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Until now, you've had to suffer.
You've arrived here for a reason. Maybe you
|
Wednesday, October 8, 2008
Tuesday, October 7, 2008
Heart Disease Facts
Heart Disease Facts
- Heart disease is the leading cause of death for both women and men in the United States.
- In 2002, 696,947 people died of heart disease (51% of them women). This was 29% of all U.S. deaths. The age-adjusted death rate was 241 per 100,000 population.1
- Heart disease is the leading cause of death for American Indians and Alaska Natives, blacks, Hispanics, and whites. For Asians and Pacific Islanders, cancer is the leading cause of death (accounting for 26.1% of all deaths), heart disease is a close second (26.0%).1
- Heart disease crude death rates per 100,000 population for the five largest U.S. racial/ethnic groups are as follows: Hispanics, 72; Asians and Pacific Islanders, 78; American Indians, 80; blacks, 206; and whites, 259.1
- In 2002, age-adjusted death rates for diseases of the heart were 30% higher among African Americans than among whites.2 Age-adjusted rates are used to compare populations with differing age distributions.
- By state, age-adjusted death rates per 100,000 for diseases of the heart ranged from 165 (Minnesota) to 327 (Mississippi) in 2002.3
- Coronary heart disease is the principal type of heart disease. There were 494,392 people that died from coronary heart disease in 2002. That is about 71% of all heart disease deaths.4
- It is estimated that about 47% of cardiac deaths occur before emergency services or transport to a hospital.5
- In 2006, heart disease is projected to cost more than $258 billion, including health care services, medications, and lost productivity.6
- Worldwide, coronary heart disease kills more than 7 million people each year.7
- Risk factors for heart disease among adults (for years 1999–2002 unless noted):2
Percentage of persons aged 20 years and older with hypertension or taking hypertension medications: 30.2%
Percentage of persons aged 20 years and older with high blood cholesterol: 17.3%
Percentage of persons aged 20 years and older with physician-diagnosed diabetes: 6.5%Percentage of persons aged 20 years and older who are obese: 30.5%
Percentage of adults aged 18 years and older who are current cigarette smokers (2003): 21.6%
Percentage of adults aged 18 years and older who engage in no leisure-time physical activity (2003): 37.6%
- In 2003, approximately 37% of adults reported having two or more of six risk factors for heart disease and stroke (high blood pressure, high cholesterol, diabetes, current smoking, physical inactivity, and obesity).8
- Timely access to emergency cardiac care and survival is partly dependent on early recognition of heart attack symptoms and immediate action by calling emergency services. In a 2001 survey, most persons (95%) recognized chest pain as a heart attack symptom, but only 11% correctly classified all symptoms and knew to call 9–1–1 when someone was having a heart attack.9
- Studies among people with heart disease have shown that lowering high blood cholesterol and high blood pressure can reduce the risk of dying of heart disease, having a nonfatal heart attack, and needing heart bypass surgery or angioplasty.
- Studies among people without heart disease have shown that lowering high blood cholesterol and high blood pressure can reduce the risk of developing heart disease.
Monday, September 15, 2008
Boost to artery block treatment
Boost to artery block treatment
The coronary arteries supply the heart muscle with blood
Scientists are working on ways to cut the risk of blood clots following treatment to unblock clogged arteries.
Stents, which are tiny tubes used to hold open the diseased blood vessels of heart patients, can themselves become blocked following treatment.
A team from Germany reports success in The Lancet with a new biodegradable prototype. And an Irish team is to begin testing a new coating for stents.
Experts welcomed the findings but said more work was needed.
Treating clogged arteries
To improve blood flow through clogged heart blood vessels, a balloon is inflated inside the artery.
This treatment - angioplasty - improves the blood supply to the heart muscle, which helps prevent angina and heart attacks.
Once the balloon is withdrawn stents are inserted to prevent the artery from re-narrowing. The need for stenting is only temporary, but current metal stents remain in place for life.
There is a risk that blood clots can occur within the stent and re-block the artery.
Such events are rare, but can be life threatening.
New developments
The stents tested by an international team led by Professor Raimund Erbel of the West German Heart Centre Essen, are made from biodegradable magnesium.
Within four months of fitting they can dissolve and completely disappear, which the scientists reason will eliminate the risk of stent re-blockage.
In tests, the biodegradable stents worked as well as conventional metal stents over 12 months, The Lancet reports.
They were also safe - none of the 63 patients had heart attacks or developed a clot where the stent had been.
Almost half of the patients had new blockages elsewhere in their arteries which would need treatment.
This research shows that absorbable stents can be used as a safe alternative in the future
Professor Peter Weissberg
But this is expected in heart patients because of the poor general state of their arteries and is unrelated to the type of stent used.
Meanwhile, Professor Jim McLaughlin and colleagues in Ulster have developed a 3D plasma coating technique for stents, and are now preparing to test it in clinical trials.
The stents, only a few millimetres wide, are covered in a diamond-like carbon structure.
This forms a coating which is theoretically smooth enough to repel the proteins which could form clots.
Professor McLaughlin said some forms of carbon were already well-known implant materials used for heart valves.
He said: "Our group are now seeking to further develop and even commercialise the 3-D plasma-coating technique, which has already shown to be highly biocompatible and promising with regards to its mechanical properties."
Professor Peter Weissberg, medical director at the British Heart Foundation, said: "This research shows that absorbable stents can be used as a safe alternative in the future, allowing the blood vessel to repair itself before the scaffold dissolves.
"But before they can be used in routine practise, further research is needed to refine the stents to get the best result."
Coronary artery disease
Coronary artery disease
From MayoClinic.com
Special to CNN.com
Introduction
How healthy are your coronary arteries? If you eat healthy foods, get physical activity every day and don't smoke, you're well on your way to preventing symptoms of coronary artery disease — a leading type of heart disease.
The coronary arteries supply your heart with blood, oxygen and nutrients. When blood flow through the coronary arteries becomes obstructed, it's known as coronary artery disease.
Coronary artery disease is caused by the gradual buildup of fatty deposits in your coronary arteries (atherosclerosis). As the deposits slowly narrow your coronary arteries, your heart receives less blood. Eventually, diminished blood flow may cause chest pain (angina), shortness of breath or other symptoms. A complete blockage can cause a heart attack.
