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Patient Education: General Cardiology

The following information is designed to help you understand terms or concepts that you may be exposed to either in our web site or at the clinic. This information is not intended to give any diagnosis or prescription to the reader. Only your physician can do that. For more information, please consult with your physician.

• Angina/Chest Pain

Angina is another term for temporary discomfort in your chest; arm or jaw that occurs when part of your heart does not receive enough oxygen. This is often caused by a narrowed or blocked coronary artery. Typically, angina occurs with exertion or stress, when your heart works harder and needs more oxygen.

The most common cause of angina is coronary artery disease, which is the buildup of fatty deposits inside the walls of your coronary arteries. Over time these deposits, known as plaque, can expand and eventually reduce the blood flow in your coronary arteries. The resulting diminished blood flow may cause angina or a heart attack. Other causes of angina include coronary spasm, thickened heart muscle or valvular disease.

To properly diagnose the cause of your angina, your physician will ask you several questions about your pain, such as where is it located, when you feel it, what makes it start and how long does it last. Your physician will also review your past medical history, family history and lifestyle. He or she will ask you about specific risk factors such as high cholesterol and cigarette smoking. After this, your physician may recommend certain diagnostic tests to further evaluate your heart. These tests may include an electrocardiogram (ECG), an exercise ECG Test, a thallium scan, exercise cardiogram or an angiogram.

 

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• Arrhythmia

When the electrical system of your heart is not working properly, your heart may beat abnormally. It may beat too slow, too fast or in an uncoordinated fashion. These irregular heartbeats are referred to as arrhythmia or dysrhythmia and may have many causes, including age, damage from a previous heart attack, hereditary heart defects and certain illnesses. Arrhythmias can vary in intensity and range from relatively harmless to life threatening.

• Bradycardia. Too slow a heartbeat, or bradycardia, can result in dizziness, fatigue and/or fainting spells. It is the most common reason for pacemaker therapy.
• Atrial Fibrillation. Sometimes referred to as AFib, atrial fibrillation , is another common heart arrhythmia that can affect people of all ages. During AFib, the SA Node in the right atrium (where the electrical signals of the heart begin) sends out extra electrical signals that are not coordinated. Your atria beat so fast they may quiver instead of contracting fully. When this happens, blood is not effectively pumped into the ventricles, and they in turn do not pump enough blood out to your body.

Since your atria are not emptying effectively, some blood may pool there and form a blood clot, which increases your risk for stroke. To help prevent this, people suffering from AFib often take a "blood thinner" medication such as coumadin (Warfarin).

People who have high blood pressure, a history of heart or valve disease, coronary artery disease or hyperthyroidism are at risk for AFib.

• Ventricular Fibrillation. VFib is similar to atrial fibrillation only it affects the ventricles. During ventricular fibrillation, your ventricles do not contract effectively or in a coordinated fashion. Thus, freshly oxygenated blood is not circulated to you body. A person in VFib will lose consciousness and soon die if not treated with emergency procedures such as electrical shock and/or medications immediately.
• Premature Ventricular Contractions (PVCs). When the electrical signals of your heart cause your ventricles to contract before they are filled with blood from the atria, less blood is pumped out to your body. Symptoms of PVC include lightheadedness, weakness, fainting, shortness of breath and chest pain. If this happens frequently or over an extended period of time, it can lead to ineffective blood circulation, exhausted ventricles and even death.

Multiple PVCs occurring in a row is called ventricular tachycardia, or V-tach, and can be life threatening.

 

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• Cigarette Smoking

Tobacco smoke is a major risk factor of heart attack and stroke. Smoking increases the speed of atherosclerosis, reduces the levels of HDL cholesterol and may trigger the formation of blood clots. Cigarette smoking is also the biggest risk factor in sudden cardiac arrest, where the heart stops pumping. Death may be instantaneous or follow soon after symptoms start. Long-term exposure to secondhand smoke, as well as cigar and pipe smoke, can also increase the risk of cardiovascular disorders in smokers and nonsmokers alike. In addition to heart conditions, smoking can also lead to lung cancer, emphysema and chronic bronchitis.

If you do smoke, find help to quit. As soon as you quit, your risk of heart attack and stroke will go down. Over time your risk may return to a level as if you never smoked. Several effective programs are available that can help you quit. Talk to your physician today about which one is right for you.

For help stopping smoking: American Lung Association

 

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• Cholesterol

Cholesterol is a fatlike substance found naturally in cells and is necessary for many functions in the body. Although a certain amount of cholesterol in the bloodstream is normal, an elevated level of cholesterol is considered a major risk factor for coronary artery disease and heart attack. It is also a secondary risk factor for stroke.

