Angina

Heart Disease

Tests for angina

Many problems can be confused with angina, especially indigestion or gastro-oesophageal reflux. It’s important tests are done to establish the diagnosis, to ensure the affected person gets the right treatment.

An electrocardiogram (ECG) is essential and may show typical changes but can be normal in angina. Blood tests can be done to check for causes such as anaemia and look for chemical enzymes (called Troponins) released from the heart if a heart attack has occurred. Other checks for cholesterol levels, blood fats, diabetes and thyroid disease may be done. In most areas of the UK these tests will be done at the local Rapid Access Chest Pain Clinic.

More complex tests such as an ECG during exercise, echocardiogram or other sophisticated x-ray tests may be recommended. However, NICE has recently produced guidelines which direct which tests should be done based on a statistical calculation of how likely to patient is to have angina. For example, invasive coronary angiography (where a tube is inserted into the coronary arteries and dye injected to produce x-rays pictures of the coronary arteries) is usually offered when there is a greater than 61 per cent chance of coronary artery disease.

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Angina

Heart Disease

What is it angina?

Angina pain develops when the muscles of the heart are not getting enough oxygen. This is usually caused by narrowing or blockages of the coronary arteries that deliver oxygen-rich blood to the heart muscle, known as coronary artery disease. Angina is a sign of heart disease.

If the blockage of a coronary artery progresses and becomes complete, the blood supply to part of the muscles of the heart is lost, causing a heart attack. Angina is a warning sign that the heart is at risk of an attack and should be taken very seriously. One patient in 10 will go on to have a heart attack within a year of diagnosis of angina.

Angina may be an occasional problem or may rapidly increase in severity and duration until a heart attack occurs.

Cardiac Rehabilitation

Heart Disease

WHAT ARE THE GOALS OF CARDIAC REHABILITATION?

The overall goals of cardiac rehab are to help you:

  • Recover after a heart attack or heart surgery.
  • Address risk factors that lead to coronary artery disease and other heart problems. These risk factors include high blood pressure, high blood cholesterol, overweight or obesity, diabetes, smoking, lack of physical activity, and depression and other emotional health concerns.
  • Adopt healthy lifestyle changes.
  • Improve your health and quality of life.

The rehab team will work with you to reach these goals. You will do this through increased daily physical activity, following a heart healthy eating plan, quitting smoking, and improving your emotional health.

Cardiac Rehabilitation

Heart Disease

WHO NEEDS CARDIAC REHABILITATION?

Many people with heart problems can benefit from cardiac rehab. Rehab may help people who have had:

  • A heart attack
  • Angioplasty or coronary artery bypass grafting for coronary artery disease
  • Heart valve repair or replacement
  • A heart transplant or a lung transplant
  • Stable angina
  • Heart failure

People of all ages can benefit from cardiac rehab. It’s equally helpful to both men and women. Cardiac rehab can improve your overall health and prevent future heart problems and even death.

Cardiac Rehabilitation

Heart Disease

WHAT IS IT?
Cardiac rehabilitation (rehab) is a medically supervised program that helps improve the health and well-being of people who have heart problems. Rehab programs include exercise training, education on heart healthy living, and counseling to reduce stress and help you return to an active life

BASIC FACTS
Cardiac rehabilitation (rehab) is a medically supervised program that helps improve the health and well-being of people who have heart problems.

Rehab includes exercise training, education on heart healthy living, and counseling to reduce stress and help you return to an active life.
Cardiac rehab involves a long-term commitment from the patient and a team of health care provides, such as doctors, nurses, exercise specialists, physical and occupational therapists, dietitians or nutritionists, and psychologists or other mental health specialists.

Many people with heart problems can benefit from cardiac rehab. Rehab can help people who have had a heart attack, angioplasty or coronary artery bypass grafting for coronary artery disease, heart valve repair or replacement, a heart transplant or a lung transplant, or stable angina.

The goals of cardiac rehab are to help you recover after a heart attack or heart surgery, address risk factors for heart problems, adopt healthy lifestyle changes, and improve your health and quality of life.