Since coronary artery disease often develops over decades, it can go virtually unnoticed until it produces a heart attack. But there's plenty you can do to prevent coronary artery disease. Start by committing to a healthy lifestyle.
Signs and symptoms
If your coronary arteries become narrowed, they can't supply enough oxygenated blood to your heart — especially when it's beating hard, such as during physical activity. At first, the restricted blood flow may not cause any symptoms. As the fatty deposits continue to accumulate in your coronary arteries, however, you may have:
Chest pain. You may feel pressure or tightness in your chest, as if someone were standing on your chest. The pain is usually triggered by physical or emotional stress. It typically goes away within minutes after stopping the stressful activity. Atypical chest pain — more common in women — may be fleeting or sharp and noticed in the abdomen, back or arm.
Shortness of breath. If your heart can't pump enough blood to meet your body's needs, you may develop symptoms of heart failure — shortness of breath, extreme fatigue with exertion, and swelling in your feet and ankles.
Heart attack. If a coronary artery becomes completely blocked, you may have a heart attack. The classic symptoms of a heart attack include crushing pain in your chest, pain in your shoulder or arm, and shortness of breath. Women are somewhat more likely than men to experience other warning signs of a heart attack, including nausea and back or jaw pain. Sometimes a heart attack occurs without any apparent signs or symptoms.
Causes
Coronary artery disease is thought to begin with damage or injury to the inner layer of a coronary artery, sometimes as early as childhood. The damage may be caused by various factors, including:
Smoking
High blood pressure
High cholesterol
Certain diseases, such as diabetes
Radiation therapy to the chest, as used for certain types of cancer
Once the inner wall of an artery is damaged, fatty deposits (plaques) accumulate. If the surface of these fatty deposits breaks or ruptures, blood cells called platelets will clump at the site to try to repair the artery. This clump can block the artery, leading to a heart attack.
Risk factors
Men are generally at greater risk of coronary artery disease than are women. However, the risk for women increases after menopause. A family history of heart disease and simply getting older increases the risk as well.
Other risk factors for coronary artery disease include:
Smoking
High blood pressure
High cholesterol
Diabetes
Obesity
Physical inactivity
Stress and anger
Risk factors often occur in clusters and may feed one another, such as obesity leading to diabetes and high blood pressure. When grouped together, certain risk factors put you at an ever greater risk of coronary artery disease. For example, metabolic syndrome — a cluster of conditions that includes elevated blood pressure, high triglycerides, elevated insulin levels and excess body fat around the waist — greatly increases the risk of all types of heart disease.
Sometimes coronary artery disease develops without any classic risk factors. Researchers are studying other possible factors, including:
C-reactive protein. Your liver produces C-reactive protein (CRP) in response to injury or infection. CRP is also produced by muscle cells within the coronary arteries. CRP is a general sign of inflammation, which plays a central role in atherosclerosis.
Homocysteine. Homocysteine is an amino acid your body uses to make protein and to build and maintain tissue. But excessive levels of homocysteine may increase your risk of coronary artery disease and other cardiovascular conditions.
Fibrinogen. Fibrinogen is a protein in your blood that plays a central role in blood clotting. But too much may promote excessive clumping of platelets, the type of blood cell largely responsible for clotting. That can cause a clot to form in an artery, leading to a heart attack or stroke. Fibrinogen may also be an indicator of the inflammation that accompanies atherosclerosis.
Lipoprotein (a). This substance forms when a low-density lipoprotein (LDL) cholesterol particle attaches to a specific protein. The protein that carries lipoprotein (a) may disrupt your body's ability to dissolve blood clots. High levels of lipoprotein (a) may be associated with an increased risk of cardiovascular disease, including coronary artery disease and heart attack.
When to seek medical advice
If you have risk factors for coronary artery disease, talk to your doctor. He or she may want to test you for the condition — especially if you have signs or symptoms of narrowed arteries. Even if you don't have evidence of coronary artery disease, your doctor may recommend aggressive treatment of your risk factors. Early diagnosis and treatment may stop progression of coronary artery disease and help prevent a heart attack.
Screening and diagnosis
The doctor will ask questions about your medical history, do a physical exam and order routine blood tests. He or she may suggest one or more diagnostic tests as well, including:
Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack or one that's in progress. In other cases, Holter monitoring may be recommended. With this type of ECG, you wear a portable monitor for 24 hours as you go about your normal activities. Certain abnormalities may indicate inadequate blood flow to your heart.
Echocardiogram. An echocardiogram uses sound waves to produce images of your heart. During an echocardiogram, your doctor can determine whether all parts of the heart wall are contributing normally to your heart's pumping activity. Parts that move weakly may have been damaged during a heart attack or be receiving too little oxygen. This may indicate coronary artery disease or various other conditions.
Stress test. If your signs and symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG. This is known as an exercise stress test. In other cases, medication to stimulate your heart may be used instead of exercise.
Some stress tests are done using an echocardiogram. These are known as stress echos. For example, your doctor may do an ultrasound before and after you exercise on a treadmill or bike. Or your doctor may use medication to stimulate your heart during an echocardiogram.
Another stress test known as a nuclear stress test helps measure blood flow to your heart muscle at rest and during stress. It's similar to a routine exercise stress test but with images in addition to an ECG. Trace amounts of radioactive material — such as thallium or a compound known as sestamibi (Cardiolite) — are injected into your bloodstream. Special cameras can detect areas in your heart that receive less blood flow.
Angiogram. To view blood flow through your heart, your doctor may inject a special dye into your arteries before a chest X-ray. This is known as an angiogram. The dye outlines narrow spots and blockages on the X-ray images. If you have a blockage that requires treatment, a balloon or stent can be used to improve the blood flow in your heart.
Electron beam computerized tomography (EBCT). This test, also called an ultrafast CT scan, can detect calcium within fatty deposits that narrow coronary arteries. If a substantial amount of calcium is discovered, coronary artery disease is likely. Other types of CT scans can also generate images of your heart arteries.
