Cardiology 101 -- August 6, 2012 -- Dr. Britt Mioton - NewsChannel5.com | Nashville News, Weather & Sports

Cardiology 101 -- August 6, 2012 -- Dr. Britt Mioton

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Saint Thomas Health Medical Mondays
Monday, August 6, 2012
TOPIC: Cardiology 101Britt Mioton, MD: interventional cardiologist
 
MTMC | Saint Thomas Heart
news notes via www.webmd.com

 

HOW CAN YOU AFFECT YOUR RISK FOR HEART DISEASE?

Do you know how these controllable risk factors affect your risk of heart disease?

  • smoking
  • high blood pressure
  • high blood cholesterol
  • diabetes
  • being overweight or obese
  • physical inactivity

It's essential that you measure your risk of heart disease and make a plan for how to prevent it in the near future.

Heart Disease Risk Assessment

 

This risk assessment tool, commonly used by cardiologists and other physicians, can help predict your risk of developing a heart attack or dying from coronary disease in the next 10 years.  This tool is designed for people aged 20 years and older without known heart disease and who do not have diabetes.

The Heart Disease Risk Assessment Tool is based on findings from a major research project called the "Framingham Heart Study," in which three generations of men and women from Framingham, Massachusetts were evaluated to better understand the causes of cardiovascular disease.  The score takes your personal risk factors into consideration and tells you what your chances are for having heart attack or dying in the next 10 years.  A risk score of 10% means that 10 out of 100 people in that risk category will have a heart attack or die within 10 years.  The lower your score, the better.

This tool is only useful for assessing the risk of suffering a heart attack or dying due to coronary disease for people age 20 or older who do not already have heart disease and have not been diagnosed with diabetes.  Here are some explanations on the data used in the risk assessment tool, and pointers for entering your data:

Total Cholesterol:  Total cholesterol is the sum of all the cholesterol in your blood. The higher your total cholesterol, the greater your risk for heart disease.  In general, here are the total cholesterol values that matter to you:

  • Less than 200 mg/dL – Desirable level that puts you at lower risk for heart disease.  A cholesterol level of 200 mg/dL or greater increases your risk.
  • 200 to 239 mg/dL – Borderline-high
  • 240 mg/dL and above – High blood cholesterol.  A person with this level has more than twice the risk of heart disease compared to someone whose cholesterol is below 200 mg/dL.

High Density Lipoproteins (HDL) Cholesterol:  The "good" cholesterol. HDL carries cholesterol in the blood from other parts of the body back to the liver, which leads to its removal from the body. So HDL helps keep cholesterol from building up in the walls of the arteries. Here are the HDL Cholesterol levels that matter to you:

  • Less than 40 mg/dL is considered low.  A major risk factor for heart disease.
  • 40 to 59 mg/dL is considered normal.  The higher your HDL, the better.
  • 60 mg/dL and above is excellent.  An HDL of 60 mg/dL and above is considered protective against heart disease.

Systolic blood pressure:  Systolic blood pressure is the first number of your blood pressure reading. For example, if your reading is 120/80 (120 over 80), your systolic blood pressure is 120.

Diastolic blood pressure:  Diastolic blood pressure is the second number of your blood pressure reading. For example, if your reading is 120/80 (120 over 80), your diastolic blood pressure is 80.

Smoker:  Select "Yes" if you have smoked any cigarettes in the past month.

THE RESULTS: WHAT DO THEY MEAN?

You should interpret your risk score in consultation with your cardiologist.  In general, the following risk categories are based on guidelines established by the National Cholesterol Education Program.

Risk Score Greater Than 20%:  Highest risk range, with a greater than 20% risk that you will develop a heart attack or die from coronary disease in the next 10 years. This risk can be reduced by addressing and managing your risk factors with the help of your cardiologist.

Risk Score between 10% – 20%:  Intermediate risk range, with a 10 to 20% risk that you will develop a heart attack or die from coronary disease in the next 10 years. This risk can be reduced by addressing and managing your risk factors with the help of your cardiologist.

Risk Score Less Than 10%:  Low risk range, with less than 10% risk that you will develop a heart attack or die from coronary disease in the next 10 years. Continue to manage your risk factors and visit your doctor regularly to assess your risk. Important Note: The presence of any cardiovascular disease risk factor, including a family history of cardiovascular disease, requires appropriate attention because a single risk factor may mean that you have a high risk for developing cardiovascular disease in the long run, even if the 10-year risk does not appear to be high.

HEART ATTACK| DO YOU KNOW THE SYMPTOMS?

  • A crushing, squeezing, or burning pain, pressure, or fullness in the center of the chest. The pain may radiate to the neck, one or both arms, the shoulders, or the jaw. The chest discomfort lasts more than a few minutes. It can diminish in intensity and return.
  • Shortness of breath, dizziness
  • Nausea, heartburn, or upset stomach
  • Sweating or feeling "the chills"
  • A weak, fast pulse.
  • An irregular heart beat
  • Cold, clammy skin, or a gray color to the face
  • Fainting or loss of consciousness
  • Fatigue

You may not feel all of these symptoms. Some people experience no symptoms -- this is called silent ischemia.

Women often have different symptoms of a heart attack than men. They may not experience chest pain but may have other symptoms, such as pain high in the abdomen or chest, or pain in the jaw, back, or neck.

