In the last few months leading up to American Heart Month, we’ve been focusing on heart disease and heart-healthy habits. This is a time to shine a light on heart disease specifically and remind ourselves just how crucial it is to prioritize heart health. As previously mentioned, heart disease has been named the leading cause of illness and death in the United States. In fact, 1 in every 5 deaths was caused by heart disease in 2020 alone (this equates to roughly 670,000 people).
Prevention and awareness are two key components of limiting the effects of heart disease. Although there may be a genetic predisposition in some cases, there are many things that can be done to limit the chances of developing heart disease, as well as its effects once developed. Let’s take a closer look at heart disease and what factors may contribute to this life-threatening condition.
What Is Heart Disease?
Also referred to as cardiovascular disease, heart disease refers to any disease that affects the heart muscle, valves or blood vessels. These diseases can be asymptomatic for long periods of time, meaning that they can cause damage long before a person is aware there is a problem.
In general, heart disease can cause issues involving:
- irregular heart rhythms
- heart muscle and valves that don’t function properly
- narrowing of the blood vessels in your heart and other organs
What Types of Heart Disease Are There?
Although most forms of heart disease develop over time, there are some types of heart disease that a person can be born with. Let’s take a look at the different forms of heart disease and what differentiates them.
Congenital heart disease refers to any heart condition or defect that a person is born with. Congenital heart disease is the most common type of birth defect in the United States and affects roughly 40,000 births each year. In some cases, it can cause critical complications and structural issues, for example, a missing ventricle, or a problem with the connection between main arteries. Common congenital heart defects include:
- atresia: a missing heart valve
- atypical heart valves: where valves do not open properly or leak
- septal defect: a hole in the wall between the lower or upper two chambers of the heart
Coronary artery disease (also referred to as coronary heart disease and CAD) is the most common type of heart disease and was the cause of death for 382,820 people in 2020 alone. CAD develops gradually over time as plaque accumulates in the arteries that supply blood to the heart. If left unaddressed, the plaque build-up begins to narrow the arteries, blocking blood flow and stopping the heart from receiving oxygen. This can cause further heart complications and other forms of heart disease, such as:
- angina (a type of chest pain caused by the reduced flow of blood to the heart muscle)
- heart attacks
- heart failure
- pericardial disease
- and more.
Heart Arrhythmias describe issues with the rate and/or rhythm of the heartbeat. Some arrhythmias are very brief, having little to no effect on the heart in the long term. Others are longer, causing events where the heart rate is too fast (known as tachycardia) or too slow (known as bradycardia), and in some cases even erratic (which is known as fibrillation).
The most common type of arrhythmia is called atrial fibrillation (AF), which is where the heart beats irregularly and faster than normal. This type of arrhythmia is a common cause of stroke. Having this type of arrhythmia makes a person’s risk of stroke five times higher than that of someone with a normal heart rhythm. When the heart doesn’t beat properly, it has a harder time pumping blood effectively. Without proper blood flow, the lungs, brain and other vital organs are unable to work adequately, potentially causing long-term damage.
Heart Attacks occur when there is a severe lack of blood flow to the heart usually caused by complete blockage of one or more of the coronary arteries. The lack of blood flow then causes the tissue in the heart to start to die. According to the CDC, roughly 805,000 people have heart attacks each year. Research also indicates that about one in every five heart attacks are “silent,” meaning the person is not aware they’ve had a heart attack. Unfortunately, even when a person does not realize they’ve had a heart attack, the heart muscle can still incur long-term damage.
Heart Failure, sometimes referred to as congestive heart failure, is a chronic, progressive condition that occurs when the heart muscle is weakened and unable to pump enough blood throughout the body. In order to try and compensate for the difference, the heart will enlarge, develop more muscle mass and even pump faster to increase its output. Unfortunately, these coping mechanisms are not a long-term solution and eventually, the heart is unable to maintain its efforts. This often leads to a buildup of fluid in the lungs and extremities, leading to fatigue and difficulty breathing (which usually signifies the need for a doctor’s visit).
In many cases, heart failure is preempted by coronary artery disease, but it can also be caused by hypertension, cardiomyopathy, congenital heart disease, past heart attacks, abnormal heart valves and other conditions.
