Heart Disease 101
The heart is an amazing organ and it has many complex parts, all of which can develop their own unique problems over time.
The doctors at Trident Cardiology Associates, PA are a group of adult cardiologists specializing in the diagnosis, treatment, and management a variety of diseases and conditions of the cardiovascular system which include both the heart and blood vessels.
Read more below about the heart and common heart conditions.
The Heart: How it Works
The heart is basically a complex pump which moves blood around the body so the other organs can get the oxygen and nutrients they need to carry on daily functions. This is obviously a very important task!
Just like most pumps that we may think of in plumbing, like the one that gets fresh water up to the top of the local water tower, the heart pump requires fuel to work and has a complex electrical system to help it get the job done. It does this automatically with some input from our brain to tell it when to speed up and slow down. It truly is an astonishing thing!
When there is a problem with one of the pump’s systems, it can develop signs of failure. This may be seen as symptoms including chest pain, shortness of breath, and swelling, among many others.
Read more below about the heart and common heart conditions.
Coronary Artery Disease
WHAT IS CORONARY ARTERY DISEASE?
Coronary artery disease, or “CAD”, develops through a complex set of interactions in the arteries supplying blood to the heart. These are the “coronary arteries”. Namely, inflammation and microscopic injury locally at the level of the coronary arteries leads to cholesterol plaque accumulation. This can lead to the blood pathway through the artery becoming narrowed (blocked) to the point where the supply of blood is less than the demand. This can lead to “angina”, which is the chest discomfort caused by lack of blood flow to an area of the heart
WHAT IS A “HEART ATTACK?”
If an area of heart muscle is starved of its blood supply due to a blocked artery for a prolonged period of time, this can cause what is frequently described as a “heart attack”. Health care providers refer to this as a myocardial infarction.
If not treated in time, this can cause irreversible damage to the heart and in some cases cause the heart’s pumping function to decrease and potentially result in rhythm disorders. This can certainly be dangerous or even deadly…so if you have chest pain or discomfort, get to a hospital!
Please understand, it’s usually best not to drive yourself or even have someone drive you due to how quickly things can change if you actually are having a heart attack. So if you’re ever in doubt, call 911!
WHAT ARE THE SYMPTOMS OF CORONARY ARTERY DISEASE?
Remember some of the common symptoms of a heart attack:
- Chest pain, tightness, heaviness, or pressure
- Arm or shoulder pain (left or right arm)
- Pain in the neck, jaw, or teeth
- Heartburn, “gas” pain, upset stomach
- Sweatiness or hot flashes
HOW IS CORONARY ARTERY DISEASE TREATED?
Treatment of CAD is probably one of the more common scenarios where cardiologist is pictured. The heavy chest pain which leads some patients to an Emergency Room in the middle of the night may be caused by a blocked artery supplying blood to the heart muscle. In other cases, a heart artery blockage may develop more slowly over time but can lead to the same type of chest discomfort in a more subtle pattern as the blockage grows. This may occur over months or even years.
A cardiologist may need to look at the heart arteries with a procedure called a heart catheterization to determine if blocked arteries are causing the problem. In some cases, a stent (small mesh wire cylinder), which travels to the blockage on a small retrievable balloon can be used to open the artery. This is called angioplasty. Alternatively, bypass surgery may be necessary if stents are not the best choice to fix certain types of heart blockages. (Click here to learn more about heart catheterizations)
In all scenarios, once CAD has been diagnosed, your cardiologist will make a tailored recommendation of important medications to prevent the progression of heart disease. Don’t hesitate to ask what each medicine is for as there are frequently several! Each one works in a different way so please understand they are all important.
If you are ever considering stopping any of your heart medications please do so only after speaking with your cardiologist first. Stopping medications abruptly or too soon can have very bad consequences, and in some cases fatal. There are usually alternative medications that your cardiologist may substitute if you suspect a side effect is getting the better of you. We are always happy to work with you to find a balance that fits!
Congestive Heart Failure
WHAT IS CONGESTIVE HEART FAILURE?
