Cardiovascular Disease

Cardiovascular disease is the leading cause of death among both men and women, and among all ethnic and racial groups. It is responsible for 40 percent of all deaths occurring in the United States each year. Cardiovascular disease is made up of a group of various health conditions that affect the heart and blood vessels. The most common of these conditions are high blood pressure, coronary artery disease, and stroke.

High blood pressure
Blood pressure is the force of blood pushing against blood vessel walls. The heart pumps blood into the arteries (blood vessels), which carry the blood throughout the body. High blood pressure, also called hypertension, means the pressure in your arteries is above the normal range. One in four American adults has high blood pressure, and as many as a third of these people are unaware they have it. Diagnosing and treating high blood pressure is easily done. However, if left untreated, high blood pressure can lead to serious health conditions such as stroke, heart failure, and kidney failure.

When measuring blood pressure, it is written as two numbers, such as 124/72. The first number is the systolic pressure. This is the pressure in the arteries when the heart beats and fills them with blood. The second number is the diastolic pressure. This is the pressure in the arteries when the heart rests between beats. In order to receive a proper measurement of your blood pressure, you should schedule an appointment with your doctor. Measuring devices that are often found in drug stores are not considered accurate enough to be reliable.

Type of blood pressure reading

Normal blood pressure

Normal to high blood pressure

High blood pressure

Systolic

Under 120

120-139

Over 140

Diastolic

Under 80

80-89

Over 90

While the exact cause of high blood pressure is uncertain, some factors are known to contribute to it. Some of these factors are subject to behavioral control, while others are not.

• Smoking
• Being overweight
• Inactive lifestyle
• Eating too many fatty foods or food with too much salt
• Using birth control pills
• Alcohol use

Non-modifiable

• Family history of high blood pressure
• African-American descent
• Pregnancy
• Being over 35 years of age

If you are diagnosed with high blood pressure, there are many ways you can manage it and keep it under control. First, you must work on starting and maintaining a healthy lifestyle. Once you have done this, and if your pressure is still elevated, there are medicines that can be prescribed. The following actions can help lower your blood pressure:

• Lose weight, if you are overweight.
• Eat a diet that is low in salt and fat.
• Eat foods high in calcium, fiber, potassium, and magnesium (after talking to your doctor).
• Limit alcohol to no more than 2 drinks (beer, wine, or whiskey) each day.
• Follow a regular exercise program.
• Learn to manage stress and anger.
• Quit smoking.
• Take blood pressure medicine if your health care provider prescribes it, and follow your provider's directions carefully.
• Have regular blood pressure checks.

Coronary artery disease
Coronary artery disease is a weakening or deadening of parts of the heart, caused by a narrowing of the arteries that provide oxygen and nutrients to the heart muscle (coronary arteries). When the blood flow is slowed, the heart doesn't get enough oxygen. This usually results in chest pain called angina. When one or more of the coronary arteries are completely blocked, the result is a heart attack.

Coronary arteries become narrowed or clogged by a build-up of plaque in the artery walls. Plaque is made up of excessive cholesterol covered over by scar tissue. As excessive cholesterol continues to settle in the arteries, more scar tissue forms over it. This creates larger plaque deposits and, in turn, less room for blood to flow through the arteries. Plaque build-up in the arteries is called atherosclerosis, also known as "hardening of the arteries."

Like other forms of cardiovascular disease, some risk factors for coronary artery disease can be changed behaviorally while others cannot. These risk factors include:

• Smoking
• High cholesterol
• High blood pressure
• Diabetes mellitus
• Obesity
• Inactive lifestyle

• Age
• Male gender
• Family history of coronary artery disease

The following lifestyle changes can help combat the development of coronary artery disease.

• Quit smoking (if you smoke).
• Keep your blood pressure under control and have it checked routinely.
• Control your cholesterol levels through diet, exercise, and medicine, if necessary.
• Get checked for diabetes; and if you have it, keep it in control.
• Lose weight if necessary.
• Give your heart a workout by exercising at least 20 minutes, 3 times a week.

