Caring For Your Heart: Do You Have The Facts?
We all know the basics of preventing heart disease: Get regular exercise. Eat a diet low in animal fats and cholesterol and high in fruits, vegetables, and grains. Stay away from cigarettes. Keep body weight within a healthy range. And keep your blood pressure and blood sugar under control if you have high blood pressure or diabetes. This knowledge is paying off in many ways. Since the early 1960s, the number of deaths from heart disease has dropped by half. Better treatments are responsible for some of that improvement, but if you’re paying attention to following a healthier lifestyle, you deserve credit too.
Still, heart disease remains the number one killer in the United States. Why? Our fast-paced lives can sometimes make it difficult to stick with healthy habits. And even the most health-conscious person may not be able to overcome an inherited risk for heart disease or a problem in the structure of the heart.
There’s plenty of good news though. Continual advances in medical research and technological innovations mean that cardiologists are better prepared than ever to treat all forms of heart disease-and help you live a long and healthy life.
When Should You See A Cardiologist?
For certain problems involving the heart and blood vessels, your primary care physician may manage your care. Examples would be high blood pressure or high blood cholesterol that are successfully treated with medication. Your family doctor will also take the lead in helping you to lose a few pounds, get more exercise, or stop smoking, if these are changes you need to make. But if your heart problems are more complicated, it’s time to see a cardiologist.
Cardiologists are the experts when it comes to diagnosing and treating heart disease. In fact, studies have shown that cardiologists are at the forefront in applying the latest research and following practice guidelines in treating patients with heart disease. And if you have another medical condition, such as diabetes or kidney disease, your cardiologist will know how to plan your care in a way that takes into account all of your health needs.
Sometimes your family doctor will ask a cardiologist to evaluate your heart and simply recommend the right treatment or further tests. An example of this might be doing a stress test in someone with a strong family history of heart disease. In other cases, however, your heart problem may be serious enough that it will require the ongoing care of a cardiologist.
Chest pain or discomfort is one of the most common reasons to see a cardiologist. Also known as angina, it may be caused by a build up of cholesterol that narrows the arteries supplying blood to your heart. If your heart can’t get enough blood and oxygen during physical activity, the result can be chest pain or discomfort. Cholesterol deposits in the coronary arteries can suddenly break open and cause a blood clot to form, completely blocking blood flow in the coronary artery to the heart and causing a heart attack. A cardiologist will use an electrocardiogram (referred to as an ECG or EKG), which traces the electrical activity in your heart, as well as blood tests, to determine whether you have had a heart attack. The information from these tests will help your cardiologist to plan the appropriate treatment for you.
When there’s a disturbance in the rhythm of your heartbeat, called an arrhythmia, you also need to see a cardiologist. Unexplained shortness of breath might be another reason, as difficulty breathing could be a sign of congestive heart failure or a problem with the valves in your heart.
Different Cardiologists for Different Problems
All cardiologists are well versed in diagnosing and treating heart disease. Some, however, specialize in certain aspects of cardiology-for example, the use of medical scanners to create detailed pictures of the heart, or the use of catheters, balloons, and “stents” to open blocked coronary arteries.
The type of heart problem you have will determine the type of cardiologist you need to see.
One type of cardiology “subspecialty” is cardiovascular imaging. Cardiovascular imaging specialists fall into two general categories. One group, nuclear cardiologists, is highly trained in the use of radioactive “imaging” tests and special nuclear cameras. The results of this work are nuclear scans that reveal how effectively the heart is pumping and whether there are any blockages in its blood flow. The other group, echocardiographers, uses equipment that bounces high-frequency sound waves off the heart and uses the return signal, or echo, to create moving pictures of the heart in action. Echocardiography can show how well the heart is pumping and whether heart valves are functioning properly. Exercise echocardiography examinations now offer the cardiologist indirect evidence of blockages in blood flow to the heart.
Preventive cardiologists evaluate your risk of heart disease and institute and monitor preventive therapy, while rehabilitative cardiologists focus on your recovery after a heart attack or an episode of congestive heart failure. Both help you to make healthy changes in many parts of your life, including eating a better diet, getting more exercise, managing stress, and quitting smoking, in addition to taking the appropriate medications for your particular problems. Preventive cardiologists, in particular, can help manage more challenging cholesterol, blood pressure, and diabetes problems. Invasive cardiologists are experts in the use of slender tubes called catheters, using them to perform diagnostic exams by injecting contrast material, such as iodine dye, into blood vessels, which can be seen on an x-ray. The x-rays, called angiograms, show whether there are any narrowed areas in the arteries of the heart. Then there are interventional cardiologists, who rely on similarly shaped catheters to widen the narrowed sections of clogged arteries. A catheter is carefully advanced through the vessels into the clogged artery and used to inflate a tiny balloon, in a procedure called an angioplasty. Another device can also be used to cut away or drill through the cholesterol blockage, a technique called atherectomy. Often, interventional cardiologists also insert tiny metal tubes or scaffolds called stents to prop open an artery that had been severely blocked. In fact, because they have proven to be so effective, the majority of angioplasty procedures now involve the use of an intra-coronary stent.
For patients who have multiple coronary artery blockages, a cardiovascular surgeon may be needed. Cardiovascular surgeons can re-route blood around a diseased coronary artery by taking an artery from the chest or a vein from the leg and attaching it above and below the narrowed section-thus “bypassing” the problem. Newer methods have been developed that make it possible to do bypass surgery through a smaller opening in the chest. Cardiovascular surgeons also repair and replace worn or diseased heart valves and also correct birth defects in the heart.
