Most common heart-related
conditions
- provided by America's leading
cardiologists
Heart Disease Prevention / Risk
Factors
Heart disease is a leading cause of death for Americans,
but with education and awareness, you can take healthy
steps to keep your heart in good shape. Avoiding
risk factors, carefully planning and following a
healthy diet and even simple exercises can help
you avoid the dangers of heart disease.
Can Cardiovascular Disease be Prevented?
More than seventy million Americans suffer
from cardiovascular disease, which is a disease
of the heart or blood vessels. Tune in to find out
if you're at risk for it.
Participants:
Richard P. Lewis, MD, MACC
Professor of Internal Medicine, Ohio State University,
Columbus, Ohio
Suzanne Hughes, MSN, RN
Education Coordinator, Center for Family Medicine,
Akron General Medical Center, Akron, Ohio
Adolph M. Hutter Jr, MD, MACC, FAHA, FESC
Past President and Editor-in-Chief Conversations
with the Experts American College of Cardiology
Webcast Transcript:
Cardiovascular disease affects all aspects
of heart function, from the arteries that
supply it with
blood, to the valves to the heart muscle
itself.
RICHARD P. LEWIS, MD: Cardiovascular disease is
the commonest chronic illness in our society, and
I think in the world now. It causes about half of
the deaths in our country today in one form or another,
either as a heart attack or sudden death or dying
of congestive heart failure.
Strokes are also a manifestation of cardiovascular
disease, and a final one is called intermittent
claudication, which is disease to the leg blood
vessels that may lead to an amputation of the legs
if it's severe.
ANNOUNCER: There are factors that can add to a
patient's risk for the disease.
SUZANNE HUGHES, MSN, RN: There are only three risk
factors for heart disease that we can't change.
We haven't found the Fountain of Youth, so we can't
turn back the clock: Age is a huge risk factor for
cardiovascular disease. Being a man early in life
is a risk factor for heart disease, which certainly
is not changeable. And then the third thing is that
we can't choose our parents. Family history is a
risk factor for cardiovascular disease.
ANNOUNCER: Different medications can be prescribed
to help prevent or control cardiovascular disease
ADOLPH M. HUTTER, Jr., MD: There are a number of
medications that are actually very effective in
preventing heart attacks and other forms of atherosclerosis.
One is the simple drug aspirin. Aspirin has been
shown to reduce strokes in women and heart attacks
in men.
Another very important class of drugs are the drugs
called statins. The statins are drugs that lower
the bad cholesterol, the LDL. They lower it very
effectively, and many studies have shown that these
drugs can prevent the onset of heart disease and
the progression of heart disease if you already
have it.
A class of drugs called beta blockers can be very
effective in protecting people who have already
had a heart attack. They're also helpful in controlling
blood pressure and controlling angina, which is
a symptom of chest discomfort due to a blockage
in the artery.
ANNOUNCER: It is also crucial that a patient makes
lifestyle modifications.
ADOLPH M. HUTTER, Jr., MD: Heart disease is very
preventable. You must absolutely stop smoking. You
must have a low cholesterol, particularly the low
bad cholesterol, the LDL. You must have your blood
pressure controlled. You should exercise regularly
and keep a lean weight.
RICHARD P. LEWIS, MD: We have made enormous strides
in treating cardiovascular disease in all types.
We can prevent the progression of this disease or
the occurrence of clinically significant disease
with our modern treatments if people will but do
them. And it's not a disaster, even if you have
the disease.
Do I Have a Normal Body Mass Index?
BMI is an often-discussed topic today. Learn
the basics about this tool doctors use to measure
obesity.
Participants:
Suzanne Hughes, MSN, RN
Education Coordinator, Center for Family Medicine,
Akron General Medical Center, Akron, Ohio
Webcast Transcript:
ANNOUNCER: With obesity such a critical issue
for Americans today, it's important to know
the key
indicators used to determine whether a person
is overweight. One example is BMI, or body mass
index.
SUZANNE HUGHES, MSN, RN: Body mass index is kind
of a term that we've been using over the last several
years. People might remember in the past they had
those insurance charts, and you'd look up what your
height was, and then it would tell you how much
you were kind of allowed to weigh for a given height.
That has now been kind of changed to a single figure,
and there is a rather elaborate formula to calculate
one's own body mass index. But most often, we as
health care providers use a chart or a wheel to
sort of key in someone's height and weight and then
see what their body mass index number is.
