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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

Heart disease can lead to heart attack, stroke, diabetes, and other medical conditionsLife 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A heart attack means that part of the heart muscle has lost its blood supply, has died, and has been replaced by scar tissue.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.

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.

Picture of the Heart and Heart Attack



Next: How is heart disease diagnosed? »

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Heart Disease

1) What Is Cholesterol?

Cholesterol is a waxy, fat-like substance that occurs naturally in all parts of the body and is made by the liver. Cholesterol also is present in foods we eat. People need cholesterol for the body to function normally. Cholesterol is present in the cell walls or membranes everywhere in the body, including the brain, nerves, muscles, skin, liver, intestines, and heart.

2) Why Should I Be Concerned About Cholesterol?

Too much cholesterol in your body means that you have an increased risk of getting cardiovascular diseases such as heart disease. If you have too much cholesterol in your body, the cholesterol can build up on the walls of the arteries that carry blood to your heart. This buildup, which occurs over time, causes less blood and oxygen to get to your heart. This can cause chest pain and heart attacks.

3) What's the Difference between "Good" and "Bad" Cholesterol?

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Read the High Cholesterol: Frequently Asked Questions article »











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