Coronary artery disease often produces few, if any, symptoms, so it is important to be regularly screened and examined by a doctor. In order to diagnose coronary artery disease, your doctor will first perform a thorough physical examination, as well as look at your own and your family’s medical history. If coronary artery disease is suspected, the doctor will then order diagnostic tests, which might include:

• Electrocardiogram (EKG) — An EKG records the electrical activity of the heart and can detect an abnormality in the heart rate or the heart’s rhythm.
• Stress test — During a stress test, a patient exercises on a treadmill or stationary bicycle while he or she is closely monitored with heart and blood pressure monitors. The heart’s response to exercise is then measured. When used with an EKG, a stress test can detect stress-related problems in the heart muscle that might not have been evident in an EKG performed while the patient was at rest.
• Coronary angiogram — This test is considered the most accurate method for diagnosing coronary artery disease. During this test, a catheter — a thin, hollow, flexible tube — is inserted into the groin or forearm, and then directed toward the heart using X-ray guidance. A dye is then injected and photographed as it moves through the heart's chambers, valves, and major vessels. From these photographs, doctors can tell whether the coronary arteries are narrowed, whether the heart valves are working correctly, and whether the strength of the heart muscle is adequate. If a blockage is found in one of the heart's arteries, it might need to be corrected with angioplasty or bypassed with surgery.

Stroke
Each year, ½ million Americans suffer strokes. A stroke is damage to part of the brain tissue as a result of a loss of blood and oxygen. It occurs when blood vessels become damaged or blocked, preventing blood from reaching a part of the brain tissue. The brain cannot store oxygen, so it relies on a network of blood vessels to provide it with blood that is rich in oxygen. Brain tissue needs a constant supply of oxygen and nutrients to keep nerve cells and other parts of the tissue alive and functioning. When the tissue is cut off from its supply of oxygen for more than three to four minutes, it begins to die.

Seventy percent of all strokes that are caused by a bleeding blood vessel occur in people who have high blood pressure. High blood pressure puts added stress on the blood vessels walls, which can weaken them and make them more likely to burst. It can also speed up the build-up of fatty deposits in blood vessels throughout the body. Other strokes caused by a bleeding blood vessel can be due to a birth defect that makes the blood vessel weak and more likely to burst (aneurysm).

There are many warning signs that indicate you might be suffering a possible stroke. If you experience any of the major stroke warning signs listed below, call 9-1-1. It is important to get to the hospital immediately.

• Sudden numbness or weakness in the face, arm, or leg (especially on one side of the body)
• Sudden nausea, fever, and vomiting
• Difficulty speaking or understanding words or simple sentences
• Sudden blurred vision or decreased vision in one or both eyes
• Difficulty swallowing
• Dizziness, loss of balance, or uncoordination
• Brief loss of consciousness
• Sudden inability to move part of the body (paralysis)
• Sudden, unexplainable, and intense headache

Stroke warning symptoms are the signs of a medical emergency. For every minute that brain cells are deprived of oxygen during a stroke, brain damage increases. Also, the chances for survival and recovery are much better when the right treatment is started within the first few hours of noticing stroke warning signs.

There are many risk factors that increase the risk of stroke. Some of these factors can be controlled and changed while others cannot.

• High blood pressure
• High cholesterol
• Heart disease
• Being overweight
• Heavy drinking
• Smoking

Non-modifiable

• Age
• Gender (Men are more likely than women to have strokes.)
• Family history of stroke

There are ways to reduce some of the modifiable risk factors.

• Quit smoking.
• Have your cholesterol checked regularly.
• Control your cholesterol intake.
• Limit the amount of alcohol you drink.
• Have your blood pressure checked regularly.
• Control your blood pressure, if necessary.
• Follow your health care provider's instructions for changing your diet.
• If you have diabetes, follow your health care provider's instructions for managing the disease.
• Follow your health care provider's instructions for using preventive medicines.

