Heart disease treatment and prevention

Everything you need to know about heart disease

Share on PinterestThere are many different types of heart disease.

There are many types of heart disease that affect different parts of the organ and occur in different ways.

Congenital heart disease

This is a general term for some deformities of the heart that have been present since birth. Examples include:

  • Septal defects: There is a hole between the two chambers of the heart.
  • Obstruction defects: The flow of blood through various chambers of the heart is partially or totally blocked.
  • Cyanotic heart disease: A defect in the heart causes a shortage of oxygen around the body.

Arrhythmia

Arrhythmia is an irregular heartbeat.

There are several ways in which a heartbeat can lose its regular rhythm. These include:

  • tachycardia, when the heart beats too fast
  • bradycardia, when the heart beats too slowly
  • premature ventricular contractions, or additional, abnormal beats
  • fibrillation, when the heartbeat is irregular

Arrhythmias occur when the electrical impulses in the heart that coordinate the heartbeat do not work properly. These make the heart beat in a way it should not, whether that be too fast, too slowly, or too erratically.

Irregular heartbeats are common, and all people experience them. They feel like a fluttering or a racing heart. However, when they change too much or occur because of a damaged or weak heart, they need to be taken more seriously and treated.

Arrhythmias can become fatal.

Coronary artery disease

The coronary arteries supply the heart muscle with nutrients and oxygen by circulating blood.

Coronary arteries can become diseased or damaged, usually because of plaque deposits that contain cholesterol. Plaque buildup narrows the coronary arteries, and this causes the heart to receive less oxygen and nutrients.

Dilated cardiomyopathy

The heart chambers become dilated as a result of heart muscle weakness and cannot pump blood properly. The most common reason is that not enough oxygen reaches the heart muscle, due to coronary artery disease. This usually affects the left ventricle.

Myocardial infarction

This is also known as a heart attack, cardiac infarction, and coronary thrombosis. An interrupted blood flow damages or destroys part of the heart muscle. This is usually caused by a blood clot that develops in one of the coronary arteries and can also occur if an artery suddenly narrows or spasms.

Heart failure

Also known as congestive heart failure, heart failure occurs when the heart does not pump blood around the body efficiently.

The left or right side of the heart might be affected. Rarely, both sides are. Coronary artery disease or high blood pressure can, over time, leave the heart too stiff or weak to fill and pump properly.

Hypertrophic cardiomyopathy

This is a genetic disorder in which the wall of the left ventricle thickens, making it harder for blood to be pumped out of the heart. This is the leading cause of sudden death in athletes. A parent with hypertrophic cardiomyopathy has a 50 percent chance of passing the disorder on to their children.

Mitral regurgitation

Also known as mitral valve regurgitation, mitral insufficiency, or mitral incompetence, this occurs when the mitral valve in the heart does not close tightly enough. This allows blood to flow back into the heart when it should leave. As a result, blood cannot move through the heart or the body efficiently.

People with this type of heart condition often feel tired and out of breath.

Mitral valve prolapse

The valve between the left atrium and left ventricle does not fully close, it bulges upwards, or back into the atrium. In most people, the condition is not life-threatening, and no treatment is required. Some people, especially if the condition is marked by mitral regurgitation, may require treatment.

Pulmonary stenosis

It becomes hard for the heart to pump blood from the right ventricle into the pulmonary artery because the pulmonary valve is too tight. The right ventricle has to work harder to overcome the obstruction. An infant with severe stenosis can turn blue. Older children will generally have no symptoms.

Treatment is needed if the pressure in the right ventricle is too high, and a balloon valvuloplasty or open-heart surgery may be performed to clear an obstruction.

Treatment and Prevention of Heart Disease

Medication, frequent exercise, and a healthy diet are all ways to prevent and treat heart disease. .com

Treatment for heart disease varies by condition and severity. For example, coronary artery disease can be treated with lifestyle changes or medication, while a serious heart rhythm problem may need an implantable device, like a pacemaker.

Your doctor will devise a treatment plan that is best for your needs. Make sure to follow directions carefully and fully.

Generally, heart disease treatment can include:

Lifestyle Modifications These are often the first steps to managing heart disease. Lifestyle changes include eating a heart-healthy diet low in sodium and fat, exercising regularly, quitting smoking, and limiting alcohol use.

