Risk Awareness 

     The heart is a muscle that pumps oxygen-filled blood to all parts of the body. In healthy adults, the heart is usually about the size of a closed fist and pumps approximately 1,900 gallons of blood every day through the circulatory system.

     Your heart needs an oxygen-rich blood supply to do its job properly. If the blood supply from the coronary arteries is not adequate, the heart cannot pump effectively. There are three major coronary arteries, the Right Coronary Artery (RCA), the Left Anterior Descending Artery (LAD), and the Left Circumflex. (LCX)

Coronary Heart Disease

     Coronary arteries are normally elastic. They expand to allow blood to flow easily through them. As we age our arteries naturally harden and lose some of their ability to expand.
     
     In coronary artery disease, arteries become narrowed or blocked by a build-up of fatty deposits (cholesterol) within the artery wall, which reduces the blood flow to the heart muscle.  This build-up is called atherosclerosis and may start slowly progressing in childhood. If the build-up reduces blood flow mildly, there may be noticeable symptoms such as chest pressure with increased activity or stress or even at rest. When blood flow is reduced significantly, the heart muscle does not receive enough blood to meet the need and symptoms such as angina pectoris, heart attack, or rhythm disturbances may occur.

What is Angina?

     Angina or angina pectoris is a recurring discomfort. It is usually located near the center of the chest. The pain or discomfort occurs when the blood supply to a part of the heart muscle does not meet the heart's needs. As a result, the heart does not get enough oxygen and nutrients.
     
     Angina can occur anytime, but the discomfort occurs most often during physical activity, after eating meals, during emotional stress, or exposure to cold weather. This is when the heart rate and blood pressure increase and the heart muscle demands more oxygen.

     Angina pain or discomfort is usually brief, lasting just a few minutes. People describe it as a heaviness, tightness, oppressive pain, burning, pressure or squeezing. Usually it is located behind the breastbone. Sometimes it spreads to the arms, neck, jaws or between the shoulder blades. It may also cause numbness in the shoulders, arms or wrists. It can also take the form of unusual shortness of breath, weakness or fatigue when you have not been exerting yourself. Women and diabetics may have intermittent pain or no pain at all. Frequently, women do not experience the "classic" symptoms listed above, but may instead experience dizziness, palpitations, cold sweats, paleness or unexplained anxiety.

     Angina and a heart attack are different. The blood flow is reduced to the heart muscle with angina. With a heart attack, the blood flow to a part of the heart muscle has suddenly stopped. As a general rule, angina attacks to not permanently damage the heart muscle; a heart attack does.

Notify Your Doctor If...

• You have never had angina before and you think you are having it now.
• You have angina while you are resting.
• You feel your angina is getting more intense, or is occurring more often.
• The nitroglycerin does not help as quickly or as effectively as before or you are using it more often.
• Your angina is waking you up at night.
• You experience sudden unexplained fatigue or shortness of breath.

     If you think you are having angina, follow these steps:

• Stop what you are doing, and rest.
• Place a nitroglycerin tablet under your tongue and let it dissolve. You might experience a slight stinging or burning under your tongue or a sense of fullness in your head. This could mean your nitroglycerin is fresh and should relieve your discomfort. Sit or lie down prior to using nitroglycerin. It may cause you to feel dizzy or faint because it opens all arteries.
• If you still have angina after five minutes, take another tablet and continue to rest. Look at your watch or clock.
• Take a third tablet if you still have discomfort after five minutes and call 911. DO NOT DRIVE YOURSELF to the hospital.
• You may also take an aspirin while you are waiting for the ambulance.
  

What is a Heart Attack?

     A heart attack occurs when  a coronary artery becomes totally blocked. Like all muscles in your body, your heart muscle needs oxygenated blood in order to survive. When the blood stops, permanent damage can occur.

     Coronary Atherosclerosis or Coronary Thrombosis also referred to as Myocardial Infarction (MI) indicates death of the myocardial tissue. (heart muscle)

Causes of a Heart Attack

• Coronary artery disease: a build-up of fatty deposits in the blood vessel walls.
• Blood clot: blood cells clump together and stick to fatty deposits inside the artery.
• Spasm: coronary artery contracts or tightens preventing blood flow.

     It is important to learn about signs and symptoms, diagnosis and treatment for a heart attack. Heart problems should not be ignored. It's a matter of life and death. Heart attack symptoms are usually more severe than angina, last longer, and usually do not respond to nitroglycerin.

     You may experience severe tightness in the center of the chest, intense burning or pressure sensations. These sensations may travel to neck, jaw, back, arms or shoulders. There also may be some sweating, shortness of breath, nausea and/or vomiting and generalized weakness.

     If these symptoms are not relieved with rest and nitroglycerin, you may be having a heart attack. Don't delay. Seek medical help right away!. CALL 911

Treatment May Also Include Coronary Artery Procedures

Cardiac Catheterization
During cardiac catheterization, a catheter is inserted into a blood vessel and gently guided toward the heart. This procedure will tell your doctor whether you have coronary artery disease.