Congestive heart failure or CHF, develops due to problems with the pumping function of the heart. This is most frequently thought of as due to issues with the squeezing function of the heart and thus the heart is “weak” heart – this is called systolic congestive heart failure.
On the other hand, problems with the relaxing (blood filling) portion of the heart pump cycle can lead to another type of heart failure called diastolic heart failure (see our Echocardiography page), sometimes thought of as a stiffness problem with the heart. Echocardiography (heart sonogram or “echo”) is often key in the diagnosis of congestive heart failure.
There are many good therapies for heart failure and the decision tree as to which is best can be complicated. Your cardiologist will evaluate a great deal of information and help decide with you what is best to manage your type of heart failure.
WHAT ARE THE SYMPTOMS OF CHF?
Regardless of the type of heart failure, patients with congestive heart failure frequently suffer from a variety of symptoms such as:
- Shortness of breath at rest or when exerting themselves
- Trouble breathing when lying flat (orthopnea)
- Swelling of the ankles, legs or belly
WHAT CAUSES CONGESTIVE HEART FAILURE?
The reasons for heart failure are typical split into two major categories.
Ischemic (is-keem-ik): (heart failure due to blockages of the heart arteries resulting in damage to the heart pump)
- Typically someone may have had a heart attack in the past which damaged a part of the heart making the pumping efficiency weakened.
- This type of heart failure may recover in certain degrees if the blockages are identified and treated in time.
Non-ischemic: Simply, this is heart failure which is due to something other than damage to the heart from blocked heart arteries.
- A stress test and/or heart catheterization is usually needed to rule out the possibility of heart blockages.
- Several different non-ischemic heart failure syndromes exist some of which are due to:
- Viral illness
- Abnormal deposits of iron or protein in the heart
- Longstanding high blood pressure
- Metabolism disorders of the thyroid
- Abnormal heart muscle cell structure
HOW IS HEART FAILURE TREATED?
While medications remain the mainstay of most heart failure therapy in the long run, sometimes invasive procedures are needed to treat heart failure. This may include a heart catheterization of either the left and/or right side of the heart, and in some cases, implantation of a defibrillator for those patients at risk of dangerous rhythm disorders. Your cardiologist will decide with you if that is appropriate for your individual needs.
Valvular Heart Disease
WHAT IS VALVULAR HEART DISEASE?
The heart is divided into four chambers – two holding chambers and two pumping chambers. There are, likewise, four valves, or doors, which separate these chambers from one another. These keep blood moving in a forward direction from the right side of the heart, through the lungs to pick up fresh oxygen, and then back to the left side of the heart where it exits to go the rest of the body.
There are two main types of valve disease:
- Stenosis (stin-o-sis): This is when a valve becomes “tight” and there is difficulty in blood getting across that valve. This is sort of like a door developing rusty hinges over time which make it difficult to open. Just like with the door, more pressure is needed to push it open and this strains the heart.
- Regurgitaiton (re-gergi-tay-shun): This what is referred to as a “leaky” valve. If the valve leaks, blood returns backward into the chamber from where it was last. This effectively makes an inefficient pump, and the heart ends up doing more work to get the same amount of blood moving forward which the body is demanding. A small amount of leak is normal for most heart valves so if you see this in your echo report, don’t panic!
While neither type is good for the heart, both may be treated with surgery or in some cases, less invasive means of valve treatment. Medications can be helpful for some heart valve diseases but not all. Heart valve disease can progress over time and your doctor will help you decide when its time to do something about it.
Heart Rhythm Disorders
HOW IS THE HEART WIRED?
The heart has a complex electrical system which involves specialized cells which conduct small electrical signals. These signals tell the heart muscle cells when to squeeze which generates a “heart beat” and blood flow out of the heart pumping chambers. These electrical cells form a “wiring system” of the heart which is also subject to wear and tear over time but can also suffer damage from problems like heart attacks.
WHAT IS A PACEMAKER?
In some cases pacemakers may be recommended by a cardiologist which can replace the original electrical system of the heart. It is always best to try to use the parts of the hearts wiring system that are still functional to take advantage of the crosstalk between the brain and the heart. Modern pacemakers are amazingly intelligent and can be programmed in many different ways which are always individualized to a particular patient’s needs.