Magnetic resonance angiography (MRA). This technique uses magnetic waves to produce a 3-D image of your coronary arteries, which your doctor can check for areas of narrowing or blockages — although the details may not be as clear as those provided by an angiogram.
Complications
When your coronary arteries narrow, your heart may not receive enough blood when demand is greatest — particularly during physical activity. This can cause chest pain or shortness of breath. If a cholesterol plaque ruptures, complete blockage of your heart artery may trigger a heart attack.
The lack of blood flow to your heart during a heart attack leads to irreversible damage to your heart muscle. The amount of damage depends in part on how quickly you receive treatment. If your heart has been damaged and can't pump enough blood to meet your body's needs, you may experience heart failure.
Treatment
Lifestyle changes can promote healthier arteries. If you smoke, quitting is the most important thing you can do. Eat healthy foods, and exercise regularly. Sometimes medication or procedures to improve blood flow are recommended as well.
Medications
Various drugs can be used to treat coronary artery disease, including:
Cholesterol medications. Aggressively lowering your low-density lipoprotein (LDL), or "bad," cholesterol can slow, stop or even reverse the buildup of fatty deposits in your arteries. Boosting your high-density lipoprotein (HDL), or "good," cholesterol may help, too. Your doctor can choose from a range of cholesterol medications, including drugs known as statins and fibrates.
Aspirin. A daily aspirin or other blood thinner can reduce the tendency of your blood to clot, which may help prevent obstruction of your coronary arteries. If you've had a heart attack, aspirin can help prevent future attacks.
Beta blockers. These drugs slow your heart rate and decrease your blood pressure, which decreases your heart's demand for oxygen. If you've had a heart attack, beta blockers reduce the risk of future attacks.
Nitroglycerin. Nitroglycerin tablets, spray and patches can control chest pain by opening up your coronary arteries and reducing your heart's demand for blood.
Angiotensin-converting enzyme (ACE) inhibitors. These drugs decrease blood pressure and may help prevent progression of coronary artery disease. If you've had a heart attack, ACE inhibitors reduce the risk of future attacks.
Calcium channel blockers. These medications relax the muscles that surround your coronary arteries and cause the vessels to open, increasing blood flow to your heart. They also control high blood pressure.
Procedures to restore and improve blood flow
Sometimes more aggressive treatment is needed. Here are a few options:
Angioplasty and stent placement (percutaneous coronary revascularization). In this procedure, your doctor inserts a long, thin tube (catheter) into the narrowed part of your artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls. A mesh tube (stent) is often left in the artery to help keep the artery open. Some stents slowly release medication to help keep the artery open.
Coronary artery bypass surgery. A surgeon creates a graft to bypass blocked coronary arteries using a vessel from another part of your body. This allows blood to flow around the blocked or narrowed coronary artery. Because this requires open heart surgery, it's most often reserved for cases of multiple narrowed coronary arteries.
Coronary brachytherapy. If the coronary arteries narrow again after stent placement, radiation may be used to help open the artery again.
Laser revascularization. If standard treatments aren't effective, a new surgery known as laser revascularization may be considered. During this procedure, a laser beam is used to make tiny new channels in the wall of the heart muscle. New vessels may grow through these channels and into the heart to provide additional paths for blood flow.
On the research front
Researchers are exploring new techniques for treating coronary artery disease, such as gene therapy. In this experimental procedure, genes and growth factor proteins may be injected through a catheter or directly into the heart to stimulate growth of new blood vessels and restore blood flow to the heart. Gene-coated stents that could encourage the repair of coronary arteries are being studied as well.
Prevention
Lifestyle changes can help you prevent or slow the progression of coronary artery disease.
Stop smoking. Smoking is a major risk factor for coronary artery disease. Nicotine constricts blood vessels and forces your heart to work harder, and carbon monoxide reduces oxygen in your blood and damages the lining of your blood vessels. If you smoke, quitting is the best way to reduce your risk of a heart attack.
Control your blood pressure. Ask your doctor for a blood pressure measurement at least every two years. He or she may recommend more frequent measurements if your blood pressure is higher than normal or you have a history of heart disease. Normal blood pressure is below 120 systolic/80 diastolic as measured in millimeters of mercury (mm Hg).
Check your cholesterol. Ask your doctor for a baseline cholesterol test when you're in your 20s and then at least every five years. If your test results aren't within desirable ranges, your doctor may recommend more frequent measurements. Most people should aim for an LDL level below 130 mg/dL. If you have other risk factors for heart disease, your target LDL may be below 100 mg/dL. If you're at very high risk for heart disease — if you've already had a heart attack or have diabetes, for example — you may need to aim for an LDL level below 70 mg/dL.
Keep diabetes under control. If you have diabetes, tight blood sugar control can help reduce the risk of heart disease.
Get moving. Exercise helps you achieve and maintain a healthy weight and control diabetes, elevated cholesterol and high blood pressure — all risk factors for coronary artery disease. With your doctor's OK, aim for 30 to 60 minutes of physical activity most days of the week.
Eat healthy foods. A heart-healthy diet based on fruits, vegetables and whole grains — and low in saturated fat, cholesterol and sodium — can help you control your weight, blood pressure and cholesterol. One or two servings of fish a week are also beneficial.
Maintain a healthy weight. Being overweight increases your risk of coronary artery disease. Weight loss is especially important for people who have large waist measurements — more than 40 inches for men and more than 35 inches for women — because people with this body shape are more likely to develop diabetes and heart disease.
Manage stress. Reduce stress as much as possible. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing.
In addition to healthy lifestyle changes, remember the importance of regular medical checkups. Some of the main risk factors for coronary artery disease — high cholesterol, high blood pressure and diabetes — have no symptoms in the early stages. Early detection and treatment can set the stage for a lifetime of better heart health.
Also ask your doctor about a yearly flu vaccine. Coronary artery disease and other cardiovascular disorders increase the risk of complications from the flu.
Drug-eluting stents: Do they increase heart attack risk?
Bypass surgery vs. angioplasty for coronary artery disease
Coronary calcium scans: Heart scans mired in controversy
Coronary angioplasty and stenting: Opening clogged arteries
Video: Echocardiogram
Echocardiogram: Sound imaging of the heart
Electrocardiogram: Tracing the electrical path through the heart
Video: Electrocardiogram
Cardiac stents: Can they be replaced?
