Heart Disease*The information on this website is not intended to diagnose, treat, cure or prevent any disease.
WHAT IS HEART DISEASE?
Heart disease is any disease that affects the muscle, valves, blood vessels, or rhythm of the heart. In the United States, heart disease is responsible for 25% of all deaths and is the number one killer of both men and women. Of the different types of heart disease, coronary artery disease (CAD) is most cost common, which can eventually lead to a heart attack. Coronary artery disease is the result of the accumulation of plaques in the walls of the blood vessels which supply the heart (the coronary arteries). Over time, these plaques narrow the vessel, making it harder for blood to circulate. Eventually, these vessels become so narrow that the heart cannot get enough blood (and therefore, oxygen). This results in a heart attack, and can result in death or permanent damage to the heart muscle.
Other types of heart disease include diseases which impair the function of the muscle of the heart (cardiomyopathies), result in abnormal heart rhythms (arrhythmias like atrial fibrillation or premature ventricular contractions), or leaky valves that allow blood to flow in the wrong direction when the heart is pumping (valvular disease). Some people are also born with heart disease (congenital heart disease) in which parts of the heart did not form correctly, leading to “holes in the heart” like atrial or ventricular septal defects, or inappropriately formed or narrowed valves (valvular dysplasia and/or valvular stenosis).
Over time, any of these conditions may lead to a condition called “heart failure.” Heart failure means that the heart is no longer able to adequately move blood forward (like a pump that can’t move water fast enough to keep up with the amount of water building up behind it). When this happens, blood starts to accumulate in the veins which are trying to bring blood to the heart to be pumped. As pressure builds up in these veins, the veins start to become leaky, and fluid starts to leak out around them.
Heart diseases are often serious conditions which may require management, but some may be preventable. Early identification of heart disease is also important to so that it can be managed early, which can improve both quality and quantity of life.
The symptoms of heart disease can vary depending on the specific problem, but common signs of heart disease include:
Shortness of breath
Tingling and pain in the arms/hands
Pain in the jaw/neck/throat
Rapid or irregular heartbeats (“palpitations”)
Slow heart beats
Swelling of the legs and feet
There are many different techniques used to diagnose heart disease, and usually multiple tests are performed so doctors can get a complete understanding of what is happening in your heart.
Echocardiogram: An echocardiogram is an ultrasound (or sonogram) of the heart itself. An echocardiogram allows live images of the heart to be seen using sound beams which allow a computer to generate an image. With these images, the walls and chambers of the heart can be accurately measured and the function of the heart (how well it squeezes and relaxes) can be seen. An echocardiogram can also see how blood is moving across the valves of the heart and detect back-flow of blood.
Electrocardiogram (ECG or EKG): This test shows the actual rhythm of the heart and can aid in determining if premature/early beats are occurring, and where they are coming from. Sometimes, a special type of ECG called a Holter Monitor may be sent home with a patient. A Holter monitor is an ECG which is worn for 24 hours or more to evaluate the heart rhythm over a long period of time. This is important if arrhythmias are thought to be happening infrequently, randomly, or sometimes to see if a new medication is adequately controlling arrhythmias.
Angiography: This is a test which allows the blood vessels of the heart to be seen by injecting a contrast agent directly into the coronary arteries. This contrast agent will fill the coronary arteries and can be seen on a type of imaging called “fluoroscopy,” which is like a live x-ray. By filling the blood vessels with contrast, areas of narrowing or complete obstruction to blood flow can be seen.
Biomarkers: Biomarkers are compounds in the blood which correspond to changes in the body. There are a number of different biomarkers which can be useful in heart disease. Some biomarkers are released by the heart in response to over-stretching, scarring, or muscle damage. These biomarkers can help aid in diagnosis, but also can sometimes be helpful in monitoring recovery, response to treatment, or formulating long-term prognoses.
Physical Examination: A physical exam by a medical professional can go a long way toward identifying heart disease. A thorough physical exam can identify heart murmurs or abnormal beats which can be subtle and a person may be unaware of. Regular doctor visits are a powerful way to stay ahead of heart disease.
Depending on the underlying disease, there may be many different treatment recommendations. Depending on the specific condition being treated, a doctor may recommend different pharmaceutical treatments. In general, there are a few major groups of medications which are used for the management of heart disease:
Beta Blockers: Beta blockers are a large group of medications which include drugs like atenolol, metoprolol, propranolol and carvedilol (most of them end in “-lol”) which block beta receptors on the heart. These drugs are protective for the heart by slowing down the heart rate and decreasing the oxygen needs of the heart muscle. Interestingly, although they have a direct effect of making the heart pump less strongly, over time they actually improve the pumping ability of the heart.
