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Most common heart-related conditions

- provided by America's leading cardiologists

Heart Attack

 


What is a Heart Attack?
A heart attack is caused when a blockage forms in the heart's blood vessels. Knowing what causes a heart attack and how to prevent it could save your life.

Participants:
David F. Kong, MD
David R. Holmes, Jr., MD

Webcast Transcript:

ANNOUNCER: A heart attack is a sudden condition caused by a blockage in the arteries that feed blood to the heart. When that happens, sections of heart muscle can become severely damaged and die.

DAVID F. KONG, MD: Heart attacks are very common. In fact, there are approximately 7 million people in the United States living today who have had a previous heart attack or other symptoms from blockages of the blood vessels that feed the heart.

ANNOUNCER: Myocardial infarction is the medical term for heart attack.

DAVID F. KONG, MD: Myocardial infarction is a blockage of the blood vessels that feed the heart. Fundamentally, "myocardial" means heart muscle, and "infarction" means a strangling, essentially.

ANNOUNCER: A heart attack can lead to heart failure, abnormal heart rhythms, and sometimes death. Cardiac arrest is a dangerous condition that can also result from a heart attack. It occurs when the heart suddenly stops beating.

DAVID F. KONG, MD: Cardiac arrest is when the heart doesn't do its job and doesn't develop a pulse or doesn't develop a blood pressure. As a result, people who have cardiac arrest are often not conscious, have no breathing and have no pulse.

DAVID R. HOLMES, Jr., MD: The difference between a myocardial infarction and a cardiac arrest is incredibly important, because most of the time in patients with myocardial infarction, we can have them survive. They get to the hospital, and we can treat them. The problem with cardiac arrest is that that is often a lethal event. That's the sort of situation where a person is walking down the street, falls over dead.

ANNOUNCER: There are different signs and symptoms of heart attacks that everyone should be aware of.

DAVID R. HOLMES, Jr., MD: The signs and symptoms of a heart attack can vary. The typical sign that we would look for would be the development of chest discomfort or upper body discomfort that lasts. It may be associated with shortness of breath, sweating, but it would be described as a sense of fullness or pressure that lasts for more than 15 minutes.

Women oftentimes have different symptoms, and they often have a delayed presentation: perhaps nausea, perhaps just an uneasy feeling. But not the typical findings that we would usually see in men.

ANNOUNCER: Many times a heart attack can be avoided. There are things you can do to help prevent a heart attack from occurring in the first place.

DAVID F. KONG, MD: There are a lot of risk factors that sometimes people can change to reduce the risk of having a heart attack. These: include level of activity; controlling weight; diet, especially avoiding foods that are high in fat and high in cholesterol, and avoidance of tobacco.

ANNOUNCER: But if you think you may be experiencing a heart attack, what you do early on can affect your chances for survival.

DAVID F. KONG, MD: Aspirin has been considered to be very important in initial treatment of people who are having heart attacks. We know that people who use aspirin can reduce their risk of dying from their heart attack by about 30 percent.

For people experiencing signs or symptoms of a heart attack, the important thing to remember is that time is crucial. The important thing is to dial 911 to get emergency responders available to you, and the sooner that you're able to seek medical attention, the better your odds are of survival and of reducing the amount of impairment that you might have later on.

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How Does a Heart Attack Change Your Life?
After you've already suffered from a heart attack, you are at high risk for a second. Tune in to learn how to help prevent a second heart attack.

Participants:
David F. Kong, MD
David R. Holmes, Jr., MD

Webcast Transcript:

ANNOUNCER: After a person has experienced a heart attack, a full recovery can depend on what happens as soon as they leave the hospital.

DAVID F. KONG, MD: When you leave the hospital, you usually are able to walk, climb stairs and do other things necessary to be safe at home. So as a result, it's important to provide patients with cardiac rehabilitation, supervised exercise that's designed to train the remaining heart muscle to be able to sustain the needs of the patient.

ANNOUNCER: Sometimes the period after a heart attack can be difficult for patients.

DAVID R. HOLMES, Jr., MD: After having a myocardial infarction, a heart attack, there are good changes that can happen and there are bad changes. Depression is a significant problem. Someone comes in with a heart attack that had felt fine, and all of a sudden now their life has changed because they've had a heart attack. And so depression is often unrecognized, often undertreated, but is a major problem following a heart attack.

ANNOUNCER: Preventing a second heart attack is a priority for patients. They will need to control cholesterol levels through diet, increase physical activity on a gradual basis and avoid tobacco products and secondhand smoke. And medications also play a part in prevention.