Coronary artery bypass surgery
Dressler's syndrome
Nuclear stress test: What to expect
Video: Coronary angioplasty
Coronary angiography and other heart catheterization procedures
July 07, 2006
Coronary artery disease
Coronary artery disease
From MayoClinic.com
Special to CNN.com
Introduction
How healthy are your coronary arteries? If you eat healthy foods, get physical activity every day and don't smoke, you're well on your way to preventing symptoms of coronary artery disease — a leading type of heart disease.
The coronary arteries supply your heart with blood, oxygen and nutrients. When blood flow through the coronary arteries becomes obstructed, it's known as coronary artery disease.
Coronary artery disease is caused by the gradual buildup of fatty deposits in your coronary arteries (atherosclerosis). As the deposits slowly narrow your coronary arteries, your heart receives less blood. Eventually, diminished blood flow may cause chest pain (angina), shortness of breath or other symptoms. A complete blockage can cause a heart attack.
Since coronary artery disease often develops over decades, it can go virtually unnoticed until it produces a heart attack. But there's plenty you can do to prevent coronary artery disease. Start by committing to a healthy lifestyle.
Signs and symptoms
If your coronary arteries become narrowed, they can't supply enough oxygenated blood to your heart — especially when it's beating hard, such as during physical activity. At first, the restricted blood flow may not cause any symptoms. As the fatty deposits continue to accumulate in your coronary arteries, however, you may have:
Chest pain. You may feel pressure or tightness in your chest, as if someone were standing on your chest. The pain is usually triggered by physical or emotional stress. It typically goes away within minutes after stopping the stressful activity. Atypical chest pain — more common in women — may be fleeting or sharp and noticed in the abdomen, back or arm.
Shortness of breath. If your heart can't pump enough blood to meet your body's needs, you may develop symptoms of heart failure — shortness of breath, extreme fatigue with exertion, and swelling in your feet and ankles.
Heart attack. If a coronary artery becomes completely blocked, you may have a heart attack. The classic symptoms of a heart attack include crushing pain in your chest, pain in your shoulder or arm, and shortness of breath. Women are somewhat more likely than men to experience other warning signs of a heart attack, including nausea and back or jaw pain. Sometimes a heart attack occurs without any apparent signs or symptoms.
Causes
Coronary artery disease is thought to begin with damage or injury to the inner layer of a coronary artery, sometimes as early as childhood. The damage may be caused by various factors, including:
Smoking
High blood pressure
High cholesterol
Certain diseases, such as diabetes
Radiation therapy to the chest, as used for certain types of cancer
Once the inner wall of an artery is damaged, fatty deposits (plaques) accumulate. If the surface of these fatty deposits breaks or ruptures, blood cells called platelets will clump at the site to try to repair the artery. This clump can block the artery, leading to a heart attack.
Risk factors
Men are generally at greater risk of coronary artery disease than are women. However, the risk for women increases after menopause. A family history of heart disease and simply getting older increases the risk as well.
Other risk factors for coronary artery disease include:
Smoking
High blood pressure
High cholesterol
Diabetes
Obesity
Physical inactivity
Stress and anger
Risk factors often occur in clusters and may feed one another, such as obesity leading to diabetes and high blood pressure. When grouped together, certain risk factors put you at an ever greater risk of coronary artery disease. For example, metabolic syndrome — a cluster of conditions that includes elevated blood pressure, high triglycerides, elevated insulin levels and excess body fat around the waist — greatly increases the risk of all types of heart disease.
Sometimes coronary artery disease develops without any classic risk factors. Researchers are studying other possible factors, including:
C-reactive protein. Your liver produces C-reactive protein (CRP) in response to injury or infection. CRP is also produced by muscle cells within the coronary arteries. CRP is a general sign of inflammation, which plays a central role in atherosclerosis.
Homocysteine. Homocysteine is an amino acid your body uses to make protein and to build and maintain tissue. But excessive levels of homocysteine may increase your risk of coronary artery disease and other cardiovascular conditions.
Fibrinogen. Fibrinogen is a protein in your blood that plays a central role in blood clotting. But too much may promote excessive clumping of platelets, the type of blood cell largely responsible for clotting. That can cause a clot to form in an artery, leading to a heart attack or stroke. Fibrinogen may also be an indicator of the inflammation that accompanies atherosclerosis.
Lipoprotein (a). This substance forms when a low-density lipoprotein (LDL) cholesterol particle attaches to a specific protein. The protein that carries lipoprotein (a) may disrupt your body's ability to dissolve blood clots. High levels of lipoprotein (a) may be associated with an increased risk of cardiovascular disease, including coronary artery disease and heart attack.
When to seek medical advice
If you have risk factors for coronary artery disease, talk to your doctor. He or she may want to test you for the condition — especially if you have signs or symptoms of narrowed arteries. Even if you don't have evidence of coronary artery disease, your doctor may recommend aggressive treatment of your risk factors. Early diagnosis and treatment may stop progression of coronary artery disease and help prevent a heart attack.
Screening and diagnosis
The doctor will ask questions about your medical history, do a physical exam and order routine blood tests. He or she may suggest one or more diagnostic tests as well, including:
Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack or one that's in progress. In other cases, Holter monitoring may be recommended. With this type of ECG, you wear a portable monitor for 24 hours as you go about your normal activities. Certain abnormalities may indicate inadequate blood flow to your heart.
Echocardiogram. An echocardiogram uses sound waves to produce images of your heart. During an echocardiogram, your doctor can determine whether all parts of the heart wall are contributing normally to your heart's pumping activity. Parts that move weakly may have been damaged during a heart attack or be receiving too little oxygen. This may indicate coronary artery disease or various other conditions.
Stress test. If your signs and symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG. This is known as an exercise stress test. In other cases, medication to stimulate your heart may be used instead of exercise.
Some stress tests are done using an echocardiogram. These are known as stress echos. For example, your doctor may do an ultrasound before and after you exercise on a treadmill or bike. Or your doctor may use medication to stimulate your heart during an echocardiogram.