As the heart fails, the body responds by release substances like epinephrine and norepinephrine which act to increase heart rate and strength of contraction. If the heart is constantly bombarded with epinephrine and norepinephrine, it becomes desensitized to them, and actually responds more poorly over time. By blocking their effects, beta blocking drugs actually help maintain the heart’s pumping ability. Beta blockers also have some anti-arrhythmic properties as well.
Blood pressure medications: Blood pressure medications contain several different classes of drugs including angiotensin-converting enzyme (ACE inhibitors; lisinopril, captopril, enalapril, etc.), calcium channel blockers (amlodipine, nifedipine), and hydralazine to name a few. Lowering the blood pressure can help reduce the workload on the heart and make it easier to move blood forward. Some of these drugs also work to prevent the body from retaining excessive amounts of sodium and water.
Diuretics: Diuretic medications are usually used in heart failure, but are also sometimes used to aid in control of blood pressure. Diuretic work by increasing urine product, which reduces the amount of water in the blood vessels. Overall, the goal is to reduce the volume of fluid the heart has to pump by preventing the body from retaining it.
Anti-arrhythmics: Anti-arrhythmics are used to control arrhythmias, which may be either slowing down fast heart rates or controlling inappropriate beats. In general, anti-arrhythmics are grouped into four categories:
Class I: Sodium Channel blockers (Lidocaine, mexiletine)
Class II: Beta blockers (the same drugs as described before)
Class III: Potassium channel blockers (Sotalol, amiodarone)
Class IV: Calcium channel blockers (Diltiazem)
Nitrates: Drugs like nitroglycerin are sometimes used to help prevent coronary blood vessels from spasming and restricting blood flow to the heart. These drugs include nitroglycerin and are sometimes used “as needed” to control angina – chest pain which people may feel in response to the blood vessel spasming
Blood thinners: In some types of heart disease (like atrial fibrillation), clots may develop inside the heart which can potentially be pumped out in to the body. This can lead to stroke or damage to other organs. To reduce the chance of this occurring, over the counter drugs like aspirin or prescription drugs like clopidogrel which make platelets less sticky and therefore less likely for form clots may be needed.
Statins: Statins are lipid-lowering medications which reduce the risk of coronary artery disease. This class includes drugs that end in “statin” such as atorvastatin, lovastatin, and simvastatin. These drugs can be very powerful tools in helping to reduce the risk of things like heart attacks, but lifestyle modification is often still recommended first before beginning one of these medications.
Medical Procedures –
Besides drugs, there are also certain procedures which can be performed to manage heart disease as well. Procedures which may be recommended include
Coronary Bypass: A coronary bypass procedure is a major surgical procedure which diverts blood flow around a blocked or narrowed coronary artery. These are performed in individuals who have suffered or are at high risk of suffering a heart attack. A surgeon will usually use healthy blood vessels harvested from other parts of the body to create a new path of blood flow (a bypass route) which goes around the blockage.
Balloon valvuloplasty: This procedure may be performed in congenital heart disease where the valves are too narrow. A long catheter with a balloon on the end is introduced into the heart from a peripheral blood vessel. The balloon is inflated in the valve in an attempt to stretch it open and allow better flow of blood.
Pacemaker: A pacemaker is an electronic device that is used to help keep the heart rate higher. In some instances, people have a heart rate which is inappropriately slow, or experience pauses which can cause them to faint or feel weak. A pacemaker senses the rhythm of the heart and will deliver electrical impulses to the heart to force the heart rate to stay at a minimum level. The pacemaker will allow the heart to have its own rhythm as long as it is fast enough.
Left ventricular assist device (LVAD): This device (often abbreviated as LVAD) is a used to help the heart pump blood more effectively.
Intracardiac defibrillator (ICD): This device may be implanted to deliver a powerful shock to the heart in the event a potentially fatal arrhythmia (called ventricular fibrillation) occurs. The shock will reset the electrical activity of the heart and give the normal biologic pacemaker of the heart a chance to regain normal activity.
Transcatheter aortic valve replacement (TAVR): This is a minimally-invasive procedure which is used to replace a damaged or dysfunctional aortic valve. A catheter with a replacement valve attached is advanced into the aorta and deployed, allowing replacement of the faulty aortic valve.
Non-Pharmaceutical Treatments –
Heart disease has a large number of variables, and there are a number of other treatments which can be helpful in specific conditions or are exciting options in the future. These include things like:
- Stem Cell Therapy
- Chelation Therapy
- Dietary approaches
- Integrative Medicine
- Hawthorn Berry: Hawthorn berry may be helpful in helping the heart pump more effectively, as well as relaxing the blood vessels and decreasing blood pressure. Hawthorn may also help lower cholesterol and has anti-oxidant properties.