Heart valve disease occurs when one or more of the four valves in the heart are unable to open or close properly. This causes disruption of blood flow to your heart. There are two main types of heart valve disease; endocarditis and rheumatic heart disease. Endocarditis is caused by bacteria that enters the blood during illness, after surgery or after using intravenous drugs. This type of heart disease is often treated with high doses of antibiotics (usually intravenously) but can be life-threatening if left untreated.
Rheumatic heart disease develops when the heart muscles and valves are damaged by rheumatic fever (which is linked to strep throat and other illnesses). In modern-day America, rheumatic heart disease is considered rare; however, it is present in low-income and developing parts of the world. In the U.S. and other developed nations, we are able to prevent rheumatic heart disease by utilizing antibiotics when treating the types of illnesses that lead to it.
Pericardial Disease specifically addresses diseases that affect the pericardium which is the fibroelastic sac surrounding the heart. This type of heart disease is often caused by an infection from a virus, inflammatory diseases (like rheumatoid arthritis or lupus), or injury to the heart and pericardium. Types of pericardial disease include:
- cardiac tamponade: pressure on the heart that occurs when blood/fluid builds up between the sac and the heart muscle
- pericardial effusion: the buildup of too much fluid in the sac
- pericarditis: an inflammation of the sac
Cardiomyopathy (also known as heart muscle disease) is any disorder or disease that affects the heart muscle. In most cases, cardiomyopathy causes the heart to become weakened and lowers its ability to pump blood effectively throughout the body. The clinical course of the disease tends to be highly variable. In some cases, it is progressive, at times worsening quickly; in other cases, it is transient and mild, resolving quickly and without intervention. In some cases, cardiomyopathy is genetic, while at other times, it can be caused by the body’s reaction to a drug, a vaccine or a toxin, a viral infection, or even chemotherapy. In the past two years, there has been a focus on COVID-19 and the mRNA COVID-19 vaccines as potential causes of myocarditis. In general, the vaccine-associated forms of myocarditis tend to be self-limiting and not a significant cause for concern. Exact causes are not always known, and every case needs to be evaluated carefully.
What Are the Symptoms of Heart Disease?
It’s important to note that some symptoms of heart disease are forms of heart disease in and of themselves. Symptoms vary and overlap depending on the specific type of heart disease that a person may have. In many cases, there are no visible symptoms for long periods of time.
Unfortunately, it is not uncommon for a person to be completely unaware they even have heart disease until they experience a heart attack (usually chest pain) or heart failure (usually shortness of breath).
That said, the following symptoms can signify a heart problem:
- chest pain, tightness, pressure, or discomfort (angina)
- cold sweats
- extreme fatigue
- heartburn or indigestion
- irregular heartbeats that feel rapid, pounding or fluttering
- low blood pressure
- pain, numbness or tingling, weakness or coldness in the extremities
- pain or discomfort that spreads to the shoulder, arm, back, neck, jaw, teeth or sometimes the upper belly (indicating possible heart attack)
- persistent cough or wheezing with white or pink blood-tinged mucus (indicating possible heart failure)
- shortness of breath
- swollen legs, ankles or feet
- reduced ability to exercise
If you are experiencing any, or a combination of, these symptoms, it’s important to reach out to a doctor for examination and testing. The sooner a diagnosis is made, the better chance you likely have of managing your heart disease.
What Causes Heart Disease?
Similar to the symptoms of heart disease, its causes can vary depending on the form. For example, coronary artery disease and peripheral artery disease are most often caused by plaque buildup in the arteries. Arrhythmias can be caused by coronary artery disease, scarring of the heart muscle, genetic factors and a body’s reaction to different medications. Aging, infections and other diseases/conditions can also trigger different forms of heart disease. In some cases the direct cause is unknown.
That said, there are risk factors that can contribute to the likelihood of a person developing this life-altering condition.
What Are The Risk Factors?