Another stress test known as a nuclear stress test helps measure blood flow to your heart muscle at rest and during stress. It's similar to a routine exercise stress test but with images in addition to an ECG. Trace amounts of radioactive material — such as thallium or a compound known as sestamibi (Cardiolite) — are injected into your bloodstream. Special cameras can detect areas in your heart that receive less blood flow.
Angiogram. To view blood flow through your heart, your doctor may inject a special dye into your arteries before a chest X-ray. This is known as an angiogram. The dye outlines narrow spots and blockages on the X-ray images. If you have a blockage that requires treatment, a balloon or stent can be used to improve the blood flow in your heart.
Electron beam computerized tomography (EBCT). This test, also called an ultrafast CT scan, can detect calcium within fatty deposits that narrow coronary arteries. If a substantial amount of calcium is discovered, coronary artery disease is likely. Other types of CT scans can also generate images of your heart arteries.
Magnetic resonance angiography (MRA). This technique uses magnetic waves to produce a 3-D image of your coronary arteries, which your doctor can check for areas of narrowing or blockages — although the details may not be as clear as those provided by an angiogram.
Complications
When your coronary arteries narrow, your heart may not receive enough blood when demand is greatest — particularly during physical activity. This can cause chest pain or shortness of breath. If a cholesterol plaque ruptures, complete blockage of your heart artery may trigger a heart attack.
The lack of blood flow to your heart during a heart attack leads to irreversible damage to your heart muscle. The amount of damage depends in part on how quickly you receive treatment. If your heart has been damaged and can't pump enough blood to meet your body's needs, you may experience heart failure.
Treatment
Lifestyle changes can promote healthier arteries. If you smoke, quitting is the most important thing you can do. Eat healthy foods, and exercise regularly. Sometimes medication or procedures to improve blood flow are recommended as well.
Medications
Various drugs can be used to treat coronary artery disease, including:
Cholesterol medications. Aggressively lowering your low-density lipoprotein (LDL), or "bad," cholesterol can slow, stop or even reverse the buildup of fatty deposits in your arteries. Boosting your high-density lipoprotein (HDL), or "good," cholesterol may help, too. Your doctor can choose from a range of cholesterol medications, including drugs known as statins and fibrates.
Aspirin. A daily aspirin or other blood thinner can reduce the tendency of your blood to clot, which may help prevent obstruction of your coronary arteries. If you've had a heart attack, aspirin can help prevent future attacks.
Beta blockers. These drugs slow your heart rate and decrease your blood pressure, which decreases your heart's demand for oxygen. If you've had a heart attack, beta blockers reduce the risk of future attacks.
Nitroglycerin. Nitroglycerin tablets, spray and patches can control chest pain by opening up your coronary arteries and reducing your heart's demand for blood.
Angiotensin-converting enzyme (ACE) inhibitors. These drugs decrease blood pressure and may help prevent progression of coronary artery disease. If you've had a heart attack, ACE inhibitors reduce the risk of future attacks.
Calcium channel blockers. These medications relax the muscles that surround your coronary arteries and cause the vessels to open, increasing blood flow to your heart. They also control high blood pressure.
Procedures to restore and improve blood flow
Sometimes more aggressive treatment is needed. Here are a few options:
Angioplasty and stent placement (percutaneous coronary revascularization). In this procedure, your doctor inserts a long, thin tube (catheter) into the narrowed part of your artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls. A mesh tube (stent) is often left in the artery to help keep the artery open. Some stents slowly release medication to help keep the artery open.
Coronary artery bypass surgery. A surgeon creates a graft to bypass blocked coronary arteries using a vessel from another part of your body. This allows blood to flow around the blocked or narrowed coronary artery. Because this requires open heart surgery, it's most often reserved for cases of multiple narrowed coronary arteries.
Coronary brachytherapy. If the coronary arteries narrow again after stent placement, radiation may be used to help open the artery again.
Laser revascularization. If standard treatments aren't effective, a new surgery known as laser revascularization may be considered. During this procedure, a laser beam is used to make tiny new channels in the wall of the heart muscle. New vessels may grow through these channels and into the heart to provide additional paths for blood flow.
On the research front
Researchers are exploring new techniques for treating coronary artery disease, such as gene therapy. In this experimental procedure, genes and growth factor proteins may be injected through a catheter or directly into the heart to stimulate growth of new blood vessels and restore blood flow to the heart. Gene-coated stents that could encourage the repair of coronary arteries are being studied as well.
Prevention
Lifestyle changes can help you prevent or slow the progression of coronary artery disease.
Stop smoking. Smoking is a major risk factor for coronary artery disease. Nicotine constricts blood vessels and forces your heart to work harder, and carbon monoxide reduces oxygen in your blood and damages the lining of your blood vessels. If you smoke, quitting is the best way to reduce your risk of a heart attack.
Control your blood pressure. Ask your doctor for a blood pressure measurement at least every two years. He or she may recommend more frequent measurements if your blood pressure is higher than normal or you have a history of heart disease. Normal blood pressure is below 120 systolic/80 diastolic as measured in millimeters of mercury (mm Hg).
Check your cholesterol. Ask your doctor for a baseline cholesterol test when you're in your 20s and then at least every five years. If your test results aren't within desirable ranges, your doctor may recommend more frequent measurements. Most people should aim for an LDL level below 130 mg/dL. If you have other risk factors for heart disease, your target LDL may be below 100 mg/dL. If you're at very high risk for heart disease — if you've already had a heart attack or have diabetes, for example — you may need to aim for an LDL level below 70 mg/dL.
Keep diabetes under control. If you have diabetes, tight blood sugar control can help reduce the risk of heart disease.
Get moving. Exercise helps you achieve and maintain a healthy weight and control diabetes, elevated cholesterol and high blood pressure — all risk factors for coronary artery disease. With your doctor's OK, aim for 30 to 60 minutes of physical activity most days of the week.
Eat healthy foods. A heart-healthy diet based on fruits, vegetables and whole grains — and low in saturated fat, cholesterol and sodium — can help you control your weight, blood pressure and cholesterol. One or two servings of fish a week are also beneficial.
