7199Internet Address: http://www.womenheart.org/

All material contained in this FAQ is free of copyright restrictions, and may be copied, reproduced, or duplicated without permission of the Office on Women's Health in the Department of Health and Human Services. Citation of the source is appreciated.
This FAQ was reviewed by:
Patrice Desvigne-Nickens, M.D.Leader, Cardiovascular Medicine SRGClinical and Molecular Medicine ProgramDivision of Heart and Vascular DiseasesNational Heart, Lung, and Blood Institute.

Heart Disease Overview :
Heart disease includes conditions affecting the heart, such as coronary heart disease, heart attack, congestive heart failure, and congenital heart disease. Heart disease is the leading cause of death for men and women in the U.S. Keys to prevention include quitting smoking, lowering cholesterol, controlling high blood pressure, maintaining a healthy weight, and exercising.

Heart Health Glossary:
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