Your rehab team will work with you to meet your goals. You will do this through increased daily physical activity, following a heart healthy eating plan, quitting smoking, and improving your emotional health.

Before starting any cardiac rehab program, your rehab team will assess your health. They will ask about your medical history and do a physical exam. They may order tests to check your overall health.

During cardiac rehab, your team will help create physical activity and heart healthy eating plans. They will work with you to reduce your risk factors for heart problems. If you feel sad, anxious, angry, or isolated, the team can help you get treatment to improve your emotional health.

The lifestyle changes you make during cardiac rehab have few risks. Physical activity may have some risks, but it’s very safe in the rehab setting. Very rarely, it may cause serious problems.

Cardiac rehab has many benefits. It can improve your overall health and quality of life and reduce your overall chance of dying, the chance of future heart problems, and the chance of dying from a heart attack. It also can decrease pain and lessen the chance that you will have to go back to the hospital or emergency room for a heart problem.

Watch the video on how cardiac rehabilitation can improve your heart health.

7 Heart Tests That Could Save Your Life

Heart Disease

Think a stress test and a simple blood workup are all you need to assess your heart attack risk? Wrong.


Cardiac Calcium Scoring

How It Works: A CT scanner checks for atherosclerotic plaque (made up of calcium, cholesterol, and scar tissue) in your heart’s arteries. After electrodes are attached to your chest and to an EKG machine that monitors your heartbeat, you lie on an exam table that slides into a short, doughnut-shaped tunnel and hold your breath for 10 to 20 seconds.

Cost: $99 to $399

Duration: 10 minutes

Why It’s Heart Smart: “Calcium scoring is the number one best predictor of a future heart attack,” Dr. Agatston says. Calcified plaque– a major warning sign of coronary artery disease, the leading cause of heart attacks–shows up at least 10 years before a heart attack or stroke hits. By catching the problem early, you can treat it before the buildup narrows arteries so severely that it triggers a heart attack.

Get It If: You’re 50 or older with risk factors– or you’re younger with a family history and several risk factors. Since the test involves x-rays, women shouldn’t have it if there’s any chance they might be pregnant.

What the Results Mean: You’ll get an Agatston Score (developed by Dr. Agatston), which indicates the total amount of hard and soft plaque in your heart’s arteries. A score of zero means you have no calcium deposits and a low risk of heart attack in the next 5 years. A score of 400 or more puts you at high risk of a heart attack within 10 years; a score of 1,000+ means you have up to a 25% chance of having a heart attack within a year without medical treatment.

Next Steps: If your score is 200 or higher, your doctor may advise lifestyle changes, a statin to lower cholesterol, or a diabetes drug to lower blood sugar–all of which will also reduce plaque.

7 Heart Tests That Could Save Your Life

Heart Disease

Think a stress test and a simple blood workup are all you need to assess your heart attack risk? Wrong.

Your physician has you come in to his office and run on a treadmill while you’re hooked up to an EKG. For the next 8 to 12 minutes, he’ll evaluate your heart rate, breathing, and blood pressure  as the intensity of the workout increases. When the stress test is over, he’ll tell you whether you have coronary artery disease.

Here’s news that might make your heart skip a beat: For women, there’s a 35% chance the test results will be wrong.

Most often, the test reveals false positives, meaning healthy women are told they have heart disease. Less frequently but obviously far more dangerous is when the test fails to detect clogged arteries that could, in fact, cause a heart attack. Fewer men are misdiagnosed.

Possible reason for the gender gap: Phases of the menstrual cycle and birth control pills have been shown to throw off results, indicating that estrogen’s effects on heart cells might be a factor.

For decades, doctors had nothing more sophisticated than a stress test to offer. Not anymore. Cardiologists now use advanced imaging and blood tests that give a much more accurate assessment of heart attack risk. “These tests are the best ways to tell who is in danger, because they can catch cardiovascular disease 20 to 30 years before it gets severe enough to cause a heart attack or stroke,” says Arthur Agatston, MD, an early champion of many of them.

Better detection is urgently needed: More than 1 million Americans have heart attacks every year, and almost half die. Men have more than women do, but the gap is closing. From 1988 to 2004, attacks among women ages 35 to 54 spiked 42%.