Maintain a healthy weight. Being overweight increases your risk of coronary artery disease. Weight loss is especially important for people who have large waist measurements — more than 40 inches for men and more than 35 inches for women — because people with this body shape are more likely to develop diabetes and heart disease.
Manage stress. Reduce stress as much as possible. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing.
In addition to healthy lifestyle changes, remember the importance of regular medical checkups. Some of the main risk factors for coronary artery disease — high cholesterol, high blood pressure and diabetes — have no symptoms in the early stages. Early detection and treatment can set the stage for a lifetime of better heart health.
Also ask your doctor about a yearly flu vaccine. Coronary artery disease and other cardiovascular disorders increase the risk of complications from the flu.
Drug-eluting stents: Do they increase heart attack risk?
Bypass surgery vs. angioplasty for coronary artery disease
Coronary calcium scans: Heart scans mired in controversy
Coronary angioplasty and stenting: Opening clogged arteries
Video: Echocardiogram
Echocardiogram: Sound imaging of the heart
Electrocardiogram: Tracing the electrical path through the heart
Video: Electrocardiogram
Cardiac stents: Can they be replaced?
Coronary artery bypass surgery
Dressler's syndrome
Nuclear stress test: What to expect
Video: Coronary angioplasty
Coronary angiography and other heart catheterization procedures
July 07, 2006
From MayoClinic.com
Special to CNN.com
Introduction
How healthy are your coronary arteries? If you eat healthy foods, get physical activity every day and don't smoke, you're well on your way to preventing symptoms of coronary artery disease — a leading type of heart disease.
The coronary arteries supply your heart with blood, oxygen and nutrients. When blood flow through the coronary arteries becomes obstructed, it's known as coronary artery disease.
Coronary artery disease is caused by the gradual buildup of fatty deposits in your coronary arteries (atherosclerosis). As the deposits slowly narrow your coronary arteries, your heart receives less blood. Eventually, diminished blood flow may cause chest pain (angina), shortness of breath or other symptoms. A complete blockage can cause a heart attack.
Since coronary artery disease often develops over decades, it can go virtually unnoticed until it produces a heart attack. But there's plenty you can do to prevent coronary artery disease. Start by committing to a healthy lifestyle.
Signs and symptoms
If your coronary arteries become narrowed, they can't supply enough oxygenated blood to your heart — especially when it's beating hard, such as during physical activity. At first, the restricted blood flow may not cause any symptoms. As the fatty deposits continue to accumulate in your coronary arteries, however, you may have:
Chest pain. You may feel pressure or tightness in your chest, as if someone were standing on your chest. The pain is usually triggered by physical or emotional stress. It typically goes away within minutes after stopping the stressful activity. Atypical chest pain — more common in women — may be fleeting or sharp and noticed in the abdomen, back or arm.
Shortness of breath. If your heart can't pump enough blood to meet your body's needs, you may develop symptoms of heart failure — shortness of breath, extreme fatigue with exertion, and swelling in your feet and ankles.
Heart attack. If a coronary artery becomes completely blocked, you may have a heart attack. The classic symptoms of a heart attack include crushing pain in your chest, pain in your shoulder or arm, and shortness of breath. Women are somewhat more likely than men to experience other warning signs of a heart attack, including nausea and back or jaw pain. Sometimes a heart attack occurs without any apparent signs or symptoms.
Causes
Coronary artery disease is thought to begin with damage or injury to the inner layer of a coronary artery, sometimes as early as childhood. The damage may be caused by various factors, including:
Smoking
High blood pressure
High cholesterol
Certain diseases, such as diabetes
Radiation therapy to the chest, as used for certain types of cancer
Once the inner wall of an artery is damaged, fatty deposits (plaques) accumulate. If the surface of these fatty deposits breaks or ruptures, blood cells called platelets will clump at the site to try to repair the artery. This clump can block the artery, leading to a heart attack.
Risk factors
Men are generally at greater risk of coronary artery disease than are women. However, the risk for women increases after menopause. A family history of heart disease and simply getting older increases the risk as well.
Other risk factors for coronary artery disease include:
Smoking
High blood pressure
High cholesterol
Diabetes
Obesity
Physical inactivity
Stress and anger
Risk factors often occur in clusters and may feed one another, such as obesity leading to diabetes and high blood pressure. When grouped together, certain risk factors put you at an ever greater risk of coronary artery disease. For example, metabolic syndrome — a cluster of conditions that includes elevated blood pressure, high triglycerides, elevated insulin levels and excess body fat around the waist — greatly increases the risk of all types of heart disease.
Sometimes coronary artery disease develops without any classic risk factors. Researchers are studying other possible factors, including:
C-reactive protein. Your liver produces C-reactive protein (CRP) in response to injury or infection. CRP is also produced by muscle cells within the coronary arteries. CRP is a general sign of inflammation, which plays a central role in atherosclerosis.
Homocysteine. Homocysteine is an amino acid your body uses to make protein and to build and maintain tissue. But excessive levels of homocysteine may increase your risk of coronary artery disease and other cardiovascular conditions.
Fibrinogen. Fibrinogen is a protein in your blood that plays a central role in blood clotting. But too much may promote excessive clumping of platelets, the type of blood cell largely responsible for clotting. That can cause a clot to form in an artery, leading to a heart attack or stroke. Fibrinogen may also be an indicator of the inflammation that accompanies atherosclerosis.
Lipoprotein (a). This substance forms when a low-density lipoprotein (LDL) cholesterol particle attaches to a specific protein. The protein that carries lipoprotein (a) may disrupt your body's ability to dissolve blood clots. High levels of lipoprotein (a) may be associated with an increased risk of cardiovascular disease, including coronary artery disease and heart attack.
When to seek medical advice
If you have risk factors for coronary artery disease, talk to your doctor. He or she may want to test you for the condition — especially if you have signs or symptoms of narrowed arteries. Even if you don't have evidence of coronary artery disease, your doctor may recommend aggressive treatment of your risk factors. Early diagnosis and treatment may stop progression of coronary artery disease and help prevent a heart attack.