A BIT ABOUT ARRHYTHMIAS:
There are rhythm disorders which can be grouped into a category called “arrhythmias”. These rhythm problems can come from the top chambers or bottom chambers of the heart and can be very unique in the way they are diagnosed and managed. Frequently people refer to the sensation of an arrhythmia as a “skipped beat” or a “palpitation”.
Arrhythmias can cause a multitude of bothersome symptoms including dizziness, lightheadedness, blackout spells, chest discomfort, palpitations or rapid heart rates, among others. They may be treated with medication or in some instances, require treatment with a catheter-based treatment called ablation.
Sometimes, dangerous rhythm disorders require a special type of pacemaker-like device called a defibrillator. This would typically be performed by a cardiologist with special training in rhythm disorders called an “Electrophysiologist”, the same physicians who perform ablations. We have several longstanding relationships with these specialists in the area and will help recommend one if necessary for your care.
Peripheral Vascular Disease
Just as artery blockages can develop in the arteries of the heart, they can also occur in the arteries elsewhere in the body. Peripheral arterial disease (PAD) refers to arteries that develop disease outside of the heart. Typical places this causes problems are in the arteries of the legs, arms, kidneys, and neck, though any artery can be affected.
Those blockages which develop in the arteries of the neck and brain can cause strokes. Those that develop in the legs may cause heaviness, cramping, and/or pain in the leg muscles frequently while walking, and improving with rest. Kidney artery blockages can cause chronic disease of the kidneys (CKD), difficult to control blood pressure and in some instances, may lead to episodes rapid accumulation of fluid on the lungs.
Your doctors at Trident Cardiology Associates are dedicated to diagnosing and managing all types of cardiovascular disease including peripheral arterial disease. Blood pressure measurements in the arms and legs, ultrasound studies, as well as vessel imaging either by CAT scanning or angiography in the catheterization lab (x-ray pictures) may be used to diagnose PAD. This issue may need to be dealt with using medications, balloon/stenting of the arteries (angioplasty), or possibly surgery.
WHAT ABOUT PREVENTION?
Some types of heart disease begin developing silently early in life. Having a family history of heart disease can be one of the most important risk factors when assessing one’s risk for developing heart disease later in life. That’s why the doctors at Trident Cardiology Associates incorporate Preventative Cardiology as another key component in our practice.
Once heart disease has been diagnosed, for example, after a heart attack has occurred, the cardiologist and the patient begin to manage the disease and the aftermath of heart damage. The trouble is, many times the damage is irreversible to heart muscle, and the heart may never work as well as it once did. Preventative Cardiology aims to keep patients out of that realm and avoid the ill effects of heart disease which can be dangerous and sometimes deadly.
WHAT CAN I DO TO REDUCE MY RISK?
Maintenance of a healthy diet, regular exercise, and avoidance of dangerous habits such as smoking are all key components of a prevention strategy in reducing heart disease risk. Most importantly, they are all things that can be done without the use of medications and expensive testing, and best of all, they keep you feeling good!
Congenital Heart Disease
WHAT IS CONGENITAL HEART DISEASE?
Some people are born with heart related problems which can sometimes be diagnosed even before birth. These are called “congenital heart defects.” A pediatric cardiologist and in many cases, a pediatric cardiac surgeon are needed to team up to help diagnose, treat, and manage these often complicated issues, some of which may include:
- Incorrect routing of blood through the heart
- Underdevelopment of heart chambers
- Abnormal connections between heart chamber (“holes”)
WHO MANAGES PATIENTS WITH CONGENITAL HEART DISEASE?
It may be best for an expert in the area of pediatric cardiology to manage these patients over time. When the time comes and these patients transition into adulthood, an“Adult Congenital Heart Disease Specialist” is often a great choice and usually has more experience dealing with adult diseases and those related to the long term effects of congenital heart disease.
If you have a history of congenital heart disease and you are not currently following with a specialist in adult congenital heart disease, your cardiologist may discuss the option of helping you find an expert in one of these fields listed above depending on the complexity of your heart history. We have relationships with many local experts and are happy to help!