Medication When lifestyle changes are not enough, your doctor may prescribe medication to treat heart disease. The type of drug prescribed will depend on the condition and severity.

Medication commonly used in the treatment of heart disease can include:

  • Anticoagulants, or blood thinners that decrease the clotting ability of the blood, are used to treat certain blood vessel, heart, and heart rhythm conditions. These drugs help prevent harmful blood clots from forming in the blood vessels or heart, and may prevent clots from becoming larger and causing more serious problems.
  • Angiotensin-converting enzyme (ACE) inhibitors expand blood vessels and decrease resistance by lowering levels of hormones that regulate blood pressure, allowing blood to flow through the body more easily.
  • Beta-blockers work by slowing the heart rate down and decreasing the effects of adrenaline on the heart. This helps lower blood pressure so the heart has to do less work.
  • Calcium channel blockers interrupt the movement of calcium into the cells of the blood vessels and heart. This medication can decrease the heart’s pumping strength and relax the blood vessels.
  • Digitalis can help the heart contract harder when its pumping function has been weakened.
  • Diuretics, also known as water pills, rid the body of excess fluids and sodium through urination, helping to relieve the heart’s workload. These pills also decrease the backup of fluid in the lungs and other parts of the body, like ankles and legs.
  • Cholesterol-lowering medicines, like statins, decrease levels of LDL (the “bad”) cholesterol in the blood. (1,2)

Surgery If both lifestyle changes and medication are not enough, surgery may be needed. The type of heart disease you have and how much damage has been done to your heart will determine which procedure your doctor recommends.

Medical procedures to treat heart disease can include:

  • Angioplasty is a procedure that involves special tubing with an attached deflated balloon that is threaded up to the coronary artery. The balloon is inflated to widen the areas that are blocked where blood flow to the heart has been slowed or cut off.
  • Stent placement involves a wire mesh tube, called a stent, that is used to prop open an artery during an angioplasty and stays in the artery permanently.
  • Bypass surgery treats blocked arteries by removing arteries or veins from other parts of the body and using them to reroute blood around arteries that are clogged in order to improve blood flow to the heart.
  • Radiofrequency ablation is used to treat a variety of heart rhythm problems when drugs are ineffective. It involves a catheter with an electrode at its tip being guided through the veins to the heart muscle. The catheter is placed at the exact site in the heart where electrical signals stimulate the abnormal heart rhythm, and a mild radiofrequency energy is transmitted to the pathway, destroying selected cells in a very small area.
  • Heart transplant is a procedure that’s performed in the most serious of circumstances, when a heart is irreversibly damaged. The procedure involves removing a diseased heart and replacing it with a healthy one from an organ donor. (3)

RELATED: How to Stay Healthy After a Heart Transplant

Medicines

There are many effective medicines to treat heart disease.

Medicines can reduce your risk of heart attack, angina, stroke, or heart failure. They can help manage symptoms by controlling high blood pressure and high blood cholesterol, and improve your quality of life.

Tips for taking your medicines

  • Develop a routine for taking your heart medications. Take them exactly as your doctor prescribes or directs.
  • You may want to use a pillbox marked with the days of the week. Your pharmacist or doctor can help with this.
  • Don’t stop taking your medicines unless your doctor tells you to. Most medicines have to be taken for the long term to keep on managing your heart problems. Even if you start to feel better, it’s important to continue.
  • Some of your heart medicines may cause side effects. If you experience side effects like dizziness when standing or getting out of bed, sit or lie down for a few minutes, then get up more slowly. Tell your doctor if dizziness persists. If you’re worried about side effects or want more information, talk with your doctor or pharmacist.
  • Don’t decrease your medication to save money. You must take the full amount for them to be effective. Talk with your doctor about ways to reduce medication costs.
  • Tell your doctor or pharmacist if you’re taking (or plan to take) other medicines, including herbs or vitamins. Some medicines can be badly affected by others.
  • It’s normal to have to take more than one type of medicine. Carry a list of what you’re taking with you.
  • Regularly fill prescriptions. Don’t wait until you’re completely out of medication before filling prescriptions. Ask your doctor or pharmacist any questions you have.