ANNOUNCER: A normal BMI for adults falls between
18.5 and 24.9. Twenty-five to 29.9 is overweight.
Thirty or above is considered obese and varies in
severity.
Another method physicians use to help determine
obesity is by measuring waist circumference. Over
time, excess fat around a patient's mid-section
has been linked to an increased risk of heart disease
and other obesity-related conditions like diabetes
and metabolic syndrome.
What Should Women Know About Heart Disease?
Heart disease kills 32 percent of women each
year, meaning that more women than men die from heart
disease. Tune in to learn the facts about women and
heart disease.
Participants:
Suzanne Hughes, MSN, RN
Education Coordinator, Center for Family Medicine,
Akron General Medical Center, Akron, Ohio
Noel Bairey Merz, MD
Webcast Transcript:
ANNOUNCER: Heart disease is the number one killer
of women in the United States, and eight million
women are currently living with this condition.
SUZANNE HUGHES, MSN, RN: People often think that
we're hearing more about women and heart disease
because women are out in the workplace and leading
lives more similar to men. In fact, heart disease
has always been a leading cause of death in women
C. NOEL BAIREY MERZ, MD: One in three women will
die of heart disease in their lifetime, and one
in two women in their lifetime will develop or suffer
from what we call cardiovascular disease, which
includes heart disease, as well as high blood pressure.
There are five major risk factors that determine
the majority of heart disease risk. Number one is
cigarette smoking. Number two is high blood pressure.
Number three is high blood cholesterol. Number four
is diabetes. And number five is a family history
of premature coronary heart disease.
ANNOUNCER: Another risk factor for women is age.
Nearly 35 percent of women over age 45 have some
form of heart disease. And the risk for heart disease
increases in postmenopausal women.
SUZANNE HUGHES, MSN, RN: We know that after menopause,
women do have a much higher incidence of heart disease.
There's been so much controversy around the area
of postmenopausal hormone therapy. And, from a heart
disease standpoint, the current message is very
simple: that postmenopausal hormone therapy should
not be considered a tool for heart disease prevention.
ANNOUNCER: With hundreds of thousands of women
suffering and dying from heart-related issues each
year, what can women do to prevent heart disease?
SUZANNE HUGHES, MSN, RN: The message about prevention
in women is so important. We know that women tend
to take care of everybody else before they take
care of themselves. So women who make sure that
their spouse or their significant other gets the
important preventive maintenance checkups are the
same women that might not follow that same advice
in themselves.
C. NOEL BAIREY MERZ, MD: There are five health
habits that are associated with an 82 percent risk
reduction of heart disease for women in their lifetime.
They are: not smoking; doing some type of physical
activity 30 minutes per day; eating a heart-healthy,
nutritional regimen filled with things like fish,
legumes, which are nuts or beans, fruits and vegetables,
multiple daily servings, and complex carbohydrates.
The fourth health habit is avoid being obese, defined
as being 20 percent over your ideal body weight.
So we're not talking about 10, 12 pounds. We're
talking about 30, 40, 50 pounds overweight. And
the final health habit, speak with your own health
care provider, is a single serving of alcohol per
day. So these are simple things, hard to do every
day, but things that you can do in your own life
that dramatically can reduce your risk of heart
disease as a woman.
What Is Hypertension?
Millions of Americans have hypertension,
also known as high blood pressure, without knowing
it. Tune in to learn more about this silent killer.
Participants:
Jamie B. Conti, MD
Adolph M. Hutter Jr, MD, MACC, FAHA, FESC
Past President and Editor-in-Chief Conversations
with the Experts American College of Cardiology
Suzanne Hughes, MSN, RN
Education Coordinator, Center for Family Medicine,
Akron General Medical Center, Akron, Ohio
Robert S. Schwartz, MD, FACC
Director of Preclinical Research, Minneapolis Heart
Institute, Minneapolis, MN
Webcast Transcript:
ANNOUNCER: Hypertension is the medical term for
high blood pressure. In the United States alone,
as many as 65 million adults have high blood
pressure, and the older you are, the higher
the risk for
developing hypertension.
SUZANNE HUGHES, MSN, RN: It's very common to develop
hypertension later in life. If one makes it to age
55 with normal blood pressure, their risk of developing
high blood pressure yet in their lifetime is around
90 percent. It's an important thing for people to
realize that, particularly in the early stages,
there are no symptoms of hypertension or high blood
pressure and that's why the condition has gotten
the name "the silent killer," because
damage is being done to the end organs in the absence
of any symptoms at all.