Screening and diagnosis
The doctor will ask questions about your medical history, do a physical exam and order routine blood tests. He or she may suggest one or more diagnostic tests as well, including:
Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack or one that's in progress. In other cases, Holter monitoring may be recommended. With this type of ECG, you wear a portable monitor for 24 hours as you go about your normal activities. Certain abnormalities may indicate inadequate blood flow to your heart.
Echocardiogram. An echocardiogram uses sound waves to produce images of your heart. During an echocardiogram, your doctor can determine whether all parts of the heart wall are contributing normally to your heart's pumping activity. Parts that move weakly may have been damaged during a heart attack or be receiving too little oxygen. This may indicate coronary artery disease or various other conditions.
Stress test. If your signs and symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG. This is known as an exercise stress test. In other cases, medication to stimulate your heart may be used instead of exercise.
Some stress tests are done using an echocardiogram. These are known as stress echos. For example, your doctor may do an ultrasound before and after you exercise on a treadmill or bike. Or your doctor may use medication to stimulate your heart during an echocardiogram.
Another stress test known as a nuclear stress test helps measure blood flow to your heart muscle at rest and during stress. It's similar to a routine exercise stress test but with images in addition to an ECG. Trace amounts of radioactive material — such as thallium or a compound known as sestamibi (Cardiolite) — are injected into your bloodstream. Special cameras can detect areas in your heart that receive less blood flow.
Angiogram. To view blood flow through your heart, your doctor may inject a special dye into your arteries before a chest X-ray. This is known as an angiogram. The dye outlines narrow spots and blockages on the X-ray images. If you have a blockage that requires treatment, a balloon or stent can be used to improve the blood flow in your heart.
Electron beam computerized tomography (EBCT). This test, also called an ultrafast CT scan, can detect calcium within fatty deposits that narrow coronary arteries. If a substantial amount of calcium is discovered, coronary artery disease is likely. Other types of CT scans can also generate images of your heart arteries.
Magnetic resonance angiography (MRA). This technique uses magnetic waves to produce a 3-D image of your coronary arteries, which your doctor can check for areas of narrowing or blockages — although the details may not be as clear as those provided by an angiogram.
Complications
When your coronary arteries narrow, your heart may not receive enough blood when demand is greatest — particularly during physical activity. This can cause chest pain or shortness of breath. If a cholesterol plaque ruptures, complete blockage of your heart artery may trigger a heart attack.
The lack of blood flow to your heart during a heart attack leads to irreversible damage to your heart muscle. The amount of damage depends in part on how quickly you receive treatment. If your heart has been damaged and can't pump enough blood to meet your body's needs, you may experience heart failure.
Treatment
Lifestyle changes can promote healthier arteries. If you smoke, quitting is the most important thing you can do. Eat healthy foods, and exercise regularly. Sometimes medication or procedures to improve blood flow are recommended as well.
Medications
Various drugs can be used to treat coronary artery disease, including:
Cholesterol medications. Aggressively lowering your low-density lipoprotein (LDL), or "bad," cholesterol can slow, stop or even reverse the buildup of fatty deposits in your arteries. Boosting your high-density lipoprotein (HDL), or "good," cholesterol may help, too. Your doctor can choose from a range of cholesterol medications, including drugs known as statins and fibrates.
Aspirin. A daily aspirin or other blood thinner can reduce the tendency of your blood to clot, which may help prevent obstruction of your coronary arteries. If you've had a heart attack, aspirin can help prevent future attacks.
Beta blockers. These drugs slow your heart rate and decrease your blood pressure, which decreases your heart's demand for oxygen. If you've had a heart attack, beta blockers reduce the risk of future attacks.
Nitroglycerin. Nitroglycerin tablets, spray and patches can control chest pain by opening up your coronary arteries and reducing your heart's demand for blood.
Angiotensin-converting enzyme (ACE) inhibitors. These drugs decrease blood pressure and may help prevent progression of coronary artery disease. If you've had a heart attack, ACE inhibitors reduce the risk of future attacks.
Calcium channel blockers. These medications relax the muscles that surround your coronary arteries and cause the vessels to open, increasing blood flow to your heart. They also control high blood pressure.
Procedures to restore and improve blood flow
Sometimes more aggressive treatment is needed. Here are a few options:
Angioplasty and stent placement (percutaneous coronary revascularization). In this procedure, your doctor inserts a long, thin tube (catheter) into the narrowed part of your artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls. A mesh tube (stent) is often left in the artery to help keep the artery open. Some stents slowly release medication to help keep the artery open.
Coronary artery bypass surgery. A surgeon creates a graft to bypass blocked coronary arteries using a vessel from another part of your body. This allows blood to flow around the blocked or narrowed coronary artery. Because this requires open heart surgery, it's most often reserved for cases of multiple narrowed coronary arteries.
Coronary brachytherapy. If the coronary arteries narrow again after stent placement, radiation may be used to help open the artery again.
Laser revascularization. If standard treatments aren't effective, a new surgery known as laser revascularization may be considered. During this procedure, a laser beam is used to make tiny new channels in the wall of the heart muscle. New vessels may grow through these channels and into the heart to provide additional paths for blood flow.
On the research front
Researchers are exploring new techniques for treating coronary artery disease, such as gene therapy. In this experimental procedure, genes and growth factor proteins may be injected through a catheter or directly into the heart to stimulate growth of new blood vessels and restore blood flow to the heart. Gene-coated stents that could encourage the repair of coronary arteries are being studied as well.
Prevention
Lifestyle changes can help you prevent or slow the progression of coronary artery disease.
Stop smoking. Smoking is a major risk factor for coronary artery disease. Nicotine constricts blood vessels and forces your heart to work harder, and carbon monoxide reduces oxygen in your blood and damages the lining of your blood vessels. If you smoke, quitting is the best way to reduce your risk of a heart attack.
Control your blood pressure. Ask your doctor for a blood pressure measurement at least every two years. He or she may recommend more frequent measurements if your blood pressure is higher than normal or you have a history of heart disease. Normal blood pressure is below 120 systolic/80 diastolic as measured in millimeters of mercury (mm Hg).