Learn more about taking your medicines.

Common medicines

The medicines you take depend on your heart condition and symptoms. For a heart attack or angina, it’s normal to take different kinds of medicine.

Below is a list of medicines commonly used to:

  • stop blood clots
  • manage high blood pressure
  • manage high cholesterol
  • manage and stop angina.

To find out about a specific medicine search for it on the National Prescribing Service Medicinewise website.

Anti-clotting (blood-thinning) medicines

Aspirin

You may have to take a small dose of aspirin every day. It can stop blood clots from forming in a narrow artery and reduce the risk of heart attack and stroke. If you can’t take aspirin, you might take another anti-clotting medicine.

Learn more about aspirin and its side effects on the NPS Medicinewise website.

Antiplatelet medicines

Antiplatelet medicines include clopidogrel, prasugrel and ticagrelor. They can be used with, or instead of, aspirin. They help to stop blood clots forming in your blood vessels.

You usually need antiplatelet medicines if you’ve had coronary angioplasty and stent implantation, or have had recurring heart attacks or angina.

If you take an antiplatelet medicine, unless you are suffering severe bleeding you must not stop taking it unless your cardiologist or doctor tells you to. This is even more important if you have had a stent implanted.

Learn more about antiplatelet medicines and their side effects on the NPS Medicinewise website.

Anticoagulant medicines

Warfarin

Warfarin helps to prevent blood clots forming and treats existing clots.

If you are taking warfarin you need to have regular blood tests to check you’re taking the right dose and that it’s working properly.

Other medicines, including some foods, alcohol, herbs and vitamins, can change how warfarin works. Speak to your doctor, nurse or pharmacist about what foods can interact with warfarin. Tell your doctor or pharmacist about any other medicines you take or plan to start taking and read the instructions carefully.

Learn more about Warfarin and its side effects on the NPS Medicinewise website.

NOACs

Some other anticoagulant medicines, called NOACs (novel anticoagulant therapies) include dabigatran, apixaban and rivaroxaban. These do not require blood testing.

Learn more about NOACs and their side effects on the NPS Medicinewise website.

Blood pressure medicines

Angiotensin converting enzyme (ACE) inhibitors

ACE inhibitors widen (‘dilate’) your blood vessels and reduce strain on your heart. They are used to lower blood pressure, make your heart work better and improve your chance of surviving after a heart attack.

Learn more about antiplatelet medicines and their side effects on the NPS Medicinewise website.

Angiotensin II receptor blockers (ARB)

ARBs are sometimes used instead of ACE inhibitors if you get side effects, such as a persistent cough, from taking ACE inhibitors. ARBs work like ACE inhibitors; they widen your blood vessels and reduce strain on your heart.

Learn more about ARBs and their side effects on the NPS Medicinewise website.

Beta-blockers

Beta-blockers can make your heart beat more slowly, and lower your blood pressure and risk of a heart attack. You may sometimes be given a beta-blocker for arrhythmias (abnormal heart rhythms) or angina.

Learn more about beta-blockers and their side effects on the NPS Medicinewise website.

Cholesterol medicines

Statins

Statins reduce your risk of heart attack and stroke by helping to lower your cholesterol. They also sometimes lower your triglycerides.

Statins help to stabilise plaque in arteries. They are often given to people after they have had a heart event (e.g. heart attack, stroke or angina) – even if the person’s cholesterol is in the ‘normal’ range. Statins are recommended for almost everyone with coronary heart disease.

You will usually be given a statin when you are in hospital. You will need to keep taking it when you go home. Your doctor may change the dose or type of statin you are taking, to make sure it is working properly and not causing side effects.

Learn more about statins and their side effects on the NPS Medicinewise website.

Anti-anginal medicines

Nitrates

Nitrate medicines increase blood flow to your heart by widening blood vessels. They prevent or treat angina.

There are two types of nitrate medicines.

  • Short-acting nitrate medicines relieve angina symptoms within a few minutes. These medicines are a spray or tablet that goes under your tongue. They are absorbed through the lining of your mouth into your bloodstream. The most common short-acting nitrate medicine is glyceryl trinitrate (sometimes called ‘GTN’).
  • Long-acting nitrate medicines prevent angina symptoms. They do not relieve an angina episode within a few minutes. These are usually tablets that you swallow whole (you do not put them under your tongue like short-acting nitrate medicines).

