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.
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.
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.
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.
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.
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.
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.
The information
published on this page has been provided by the
Heart Authority
in collaboration with Cardiosource – American College of Cardiology
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