There are a variety of tests your doctor can order to diagnose the occurrence of a stroke. At first, basic tests might be performed, such as checking your blood pressure and pulse, and testing your motor skills. Your doctor might also ask you a few questions to see if you are mentally alert. If — after your initial examination — your doctor believes additional tests are needed, the following tests might be performed:

• CT scan — Computed tomography, also known as a CT scan, uses computers and X-rays to produce many pictures from multiple angles to give doctors an accurate picture of the brain. CT scans are useful in ruling out hemorrhages, tumors, and infections. However, ischemic strokes (those that occur when there is a blockage in the blood vessel) might not show up immediately. Therefore a repeat test is often ordered 24 to 48 hours after the initial scan.
• MRI —  Magnetic resonance imaging (MRI) uses a magnetic field to produce images of the brain. MRIs produce images in much greater detail and more quickly than CT scans, sometimes detecting strokes within a few hours of occurrence. This can be helpful for doctors in making decisions about proper treatment.
• MRA — A magnetic resonance angiography (MRA) provides detailed pictures of blood vessels and can reveal where arteries might be narrowed or where blood flow is blocked. MRAs are also useful in detecting aneurysms.
• Angiography — During this test, a catheter is inserted and threaded upward through connecting arteries to the neck and brain. A contrast dye is then injected into the blood and X-rays are taken.
• Blood tests — If a stroke is suspected, it is not unusual for some form of blood test to be performed. Blood tests will evaluate the blood count and blood clotting time, as well as analyze the liver and kidney function by measuring certain substances in the blood.

Treatment
Treatment for cardiovascular disease depends on how severely the disease has progressed. However, the most effective method in slowing or stopping the disease’s progression is a change in personal behavior. This includes cutting fat and cholesterol intake, adding fiber and other nutrients to into your diet, exercising, maintaining a healthy weight, and quitting smoking. Other methods for treating cardiovascular disease include prescription medicines and surgery.

Medicines
There are currently many types of medicines prescribed to patients with cardiovascular disease. For those patients with high blood pressure, medicines help manage the disease by relaxing the blood vessels and enabling the blood to flow more easily. Other medicines, called diuretics, help regulate the blood pressure by reducing the body’s unneeded water and salt, passing it out of the body through urine.

For patients who have coronary artery disease, are recovering from a heart attack, or are at risk of a stroke, medicines might be prescribed that relax arteries, decrease the heart’s workload, reduce cholesterol, or reduce the tendency for the blood to form clots (anticoagulants or platelet inhibitory medications).

Interventional procedures and surgery
For those patients still at risk of a heart attack or stroke — despite lifestyle changes and medicines — or for those who have severe arterial blockage, interventional procedures or surgery are often recommended. These procedures do not cure cardiovascular disease, so lifestyle changes such as a healthy diet, exercising regularly, and quitting smoking continue to play major roles in having a healthy heart.

• Coronary angioplasty and stenting — During angioplasty, also known as balloon angioplasty, a catheter is inserted into the groin or forearm and then directed toward the heart and the site of the blockage. A balloon on the tip of the catheter is then inflated and deflated, stretching open the narrowed artery, thus improving the blood flow. Often, a stent (a mesh-like scaffolding) is inserted to keep the artery open. The catheter is then removed. If an angioplasty is unsuccessful, bypass surgery might be the next option.
• Coronary artery bypass surgery — During this operation, a blood vessel is removed from another part of the body, usually the leg, arm, or chest, and then grafted onto a clogged artery, thus bypassing the blocked area.
• Heart transplant — For untreatable conditions in which the heart cannot support the body’s needs, a heart transplant is usually recommended. During a heart transplant, the diseased heart is removed and replaced with a donated, healthy human heart. More than 2,000 Americans undergo heart transplants each year.

Management
Management of cardiovascular disease depends on the extent of the disease and the physical restrictions that might have already resulted from the disease. Many patients who have been diagnosed with a form of cardiovascular disease can lead healthy and productive lives. This can be achieved by following a doctor-recommended healthy lifestyle, as well as carefully and faithfully following the directions for any prescribed medicines.

Some patients who have had strokes lose movement in their arms or legs, the ability to walk, or the ability to speak (either partially or completely). For these patients, rehabilitation — often including speech, physical, and occupational therapy — can help recover or improve these abilities.

As is the case with any other disease or condition, education and understanding are the best weapons in preventing stroke or the complications that might arise from cardiovascular disease. The following organizations offer more information on cardiovascular disease:

American Heart Association
National Center
7272 Greenville Avenue
Dallas, Texas 75231
1-888-478-7653
www.americanheart.org

National Stroke Association
9707 E. Easter Lane
Englewood, Co. 80112
1-800-STROKES (1-800-787-6537)
www.stroke.org