ANNOUNCER: Blood pressure is measured by two numbers.
The larger number, known as systolic pressure, and
the smaller number, which is called diastolic pressure.
An ideal blood pressure reading would be equal to
or less than 120/80. A reading of 140/90 or higher
would be considered hypertension. If left undiagnosed
or uncontrolled, hypertension can cause a multitude
of medical conditions.
JAMIE B. CONTI, MD: High blood pressure can cause
several major problems, including stroke, kidney
failure and heart disease, both coronary artery
disease and heart failure. And the relationship
is in the arteries. And the longer the arteries
are under high blood pressure, the more the other
organs are affected. So ignoring one's blood pressure
over the long term is a really bad idea.
ANNOUNCER: Fortunately, once diagnosed, hypertension
can be controlled through lifestyle changes and
medication.
ADOLPH M. HUTTER, JR., MD: One of the basic treatments
for hypertension is a low salt diet. If you get
rid of the extra salt, you get on a low salt diet,
that in itself will help lower your blood pressure.
SUZANNE HUGHES, MSN: We know that it's very important
for people that have been identified as having hypertension
to avoid or quit tobacco products. Additionally,
following what we call the DASH diet: Dietary Approaches
to Stop Hypertension. This is a diet that's low
in fat, it's high in fruits and vegetables and it
also has two to three servings a day of low-fat
dairy products.
ROBERT S. SCHWARTZ, MD: Many drugs are available
that can lower the blood pressure. Or possibly lowering
the amount of water in a person's body through giving
agents that are diuretics, that is, causing water
to be lost through the urine. Other classes of drugs
do things such as relax the heart or slow the heart
rate down, all of which can lower the blood pressure
directly.
SUZANNE HUGHES, MSN, RN: I think the important
thing that people need to remember is, if one has
hypertension, it will take an average of 2.7 medications
to manage that high blood pressure.
ANNOUNCER: No matter how healthy you feel, there
is still one sure-fire way to find out if you suffer
from hypertension: Visit your physician on a regular
basis
ADOLPH M. HUTTER, JR., MD: Hypertension can be
without any symptoms. You may have hypertension
and not know it because you don't have headaches
or flushing, and you feel wonderful. So you need
to get your blood pressure checked.
What is Ejection Fraction and Why is it Important?
How does the amount of blood you heart pump
affect your health? Get the facts about this key function
of the heart.
Participants:
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
Nanette K. Wenger, MD, M.A.C.P., F.A.C.C., F.A.H.A.
Professor of Medicine, Division of Cardiology, Emory
University School of Medicine, Atlanta, Georgia
Webcast Transcript:
ANNOUNCER: In understanding how the heart works,
it important to know the meaning of the term "ejection
fraction."
ERIC MICHELSON, MD: The heart is a very effective
pump, and under normal conditions every time the
heart fills with blood, the pumping chambers, the
major chambers, the ventricles, eject that blood
into the major blood vessels. Ejection fraction
is a measure of the pumping function of the heart.
At rest, a normal person may have an ejection fraction
of approximately 55 percent. That means when the
pump is full and contracts, 55 percent of the blood
that was in the heart before it began to contract
is now ejected.
JACQUELINE NOONAN, MD: When you're not able to
maintain that normal level, it's usually because
your heart is not functioning well as a pump. Because,
remember, the heart is a pump. It's a muscle that
pumps blood and, when your ejection fraction is
low, it means the pump isn't working as well as
it should.
NANETTE KASS-WENGER, MD: The lower the ejection
fraction, the worse the pumping function of your
heart, and ejection fractions lower than 30 or 35
percent have a number of adverse consequences on
your health.
What Does it Mean to Have a Low Ejection Fraction?
An ejection fraction is a measurement of
the amount of blood pumped out of the heart with each
beat. Find out what the experts say are normal and
below normal numbers.
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
Nanette K. Wenger, MD, M.A.C.P., F.A.C.C., F.A.H.A.
Professor of Medicine, Division of Cardiology, Emory
University School of Medicine, Atlanta, Georgia
Webcast Transcript:
ANNOUNCER: Ejection fraction is the measure of the
amount of blood pumped out of the heart during each
beat.