These tests are available at most major medical centers and hospitals. If your doctor doesn’t request them for you, demand the ones that are recommended for women in your age group and risk category.

Heart Attack

Heart Disease

If you are having pain or discomfort in your chest, jaw, shoulder, arm, or back and think you may be having a heart attack, call 911 immediately. Do not delay or try to “wait it out.”

If you think you are having a heart attack, seek help immediately. Do not ignore chest pain or discomfort. Time is of vital importance. Go immediately to a hospital emergency department. Do not attempt to drive yourself or have someone else drive you. Call 911 for emergency transport.

The heart is a muscular pump located in the chest. Its job is to pump blood around the body via the circulatory system of blood vessels. The heart consists of 4 chambers: right atrium and right ventricle, and left atrium and left ventricle.

  • Blood is depleted of oxygen after circulating through the body. This blood returns into the right atrium. From there the blood flows into the right ventricle, which pumps the blood out to the lungs for oxygenation.
  • The oxygen-rich blood then returns to the left atrium. From there it flows into the left ventricle and is pumped out at high pressure into the arteries.

The high pressure is generated by powerful contraction of the heart muscle.

  • This raises the pressure of the blood and enables it to flow through the extensive network of arteries to every part of the body and return to the heart.
  • For this pumping action, the heart has to be strong.

The heart is nourished by the blood supplied directly to the heart muscle through the coronary arteries.

  • The strength of the heart muscle depends very much on this blood supply.
  • The coronary arteries are usually strong, elastic, and quite flexible. The inner lining of the arteries is normally smooth. This allows the blood to flow smoothly without clotting.

Heart attack is caused by sudden loss of blood and oxygen to your heart.

  • The most common condition that predisposes a person to heart attack is coronary heart disease, or coronary artery disease.
  • The plaque and resulting blood clots block the artery partially or completely, reducing the amount of blood that can flow through the artery to the heart.
  • This cuts off the oxygen supply to part of the heart muscle.
  • If the blood supply is cut off long enough, that part of the heart muscle dies. This is a heart attack.
  • If a large enough part of the heart muscle is affected, a dangerous rhythm disorder called ventricular fibrillation may occur.
  • If this happens, the heart may stop. This is called cardiac arrest, and most people who have cardiac arrest die.

Despite immense medical progress in the last 3 decades, heart disease continues to be a major health problem in both industrialized and developing nations.

  • About 1.5 million Americans suffer a heart attack each year (that?s 1 heart attack every 20 seconds).
  • Many people die before getting medical attention. Approximately 90-95% of people who reach a hospital alive after a heart attack will survive.
  • Overall, about one third of people who have a heart attack die.
  • Heart disease is the leading cause of death in the United States.

Clearly, time is of the essence. Recognizing the symptoms of a heart attack and seeking immediate medical attention may mean the difference between life and death.

  • Immediate death may be avoided if cardiopulmonary resuscitation (CPR) is begun within 4 minutes of the cardiac arrest.
  • CPR involves breathing for the person (mouth-to-mouth resuscitation) and performing chest compressions to keep the blood circulating. This provides at least a small amount of oxygen to the heart and brain.

Survival depends on quick action.

  • Emergency personnel will assess the situation quickly. They may record an electrocardiogram (ECG).
  • If the person has ventricular fibrillation or there is no pulse, they may administer electrical current to the chest (defibrillation) to “shock” the heart back to normal rhythm.
  • Other emergency treatments include medications and CPR.

Bystanders can help a cardiac arrest victim before emergency personnel arrive.

  • Ventricular fibrillation often can be treated successfully with a defibrillator.
  • Automated external defibrillators (AEDs) are now becoming available in many public places such as airports and airplanes, shopping malls, sports arenas, and office buildings.
  • These devices are designed so that they can be used in cardiac arrest by untrained bystanders.
  • Even if an AED is not available, you can take part in the “chain of survival” by performing CPR until help arrives.

