Hearth Health

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Description
Hardening of the arteries, congestive heart failure and other diseases of the heart are the leading killers of Americans, claiming more than 725,000 lives each year. The most common type of heart problem is hardening of the arteries, also known as coronary heart disease (CHD), which can lead to heart attack, the serious chest pain of angina or both.

Both heart attacks and angina occur when the oxygen-rich blood supply to part of the heart muscle is severely reduced. In fatal heart attacks, the blood supply may be cut off altogether. The blockage is sometimes caused by the buildup of plaque. In other cases, a blood clot becomes lodged in the coronary artery, interrupting blood flow

Symptoms
The hallmark symptom of angina is chest pain, particularly pain that becomes more intense when the heart's demands increase, such as when one runs to catch a bus.
Symptoms of a heart attack:

Uncomfortable pressure, fullness, squeezing or pain in the center of the chest lasting more than a few minutes
Pain spreading to the shoulders, neck or arms
Chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath

Risk Factors
Uncontrollable risk factors include increasing age (four of five people who die of CHD are 65 or older), male sex, family history and black race. Controllable risk factors include poor diet, smoking and inactivity. Diabetes, high blood pressure, high cholesterol and obesity also increase a person's risk of heart disease and can be controlled to varying extents through medication and lifestyle modification.

Prevention
Primary prevention -- altering risk factors to prevent heart disease in the first place -- centers on quitting smoking; keeping blood pressure levels at 140/90 mm Hg or less; keeping blood LDL cholesterol in check (less than 160 mg/dL if no more than one risk factor, less than 130 mg/dL if two or more risk factors); following a low-fat, high-fiber diet; exercising regularly and shedding excess pounds if overweight. Postmenopausal women at increased risk of heart disease also may be advised to take estrogen-replacement therapy to help reduce their risk.

Secondary prevention -- prevention of a second cardiac event in patients who have had a heart attack or suffer angina -- includes the above measures as well as drug therapy for some patients. Among the medications often prescribed are daily aspirin and prescription blood-thinning drugs, ACE inhibitors, beta-blockers and cholesterol-lowering drugs.

Treatment
For angina, nitroglycerin is the drug most often prescribed. It relaxes the veins, increasing the blood supply to the heart. Also available is laser treatment for angina patients with severe and frequent chest pain that cannot be relieved with drug therapy or other surgical options.

Both angina and heart attack patients often undergo angioplasty or coronary artery bypass surgery to open up narrowed arteries. In angioplasty, a catheter is used to insert a deflated balloon into the narrowed passage. When the balloon is inflated, it presses the plaque up against the arterial wall, thus re-opening the passage. In bypass surgery, veins from the patient's leg are used to re-route, or "bypass," the clogged arteries, thereby improving the supply of blood to the heart.

For heart attacks, clot-dissolving drugs called thrombolytics are sometimes used. Treatments for heart attacks are most likely to be successful if given in the first six hours after symptoms start.