MANDEEP MEHRA: An ejection fraction less than 35
percent refers to what we call severe to moderate
left ventricular dysfunction, and this is essentially
a decline in the pumping capacity of the heart that
qualifies a patient as being in the realm of what
is referred to as systolic heart failure.
ERIC MICHELSON, MD: Normally, the ejection fraction
at rest, sitting quietly, might be a number of approximately
55 percent. Patients who have had some damage to
the heart will have an ejection fraction often that's
some number less than that 55 percent. Many patients
often remain asymptomatic or only minimally symptomatic
when the ejection fraction might be even 40 or 45
percent. Typically, as the ejection fraction begins
to drop below a number such as 40, many more patients
are typically symptomatic, and patients whose ejection
fraction is less than 35 percent more often than
not will not be able to do all the things they'd
previously been able to do. It might be such patients
have easy fatigability. They may have shortness
of breath. They may even have difficulty sleeping
at night.
ANNOUNCER: Although most patients don't know if
their ejection fraction is low, it is important
to consult a physician if you have health concerns
or risk factors related to heart disease.
ERIC MICHELSON, MD: So patients who have cardiovascular
risk factors or conditions and begin to develop
symptoms such as easy fatigability, inability to
do the activities that they usually do with having
some symptoms, being short of breath, having trouble
sleeping, seeing that their ankles are swollen,
such patients should not just assume it's part of
the normal everyday aging process, but should seek
medical attention.
NANETTE KASS-WENGER, MD: The patient who has a
low ejection fraction at times may be completely
free of symptoms, have a perfectly normal exercise
tolerance, not have shortness of breath, and these
are the patients where we as clinicians are challenged
to make the diagnosis, because these are the patients
where the institution of appropriate medical treatments
has the likelihood of preventing the progression
of the disease or preventing adverse consequences.
What is the Prophylaxis for Endocarditis?
Learn what factors may dictate whether you
need treatment to prevent an infection in your heart.
Participants:
Jacqueline A. Noonan, MD, FACC
Pediatric cardiologist, University of Kentucky College
of Medicine, Lexington, Kentucky
Webcast Transcript:
ANNOUNCER: For those with structural heart disease,
and important question is: What is the prophylaxis
for endocarditis?
JACQUELINE NOONAN, MD: Well, the prophylaxis for
endocarditis is medicine that you take when you
are undergoing a procedure that would put you at
risk for what we call bacteremia. That is, something
happening where there are germs that are likely
to get into your blood. And we know now that, if
you go into the dentist, and he scrapes all your
tartar away or if he pulls your teeth that, if you
checked somebody's blood right afterwards, they
will find that there are germs in your blood, some
bacteria, which usually the body clears. But if
you have any kind of structural heart disease, unfortunately,
those bacteria, as they're in your bloodstream,
might land on this area in your heart and set up
housekeeping there, and you could get an infection
on your heart, which is called endocarditis.
So it's recommended when you go to the dentist,
when you get dental work done, most kinds of dental
work, not everything, it's also recommended when
you have procedures where they are going to be intubating
you, where there might be some risk, where they're
going to have urologic procedures.
You don't want to put a lot of people at risk who
have very little chance of getting endocarditis
from what they're doing and have the chance of perhaps
having them have a allergic reaction to the drug,
to perhaps having a drug then become resistant when
they really need it. So I think most physicians
would feel obliged to recommend prophylaxis for
somebody with structural heart disease when they
undergo invasive procedures of any kind.
What are the Consequences
of High Cholesterol??
Learn the basics of high cholesterol, and
it's consequences on the cardiovascular system.
Participants:
Nanette K. Wenger, MD, M.A.C.P., F.A.C.C., F.A.H.A.
Professor of Medicine, Division of Cardiology, Emory
University School of Medicine, Atlanta, Georgia
Spencer B. King, MD, MACC
Fuqua Chair of Interventional Cardiology, Fuqua
Heart Center, Piedmont Hospital, Atlanta, GA.
Webcast Transcript:
ANNOUNCER: Most people are aware that there are
different types of cholesterol, but many don't know
about the serious consequences surrounding high
levels of LDL.
NANETTE KASS-WENGER, MD: High cholesterol—and
here I would like to talk about high bad cholesterol,
or LDL, low-density lipoprotein cholesterol—means
that there is deposition of this fat in the arteries.