Ischaemic Heart Disease

Heart Disease

Introduction 

Ischaemic Heart Disease, otherwise known as Coronary Artery Disease, is a condition that affects the supply of blood to the heart. The blood vessels are narrowed or blocked due to the deposition of cholesterol plaques on their walls. This reduces the supply of oxygen and nutrients to the heart musculature, which is essential for proper functioning of the heart. This may eventually result in a portion of the heart being suddenly deprived of its blood supply leading to the death of that area of heart tissue, resulting in a heart attack.

As the heart is the pump that supplies oxygenated blood to the various vital organs, any defect in the heart immediately affects the supply of oxygen to the vital organs like the brain, kidneys etc. This leads to the death of tissue within these organs and their eventual failure or death. Ischaemic Heart Disease is the most common cause of death in several countries around the world.

Cause and Pathogenesis 

A multitude of factors are responsible for the development of Ischaemic Heart Disease. The major risk factors are smoking, diabetes mellitus and cholesterol levels. Those with Hypercholesterolaemia (elevated blood levels of cholesterol) have a much higher tendency to develop the disease. There is also the theory that Hypertension is a risk factor in the development of Ischaemic Heart Disease, Genetic and hereditary factors may also be responsible for the disease. Males are more prone to Ischaemic Heart Disease. However, in post-menopausal women, the risk is almost similar to that of men. Stress is also thought to be a risk factor, though there has been a great deal of debate on this factor of late. The disease process occurs when an atheromatous plaque forms in the coronary vessels, leading to narrowing of the vessel walls and obstructing blood flow to the musculature of the heart. Complete blockage results in deficient oxygenation and nutrient supply to the heart tissues, leading to damage, death and necrosis of the tissue, which is known as Myocardial Infarction (heart attack).

Symptoms and Signs 

Quite often, the first sign of Ischaemic Heart Disease may be the severe chest pain of Myocardial Infarction, which may be fatal. However, the warning symptoms occur in a large number of patients in the form of Angina Pectoris. The main symptom of Angina is pain over the central chest that may sometimes radiate down the left arm, to the jaw or to the back. The characteristic feature of the pain is that it is usually aggravated by exercise and relieved by rest, though variant forms may occur. The pain is also relieved by the use of nitrates kept under the tongue. The pain is usually described as a sense of compression or tightness in the middle of the chest, and may last for five to twenty minutes. The pain may be accompanied by sweating. The presence of anginal episodes is virtually diagnostic of Ischaemic Heart Disease.

Other signs that can be observed on clinical examination is the presence of Tendon Xanthomas, thickening of the Achilles Tendon and Arcus Lipidus in young patients, all of which may indicate a hereditary Hyperlipdaemia. The patient should also be examined for anaemia, obesity, diabetes, thyroid and peripheral vascular disease.

Investigations and Diagnosis 

Electrocardiography (ECG) may be normal in several patients at rest between attacks of Angina. However, during the episodes of pain there may be depression of the ST segment and a T wave inversion in several leads, indicating Ischaemia. In cases of Infarction (heart attack), there will be ST segment elevation in the ECG, which may gradually evolve. An Echocardiogram may help in showing any functional abnormalities in the various cardiac chambers and in assessing the pumping efficiency of the heart. An exercise testing (Treadmill Test-TMT) is often indicated in patients who have symptoms but have normal ECG patterns. Nowadays, TMT is being indicated in all high-risk categories beyond the age of 35 irrespective of symptoms. Myocardial perfusion scanning with radioactive thallium may also be helpful in the diagnosis. Coronary Angiogram provides accurate information about the actual site and extent of the stenosis (narrowing) and helps in deciding the method of therapy required.

Treatment and Prognosis 

Drug therapy with Nitrates, which dilate the diseased coronary arteries, administered sub-lingually are very effective in relieving the pain in a few minutes. Drugs such as Isosorbide Dinitrate and Isosorbide Mononitrate belong to the category of Nitrates. These drugs are also used as a prophylactic to prevent the pain from occurring. Beta-blockers like Propranolol are also highly effective in relieving pain by reducing myocardial oxygen demand, mainly by decreasing the heart rate. Calcium channel antagonists produce vasodilatation and relieve the symptoms by reducing the excitability and conductivity of cardiac muscle and by reducing blood pressure. For patients with hypercholesterolaemia, drugs may be used to lower cholesterol levels.