There are two kinds of cholesterol that can affect your risk of heart disease, HDL (high-density lipoprotein) cholesterol and LDL (low-density lipoprotein) cholesterol. Your cholesterol levels can be measured with a fasting blood test. Your HDL, LDL and total cholesterol, as well as your triglyceride level, can determine your risk of coronary artery disease.

• HDL, also known as the "good cholesterol," helps lower your risk for heart disease by helping your body get rid of extra cholesterol. The higher your HDL level, the better off you are.
• LDL, or "bad cholesterol," tends to accumulate on the inside of blood vessels when the levels are too high. This can lead to the formation of plaques and later narrowing and even blockage of arteries.

The following table, published by the American Heart Association, is a guideline for cholesterol levels. There are certain factors that may alter some of these values.

 

Cholesterol Level (mg/dL)	Low (Desirable)	Borderline	High Risk
Total Cholesterol	Less than 200	200 - 239	240 or higher
LDL ("Bad") Cholesterol	Less than 130	130 - 159	160 or higher
HDL ("Good") Cholesterol	35 or Higher	--	Less than 35
Triglycerides	Less that 200	200 to 400	400 to 1,000

 

When evaluating your cholesterol levels, your physician often looks at the types of dietary fat you consume. Dietary fats can be divided into saturated, polyunsaturated and monounsaturated fats. Each has different sources and different effects on the amount of cholesterol and fat in your bloodstream.

A diet high in saturated fats and cholesterol can lead to increased levels of total blood cholesterol and LDL cholesterol. Dietary cholesterol only comes from animal products, such as meats, egg yolks, dairy products, organ meats, fish and poultry. Saturated fats are also found in animal products, as well as in plant oils such as palm, palm kernel and coconut.

Polyunsaturated and monounsaturated fats tend to lower blood cholesterol levels when used instead of saturated fats. These types of fat are normally liquid at room temperature and are found in plant oils such as safflower, soy, corn and sunflower. Monounsaturated fats are found in olive, canola and peanut oils.


Triglycerides are another type of fat and are the most common type of fat in the body. A high triglyceride level combined with low HDL or high LDL can increase your risk of atherosclerosis and diabetes. High triglyceride levels may be caused by a high alcohol or sugar intake.

High cholesterol has no symptoms and can affect anyone. You should have your total cholesterol checked by your physician once every five years, starting at age 20. If you have other risk factors, you may need to have it checked more often. Consult with your physician on how best to manage your cholesterol levels.

For more information about cholesterol
"High Blood Cholesterol: What You Need to Know," from the National Heart, Lung, and Blood Institute


 

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• Congestive Heart Failure

Often referred to as just heart failure, congestive heart failure occurs when your heart fails to pump blood effectively. Because the ventricles can no longer pump the normal amount of blood out of your heart and to your body, the blood in your vessels "backs up." The resulting poor circulation leads to a buildup of fluids in your lungs and body (congestion). You may experience difficulty breathing and have swelling in your feet, ankles and legs, fatigue, weight gain and dizziness. Although there is no cure for congestive heart failure, symptoms can be managed through medication, by following a low-sodium diet, exercising regularly based on your physician's guidance and monitoring your weight.

 

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• Coronary Artery Disease

Coronary artery disease refers to narrowing of the coronary arteries and is usually caused by the accumulation of fatty deposits (plaques) inside the arteries, a coronary spasm or a blood clot. The development of plaques is also referred to as atherosclerosis. As plaques get larger, the artery gradually narrows, reducing the amount of oxygen getting to your heart. This can cause angina or a heart attack. Atherosclerosis may develop in other arteries in your body. If such narrowing or blockage occurs in the arteries to your brain, a stroke may result.

 

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• Diabetes Mellitus

Diabetes is a disease that affects your ability to make or respond properly to the hormone insulin. Insulin converts sugar and starches into energy. If you have diabetes, your body cannot pull the proper amounts of sugar from the bloodstream and convert it to energy. As a result, high levels of glucose (sugar) may accumulate in your blood causing problems that can include heart and blood vessel diseases.

The most common form of diabetes is Type II diabetes. It often occurs in adults during middle age and, in a mild form, may go undetected for many years. If left untreated, diabetes can lead to serious medical conditions, including heart and blood vessel diseases. Even when blood glucose levels are under control you are still at greater risk for heart attack and stroke because diabetes also affects cholesterol and triglyceride levels, and increases your risk of high blood pressure. Obesity and physical inactivity are two main risk factors for Type II diabetes.

If you suffer from Type II diabetes, it is very important that you have regular medical checkups to help control it. Your physician can help you develop a plan involving diet, exercise, weight loss and sometime medications to reduce your risk.