DAVID R. HOLMES, Jr., MD: The medications that are the standby medications that now become part of the patient's life indefinitely would be continued use of aspirin, number one; would be one of the group of medications called statins, which lower cholesterol, and they have other effects, and they should be on that. We oftentimes prescribe a beta blocker, which makes the heart a little bit more efficient. And then what's called an ACE inhibitor, which lowers the blood pressure, but it also stabilizes the blood vessel wall.

ANNOUNCER: Most people can resume their normal activities in a short period of time.

DAVID R. HOLMES, Jr., MD: We know that with the treatments that we currently provide for patients, they're getting back to work much sooner. In the past, it used to be with a myocardial infarction, a heart attack, patients would be put to bed rest for a long time, weeks. Now we get them up, moving. We have them be involved with physical therapy and exercise training very early on. So within a matter of a few weeks, many patients can return to not physical labor, but to doing other tasks that might be work-related.

Our goals are to improve the patient's function and to return them to a fully satisfactory life. We're not going to make them younger. Whatever age they are, they are. But we can improve the quality of their life, and hopefully the quantity of their life.

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What is Angina?
Angina pectoris is the name for a chest pain or discomfort caused by a lack of blood supply to the heart muscle. Learn more about the signs and symptoms of this common condition.

Participants:
George A. Beller, MD, MACC
Ruth C. Heed Professor of Cardiology, University of Virginia Health System, Charlottesville, Virginia
Spencer B. King, MD, MACC
Fuqua Chair of Interventional Cardiology, Fuqua Heart Center, Piedmont Hospital, Atlanta, GA.
Robert S. Schwartz, MD, FACC
Director of Preclinical Research, Minneapolis Heart Institute, Minneapolis, MN
Eric L. Michelson, MD, FACC
Senior Director, Clinical Development, AstraZeneca

Editorial Consultant:
Suzanne Hughes, MSN, RN

Webcast Transcript:

ANNOUNCER: Angina affects over 6 million Americans. It most often is described as pain or discomfort in the chest. But why does it happen? And what exactly is angina?

ROBERT S. SCHWARTZ, MD, FACC: Angina pectoris is the name for chest pain that’s caused by the heart when it lacks blood. The most frequent cause is plaque that builds up inside the arteries of people’s heart, and when that happens, it stops blood flowing into the heart. The heart is a muscle. The heart needs blood. And when it doesn’t get blood, that lack of blood is manifested as chest pain, chest pain called angina pectoris, or, for short, angina.

GEORGE A. BELLER, MD, MACC: When there is a blockage, there is an impairment of blood flow through that blockage to the heart muscle, particularly under situations like exercise stress, where the heart needs more oxygen, and the only way it gets more oxygen is by getting more blood flow. And if there is an impediment to the blood flow, then there is a sensation of chest pain. It’s the body’s way of warning the person that there’s not enough blood getting to the heart muscle, and that’s actually what is angina.

ANNOUNCER: Although chest pain is common, it’s not the only sensation a person with angina will experience.

ROBERT S. SCHWARTZ, MD, FACC: Angina can manifest itself as many things other than pain. Most common, patients refer to their pain as a pressure, or a band-like sensation, or “an elephant sitting on my chest that makes me short of breath.” Sometimes it presents as a heartburn or a burning sensation in the chest, and not really a true pain per se. Other times it will present as something strange, such as an arm pain or a neck pain or a jaw pain.

ERIC L. MICHELSON, MD, FACC: The manifestations of angina, the symptoms that patients have, because angina is a symptom, vary widely from patient to patient and are interestingly, even the differences between what men and women may typically characterize as being their angina discomfort. Women, for example, may typically have either a feeling of discomfort in their abdomen, GI distress, indigestion, feeling dizzy, feeling shortness of breath, whereas for men it’s just a little bit more typical for them to have that sort of squeezing feeling in their chest.

It’s often a more vague discomfort in both men and women, but for men it’s particularly more of that sort of fist in the chest discomfort, a little less typically for women.

SPENCER B. KING, MD, MACC: Sometimes it’s a mild discomfort. Sometimes it’s an excruciating pain. Sometimes it’s a feeling of impending doom, that something terrible is going to happen. But it’s a quite variable feeling.

The most important thing in recognizing angina is for patients or people to understand that if they have a feeling in the chest, arm, neck that is totally different from anything they’ve felt before, that they should pay attention to that. This could be a manifestation of angina.

ANNOUNCER: For some people, angina is very predictable but for others, it can appear with no warning

GEORGE A. BELLER, MD, MACC: The two types of angina that are described are stable angina, where the chest pain is predictable, like somebody walks from a parking garage, up a hill or up a bunch of steps, and every time they reach the tenth step or so they start feeling this pressure, and they will either stop or take a nitroglycerin, which is the major medication to stop the angina pain.