Surgical therapy is indicated when medical treatment has failed to relieve symptoms or when the Angiogram shows significant disease in the blood vessels. Coronary Angioplasty – dilating the blocked vessel by inflating a balloon inside the vessel and Coronary Artery Bypass Grafting (CABG) – replacing the blocked area of the vessel using a graft from the patient, may be done to relieve the blockage.

The indications for bypass surgery are increasingly becoming limited. This is due to the growing realization that except in selected cases, bypass surgery only helps to improve the quality of life and relieve symptoms. It does not significantly increase life expectancy. The current trends are to focus on medical treatment and techniques like angioplasty. With proper treatment, most patients will be able to lead normal and healthy lives. Treatment also involves advice regarding regular exercise, avoiding smoking, diet control and life style modification. Good control of diabetesand hypertension significantly improves the outlook.

Prevention

Risk factors like a fatty diet, smoking, sedentary lifestyle and stress should be avoided, as they are the main areas of focus in prevention. Avoiding foods rich in saturated fats is vital to reduce lipid levels in the blood and to prevent arteriosclerosis. Adequate regular exercise is also essential. Diabetes Mellitus and hypertension should be kept under good control with proper treatment.

The role of inflammation in coronary artery disease

Heart Disease

The role of inflammation in coronary artery disease
The year 2000 marks the year in which the link between inflammation and coronary artery disease gained widespread recognition among cardiologists.
Several lines of evidence converged last year to suggest thatatherosclerosis, unstable angina and heart attacks are all associated with inflammation of the coronary arteries. This evidence includes the following:
– Elevated levels of C-reactive protein (CRP), a protein that appears in the bloodstream during many inflammatory processes, are associated with acute coronary events. (See CRP and fibrinogen – newer risk factors for coronary artery disease.)
– Patients with acute heart attacks who also have elevated white blood cell counts (the white cells are produced in response to inflammation and infection) were found to have poorer outcomes (increased risk of heart failure and death) than patients with normal white blood cell counts.
– Older patients (> 65) who had antibodies to the herpes simplex virus had an increased risk of heart attack and cardiac death.
– DNA to the bacteria Chlamydia pneumoniae was found in a certain type of white blood cell (the CD3+ lymphocytes) in a high proportion of patients with coronary artery disease. The CD3+ lymphocytes are known to accumulate in atherosclerotic plaques.
These observations have sealed the now generally-accepted notion that vascular inflammation is an important component of coronary artery disease, and have opened many brand new lines of research into novel approaches to the prevention and treatment of coronary artery disease.
The efficacy of the statin drugs and aspirin in reducing the incidence of acute coronary events, for instance, may be related, at least in part, to their anti-inflammatory effects in addition to the cholesterol-lowering effect of statins, and the anti-clotting effect of aspirin.
And, seeing the pot of gold at the end of the rainbow, the pharmaceutical industry is now investing tens of millions of dollars in exploiting the new line of evidence that inflammation plays a major role in causing heart attacks. The clinical payoff from this important conceptual advance in coronary artery disease should begin to appear quite soon.

What is the need for cardiac CT

Heart Disease

Coronary Artery disease (CAD) is the leading cause of death in the industrialized world.

  • “Screening” is a widely accepted strategy to combat CAD for early detection of stenosis of the coronary artery lumen.
  • Exclusion of stenosis in non- symptomatic high risk patients.
  • Prior to major (non-cardiac) Surgery.
  • Atypical (unstable) chest pain.
  • Refractory chest pain with doubtful coronary origin.
  • Non-conclusive stress tests.
  • As a substitute to conventional coronary angiography prior to percatareous coronary intervention and in high risk patient like aortic disease.
  • Adjuvant to coronary Angio for Plaque characterization ,Complicated coronary intubation., Total coronary occlusion.
  • Follow-up in -Percutaneous coronary intervention-Bypass Surgery.
  • Evaluation of coronary anomalies.
  • Evaluation of chest pain at emergency department.
  • Evaluation of lifestyle, dietary or pharmacological interventions on progression /regression of coronary atherosclerosis.