- Carnitine: Carnitine plays a central role in heart health, helping heart metabolism, regulating calcium influx, and maintaining blood vessel integrity. In some heart diseases, carnitine supplementation seems to be beneficial. However, there are some links between too much carnitine and heart disease, and some researchers suspect the link between red meat and heart disease is due to the high carnitine content.
- B Vitamins: The role of B vitamins is unclear. They may play a role in preventing strokes and coronary artery disease, but it is clear that there can be too much of a good thing, too. Get the daily recommended allowance, but avoid “mega-doses” of B-vitamins. If possible, get B-vitamins through a well-balanced diet.
- Garlic: Seems to have many of the properties that heart medications also have. These include lowering bad cholesterol, reducing plaque formation, inhibiting angiotensin-converting enzyme, and reducing the activity of platelets.
- Red Yeast Rice/Cholestin: This is a traditional Chinese supplement which may have cholesterol-lowering properties, similar to the statin drugs mentioned above.
- Coenzyme Q10 (Ubiquinone): This is an anti-oxidant which has long thought to be important for heart health, and may even have properties that help the heart pump more effectively.
- Guggul gum: An Ayurvedic medicine herb, guggul may have lipid/cholesterol lowering effects.
- Fenugreek: A Middle-Eastern spice which has potential benefits for cholesterol management
- Black Chokeberry: Rich in anti-oxidants and may help protect against atherosclerosis, hypertension, and inflammation.
- Magnesium and Potassium: Can help manage high blood pressure. High magnesium and potassium diets have an inverse relationship with strokes in men.
- Alpha Lipoic Acid: An anti-oxidant which may be protective to the heart and blood vessels.
- Soluble fiber: Soluble fiber may help eliminate excess cholesterol that is normally excreted into the bile. The body tries to reabsorb this cholesterol in the intestinal tract, but soluble fiber will help bind it and allow it to pass through without reabsorption.
- Fish Oil
For some heart diseases, like coronary artery disease, prevention is key. Lifestyle modifications with regular exercise, eating a healthy, well-balanced diet, and regular health check-ups are critically important. However, it is well-known that there is a strong genetic component to many heart diseases, and even those who do everything “right” may still be at high risk. For some types of heart diseases due to genetic factors (like congenital heart disease or cardiomyopathies), there may be no effective way to prevent. For individuals with a family history of heart disease, regular appointments and screening for heart disease are especially important.
However, reducing risk factors is the major strategy for preventing heart disease. Key steps may include –
- Proper Diet
- Management of stress
- Regular exercise
- Reducing alcohol consumption:
- Quit smoking
- Manage depression and anxiety
- Heart Healthy Supplements
- Essential and aromatic oils
- Dental Hygiene
There a wide variety of potential causes of heart disease, but the number one cause in the Western world is lifestyle. Lack of exercise, diets high in sodium and processed foods, over consumption of alcohol, tobacco use, and being in a high-stress society all contribute to heart disease. Fortunately, these are also the issues that an individual can also take some effort to actually address.
Although lifestyle provides the majority of risk factors for most people, there are definitely genetic components to heart disease as well, both congenital heart disease and acquired heart disease. A family history of heart disease is a strong risk factor, and African-Americans are more likely to suffer from high blood pressure and stroke while Hispanics are more likely to have high cholesterol. Other disease which seem unrelated can also lead to heart disease, such as dental disease and diabetes mellitus, or any other disease that can lead to high blood pressure.
Heart disease can also occur due to infections (a condition called myocarditis). Myocarditis can be caused by viruses (include hepatitis, Epstein-Barr, herpes-simplex, Coxsackie, and parvo viruses) as well as bacteria including the bacteria responsible for. Lyme disease and scarlet fever. Parasites are also a known cause of myocarditis, Chagas disease, which is another disease spread by insects. Fungal infections can also cause myocarditis, especially in people who are immunocompromised.
CLINICS FOR MANAGEMENT OF HEART DISEASE
Heart disease is very common, and most hospitals and doctors will be familiar with most of the conditions listed here. However, there are certain clinics which are considered pioneers in the research and management of heart disease. These clinics can be an important resource, particularly if you have a difficult condition which is not being effectively managed.
Stanford Cardiovascular Institute
Smidt Heart Institute at Cedars-Sinai
Massachusetts General Hospital
Northwestern Memorial Hospital
Links to Articles, Research, and Other Information to Help You Heal from Heart Disease