Angioplasty
Balloon angioplasty improves blood flow to your heart.A catheter with a balloon at the tip is put into the blocked artery. The balloon is then expanded to widen the vessel, then the balloon is deflated and the catheter is removed.

Stent Implantation
A stent is a small metal coil or mesh tube. After balloon angioplasty or atherectomy is performed, a stent is placed in the artery. This helps prevent the artery from narrowing again.

Atherectomy
Atherectomy may be done to improve blood flow using a catheter with a special grinding device which clears away the plaque in the blocked artery.

Laser Angioplasty
A narrow, flexible plastic tube, the laser catheter is inserted into the coronary artery. After the laser catheter is positioned against the blockage, the laser is energized to vaporize the obstruction.

Rotoblator
The rotoblator system is a catheter based angioplasty device that removes tissue (plaque) blocking an artery and blood supply to the heart. A tiny football shaped tip catheter which is coated with microscopic diamond crystals is driven by air turbine which can set at speeds of up to 190,000 RPM.

Bypass Surgery
A blood vessel from another part of the body is used to bypass a blocked artery. The saphenous vein from the leg; radial artery from the forearm or the internal mammary artery from the chest may be used as grafts.

Medications Used for Heart Patients

Coronary Risk Factors

     After having a heart attack, your goals should be to return to a normal lifestyle and control your risk factors to reduce the chance of another heart attack.

     Risk factors are habits or inherited tendencies that contribute to blocked arteries increasing your chance of having a heart attack. Some risk factors you cannot control, but if you reduce your controllable risks, you may be able to prevent another heart attack.

RISK FACTORS YOU CANNOT CONTROL

• Family history of heart disease- Some people inherit genes that affect the way their bodies make and use cholesterol. If your family has a history of heart disease, you are at greater risk of developing problems.
• Age- As we get older, out arteries tend to lose elasticity and over time fatty deposits may build up inside arteries.
• Gender- Men are more likely to develop coronary artery disease than women, however women are equally at risk after menopause. Black women are at greater risk than other women.
  

RISK FACTORS YOU CAN CONTROL

Controllable Risk Factors

High Blood Pressure
     High blood pressure is also known as hypertension. When your blood pressure is high, damage can occur in the coronary arteries, arteries of the brain and other small arteries of the body. If your blood pressure is consistently above 120/70, you may be at an increased risk for heart disease. The systolic blood pressure (the top number) is the pressure that is created in the arteries when the heart contracts. The diastolic blood pressure( the bottom number) is the pressure inside the arteries when the heart is at rest. If the arteries have high diastolic pressure, there is an increased work demand on the heart muscle.

     High blood pressure may cause a roughness in the lining of the arteries that traps cholesterol and fats as they pass by. This causes a build-up of fatty plaques leading to coronary artery disease.

Hypertension can often be treated by:

Some cases of hypertension may require medication to decrease the blood pressure.


Stress

     Stress is part of living and our body's response to change. When you feel stressed your body shifts into overdrive. Your heart rate and blood pressure increase and your muscles become tense. When this happens, your heart must work harder. You can't remove stress from your life, but you can control how it affects you. Continuous stress or extreme stress can result in a serious emotional and physical illness.

     The first step in stress management is to identify stress and the second step is to learn methods to cope with stress.

     Identify the areas of stress in your life. In order to control stress, you must know what causes you stress. As you begin to understand what stresses you, you will be in a better position to make changes in your situation or choose to respond to the stressor in a different way.

Recognize signs and symptoms of stress.

Coping with stress

     Learn relaxation methods- reading, listening to relaxation tapes, taking a warm bath and walking are simple ways to reduce stress.

• Share your problems with friends
• Practice positive thinking
• Decide what you want in life
  

Stress Management Skills
The three A's            Avoid the Stressor
                                   Alter the Stressor
                                   Adapt to the Stressor

Smoking

     Smoking is the number one preventable risk factor for heart disease. Smoking tops the list of major risk factors of our number one killer. One-fifth of deaths from heart disease are from smoking.
     Smoking increases the plaque or blockage in the arteries, causing the coronary arteries to constrict and decrease the amount of oxygen carried in the blood. This decreased amount of blood and oxygen reaching the heart muscle causes the heart to work harder. Smoking can also make the heart work harder by increasing your heart rate and blood pressure.
     Quitting smoking is one of the most important things you can do for you health of your heart. You may want to consider joining a stop smoking program to help you "beat" this habit. Support of other smokers may help you adjust easier. Your doctor may also prescribe medications and suggest nicotine replacement products. Never use tobacco when you are using a nicotine replacement product.

Obesity

     Your heart must work harder to pump blood to those extra fat cells when you are overweight. People who are overweight are more likely to have high blood pressure and high blood cholesterol. Talk to your physician before starting any weight management program.