Unstable angina is when all of a sudden the patient starts to experience discomfort without any provocation. It can occur at rest. Or with very minimal exertion and not go right away when you stop your exercise or take a nitroglycerin. And it can come on repetitively, more frequently and more severe, and that is a warning to get right to the hospital, because the blockage has gotten suddenly worse.

ROBERT S. SCHWARTZ, MD, FACC: Typically, when these pains or these sensations come on with activity or with exertion, it’s important to get in to your doctor very rapidly, because this could mean that the arteries to the heart are developing plaque and are narrowed and that the heart is lacking blood during those times that the sensation occurs.

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How Often Should I Have an Evaluation of My Angina?
If you've been diagnosed with angina, how often you need to be monitored will depend on the severity of the angina. Tune in to learn more about the evaluation process.

Participants:
George A. Beller, MD, MACC
Ruth C. Heed Professor of Cardiology, University of Virginia Health System, Charlottesville, Virginia
Spencer B. King, MD, MACC
Fuqua Chair of Interventional Cardiology, Fuqua Heart Center, Piedmont Hospital, Atlanta, GA.

Editorial Consultant:
Suzanne Hughes, MSN, RN

Webcast Transcript:

ANNOUNCER: If you’ve been diagnosed with angina, follow-up visits with your doctor will be necessary. How often you need to be evaluated will depend on the severity of the angina.

SPENCER B. KING, MD, MACC: You monitor the patient in several ways. One is from a symptom point of view, the patient must be their own physician in some respects. If the angina is becoming more severe, if it’s coming with less effort, this is a reason to have additional evaluation.

In the absence of any of that, periodical evaluation, usually with stress testing, help us understand whether the patient’s lack of blood supply is remaining stable.

GEORGE A. BELLER, MD, MACC: Once someone has diagnosis of angina, there are two approaches that are often taken. One is medical treatment, and the other is getting a stent put in or even having bypass surgery after the full evaluation is done, even catheterization. If either one of those are done, medical therapy or revascularization, it’s called, like a stent or bypass surgery, patients will have to be followed up fairly frequently.

The first visit might be at six weeks after the institution of therapy, or several months. But then after that most patients will have to be followed every six months to make sure that the risk factors that caused the angina are under control, such as high cholesterol, high blood pressure and so forth.

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How is Angina Treated?
If you experience chest pain or discomfort, you may be suffering from angina. Tune in to find out more about this common form of heart disease.

Participants:
Richard P. Lewis, MD, MACC
Professor of Internal Medicine, Ohio State University, Columbus, Ohio
Richard O. Russell, MD

Webcast Transcript:

ANNOUNCER: Angina pectoris, often referred to as angina, is the most common type of heart disease. It's caused when the heart muscle doesn't get enough blood, and it can be treated in a variety of ways.

RICHARD P. LEWIS, MD: The bedrock treatment of angina is drugs. And the main drugs that we use are beta blockers, which are adrenalin-blocking drugs that slow the heart rate and prevent the adverse effects of adrenalin on precipitating heart attacks and abnormal heart rhythms; statin drugs, which lower the blood cholesterol, which have been shown to reduce the incidence of heart attacks and make people live longer and stabilize the heart artery disease that's causing the angina; nitroglycerin for when a person actually has an angina attack; often we will use aspirin and perhaps other blood clot inhibiting drugs as well, depending on the situation; and then we may add high blood pressure medicines if the person also has high blood pressure, which can make his angina more likely to happen.

ANNOUNCER: After diagnosis, medication is the first step in treating angina. But there are other methods doctors can use, including enhanced external counterpulsation or EECP.

RICHARD O. RUSSELL, MD: Counterpulsation is the treatment where cuffs are put on the legs, like stockings with various compartments in the stockings, and over a period of about an hour—and there is a prescribed five days a week, seven weeks of therapyfor an hour or so—these cuffs are pumped full of air, relaxed, pumped full of air and relaxed. And that is pulsation. It doesn't try to keep up with the heart rate. They are just pumped several times a minute. We think it helps to increase the collateral or detour blood flow in the arteries of the heart themselves to deliver more blood to the heart. And it's been astoundingly successful. It doesn't have any complications really. The patients come each day for five days a week, and this counterpulsation seems to improve the circulation to the heart and actually improves angina. It decreases the frequency of angina pectoris.

Lifestyle change will also play an important role after you've been diagnosed with angina.

RICHARD P. LEWIS, MD: If a person develops angina, they must stop smoking first. Smoking accelerates the process of heart artery disease and makes a heart attack and sudden death more likely to happen. In most cases, you need to lose some weight and change your diet. Getting regular exercise: It turns out that if you exercise regularly, not only does it help your blood lipids, but it makes your body less likely to have a heart attack. It lowers the level of inflammation in the heart arteries, which is what makes the disease progress. So exercise is very important.