 

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• Heart Attack

  A heart attack, also known as a myocardial infarction, happens when part of your heart muscle is damaged or dies because of inadequate blood flow. Unlike angina where the pain is temporary, damage from a heart attack is permanent. The dead muscle tissue eventually turns into scar tissue during the healing process; however, your heart may not pump as effectively as a healthy heart.

  Symptoms of a heart attack can include:

  • Pressure or tightness in your chest or arms,
  • Aching or weakness in your neck, jaw, arm, shoulder or back
  • Pain between your shoulder blades or in your upper back and neck

  Heart attacks often are associated with shortness of breath or difficulty breathing, nausea and vomiting, cold sweats, general weakness or fatigue, anxiety, strong and rapid heartbeats or palpitations and dizziness.

  The pain of angina and a heart attack can be similar. Typically, heart attack pain is prolonged and not relieved by resting. If you believe you are suffering from either angina or a heart attack, stop what you are doing and rest immediately. If you have a prescription for nitroglycerin tables, take as directed. Do not take more than three tablets in fifteen minutes. If your symptoms subside on their own within 15 minutes, call your primary physician right away for follow-up care. If your symptoms do not go away after 15 minutes, call 911 immediately. Do not drive yourself anywhere.

  Some risk factors for a heart attack include age, family history, high blood pressure, high cholesterol, smoking, obesity, lack of exercise, stress and diabetes.

  For more information about heart attack
  "Act in time to Heart Attack Signs," from the National Heart, Lung, and Blood Institute
  

 

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• Hypertension

  High blood pressure, or hypertension,is a major risk factor for both heart attack and stroke. It occurs when there is too much pressure inside the blood vessels. As the pressure increases, your heart must work harder and harder to circulate blood. Over time, this can damage your heart muscle and possibly lead to a rupturing of blood vessels.

  Blood pressure is recorded as two numbers, systolic pressure and diastolic pressure. Systolic pressure is the amount of force created by your heart when it beats and is the higher of the two numbers. Diastolic pressure is the amount of pressure in the blood vessels when your heart is at rest, or between beats. Both numbers are measured in millimeters of mercury (mmHg).

  Normal blood pressure is 120/80 mmHg. High blood pressure is defined as three consecutive blood pressure readings with a systolic pressure of 135 mmHg or greater or a diastolic pressure of 88 mmHg or greater.

  Although the exact cause of hypertension is generally not known, some risk factors include age, race (African Americans are more likely to have high blood pressure), family history, excess weight, alcohol consumption and a diet high in salt.

  Have your blood pressure checked at least once every two years or as your physician recommends.

  For more information about hypertension
  "Your Guide to Lowering High Blood Pressure," from the National Heart, Lung, and Blood Institute

   

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• Obesity

  Individuals who are obese are at increased risk for high blood pressure, high blood cholesterol, high triglycerides, diabetes, heart disease and stroke. Obesity is defined as being at least 20 percent over your ideal weight. Another measure of obesity is percent body fat. The two best ways to determine a person's amount of body fat are to measure the distance around the waist and to determine the body mass index (BMI).

  • A woman with a waistline of 35 inches or more is considered high risk, 40 inches or more for men.
  • The BMI compares a person's weight relative to their height. To determine your BMI, weigh and measure yourself wearing very little clothing and no shoes. Locate your height in feet and inches on the table below and then find your weight. If your weight is less than what the "overweight" column shows, then you are at a healthy weight for your height. The table is from the American Heart Association.

  Height	Overweight (BMI 25.0 to 29.9) Moderate Risk	Obese (BMI 30.0 and above) High Risk
  4'10"	119 - 142 lbs.	143 lbs. or more
  4'11"	124 - 147	148+
  5'0"	128 - 152	153+
  5'1"	132 - 157	158+
  5'2"	136 - 163	164+
  5'3"	141 - 168	169+
  5'4"	145 - 173	174+
  5'5"	150 - 179	180+
  5'6"	155 - 185	186+
  5'7"	159 - 190	191+
  5'8"	164 - 196	197+
  5'9"	169 - 202	203+
  5'10"	174 - 208	209+
  5'11"	179 - 214	215+
  6'0"	184 - 220	221+
  6'1"	189 - 226	227+
  6'2"	194 - 232	233+
  6'3"	200 - 239	240+
  6'4"	205 - 245	246+

   

  For help understanding obesity
  "Obesity Education Initiative," from The National Heart, Lung, and Blood Institute
  "Calculate Your Body Mass Index," from the National Heart, Lung, and Blood Institute

 

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