Heart Disease
(Coronary Artery Disease)
Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editors: Daniel
Kulick, MD, FACC, FSCAI and Melissa Conrad Stöppler, MD
A Tale of Two Heart Attacks
Medical Author: Benjamin Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD
Life isn't fair. The tales of Kelsey Grammer and Tim Russert show the two
extremes when it comes to heart disease. Mr. Grammer had some
chest pain,
wandered into a hospital, found out that he had a heart attack myocardial
infarction) and walks out a few days later. Mr. Russert has no particular chest
pain, but drops dead because of his heart attack.
A heart attack means that part of the heart muscle has lost its blood supply,
has died, and has been replaced by scar tissue. Injured heart muscle causes
injured electrical systems and can lead to ventricular fibrillation, in which
the heart jiggles instead of beats. No heart beat means no blood to the body,
which leads to sudden cardiac death.
Sudden cardiac death doesn't really care if the heart attack was mild or not. The
most common reason people die in the midst of a heart attack is due to an electrical short circuit caused by heart muscle that has been
irritated.
In Mr. Russert's case, bystanders were ready to use an
automatic external
defibrillator (AED), but the paramedics arrived at the same time to deliver
electrical shocks to the heart to treat the ventricular fibrillation. The treatment failed,
and they were unable to reverse Mr. Russert's death.
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Introduction to heart disease
The heart is like any other muscle, requiring blood to supply oxygen and
nutrients for it to function. The heart's needs are provided by the coronary
arteries, which begin at the base of the aorta and spread across the surface of
the heart, branching out to all areas of the heart muscle.
The coronary arteries are at risk for narrowing as cholesterol deposits,
called plaques, build up inside the artery. If the arteries narrow enough, blood
supply to the heart muscle may be compromised (slowed down), and this slowing of
blood flow to the heart causes pain, or angina.
A heart attack or myocardial infarction occurs when a plaque ruptures,
allowing a blood clot to form. This completely obstructs the artery, stopping
blood flow to part of the heart muscle, and that portion of muscle dies.
What are the risk factors for heart disease
Risk factors for heart disease include:
What are the symptoms of heart disease?
The typical symptoms of coronary artery disease are associated chest pain
with shortness of breath. Classically, the pain of angina is described as a
pressure or heaviness behind the breast bone with radiation to the jaw and down
the arm accompanied by shortness of breath and sweating. Unfortunately, angina
has a variety of presentations, and there may not even be specific chest pain.
There may be shoulder or back ache, nausea, indigestion or upper abdominal pain.
Women, the elderly, and people with diabetes may have different perceptions of
pain or have no discomfort at all. Instead, they may complain of malaise or
fatigue.
Healthcare providers and patients may have difficulty understanding each
other when symptoms of angina are described. Patients may experience pressure or
tightness but may deny any complaints of pain.
People with coronary artery disease usually have gradual progression of their
symptoms over time. As an artery narrows over time, the symptoms that it causes
may increase in frequency and/or severity. Healthcare providers may inquire
about changes in exercise tolerance (How far can you walk before getting
symptoms? Is it to the mailbox? Up a flight of stairs?) and whether there has
been an acute change in the symptoms.
Once again, patients may be asymptomatic until a heart attack occurs. Of
course, some patients also may be in denial as to their symptoms and
procrastinate in seeking care.
Next: How is heart disease diagnosed? »
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