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HEART DISEASE
Questions and Answers About HEART DISEASE
1. What is heart disease?
2. How common is coronary heart disease?
3. What causes coronary heart disease?
4. Does hormone replacement after menopause protect women from coronary heart
disease?
5. Can I prevent coronary heart disease?
6. How do we diagnose coronary heart disease?
7. How do we treat coronary heart disease?
8. What are the catheter-based therapies to treat coronary heart disease?
9. What are the surgical options in the treatment of coronary heart disease?
10. Where can I find more information on heart disease?
11. What doctors treat heart failure at
UAMS Medical Center?
Making an Appointment
at UAMS Medical Center
To make an appointment, call 1-501-686-8000.
1. What is heart disease?
Like any other organ in the body, the heart is exposed to a number of diseases. Some
of the diseases are congenital, or in-borne, and others are acquired. The acquired heart
diseases generally affect either the muscle, the valves in the heart, or the arteries,
which supply oxygenated blood to the heart muscle. These are called coronary arteries.
Valves can be affected by the aging process or by rheumatic heart disease, as well as by
some infections. Heart muscle can become diseased from excessive alcohol intake, viral
infection, metabolic diseases, and occasionally, tumors.
The most common form of heart disease is coronary artery disease. This is also referred to
as ischemic heart disease or coronary heart disease.
2. How common is coronary heart
disease?
Coronary heart disease is the most common disease in the Western Hemisphere. It is
expected that almost half of the population in the Western World will get symptoms related
to coronary heart disease. Coronary heart disease may well be the cause of death in about
30% of all subjects in the West. Deaths from coronary heart disease exceed all other forms
of deaths, including cancers, kidney disease, and automobile accidents.
3. What causes coronary heart disease?
The precise cause for coronary heart disease is not known. We think that in most heart
patients, coronary heart disease is caused by progressive narrowing of the coronary artery
lumen by deposition of bad cholesterol in the coronary artery. This process is known as
atherosclerosis. The precise cause of atherosclerosis is not known, but it appears that
certain conditions are associated with risk of atherosclerosis. These risk factors
include:
- family history of coronary heart disease,
- hypertension,
- smoking,
- diabetes,
- high blood pressure
- and dyslipidemia.
Dyslipidemia implies abnormal lipids in the blood. This
could include either excessive levels of bad cholesterol (LDL-cholesterol) and/or low
levels of good cholesterol (HDL-cholesterol).
Many of these disorders can be inherited. Males are more prone to develop coronary heart
disease in their 40’s and 50’s, but females tend to develop coronary heart
disease in their post-menopausal years even faster than the comparable age group of men.
Both men and women in their 60’s and 70’s have similar prevalence of coronary
heart disease.
4. Does hormone replacement after
menopause protect women from coronary heart disease?
We had always thought that during pre-menopausal years, the presence of female sex
hormones (estrogens and progesterones) protects women from coronary heart disease.
Therefore, trials were begun to compare the effects of hormone replacement in the
post-menopausal women to evaluate the incidence of coronary heart disease. Much to our
dismay, early results of these studies do not show protective effects of hormone
replacement against coronary heart disease in women. However, hormone replacement may have
protective effects against osteoporosis.
5. Can I prevent coronary heart
disease?
Certainly, everyone would like to prevent coronary heart disease. Since we believe
that much of the risk for coronary heart disease is inherited, it is unlikely that we will
be able to totally prevent atherosclerosis and its complications. However, certain risk
factors are modifiable.
These include:
- strict control of diabetes,
- controlling dyslipidemia,
- controlling hypertension,
- quitting smoking,
- and exercise.
Routine exercise has been shown to decrease the severity of
coronary heart disease.
6. How do we diagnose coronary
heart disease?
Most often, coronary heart disease symptoms appear in men in their late 40’s and
50’s; whereas, in women, the onset of coronary heart disease is delayed by a decade.
The most common symptoms of coronary heart disease are chest pain, shortness of breath
from exertion, and occasionally, dizziness and stroke.
Sudden death and heart attack can be the first manifestations of coronary heart disease.
Generally, we diagnose coronary heart disease based on history, physical examination, and
some simple tests, such as an electrocardiogram (also known as EKG or ECG). Certain tests,
such as an exercise stress test, an ultrasound examination of the heart
(echocardiography), and other forms of stress tests using radio neuclide materials can be
very useful in diagnosing coronary heart disease. Sometimes we have to do invasive
procedures, such as coronary angiography, to document the presence of coronary heart
disease.
7. How do we treat coronary heart disease?
The most important thing in the treatment of coronary heart disease is control of the
coronary risk factors discussed above. It has been shown that better control of diabetes
and high blood pressure, dietary modifications, and lifestyle changes can be extremely
beneficial. There are a number of drugs, which have changed the outcome of patients with
coronary heart disease. These include:
- aspirin,
- beta-blockers (for example, metoprolol, atenolol, etc.),
- blood pressure lowering drugs (for example, enalapril,
losartan, amlodipine, etc.),
- and nitrates are extremely useful in the treatment of
coronary heart disease.
The precise medical therapy can be determined only after
consultation with an internist or a specialist in cardiovascular medicine who will decide
the severity and the type of heart disease and recommend appropriate therapy.
8. What are the catheter-based
therapies to treat coronary heart disease?
Recently, medical techniques such as balloon angioplasty have been developed to treat
coronary heart disease and help facilitate blood flow. In this procedure, a balloon placed
on the tip of a catheter can be slid into the area of the coronary artery narrowing. After
insertion to the proper area, the balloon is blown up thereby compressing the
atherosclerotic plaque towards the wall, leaving the channel open to blood flow. This
often results in relief of the symptoms of coronary heart disease.
Unfortunately, one of the major problems with this procedure is that re-occlusion of the
site of balloon dilatation can occur. In order to prevent re-occlusion, devices, such as
stents (an elastic spring-like device), which maintain the vessel in a dilated form, have
been utilized. The incidence of re-occlusion of the coronary artery after stent placement
is relatively less than without stent placement. However, the continued use of medical
therapy is imperative in these patients.
9. What are the surgical options
in the treatment of coronary heart disease?
There have been advances in anesthesia and surgical treatment of coronary heart
disease. These include primarily putting bypass grafts to "bypass" the
occlusion. In the procedure, veins from the lower extremities can be connected on one side
to the aorta and on the other end to the coronary artery beyond the narrowings. This
results in bypassing the occlusion.
There are certain arteries in the chest wall, and abdomen, which can be used as conduits
to restore flow to the ischemic myocardium. The results of the restoration of flow with
arterial channels are much better than that with veins taken from the leg. Again,
following the coronary bypass surgery, use of aspirin and cholesterol-lowering drugs is
extremely beneficial.
10. Where can I find more
information on heart disease?
Click
here for links to more information and to national organizations for heart disease.
11. What doctors treat heart
disease at UAMS Medical Center?
Heart Surgeons
Tamim
Antakli, M.D.
Acting Chief;
Assistant Professor of Surgery;
Program Director
Joseph
K. Bissett, M.D., F.A.C.C.
Professor of Medicine
Aytekin
Ozdemir, M.D.
Assistant Professor of Surgery
Jorge
Saucedo, M.D.
Assistant Professor of Medicine
H.
Gareth Tobler, M.D.
Assistant Professor of Surgery
Making an Appointment at
UAMS Medical Center
To make an appointment, call 1-501-686-8000.
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