Tips to lose weight:

• Set a reasonable goal. Your goal should be self-management. You are responsible for taking care of yourself.
• Write down what you eat and when you eat. Take small portions. Eat slowly.
• Replace high-calorie, high-fat foods with nutritious foods such as fresh fruits an vegetables. Always keep fresh low-fat foods around so you won't be tempted to snack on unhealthy foods.
• When you are hungry between meals, have a glass of water or eat a piece of fruit.
• Plan your meals. Skipping meals can lead to extreme hunger and cravings for high-sugar, high-fat foods.
• Stay active. Exercise. Find a partner to encourage your and keep you motivated.
• Remember, this is a lifelong process that takes commitment. Don't get discouraged. If you have a bad day and overeat or skip exercise, you can get back on track. 
  

Lack of Exercise

     The heart is a muscle. Like all muscles it needs regular exercise to work mor efficiently. Exercise had many benefits.

     Before you begin your exercise program check with your physician. You will be advised what type of exercise is best for you.
     When you get home from the hospital, follow the sample exercise program below. The hospital staff will set a goal for you. A reasonable goal for many people is 30 minutes once a day, four to six days a week.
     Aerobic exercise will condition your body to use oxygen more efficiently and will slowly increase breathing and heart rate. These exercises work large muscles non-stop for 20 to 30 minutes. Every exercise period should include a 5 to 10 minute warm up and cool down activity.

     Learn to take your pulse. Take your pulse before, during and after your exercise program. You will be able to determine your target heart rate and whether you are doing too much or too little. Your nurse or exercise specialist will help you determine your target heart rate.
     If your experience chest discomfort, shortness of breath, fast heartbeat, weakness, fainting, dizziness or lightheadedness, or leg cramps, STOP and rest. If you have nitroglycerine with you, take it. Resume exercising slowly after symptoms have subsided.

Diabetes

     Diabetes is a condition in which the body is unable to use food properly. When you eat, the food is broken down into sugar called glucose. Glucose is the body's main source of energy. Glucose cannot get into the cells by itself. Insulin helps glucose enter the cells. When you do not have enough insulin, sugar builds up into your blood. As sugar remains in your blood vessels, they become thick and narrow, leaving less room for blood to flow.

     The link between diabetes and heart disease- increased blood sugar causes narrowed arteries leading to the decreased blood flow to your heart.

     If you have diabetes, adopt habits to help you prevent or control heart disease:

• Follow a prescribed meal plan
• Speak to a dietitian to assist you in a diet that's right for you.
• Exercise regularly
• Lose weight.
• Take your diabetes medication as prescribed.
• Test your blood sugar on a regular basis or as suggested by your physician.
• Quit smoking.
• Attend diabetes classes. See if your local medical center offers a Diabetes Education Program.

     If you have never been diagnosed with diabetes, is it possible you have diabetes? Contactyour physician if you have any of the following risk factors:

• You have a family member with diabetes.
• You are 45 or older and do not exercise regularly
• You are overweight.
  

High Cholesterol
     
     Cholesterol is a waxy fat that circulates through the body in the blood. Most cholesterol is made by the body and the rest comes from the food we eat. Most heart disease comes from atherosclerosis, the build-up of fatty deposits in the arteries that supply blood to the heart muscle.

     There are two kinds of cholesterol: LDL "bad" cholesterol and HDL "good" cholesterol.

     LDL- Low density lipoproteins travel through the bloodstream and are used by the cells, LDL not used by the cells collect in the arteries and cause blockage.

     HDL- High density lipoproteins send leftover LDL's back to the liver where they are removed from the body.

Triglycerides are another type of fat found in the blood. They are made in the liver and containing fatty acids and other substances. Diets high in sugar, alcohol and fat increase the amount of triglycerides in the blood.

     A blood test will determine your total cholesterol and triglycerides. Your doctor may order this test once a year. If your LDL or triglycerides are high, your doctor may prescribe medication to help lower them. Remember, medication does not substitute eating a diet low in fat and cholesterol.

     You should not consume more than 200 to 300mg of cholesterol per day. No more than 20 to 30 percent of your total calories should come from fat. No more than 7 to 10 percent of your total calories should come from saturated fat.
     Remember to limit the amount of alcohol to no more than two servings per day. Caffeine should also be limited to two cups of coffee per day. Caffeine is also found in tea, cola, and chocolate.
     Please refer to your dietitian instructions regarding specific dietary restrictions. Literature is available from the dietitian and your cardiac educator.

Resources

American Heart Association Toll-Free Lines:
1-800-AHA-USA1- American Heart Association National Main Number
1-888-4-STROKE- American Stroke Association* (Information and Warmline)
1-877-AHA-4-CPR - CPR and Automated External Defibrillator class information.
*The American Stroke Association Association is a division of the American Heart Association.

American Heart Association Web Site- www.americanheart.org