Check your cholesterol. Ask your doctor for a baseline cholesterol test when you're in your 20s and then at least every five years. If your test results aren't within desirable ranges, your doctor may recommend more frequent measurements. Most people should aim for an LDL level below 130 mg/dL. If you have other risk factors for heart disease, your target LDL may be below 100 mg/dL. If you're at very high risk for heart disease — if you've already had a heart attack or have diabetes, for example — you may need to aim for an LDL level below 70 mg/dL.
Keep diabetes under control. If you have diabetes, tight blood sugar control can help reduce the risk of heart disease.
Get moving. Exercise helps you achieve and maintain a healthy weight and control diabetes, elevated cholesterol and high blood pressure — all risk factors for coronary artery disease. With your doctor's OK, aim for 30 to 60 minutes of physical activity most days of the week.
Eat healthy foods. A heart-healthy diet based on fruits, vegetables and whole grains — and low in saturated fat, cholesterol and sodium — can help you control your weight, blood pressure and cholesterol. One or two servings of fish a week are also beneficial.
Maintain a healthy weight. Being overweight increases your risk of coronary artery disease. Weight loss is especially important for people who have large waist measurements — more than 40 inches for men and more than 35 inches for women — because people with this body shape are more likely to develop diabetes and heart disease.
Manage stress. Reduce stress as much as possible. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing.
In addition to healthy lifestyle changes, remember the importance of regular medical checkups. Some of the main risk factors for coronary artery disease — high cholesterol, high blood pressure and diabetes — have no symptoms in the early stages. Early detection and treatment can set the stage for a lifetime of better heart health.
Also ask your doctor about a yearly flu vaccine. Coronary artery disease and other cardiovascular disorders increase the risk of complications from the flu.
Drug-eluting stents: Do they increase heart attack risk?
Bypass surgery vs. angioplasty for coronary artery disease
Coronary calcium scans: Heart scans mired in controversy
Coronary angioplasty and stenting: Opening clogged arteries
Video: Echocardiogram
Echocardiogram: Sound imaging of the heart
Electrocardiogram: Tracing the electrical path through the heart
Video: Electrocardiogram
Cardiac stents: Can they be replaced?
Coronary artery bypass surgery
Dressler's syndrome
Nuclear stress test: What to expect
Video: Coronary angioplasty
Coronary angiography and other heart catheterization procedures
July 07, 2006
What Causes Angina?
What Causes Angina?
Underlying Causes
Angina is a symptom of an underlying heart condition. Angina pain is the result of reduced blood flow to an area of heart muscle. Coronary artery disease (CAD) usually causes the reduced blood flow.
This means that the underlying causes of angina are generally the same as the underlying causes of CAD.
Research suggests that damage to the inner layers of the coronary arteries causes CAD. Smoking, high levels of fat and cholesterol in the blood, high blood pressure, and a high level of sugar in the blood (due to insulin resistance or diabetes) can damage the coronary arteries.
When damage occurs, your body starts a healing process. Excess fatty tissues release compounds that promote this process. This healing causes plaque to build up where the arteries are damaged. Plaque narrows or blocks the arteries, reducing blood flow to the heart muscle.
Some plaque is hard and stable and leads to narrowed and hardened arteries. Other plaque is soft and is more likely to break open and cause blood clots.
The buildup of plaque on the arteries' inner walls can cause angina in two ways. It can:
Narrow the arteries and greatly reduce blood flow to the heart
Form blood clots that partially or totally block the arteries
Immediate Causes
There are different triggers for angina pain, depending on the type of angina you have.
Stable Angina
Physical exertion is the most common trigger of stable angina. Severely narrowed arteries may allow enough blood to reach the heart when the demand for oxygen is low (such as when you're sitting). But with exertion, like walking up a hill or climbing stairs, the heart works harder and needs more oxygen.
Other triggers of stable angina include:
Emotional stress
Exposure to very hot or cold temperatures
Heavy meals
Smoking
Unstable Angina
Blood clots that partially or totally block an artery cause unstable angina. If plaque in an artery ruptures or breaks open, blood clots may form. This creates a larger blockage. A clot may grow large enough to completely block the artery and cause a heart attack. For more information, see the animation in "What Causes a Heart Attack?"
Blood clots may form, partly dissolve, and later form again. Angina can occur each time a clot blocks an artery.
Variant Angina
A spasm in a coronary artery causes variant angina. The spasm causes the walls of the artery to tighten and narrow. Blood flow to the heart slows or stops. Variant angina may occur in people with or without CAD.
Other causes of spasms in the coronary arteries are:
Exposure to cold
Emotional stress
Medicines that tighten or narrow blood vessels
Smoking
Cocaine use
Miracle Cure Found
What if there was a miracle pill that if you took it each day would give you a 20% less chance of getting breast cancer, a 30% less chance of getting heart disease, a 50% less chance of diabetes, and would help you live longer and healthier into old age. How much would you pay for it? Wouldn't you insist your children, parents, and loved ones take it, too?
The miracle cure:strap on your walking shoes for an hour a day and you will reap all of these health benefits, according to recent health studies published in major medical journals.
How Fast?
Results from the 20-year long Nurse's Health Study have shown significant decreases in occurrence of breast cancer and Type II diabetes in women who engaged in "brisk" walking or other vigorous exercise for seven hours a week, and as little as three hours a week for heart disease reduction.
In this study, brisk walking was defined as 3 - 3.9 miles per hour, or 15 - 20 minutes per mile. This is really just a purposeful stroll for most people.
How Long?
An hour a day, or a total of seven hours a week, is associated with decreased risk for breast cancer and Type II diabetes. As little as a half hour a day, or three hours a week, is associated with decreased risk of heart disease.
How Many Years?
The studies have not keyed in on when in your life it is best to exercise - is it too late if you wait until you are 55? Or can you begin reducing your risks at any age? Studies have shown decreased risk of death in older men and women who walk regularly, so my reply would be to start now and never stop! Walking will also provide weight-bearing exercise to maintain your bone density and prevent osteoporosis.
What Good Does It Do?
Breast Cancer: 20% reduction
Diabetes: 50% reduction
Heart Disease: 30-40% reduction
Colon Cancer: exercise reduces risk
Stroke: exercise reduces risk
Now you know the secret of the miracle pill - isn't it time to start taking it?
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