Heart Disease Q&A

By:
iVillage Health & Well-Being Staff Writer

Where does heart disease rank among the causes of death for women?

Coronary heart disease is the leading cause of death among American women, with stroke being the number-one cause of serious, long-term disability among women.

What causes heart disease?

Coronary heart disease, the most common form of heart disease, develops over many years. It can begin in childhood as a result of a process known as atherosclerosis, in which fatty substances build up inside the walls of blood vessels. Blood components also stick on the inside surface of these same vessel walls.

What happens when these fatty substances and blood components start to build up inside the blood vessel?

This causes the vessels to narrow and "harden," becoming less flexible. The buildup and narrowing proceed gradually. Over time, this can limit blood flow and, eventually, cause symptoms to develop. This buildup or "plaque" may also break open and produce a blood clot that can block a blood vessel.

What happens when the blood flow to the heart is reduced?

Reduced blood flow to the heart can cause chest pain, or angina. If blood flow is nearly or completely blocked, a heart attack can occur, causing muscle in the heart to die. Once damaged, these cells cannot be replaced; the result is permanent heart damage.

Does heart disease affect women of all ages?

Coronary heart disease rarely affects young women. Instead, it usually develops after menopause. Before menopause, the ovaries make estrogen, which helps to protect the heart. One in 10 American women age 45 to 64 has some form of heart disease. That figure increases to one in five for women over age 65.

What are some of the other risk factors for heart disease?

There are several; they include:

• family history of early heart disease
• cigarette smoking
• high blood pressure
• high blood cholesterol
• being overweight
• physical inactivity
• diabetes

These risk factors do not add their effects in a simple way. Rather, they multiply each other's effects. For example, if you smoke and have high blood pressure and high blood cholesterol, you're eight times more likely to develop coronary heart disease than a woman with no risk factors.

What is meant by unchangeable and changeable risk factors?

Risk factors that cannot be controlled are known as unchangeable. Those that you have some control over are known as changeable. Examples of unchangeable risk factors are:

• being age 55 or older
• having a family history of early heart disease -- that is, having a mother or sister who has been diagnosed with heart disease before age 65, or a father or brother diagnosed before age 55

Examples of changeable risk factors are:

• cigarette smoking
• high blood pressure
• high blood cholesterol
• being overweight
• physical inactivity
• diabetes

Does coronary heart disease always create symptoms?

No. You can have coronary heart disease without being aware of it. The best way to protect your heart is to know whether you have coronary heart disease and treat it as early as possible.

What are some of the most some common warning signs of a heart attack?

• uncomfortable pressure, fullness, squeezing or pain in the center of the chest that lasts more than a few minutes, or goes away and comes back
• pain that spreads to the shoulders, neck or arms
• chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath

Do men and women have the same symptoms?

As a woman, you may have other, less common warning signs than those usually reported. They are:

• atypical chest pain, stomach pain or abdominal pain
• nausea or dizziness
• shortness of breath and difficulty breathing
• unexplained anxiety, weakness or fatigue
• palpitations, cold sweat or paleness

What should you do if you suspect you are having a heart attack?

Always be prepared with the telephone number to call to get emergency transportation to the hospital. (In most areas this telephone number is 911.) Getting to a hospital fast may allow doctors to inject a blood-clot-dissolving agent into your artery to help restore blood flow. This type of therapy saves many lives and reduces damage to the heart muscle.

What can be done to reduce the risk of complications of coronary heart disease?

There are three main types of treatment:

Lifestyle. If you have been diagnosed with coronary heart disease, there are five key steps for you to follow to keep your heart as healthy as possible:

• Stop smoking.
• Lower blood pressure.
• Lower high blood cholesterol.
• Lose any extra weight.
• Become physically active.

Medications. A healthy lifestyle will improve your heart's condition. But you may need medication too, especially if you have chest pain or if you have blood pressure or high blood cholesterol that was not lowered enough with lifestyle changes. Drugs can have side effects, so none should be taken without first seeing a physician. If you take a drug, follow the dose instructions carefully and report any troublesome side effects to your doctor immediately. Often a change in dose or type of drug can stop the side effect. Some of the drugs that may be prescribed for you are:

• Aspirin -- helps prevent heart attacks when taken regularly in a low dose on a doctor's order.
• Digitalis -- makes the heart contract harder and is used when the heart's pumping function has been weakened; it can also slow a fast heart rhythm.
• ACE inhibitor -- stops production of a chemical that makes blood vessels narrow; used for high blood pressure and heart muscle that has been damaged.
• Beta-blocker -- reduces how hard the heart must work; used for high blood pressure, chest pain, and to prevent a repeat heart attack.
• Nitrate -- relaxes blood vessels and alleviates chest pain.
• Calcium-channel blocker -- relaxes blood vessels; used for high blood pressure and chest pain.
• Diuretic -- decreases fluid in the body; used for high blood pressure.
• Blood cholesterol-lowering agents -- used to lower high blood cholesterol that cannot be controlled by diet alone.

Special procedures. If you have advanced atherosclerosis, you may need a special procedure to open an artery and improve blood flow. This is usually done to ease severe chest pain or clear major or multiple blockages in blood vessels. The two main procedures are:

• Coronary angioplasty -- also called balloon angioplasty. In this procedure a fine tube is threaded through an artery to the narrowed heart vessel, where a tiny balloon at its tip is inflated. The balloon flattens the buildup and stretches the artery, improving blood flow. The balloon is then deflated and removed, along with the tube.
• Coronary artery bypass graft surgery -- also known as bypass surgery. In this surgery, a piece of blood vessel is taken from the leg or chest and is stitched onto the narrowed heart artery, making a bypass around the blockage. Sometimes more than one bypass is needed. Bypass surgery is done when the blockages in an artery can't be reached by angioplasty or are too long or hard for angioplasty.