Electrophysiologists focus on the electrical activity of the heart, using ECGs to diagnose problems that cause the heart to beat too quickly (tachycardia), too slowly (bradycardia), or with a highly irregular pattern (fibrillation). These very common electrical disturbances, or arrhythmias, are often felt as palpitations. Serious rhythm problems can prevent the heart from working properly, leading to severe symptoms such as dizziness or loss of consciousness. An electrophysiologist will often use a catheter with a special tip at the end that can detect where an arrhythmia starts. In some cases, the electrophysiologist can use radiofrequency energy to “burn” that tiny section of the heart and cure the cause of the rhythm abnormality. More and more frequently, electrophysiologists have been turning to small, implanted devices that monitor the heart and can shock it back into a normal rhythm whenever it starts beating abnormally.
Warning Signs of a Heart Attack
Some people say a heart attack feels like an elephant is sitting on your chest. It’s true that crushing, severe chest pain that lasts several minutes is one of the most common signs, but there are others you should be aware of, too. The following symptoms, especially when several of them occur at one time, are important warning signs of a heart attack:
• Pressure, squeezing, or a feeling of heaviness in your chest, even if it’s not severe
• Pain or pressure in your neck, jaw, back, or arm
• Heavy sweating
• Paleness, breaking out in a cold sweat, or feeling strong, rapid, or uneven heart beats
• Difficulty catching your breath
• Feeling sick to your stomach
• Lightheadedness or fainting
• Feeling weak or tired for no particular reason
Women, the elderly, and those with diabetes often experience mild or unusual symptoms, such as a backache or nausea, which can make a heart attack harder to detect. If you think you or a loved one may be having a heart attack, call 911. For most people, chewing one uncoated aspirin while you wait for help is a good idea, as it can help restore blood flow to the heart.
Common Heart Medications and What They Do
Today’s cardiologists have a whole array of powerful and effective medications to choose from in treating heart disease and are using them to help people live longer and healthier lives. Here are some of the most common medications and a brief explanation of what they do.
Statins lower blood cholesterol levels and help prevent the build up of fatty deposits in blood vessels supplying the heart. In this way, they reduce the risk of chest pain and heart attack. Beta blockers lower blood pressure and prevent chest pain and irregular heart beats. Some types of beta blockers have recently proved useful for treating congestive heart failure as well. Clot dissolvers, also called thrombolytics, dissolve the blood clots that interrupt blood flow to the heart and cause a heart attack. Clot dissolvers are most effective when given within a few hours of a heart attack, so it’s important to get to the hospital quickly. ACE inhibitors lower blood pressure, prevent heart attacks, help the heart to heal after a heart attack, and improve the heart’s function during congestive heart failure. Angiotensin II receptor blockers appear to lower blood pressure as effectively as ACE inhibitors but are less likely to cause coughing. Studies are also evaluating whether they are as effective for treating congestive heart failure. Antiplatelet medications keep blood clots from forming and markedly improve the success of procedures like angioplasty. Blood thinners work in a different way but also prevent blood clots from forming. They are often used after surgery for diseased heart valves and as part of the treatment for an abnormal heart rhythm called atrial fibrillation. Calcium-channel blockers lower blood pressure and help prevent chest pain and irregular heart beats. Digitalis helps the heart work better in congestive heart failure and is used to treat irregular heartbeats that start in the heart’s upper chamber, or atrium. Nitrates relieve chest pain and improve the heart’s function in congestive heart failure.
Research Advances, Now and in the Future
Over the years, cardiology researchers have made some truly impressive advances. It’s hard to believe that if you had a heart attack just 50 years ago, your chances of dying were one in four. Today, thanks to drugs like clot dissolvers and procedures like angioplasty, about 97 percent of patients survive. Researchers are hard at work on developing ways to provide even better care to patients. Some advances are very close to being ready for everyday use, such as simple blood tests that could clearly show whether you are at risk for heart disease well before any symptoms develop. These could prompt your doctor to start aggressive preventive treatment while you’re still healthy. Some innovations need more research and testing but still hold great promise. For example, before long it may be common to use MRI or CT scanning to take quick and painless pictures of the arteries of your heart.
Cardiovascular surgeons are investigating the use of robotic arms for doing delicate procedures on the heart through small, keyhole-size openings in the chest. Other scientists are focusing on ways to stimulate new blood vessels to grow in the place of severely narrowed coronary arteries. Still others are looking into ways to uncover and repair genes that put entire families at risk for sudden death.
Advances such as these have allowed cardiologists to be recognized throughout the medical profession for their dedication to research and the high standards they apply to determining the value of each new therapy. Keep watching – more exciting innovations are on the way.
Are you at risk for heart disease?
Why do some people live to a vigorous old age while others die of a heart attack in their early 40s? We don’t have a complete answer to that question, but we do know that certain characteristics increase your risk of developing heart disease. The bad news is that the more of these “risk factors” you have, the greater your chances of developing heart disease. The good news is that many can be prevented or controlled by following a healthy lifestyle and, if necessary, taking medications prescribed by your doctor. If you have any of the following major risk factors for heart disease, ask your doctor what you can do to make heart-healthy changes in your life.
• High blood pressure
• High blood cholesterol
• Physical inactivity
• Male gender
• Females over the age of 55 with premature menopause
• Increasing age
• Family history of heart disease
FACC – A Mark of Professional Excellence
We’re all used to seeing MD at the end of our doctor’s name, but you may have wondered what the initials FACC stand for. In short, additional years of training are needed for developing expertise in a cardiology subspecialty, such as electrophysiology or interventional cardiology. A pediatric cardiologist provides the very best patient care. And they must maintain those skills throughout their careers by participating in ongoing training and education programs.
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