Nitrate medicines may also come as patches, and you gradually absorb the medicine through your skin.

Men should not take erectile dysfunction drugs with nitrate medicines.

Learn more about nitrates and their side effects on the NPS Medicinewise website.

Can’t find your medicine?

To find out about a specific medicine not listed here go to the NPS Medicinewise website.

Recovering from a heart attack?

Learn more about heart attack recovery, the treatments you had in hospital and how you can recover sooner and the actions you can take.

Learn more

How to Prevent Heart Disease

Heart disease is the leading cause of the death in the United States. It is also a major cause of disability. There are many things that can raise your risk for heart disease. They are called risk factors. Some of them you cannot control, but there are many that you can control. Learning about them can lower your risk of heart disease.

What are the heart disease risk factors that I cannot change?

  • Age. Your risk of heart disease increases as you get older. Men age 45 and older and women age 55 and older have a greater risk.
  • Gender. Some risk factors may affect heart disease risk differently in women than in men. For example, estrogen provides women some protection against heart disease, but diabetes raises the risk of heart disease more in women than in men.
  • Race or ethnicity. Certain groups have higher risks than others. African Americans are more likely than whites to have heart disease, while Hispanic Americans are less likely to have it. Some Asian groups, such as East Asians, have lower rates, but South Asians have higher rates.
  • Family history. You have a greater risk if you have a close family member who had heart disease at an early age.

What can I do to lower my risk of heart disease?

Fortunately, there are many things you can do to reduce your chances of getting heart disease:

  • Control your blood pressure. High blood pressure is a major risk factor for heart disease. It is important to get your blood pressure checked regularly – at least once a year for most adults, and more often if you have high blood pressure. Take steps, including lifestyle changes, to prevent or control high blood pressure.
  • Keep your cholesterol and triglyceride levels under control. High levels of cholesterol can clog your arteries and raise your risk of coronary artery disease and heart attack. Lifestyle changes and medicines (if needed) can lower your cholesterol. Triglycerides are another type of fat in the blood. High levels of triglycerides may also raise the risk of coronary artery disease, especially in women.
  • Stay at a healthy weight. Being overweight or having obesity can increase your risk for heart disease. This is mostly because they are linked to other heart disease risk factors, including high blood cholesterol and triglyceride levels, high blood pressure, and diabetes. Controlling your weight can lower these risks.
  • Eat a healthy diet. Try to limit saturated fats, foods high in sodium, and added sugars. Eat plenty of fresh fruit, vegetables, and whole grains. The DASH diet is an example of an eating plan that can help you to lower your blood pressure and cholesterol, two things that can lower your risk of heart disease.
  • Get regular exercise. Exercise has many benefits, including strengthening your heart and improving your circulation. It can also help you maintain a healthy weight and lower cholesterol and blood pressure. All of these can lower your risk of heart disease.
  • Limit alcohol. Drinking too much alcohol can raise your blood pressure. It also adds extra calories, which may cause weight gain. Both of those raise your risk of heart disease. Men should have no more than two alcoholic drinks per day, and women should not have more than one.
  • Don’t smoke. Cigarette smoking raises your blood pressure and puts you at higher risk for heart attack and stroke. If you do not smoke, do not start. If you do smoke, quitting will lower your risk for heart disease. You can talk with your health care provider for help in finding the best way for you to quit.
  • Manage stress. Stress is linked to heart disease in many ways. It can raise your blood pressure. Extreme stress can be a “trigger” for a heart attack. Also, some common ways of coping with stress, such as overeating, heavy drinking, and smoking, are bad for your heart. Some ways to help manage your stress include exercise, listening to music, focusing on something calm or peaceful, and meditating.
  • Manage diabetes. Having diabetes doubles your risk of diabetic heart disease. That is because over time, high blood sugar from diabetes can damage your blood vessels and the nerves that control your heart and blood vessels. So, it is important to get tested for diabetes, and if you have it, to keep it under control.
  • Make sure that you get enough sleep. If you don’t get enough sleep, you raise your risk of high blood pressure, obesity, and diabetes. Those three things can raise your risk for heart disease. Most adults need 7 to 9 hours of sleep per night. Make sure that you have good sleep habits. If you have frequent sleep problems, contact your health care provider. One problem, sleep apnea, causes people to briefly stop breathing many times during sleep. This interferes with your ability to get a good rest and can raise your risk of heart disease. If you think you might have it, ask your doctor about having a sleep study. And if you do have sleep apnea, make sure that you get treatment for it.

