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Learn about your Heart

I have made the following information available so that patients may gain insight and understanding of their heart related conditions. I have included some of the more common questions I have been asked over the years.

This is by no means an exhaustive list and I recommend that patients also look for additional information on the Mayo Clinic website.

Risk factors for Heart Disease

High cholesterol and high blood pressure are important risk factors for coronary heart disease. Other important risk factors are smoking, diabetes and increased abdominal girth.

It is important to realize that when two or more risk factors are present the risk is compounded. For example, the combination of smoking and high cholesterol, or smoking and diabetes are highly dangerous combinations.

Many of these risk factors can be reduced by lifestyle changes like stopping smoking, losing weight, and engaging in exercise. The treatment of high blood pressure and controlling glucose levels in diabetics is also very important in reducing the risk.

High Cholesterol

Cholesterol is an important component of body cells. However, high blood cholesterol can be associated with an increased risk of heart disease. The two major components being LDL (low density lipoprotein) and HDL (high density lipoprotein).

High levels of HDL cholesterol are protective and are increased with exercise. It is important for your doctor to decide whether dietary changes or statin therapy is necessary.

High levels of LDL cholesterol increase the risk of plaque formation, whereas HDL cholesterol is protective and can actually remove plaque from the arteries.
The ideal cholesterol level varies from person to person, and slightly raised levels may not be important.

However, if the patient has previous cardiac disease such as angina or a prior heart attack or stroke, it is very important to lower the LDL cholesterol, and this almost invariably requires statin therapy.

Detecting High Blood Pressure

High blood pressure also known as hypertension is a very common condition. As you age the incidence of hypertension increases and about 70% of people over 70 years of age have high blood pressure.

As seen in this animation blood pressure rises when the heart pumps and drops when the heart relaxes.

The top reading (the systolic pressure) and the bottom reading (the diastolic blood pressure) vary within a green range as demonstrated. This range should be below 140/85 mmHg.

It is extremely important to understand that blood pressure taken in a doctor’s office is often falsely elevated. This is called “white coat hypertension”.

More accurate readings can be obtained if readings are taken at home when the patient is relaxed. This can be accomplished by the patient purchasing an automatic blood pressure measuring device. The readings taken from the machine can then be reported to the doctor and an accurate assessment can be made as to whether the patient has hypertension or not.

Treating High Blood Pressure

If your blood pressure is mildly elevated i.e. between 130 – 139/85 or 139/89 mmHg, lifestyle changes should be instituted namely, stopping smoking, weight loss if overweight, limitation of alcohol intake, increase in physical activity and limitation of sodium (salt) intake.

Unfortunately in many cases, drug therapy is necessary in addition to lifestyle changes. There are many different types of medications which can lower blood pressure and often more than one drug is required to bring the blood pressure within recommended limits.

Treatment for high blood pressure is generally life-long. It is very important for the patient to understand these concepts, as often there is a natural resistance to accept that one may have to take medication for ever.


Detecting Narrowed Arteries

If you have a narrowed artery central chest pain usually occurs with exertion. A stress ECG may then be indicated and depending on the results add mission to hospital and coronary angiography may follow. Pain can also occur at rest, in which case admission to hospital may be required for angiography.

How Heart Attacks Happen

When the plaque grows it has a tendency to rupture (especially in smokers). Once the plaque ruptures a blood clot forms, and if the clot is large enough it can completely block the vessel. This then causes severe pain in the centre of the chest and a heart attack results causing damage to heart muscle.

Treatment for Narrowed Arteries

Once the narrowed artery has been identified this blockage can be opened by placing a stent in the narrowed artery resulting in restoration of blood flow.

The stent will remain in place for life. It is important to take blood thinning medication to prevent blood clots forming on the stent.

The blood thinning medication is for a temporary period dependent on the type of stent.

If the plaque is calcified it may be necessary to decalcify the plaque using a special rotoblator device. See animation.

Chest Pain

While your heart is in the left side of your chest, it is important to know that pain arising from the heart is generally felt in the centre of the chest.

When a coronary artery becomes blocked or narrowed, due to a plaque developing, it can cause pain.

Pain that occurs when an artery is narrowed is called angina, and is felt as a tight discomfort in the middle of the chest. This is aggravated by walking, especially walking uphill, and is also aggravated by cold weather. The pain may also become more intense in the cold weather and with activity after eating a heavy meal.

The pain of gradual plaque progression in the artery may develop over many years and can occur gradually, or the pain can also develop suddenly.

This plaque can also rupture and lead to a clot which then adheres to the rupture and blocks the artery. This is the common cause of a heart attack (myocardial infarction).

It is important to remember that there are many causes of chest pain which are not serious and may be due to muscle or skeletal problems. Lung disease can also cause chest pain.


Palpitations, dizzy spells and blackouts

Palpitations are a common symptom and may not signify an underlying important condition.

Occasional awareness of heartbeats is common, and most people experience extra heartbeats from time to time, and in most cases this is not dangerous.

However if rapid persistent heartbeats occur, particularly if the heart rate is in excess of 120 beats per minute, it may be important to diagnose a condition which is causing an abnormal heart rhythm.

Dizzy spells and blackouts may be caused by a drop in blood pressure, and while many dizzy spells are not significant, they should always be investigated.

Many blackouts are just due to the so-called faint which occurs in about 10% of the population, and the blackout may not be due to a serious cardiac condition.

Blackouts can also be caused by neurological conditions such as epilepsy, and the differentiation between blackouts due to cardiac problems and neurological problems should be made by your doctor.

Fluid retention

Fluid retention has a number of causes and commonly results in swollen ankles.

This can occur with advancing age, and may just be due to incompetent veins in the lower limbs, or by reduced mobility and lack of exercise.

There are many drugs that can cause fluid retention and swelling.

Occasionally fluid retention can be due to heart failure. There are blood tests at present which can accurately differentiate important causes of ankle swelling like heart failure from unimportant causes.