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How does the heart work? Your heart is a lot like your house, complete with a framework, plumbing, and an electrical system. It has one mission: to keep blood moving.
The framework is provided by the heart muscle itself. The coronary arteries function as the external plumbing, supplying the heart muscle with oxygen-rich blood. The heart’s internal plumbing—its four chambers—squeeze and relax in precise sequence, controlled by the electrical system, the nerves that regulate heartbeat.
A disturbance at any point in this well-choreographed process might impede the blood’s movement and create cardiovascular disease. For instance:
- Over time, plaque can become deposited on the walls of arteries, narrowing the pipeline and reducing blood flow. When the narrowing blocks a coronary artery, cells within the heart muscle can die, a condition known as heart attack. A narrowing can cause angina—pain or pressure in the chest; more severe blockage can lead to more extensive muscle damage—heart attack.
- Things can also go wrong in the internal plumbing, the chambers and valves. Some problems result from physical defects in the heart structure, often congenital—something we’re born with. These may include defective valves or deviations in the heart wall, both of which can prevent the heart from filling and emptying normally.
- Electrical problems can cause arrhythmia, an unstable heart rhythm. The worst case is cardiac arrest, when the heart is unable to pump a life-sustaining volume of blood. Other electrical problems include irregular heartbeat, when the heart beats too fast or too slow; and fibrillation.
Disease can also directly affect the heart muscle. A common example is heart failure, defining a heart that is in a weakened state. As the pump weakens, some blood is left behind with every heartbeat. This blood backs up and congests the circulatory system, triggering palpitations, shortness of breath, even potential organ failure.
Inflammatory or infiltrative conditions—such as cardiac sarcoidosis and cardiac amyloidosis—can hijack normal cardiac muscle cells, replacing them with diseased tissue. Infection in the heart can cause endocarditis, a life-threatening inflammation of the inner surfaces of the heart and valves.
Some risks for cardiovascular disease cannot be controlled. But many can. The better we manage them, the better our odds of leading a long life. More from @HashimHayder. https://bit.ly/2LDk2Ch via @MedStarWHC
Risk Factors for Heart Disease
As we age, to some extent, all of us have a greater risk of heart disease. But each person’s actual risk is unique, a product of their own inherited and acquired factors.
- A person at low-risk has few or no existing risks and avoids them by pursuing healthy habits.
- A person at average risk perhaps has a few unmodifiable risks and some lifestyle risks.
- A person at high-risk may have unmodifiable risks and also eat poorly, have high blood pressure, not exercise, not see the doctor, and use tobacco. These factors can culminate in a serious health event.
We can’t control genetic makeup, family history, age, sex, or race—all of which can contribute to our personal level of risk. But we can delay the onset of disease and/or reduce the severity of illness by concentrating on risk factors for coronary heart disease that we can control, such as blood pressure, diabetes, inactivity, weight, smoking, and stress.
- Blood Pressure: High blood pressure makes the heart work harder. Uncontrolled hypertension can weaken blood vessels and accelerate the deposit of plaque. That increases the risk of coronary artery disease, stroke, and peripheral artery disease.
Treating high blood pressure can be a challenge since it presents no symptoms. Checking blood pressure regularly, reducing salt in the diet, and taking any medications your doctor has prescribed are keys to success.
- Diabetes: Uncontrolled diabetes causes blood vessel damage, and peripheral artery disease can result in loss of vision or limbs. It also puts a patient at higher risk for stroke and heart attack.
Type 2 diabetes can often be prevented with weight control and healthy eating. Once a patient has been diagnosed, however, it’s very important to keep it under control with a doctor’s help.
- Weight and Exercise: Excess weight makes the heart work harder to distribute blood over a larger body mass, potentially leading to heart failure. It often results from inactivity and poor diet, accelerating the buildup of plaque and increasing the risk for type 2 diabetes.
Controlling weight is about burning the calories we consume, but most Americans eat far more than they burn. Managing weight isn’t easy, but exercise can make a big difference. Exercise strengthens your heart and burns more of the calories you consume. It can also serve as a useful sentinel for cardiovascular problems. People who exercise regularly are more likely to notice when they suddenly can’t complete their normal routine or feel chest pain or shortness of breath walking up a hill they climb daily.
The American Heart Association recommends at least 150 minutes of moderate exercise each week for adults—that’s 30 minutes per day, for at least five days. If more Americans follow this guideline, we will see drastic reductions in cardiovascular disease.
- Tobacco: Even if you eat right and exercise, smoking significantly increases your risk of heart disease. Tobacco acts very aggressively in the cardiovascular system.
Like high blood pressure, it accelerates the growth of plaque. It calcifies the arteries, making them rigid and less flexible. It also hinders interventional treatments—stiffened arteries can resist expansion from catheterization and stents.
- Alcohol: Alcohol in moderation may have a limited protective effect. While science has yet to prove a direct link between alcohol and heart health, we do see an association between red wine and reduced risk of death from heart disease. Antioxidants in red wine may improve cholesterol.
Assuming that you exercise, avoid tobacco, and adopt other healthy habits, I recommend four ounces of red wine per day for women, eight ounces for men.
Keep in mind that higher levels of alcohol consumption can alter liver function, increasing cholesterol levels. And excessive drinking can actually cause heart failure, a condition known as alcohol-induced cardiomyopathy.
- Dental Neglect: When dental issues are present, bacteria in the mouth can enter the bloodstream and collect in the heart, causing endocarditis or valve problems. We also know that inflammation from poor dental hygiene can make plaque and coronary artery disease more aggressive.
Everyone should have a dental exam at least twice per year.
A traumatic physical or emotional event can cause stress cardiomyopathy, also called takotsubo cardiomyopathy or broken heart syndrome. Stress cardiomyopathy behaves very much like a heart attack, but without ischemic muscle loss. Fortunately, most patients recover without long-term damage.
Stress is part of life, especially during a global pandemic. But chronic, persistent, daily stress can take a slow and dangerous toll.
You can’t change your basic personality, but you can change how you respond to stress. It’s important to de-stress in a way that works well for you: meditation, yoga, listening to music, chatting with friends. This is where exercise can also provide amazing benefits. Going for a walk, run, bike ride or swim can help off-load the negativity of the day.
Don’t Delay Care
When it comes to cardiovascular disease, any symptom must be taken seriously, including chest pain, tightness, or heaviness; shortness of breath; nausea; dizziness; or pain in the jaw, neck, or left arm.
If you experience any of these indicators, don’t try home remedies or procrastinate—it’s time to seek emergency care. Even if you suspect it’s just indigestion, it’s safer to be examined by a medical professional, especially if you have pre-existing risk factors.
This is particularly vital advice for women, whose symptoms are often less specific than men’s and could potentially also include discomfort through the shoulders, shortness of breath, chills, profound fatigue, or sudden dizziness.
MedStar Heart & Vascular Institute is a national leader in the research, diagnosis, and treatment of cardiovascular disease. Our experts are well equipped with the knowledge and technology to offer the outstanding level of heart and vascular care that patients in our region deserve.