As can be expected from an organ responsible for getting blood throughout the body, the root of heart disease is when that blood flow is blocked.

Heart disease, or cardiovascular disease, encompasses a range of conditions, including blood vessel diseases such as coronary artery disease, problems with heart rhythm (arrhythmias) and congenital heart defects, according to the Mayo Clinic.

Symptoms and types

Coronary artery disease is the most common type of heart disease in the United States, according to the CDC. It occurs when cholesterol builds up in arteries — called plaque — narrowing the space blood can flow through, a condition called atherosclerosis.

In other words, “anything that blocks the vessel,” said Lawrence Phillips, a cardiologist and assistant professor at NYU Langone Medical Center, in New York.

Ultimately, the narrowing can build up enough to cause chest pain and shortness of breath — called angina, or it can block the vessel completely, causing a heart attack. Heart attacks can also be caused by the rupture of a plaque that causes a blockage of the blood vessels, Phillips said. Over 1 million Americans suffer heart attacks each year, according to the American Heart Association.

Another cause of heart disease is an arrhythmia, a condition where the heart beats too quickly (tachycardia), too slowly (bradycardia) or irregularly. Symptoms can include a fluttering feeling in the chest, racing heartbeat, slow heartbeat, chest pain or discomfort, shortness of breath, lightheadedness, dizziness, fainting (syncope) or near fainting, according to the Mayo Clinic.

Heart disease may also be caused by problems a person is born with, known as congenital heart defects. Symptoms of heart defects in children can include pale gray or blue skin (cyanosis), swelling in the legs, abdomen or around the eyes, and shortness of breath during feeding in infants (causing poor weight gain), according to the Mayo Clinic.

Less serious congenital heart defects may not be diagnosed until late childhood or adulthood. These defects are not immediately life threatening, and symptoms include becoming short of breath or tired easily during exercise or activity, as well as swelling in the hands, ankles or feet.

Other forms of heart disease can be caused by weak heart muscle, heart infections, or diseases of the heart valves.

Diagnosis and tests

Five symptoms can indicate when someone is having a heart attack and requires immediate emergency care. These include pain in the jaw, neck or back; pain in the arms or shoulder; chest pain; lightheadedness or weakness; and shortness of breath, Phillips said.

Heart disease symptoms may differ for men and women, according to the Mayo Clinic. Men are more likely to have chest pain, while women are more likely to have shortness of breath, nausea and extreme fatigue.

A number of factors play a role in heart disease risk. Some include family history and age (if your relatives have heart disease or you are older, your risk goes up), but others you have more control over.

Much of the advice to avoid heart disease is the same health advice given for other conditions: stop smoking, exercise and eat a diet that is low in cholesterol and salt — cholesterol being the source of blockage and salt contributing to higher blood pressure. Other things to avoid in the diet include saturated fats, which typically come from animal fats and oils, and trans fats, which occur in vegetable oil, but have largely been removed from the marketplace because of consumer demand.

According to the NIH, diabetes can increase heart disease risk by as much as 100 percent, as the higher levels of glucose in the blood that are characteristic of diabetes can leave fatty deposits in blood vessels, which, like cholesterol plaques, can cause blockage of the heart.

Prevention

In addition to lifestyle changes, some treatments are available to help avoid heart disease. Many of these medications are designed to lower cholesterol.

There are two types of cholesterol. The first, LDL, is called “bad cholesterol” because it is the type that can build up and block blood vessels. The other, HDL, is called “good cholesterol” because it is responsible for transporting LDL to the liver, ultimately removing it from the blood stream.

Optimally, HDL cholesterol levels should be above 40 (measured in milligrams per deciliter of blood) and LDL cholesterol should be below 100, according to the CDC.