Smoking, high blood pressure, and high cholesterol (especially LDL) are all major risk factors for heart disease. The CDC estimates that one or more of these three risk factors are present in about 47% of Americans. Alongside these risk factors, heart disease can also be triggered by the following:
- alcohol, drug, and tobacco abuse
- a sedentary/inactive routine
- an unbalanced/unhealthy diet
- being postmenopausal
- congenital heart defects
- damage to all, or any part of the heart
- high anxiety
- high stress levels
- family history
- sleep apnea
- secondhand smoke exposure
- obesity or excess weight
- uncontrolled stress, depression, and anger
While some risk factors can not be altered such as age, being post-menopausal and having a genetic predisposition, there are things you can do to lower your risk of developing heart disease. Before diving into preventive practices, let’s explore how heart disease is diagnosed and how it can be treated.
How Is Heart Disease Diagnosed?
In most cases, the doctor will start by taking a personal and family medical history alongside a recording of a patient’s past and current symptoms. Following that, there are several tests that can be used to evaluate heart disease. Some are non-invasive (meaning that there are no medical instruments inserted into the body), while others are a bit more invasive and require insertion of catheters into the blood vessels or heart. Doctors and physicians will often use a combination of the following tests to confirm a diagnosis.
- Alanine Transaminase (ALT) and Aspartate Aminotransferase (AST): measures the amount of AST enzymes in blood and detects inflammation/damage in the liver
- Blood Urea Nitrogen (BUN) and Creatinine: measures kidney function by detecting how much waste product a person has in their blood
- C-Reactive Protein (CRP): measures the level of c-reactive protein (CRP) in a sample of blood. CRP is produced in the liver as a part of the body’s response to injury. The higher the level of CRP in the bloodstream, the more inflammation in the body. Higher levels of CRP can indicate a significant health issue.
- Complete Blood Count (CBC): measures your white blood cells, red blood cells, platelets, hemoglobin, hematocrit and mean corpuscular volume (MCV)
- Fasting Glucose and Hemoglobin A1c: measures blood sugar after an overnight fast. This test is commonly performed when diagnosing diabetes and pre-diabetes but is also utilized when diagnosing heart disease and other conditions. The HbA1c estimates what your blood sugar was over the past two to three months and is an excellent predictor of insulin insensitivity.
- Homocysteine: measures the amount of homocysteine (an amino acid) in a sample of blood. This amino acid is used in the production of protein and building/maintaining tissue. Having a high level of homocysteine can damage the inside of the arteries and increase a person’s risk of forming blood clots and having a stroke.
- Troponin: measures the levels of troponin T or troponin I proteins in the blood. These proteins are released when the heart muscle has been damaged, such as occurs with a heart attack. The more damage there is to the heart, the greater the amount of troponin there will be in the blood. Recently, high sensitivity versions of the test have been developed, which add to the accuracy and utility of the test in patients suspected of having a heart attack.
- Lipid Profile: measures total cholesterol, LDL (low-density lipoprotein), cholesterol, HDL (high-density lipoprotein), and triglycerides in a sample of blood. This test helps determine a person’s risk of plaque buildup in the arteries.
- Lipoprotein (a): measures a special type of lipid-containing protein in the blood that carries cholesterol through the bloodstream to the cells. Higher levels can indicate a higher risk for heart disease and stroke.
- Sodium and Potassium Levels: helps detect issues with the electrolyte balance in body fluids
- Thyroid Stimulating Hormone (TSH): measures thyroid function and the amount of TSH in your blood
Non-blood Related Invasive Tests
- Cardiac Catheterization: a common diagnostic procedure in which a catheter is guided through a blood vessel to the heart. This test can show narrowing in the blood vessels, whether a heart is pumping blood effectively, if the valves are operating optimally, and more. During this process, additional tests can be performed, treatments can be delivered and in some cases, a piece of heart tissue is removed for further examination.
- Electrophysiology (EP) Study: a test that captures the electrical activity of the heart. For this test, a doctor safely triggers an arrhythmia and then tests specific medications to see which can control it best. An EP study can be used to find a specific spot in the heart muscle that causes the irregular heart beat making it possible to ablate (remove) the source of the arrhythmia.
- Electrocardiogram (ECG or EKG): a common and painless test that records the electrical signal from the heart to check for different heart conditions. This test can be done at rest or during exercise (a treadmill or bicycle).