In the arteries of the heart, in the arteries of
the brain, all through the body, in the arteries
of the kidney. And the consequences can be what
we call atherosclerosis, meaning a narrowing and
a deposition of cholesterol and all the fibrous
tissue that goes in there.
SPENCER B. KING, III, MD: The consequences are
that heart attack, stroke, peripheral vascular disease,
blocked arteries in the legs and so forth, can occur.
Cholesterol has multiple components. Some parts
of cholesterol are more dangerous than others. Some
parts of the cholesterol, the HDL, the high-density
lipoprotein, is actually somewhat protective, and
parts of that are even more protective.
On the other hand, the low-density lipoproteins
are the ones that we really worry about. And when
we talk about high cholesterol, we're really more
worried about the high level of the LDL, the low-density
lipoprotein. That is the one that is most dangerous
for the progression of artery disease.
Tests That Can Track Your Heart's Health
Cardiovascular medicine has a variety of diagnostic
imaging tests used by doctors to help identify
and diagnose abnormalities in your heart.
Participants:
Richard P. Lewis, MD, MACC
Professor of Internal Medicine, Ohio State University,
Columbus, Ohio
Jacqueline A. Noonan, MD, FACC
Pediatric cardiologist, University of Kentucky College
of Medicine, Lexington, Kentucky
Webcast Transcript:
ANNOUNCER: For anyone with questions about the health
of their heart, there are a variety of diagnostic
tests available to physicians that can help provide
some answers.
RICHARD P. LEWIS, MD: Cardiovascular medicine has
more imaging tests than anybody else, by a long
ways. Actually, the first diagnostic imaging test
was a chest x-ray invented around the turn of the
20th century, so it's over 100 years old. It's still
helpful.
JACQUELINE NOONAN, MD: You know, in the olden days,
people used to use their stethoscope. And with the
stethoscope, if you had trained well, you could
diagnose rheumatic heart disease, what kind of valve
was involved, by listening. And this could be helped
by looking at an electrocardiogram, which would
tell you which side of the heart was thicker than
normal, whether the atrium was enlarged and use
certainly the chest x-ray.
Then cardiac catheterization came into vogue where
one could put a catheter into the heart and measure
pressures, put dye in and show defects, show whether
there was rheumatic heart disease, congenital heart
disease or whether the heart, which is not functioning
well. You could look at the coronary arteries with
coronary angiography.
RICHARD P. LEWIS, MD: The rest of the cardiac testing
has mostly been developed in the last 50 years,
and they fall into two basic categories: invasive
and non-invasive. And invasive means puncturing
the surface of the body. Non-invasive means not
having to do that.
The non-invasive tests consist of electrocardiogram
and chest x-ray; echocardiography, which is a widely
used test today; nuclear studies, where you inject
a radioisotope into the blood, and then look at
where it goes in the heart to see if there's areas
that aren't getting enough blood, that's a perfusion
scan. Or you can actually watch the heart contract
with the isotope that's inside the heart's blood
pool and watch the blood pool pass through the heart,
and you can define how well the heart's working.
That's a widely used test.
The echo is an extremely versatile test, because
it'll show you all of the heart valves and how they
work, the heart muscle, what kind of condition it's
in, whether there's fluid in the sac around the
heart, and a lot of other things that you could
do. And echo's an easy test to do, and you can do
it on really sick people in the intensive care unit,
emergency rooms.
Now, the invasive studies, diagnostic studies,
are mostly cardiac catheterization, which involves
putting a catheter in blood vessels, usually the
leg blood vessels, and advancing them into the heart.
And there we measure pressures inside the heart,
which is critical when you have abnormal heart valves,
and we can also inject contrast material, that you
can take an x-ray movie and see the outline of the
heart chambers and see how well the heart's working,
or you can see, most importantly, the heart arteries
and see how they're doing.
JACQUELINE NOONAN, MD: There are CAT scans, and
now there are improvements in the CAT scans, and
then there's the magnetic resonant imaging, MRIs.
So there are many different diagnostic tests that
can be used. There are also tests that can be used
to look for how good the oxygen in your heart is,
which reflects the coronary blood flow. Nuclear
scans, where one can do nuclear scans, both when
you're resting and when you're exercising, will
help us to understand whether your coronary arteries
are supplying the heart sufficient blood. So there
are many, many different kinds of diagnostic tests
available today.
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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