The FDA has approved a number of drugs for improving cholesterol levels. Perhaps the best-known are statins. They slow cholesterol production by the liver and speed up how fast it removed LDL cholesterol from the bloodstream.

Another class of drug to lower cholesterol is called bile acid sequestrants. These drugs remove bile acids from the body. Because the body produces these acids from LDL cholesterol, more LDL cholesterol will be broken down to replace them.

Niacin and fibrates are other drug classes for improving cholesterol levels. Both increase HDL cholesterol, and niacin lowers LDL cholesterol.

Treatment

Surgical options can also treat heart disease. Coronary angioplasty is performed over one million times each year on patients in the United States, according to the NIH. In this procedure, a balloon is threaded into the affected blood vessel and inflated, pushing the plaque blocking the artery to the sides of the vessel. Sometimes, this procedure is accompanied by placement of a stent — a mesh tube designed to hold the blood vessel open.

Despite all that is known about it, heart disease is the leading cause of death in both men and women in the United States, according to the CDC, claiming over 630,000 lives in 2006 — more than a quarter of all deaths.

Additional resources

  • To learn more about the causes of heart disease, check out the Mayo Clinic.
  • The National Institutes of Health explains the risk factors for heart disease.
  • For more facts and figures on heart disease, see the Centers for Disease Control and Prevention.

Staff Writer Tanya Lewis contributed to this article. Follow Tanya on Twitter. Follow us @livescience, Facebook & Google+.

Coronary Artery Disease: Prevention, Treatment and Research

Coronary artery disease (also called coronary heart disease) is the number-one killer of both men and women in the United States, and it’s the most common type of heart disease. This often preventable disease causes the dangerous thickening and narrowing of the coronary arteries—the vessels that bring blood to the heart—which disrupts the flow of oxygen and nutrients to the heart, causing serious problems.

Without enough blood, coronary artery disease can lead to angina (chest pain). Over time, the heart has to work harder, possibly causing heart failure (when the heart cannot pump efficiently) or arrhythmia (when the heart beats irregularly or too quickly). The damaged arteries may become completely blocked, or become prone to clotting, causing a heart attack.

“Coronary artery disease develops slowly, usually over decades, so the good news is that we have a huge window of opportunity for prevention, through a good lifestyle and healthy habits,” says Seth Martin, M.D., M.H.S., of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease.

Prevention

Preventing coronary artery disease is largely about controlling the risk factors. “Ideally, prevention habits start early, but they remain important all through life,” Bill McEvoyMBBCh, of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease says. It’s never too late to effect change, though the earlier in life you do so, the greater the advantage. Smart steps to take:

  • Quit smoking—or better yet, never start. Smoking is considered one of the key risk factors for heart attack. Also steer clear of secondhand smoke. If a household member is a smoker, help him or her find ways to quit, such as calling your state’s free 800-QUIT-NOW line, suggests Martin.
  • Eat less of the foods that add to heart problems, and more of the foods that protect the heart. Aim for an eating plan that’s low in saturated fats and trans fats, higher in monounsaturated and polyunsaturated the fats found in olive oil and fish, high in fiber (found in plant foods), and low in salt and sugar. Get practical ideas to eat for heart health in Eat Smart.
  • Become more active, and stay active, all through life. A good goal is at least 150 minutes (2.5 hours) of moderate exercise each week, or 75 minutes (1.25 hours) of vigorous aerobic exercise each week. Or aim to be active for 30 minutes a day, most days of the week. Check with your doctor before you launch a new workout program if you’ve never worked out before. Learn how implementing an exercise routine helps your heart in Move More.
  • Keep your weight within the normal range on a Body Mass Index (BMI) chart. If you’re overweight, losing just 5 percent to 10 percent of your current weight will lower your risk of developing coronary artery disease.
  • Find healthy outlets for your stress. Some stress is unavoidable in life. But it tends to push us toward not-so-great habits (overeating, drinking, sitting too much). You’ll be more heart-healthy if you can offload stress in ways you enjoy and that are good for you, such as exercise, meditation and relaxing with friends, says McEvoy. A stress-management program can help.

