Health Matters

Defining Heart Disease

Jun. 22, 2015

People often equate heart disease with heart attacks, but they’re not one and the same. While heart attacks occur because of heart disease, heart disease is a broad term for many conditions that can raise your risk of stroke or heart failure.

man having heart attackUR Medicine preventive cardiologist Dr. John Bisognano explains five common forms of heart disease and offers tips for managing or preventing them.

1. Coronary artery disease

Coronary artery disease (CAD) occurs when plaque (cholesterol and fat deposits) builds up in the arteries that supply oxygen-rich blood to the heart. The plaque causes arteries to narrow, slowing or preventing the flow of blood. When our hearts don’t get enough blood, the resulting pain is called angina. If the artery is completely blocked, it can cause a heart attack.

Many times people learn they have this condition after they’ve experienced a heart attack. Doctors assess your risk of CAD by checking cholesterol, blood pressure and blood glucose levels and reviewing your family’s history of heart disease. If you’re at risk, your physician will likely prescribe inexpensive medications to lower your blood pressure, cholesterol and glucose levels, and closely monitor your condition. Tests to check for CAD include electrocardiogram (EKG), exercise stress test, chest x-ray, angiogram and cardiac catheterization.

2. Hypertension

Hypertension, or high blood pressure, is a silent disease. One in five Americans have it and don’t know it. That’s why doctors make a habit of using the arm cuff to check our patients’ levels as often as we can, looking closely at both the top and bottom numbers. This is important because when the force of blood pressing against the walls of your arteries is elevated, it raises the heart’s workload and can cause serious damage to the arteries as well as the heart.

The first number of a blood pressure reading is the systolic pressure, when the heart is squeezing. The second is the diastolic blood pressure, when the heart is relaxed between beats and when the elastic recoil of the arteries continues to push blood forward. Both numbers are important.

A reading below 120/80 is normal. If your top number is between 120 and 139, or your bottom number is 80 to 89, you are on the way to having hypertension. That means you probably need to make some lifestyle changes to prevent or at least delay becoming hypertensive and needing medications to get the numbers down. If your top number is 140 or above and your bottom number is 90 or above, you have hypertension.

The higher the number, the greater your health risks. Your doctor will likely recommend a combination of lifestyle changes and medication to lower your blood pressure and reduce your risk of heart disease, kidney disease or stroke. For some people over 60 without diabetes of kidney disease, a blood pressure over 150/90 triggers the need for treatment with medications.

3. High cholesterol

High cholesterol is linked to increased risk of heart disease, stroke and peripheral vascular disease. Our bodies need some cholesterol, but not too much, which can lead to plaque build-up in arteries and reduce blood flow to the heart. There are different types of cholesterol. Doctors check cholesterol levels (through a blood test) to determine the level of “bad” cholesterol, or LDL, and triglycerides, which your body stores in fat cells. On the other hand, you want to raise your “good” (HDL) cholesterol. It helps get rid of the bad kinds. Many people try to lower their cholesterol by eating a healthy diet, which is important for our overall health, but a big factor in the cause of high cholesterol is in our genes.

4. Heart attacks

Heart attacks happen when blood flow stops to a portion of the heart. Sometimes it’s caused by a clogged artery (coronary artery disease) or a blood clot that abruptly forms in the artery, eliminating blood flow. Symptoms of a heart attack are most commonly excruciating chest pain or pressure that sometimes radiates down the left arm or the neck, shortness of breath, dizziness and nausea.

5. Cardiomyopathy

Cardiomyopathy is a weakness or stiffness or the heart muscle. This is concerning because it means the heart muscle doesn’t contract and relax normally and that means blood can’t move through the heart efficiently. It can be caused by coronary artery disease, occur as a result of a heart attack, or may result from years of high blood pressure.

John Bisognano, MD
John Bisognano, M.D., Ph.D., is a preventive cardiologist with UR Medicine Heart and Vascular and president of the American Society for Hypertension.