I tell people that have angina to listen to their body. It's amazing. "Some days," people say, "I can do anything I want to. Other days I just go up a flight of stairs and I get my angina." I tell people that if you're feeling well when you're doing it, it's okay. Your heart will let you know.

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What Conditions Can Lead to Heart Failure?
Heart failure affects approximately 5 million people in the United States. It can be caused by a number of conditions and treatment options may vary depending on the cause.

Participants:
Mandeep R. Mehra, MBBS, FACC
Professor and Head of Cardiology, University of Maryland, Baltimore, MD
Eric L. Michelson, MD, FACC
Senior Director, Clinical Development, AstraZeneca
Jacqueline A. Noonan, MD, FACC
Pediatric cardiologist, University of Kentucky College of Medicine, Lexington, Kentucky

Editorial Consultant:
Suzanne Hughes, MSN, RN

Webcast Transcript:

ANNOUNCER: Heart failure affects approximately five million people in the United States. It can be caused by a number of conditions and treatment options may vary depending on the cause

MANDEEP R. MEHRA, MBBS, FACC: The two most common conditions that lead to heart failure in the United States, and perhaps worldwide, are high blood pressure and the development of coronary artery disease. Thus almost any risk factor that is associated with the development of coronary artery disease will also typically be a risk factor for the development of heart failure. For example, smoking, poor lifestyle, diabetes, obesity. Even a family history of heart disease is a very, very important risk marker or a risk factor for the future development of heart failure.

Eric L. Michelson, MD, FACC: Patients who had previous heart attacks due to blockage of coronary arteries is another very common reason.

There are a number of other causes, all with relatively small proportions of patients having those conditions, and many of these we sort of lump together and call idiopathic, because by the time the patient gets to us, we're not quite sure which one of these may have been the specific cause.

JACQUELINE A. NOONON, MD, FACC: It's possible to develop heart failure from severe anemia, because your heart has to beat so hard and to try to make up for the low hemoglobin in your blood.

You can have heart failure if you're born with heart disease. Children with large holes in their heart can develop heart failure.

Then there are things that can happen. You had a normal heart, but then you got an infection. You got what's called myocarditis. That could cause heart failure.

You could be born with a tendency to develop what we call a cardiomyopathy and, again, that might not show up. Might show up when you're a child, but sometimes it doesn't show up until you're an adult.

So there are many, many causes of cardiac failure. And it's important to find out what the cause is because the treatment may differ, depending on the cause.

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What is Bypass Surgery?
Coronary bypass is a form of heart surgery that uses new arteries to "bypass" and replace clogged heart arteries. Tune in to learn more about this important type of heart surgery.

Participants:
Lawrence I. Bonchek MD

Webcast Transcript:

ANNOUNCER: A coronary bypass is a type of heart surgery that re-routes blood vessels around heart arteries that have become clogged with cholesterol build-up.

LAWRENCE I. BONCHEK, MD: Bypass surgery is done in order to route blood around obstructions in the coronary arteries, which are the arteries that supply blood to the heart. They're actually very small arteries, so it doesn't take a lot of cholesterol buildup in the wall of the artery to block an artery that size.

Surgeons will take a healthy blood vessel like an artery from the chest wall or a vein from the leg, and then connect the blood vessel above and below the blockage to bypass it.

LAWRENCE I. BONCHEK, MD: There are two major ways that bypass surgery is done nowadays, and people will hear the terms off-pump and on-pump bypass surgery. Traditionally, bypass surgery has always been done with a heart-lung machine so that the heart could be stopped and the lungs are not being inflated, and the heart-lung machine is doing those functions while the heart is absolutely stationary to allow very precise, meticulous sewing while the bypasses are being attached.

But in recent years, with advances in technology, there have been pieces of equipment developed that allow you to stabilize a small area of the heart that you're working on, and to do the bypass operation without the heart-lung machine. And that's known as off-pump bypass surgery.

ANNOUNCER: Lifestyle modifications are important after surgery so that the new blood vessels don't become blocked as well.

LAWRENCE I. BONCHEK, MD: The most common lifestyle modifications are correcting all the bad things that people have been doing beforehand, such as not smoking. They should lose weight. They should watch the salt in their diet. They should eat a healthier diet.

ANNOUNCER: Bypass surgery is still a major procedure, but most people can be fully recovered and active in as little as two months.

LAWRENCE I. BONCHEK, MD: My advice to anyone who has had bypass surgery is to enjoy life, because that's the purpose of having the surgery so that they can get back to full and normal activity.

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The information published on this page has been provided by the Heart Authority
in collaboration with Cardiosource – American College of Cardiology
Copyright 2005 Whitby Cardiovascular Institute. All rights reserved.