- Echocardiogram (“Echo”): an ultrasound that provides images that show the heart’s structure and checks how well it is functioning. This test provides information about the size, shape and strength of the heart, if valves are working properly, if there is any leaking, the thickness of the muscle walls, etc.
- Stress Echocardiogram: performed to see how the heart performs under stress. This test is usually performed on a treadmill or stationary bicycle or during infusion of a medicine that may pharmacologically increase the heart rate (like exercise) or blood supply to certain areas of the heart. Blood pressure and EKG are monitored throughout the duration of the test and for a few minutes thereafter. One of the challenges of the stress echo is the need for the patient to exercise vigorously while providing access to the ultrasound technician to position the ultrasound transducer (measuring device) on the chest in particular locations. This test is particularly challenging in female patients.
- Nuclear Stress Test: made up of two components; a stress test (like in a stress echo) and a scanning of the heart after the injection of a radioactive material (called a radionuclide or nuclear tracer).The radionuclide can track the heart’s metabolism, blood flow or perfusion, or viability. The test is performed to determine these parameters during stress, as well as at rest.
- Carotid Artery Doppler Ultrasound: monitors blood flow through the carotid arteries on both sides of the neck and evaluates a person’s risk of stroke.
- Abdominal Ultrasound: screens for potential abdominal aortic aneurysm (along with a chest x-ray).
- Holter Monitor: a small, portable machine is worn on the body for 24-48 hours or longer. The monitor provides an ongoing recording of the EKG during a person’s daily activities and can detect arrhythmias that may not have otherwise been shown on a single resting EKG..
- Event Recorder/Loop Recorder: similar to the Holter monitor in that this recording device is worn on the body for a length of time. Patients wear this machine for several weeks, which is helpful for those infrequent symptoms. The monitor “loops” a 2-5 minute recording, which is continually overwritten. When a person begins to experience symptoms, they press the “record” button. These recordings are transmitted to a monitoring station and sent to the doctor’s office or facility for review.
Once a diagnosis has been established, your physician will be able to review treatment options with you.
What Are the Treatments for Heart Disease?
Treatment options for heart disease vary depending on the type of heart disease a person has. Making lifestyle changes (like eating a balanced diet, exercising regularly, etc.), taking medications and undergoing surgery, or any combination of the three are common strategies when looking to lessen the effects of heart disease.
Common medication options include:
- anticoagulants (blood thinners)
- antiplatelet therapies (aspirin and similar medications)
- angiotensin-converting enzyme (ACE) inhibitors
- angiotensin II receptor blockers (ARB)
- angiotensin receptor neprilysin-like inhibitors
- beta-adrenergic blockers
- calcium channel blockers
- cholesterol-lowering medications (like statins)
- nitrates like glyceryl trinitrate (GTN) tablets or lingual spray
Common surgical options include:
- Coronary Artery Bypass Surgery: a common procedure that allows blood flow to reach a part of the heart when an artery is blocked.
- Aneurysmectomy: a procedure to remove and close up an area of expanded ventricular muscle or aortic wall.
- Coronary Angioplasty: widens narrow/blocked coronary arteries, often combined with the insertion of a drug-eluting stent (a wire-mesh tube that assists with blood flow)
- Valve Replacement or Repair: the replacement or repair of a valve that is not functioning properly; may be done surgically or through a catheter
- Structural Repair Surgery: a repair for congenital heart defects, aneurysms, and related issues
- Device Implantation: devices such as pacemakers, intra-aortic balloon catheters, or other devices are placed to regulate heartbeat, cardiac function and support blood flow
- Maze Surgery: new paths for electrical signals to pass through are created by a surgeon. This procedure may help treat atrial fibrillation.
What Can Be Done to Prevent Heart Disease?
Creating a life full of heart-healthy practices and eliminating risk factors is one of the most effective ways to prevent the development of heart disease, as well as to limit its effects once developed. Here are six things you can start doing today to promote heart health:
- Eat a healthy, balanced diet
- Eliminate smoking and avoid secondhand smoke
- Exercise regularly and incorporate daily movement
- Maintain a healthy weight
- Limit the use of alcohol
- Practice good sleep patterns
- Talk to a doctor about getting regular health screenings
For more information about preventing heart disease with heart-healthy habits, check out last month’s article here.