Diagnosis & Treatment

Diagnosis

Because coronary artery disease develops over time, the symptoms depend on the stage of illness. Damage may be present without outward signs. It’s common to first notice shortness of breath or chest pains when you exert yourself physically. Some people have mild episodes of these symptoms. For others, the first experience is more severe chest pain, even heart attack.

To diagnose coronary artery disease, your doctor will look at markers such as blood pressure, cholesterol profile and blood glucose (from a blood test) as well as your health history and family history, says McEvoy. This information can help estimate your 10-year cardiovascular risk—your odds of a heart attack or stroke.

Depending on the symptoms you have, tests that may be given to provide additional information include:

  • Coronary calcium testing: A simple CT scan provides images of the heart between beats, showing calcium and plaque buildup. “You can actually see the damage that’s known as hardening of the arteries,” says Martin. This test may be considered in persons without known coronary heart disease in whom the decision to treat with a statin and aspirin is unclear.
  • High Sensitivity C-reactive protein blood test: This indicates whether you have higher than average levels of inflammation.
  • Electrocardiogram (EKG or ECG): Measurement of the electrical activity of your heartbeat during rest.
  • Exercise stress test (“treadmill test”): A test done on a treadmill to measure your heart rate when the heart has to pump harder.
  • Echocardiogram: An ultrasound image of your heart.
  • Chest X-ray: An image of your heart, lungs and other chest organs.
  • Cardiac catheterization: A test in which a thin tube is inserted into an artery to check for blockages in heart arteries.
  • Coronary angioplasty: a procedure in which a expandable balloon is used to open up a narrowed artery. Nearly 90% of the time, a stent (metal scaffold) is placed at the site of the narrowing in the artery.

Treatment

“Treatments work better early on,” says Martin, which is why early identification and intervention are so important. Depending on your health status and goals, there are three key approaches to treating heart disease:

Lifestyle changes. The same steps for preventing coronary artery disease are part of a treatment approach to forestalling further problems—that is, modify the many factors that are in your control, like diet, exercise, de-stressing and not smoking.

Medication. You may be prescribed medications to manage the risk factors for coronary artery disease, such as high blood pressure, high cholesterol, prediabetes and diabetes.

Procedures to help open blood vessels. Several different types of surgeries (usually outpatient) may be done to repair damage to arteries. These include:

  • Coronary angioplasty. A “balloon” is inserted into the artery through a catheter (a long, narrow, flexible tube) and then inflated to enlarge the passage through the artery. Typically a stent—a wire mesh tube—is also inserted, which forms a scaffolding around the balloon to keep the artery open.
  • Atherectomy. A rotating shaver is used to remove plaque from the artery.
  • Coronary artery bypass surgery (or coronary artery bypass graft). In this more serious surgery, an artery or vein from another part of the body, such as the leg, is grafted onto the coronary artery to create a new route around a blocked section. More than one graft may be done at a time.

Living With…

Living in the shadow of a potential heart attack or other heart problems can be unnerving—but it can also be motivating. Here’s what to focus on after a diagnosis.

  • Know your numbers. Heart health is in large part a numbers game. The key numbers to know include your HDL and LDL cholesterol, total cholesterol and triglycerides, your blood pressure, your glucose, your BMI and your waist circumference measurement, says McEvoy. Get your measurements and readings as often as recommended, make the recommended lifestyle changes and be sure to take medications as directed. This knowledge can be a powerful incentive.
  • Be optimistic. Fear of future cardiac events is common and natural. You may feel anxious, or even depressed. But with good medical care and personal effort, you can still lead a long life of high quality. Small changes really do add up.

Research

Johns Hopkins experts are on the leading edge of research to prevent and treat heart disease. Examples of recent findings include:

Higher levels of physical fitness lower the risk of heart attack. It also cut the risk of death during the time of the study by 75 percent in those who have been diagnosed with coronary artery disease. A Johns Hopkins study found this true whether or not the subjects had a procedure to open blocked arteries (like stenting or bypass surgery).

The traditional formula for assessing LDL cholesterol sometimes underestimates risk. (LDL signals the buildup of plaque in arteries.) Johns Hopkins researchers discovered this risk discrepancy and have devised a more accurate calculation that uses the same basic blood test

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