Call 911 Immediately About a Heart Attack If:

  • You or someone else shows signs of a heart attack. Seek emergency help right away, without delay.
  • Your angina (chest pain) no longer responds to medication. This may indicate that a heart attack is beginning.
  • Your angina attacks become more frequent, prolonged, and severe. As angina worsens, the risk of heart attack increases.

 Call Your Doctor About a Heart Attack If:

  • You are taking aspirin to prevent heart attack and your stool appears black and tarry. This may indicate gastrointestinal bleeding and could be a sign that aspirin has thinned your blood too much, problems that can and should be corrected.

 ANGINA |  Early Warning Sign of a Heart Attack

The majority of heart attack victims are warned of trouble well in advance by episodes of angina, which is chest pain that, like a heart attack, is provoked by ischemia. The difference is mainly one of degree: With angina, blood flow is quickly restored, pain recedes within minutes, and the heart is not permanently damaged. With a heart attack, blood flow is critically reduced or fully blocked, pain lasts, and heart muscle dies without prompt treatment.

About 25% of all heart attacks occur without any previous warning signs. They are sometimes associated with a phenomenon known as "silent ischemia" -- sporadic interruptions of blood flow to the heart that, for unknown reasons, are pain-free, although they may damage the heart tissue. The condition can be detected by ECG (electrocardiogram) testing. People with diabetes often have silent ischemia.

A quarter of all heart attack victims die before reaching a hospital; others suffer life-threatening complications while in the hospital. Serious complications include stroke, persistent heart arrhythmias (irregular heart beats), heart failure, formation of blood clots in the legs or heart, and aneurysm, or bulging, in a weakened heart chamber. But those who survive the initial heart attack and are free from major problems a few hours later stand a better chance of full recovery.

Recovery is always a delicate process since any heart attack weakens the heart to some degree. But generally, a normal life can be resumed within 3 months. Depending on the severity of the attack, the subsequent scarring of the heart, and how fast a person gets treatment, a heart attack can lead to:

  • Heart failure, where the heart doesn't pump well enough to meet the body's needs.
  • Arrhythmias or abnormal heart rhythms.
  • Cardiac arrest or sudden cardiac death, where the heart stops beating.
  • Cardiogenic shock, where the heart is so damaged from the heart attack that a person goes into shock.
  • Death.

What Causes a Heart Attack?

  • Most heart attacks are the result of coronary artery disease, also known as atherosclerosis or "hardening of the arteries," a condition that clogs coronary arteries with fatty, calcified plaques over time. The typical trigger for a heart attack is often a blood clot that blocks the flow of blood through a coronary artery.
  • In the early 1980s, researchers confirmed that the trigger for nearly all heart attacks is not the obstructive plaque itself, but the sudden formation of a blood clot on top of plaque that cuts off blood flow in an already narrowed vessel. This is called "plaque rupture." Many doctors now believe that the less severe plaques are the cause of most heart attacks: It's the 30% blockages that rupture and then cause the blood clot to form.
  • Heart attacks may also be caused by coronary artery spasm, where a heart artery is temporarily constricted, although this is a fairly rare cause.
  • New research shows that inflammation also plays a role in the evolution of heart attacks. It appears that the coronary artery walls become inflamed over time, further increasing the buildup of fatty plaques.
  • While the step-by-step process leading to a heart attack is not fully understood, major risk factors for coronary artery disease are well known. Some can be controlled, including high blood pressure, high cholesterol, obesity, smoking, and a sedentary lifestyle. Stress is also believed to raise the risk, and exertion and excitement can act as triggers for a heart attack.
  • Other risk factors include having diabetes and having a family history of heart disease.

Men vs. Women: Confusion Over Heart Symptoms

Heart Attacks in Men vs. Women

Everyone needs to take care of his or her heart. Heart disease is a leading killer for both sexes. A heart attack is its most visible sign, says the American Heart Association (AHA).

Women aren't the only ones who can have "atypical" heart attack symptoms. Men can, too.

Likewise, classic heart attack symptoms don't only affect men. Women can experience the same well-known warning signs, such as:

  • A crushing, squeezing, or burning pain, pressure, or fullness in the center of the chest. The pain may radiate to the neck, one or both arms, the shoulders, or the jaw. The chest discomfort lasts more than a few minutes or can go away and return.
  • Shortness of breath, dizziness, nausea, chills, sweating, or weak pulse
  • Cold and clammy skin, gray pallor, or a severe appearance of illness
  • Fainting (rare)

Not all of these symptoms occur during a heart attack, but because every second counts, if you experience them call 911 immediately, says the American Heart Association.

How Men and Women Describe Their Symptoms

Here's how patients described their heart attack symptoms:

  • Pain, shortness of breath, fatigue. No gender differences
  • Right-side chest discomfort. 4.7 times more likely to be reported by men
  • Throat discomfort. 12 times more likely to be reported by women
  • Discomfort. 2.7 times more likely to be reported by men
  • Dull ache. 3.9 times more likely to be reported by men
  • Pressing on the chest. 7.3 times more likely to be reported by women
  • Vomiting. 3.9 times more likely to be reported by women
  • Indigestion. 3.7 times more likely to be reported by men

Men were also five times more likely than women to recognize their symptoms as being related to their heart, say the researchers.

Every Minute Counts During Heart Attack

Time can make the difference between life and death. Almost half of cardiac deaths happened before emergency services and hospital treatment could be administered, says the CDC.

Educating both genders of the full constellation of symptoms of a heart attack will help men and women recognize their symptoms sooner as cardiac related.

 

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