What is Atherosclerosis and Cardiovascular Disease?

Anthony Navone, MD
Marcus Daly Cardiology Services

Frequently Asked Heart Health Questions:

What is atherosclerosis and cardiovascular disease?
Atherosclerosis is the narrowing and thickening of the arteries in the body. Atherosclerosis develops over many years without causing symptoms. Atherosclerosis has been seen in individuals as young is 18 years old. Atherosclerosis can involve any artery in the body. When it involves the arteries to the heart, it is called coronary artery disease or CAD. When it involves peripheral arteries such as those in the legs and brain, it is called peripheral arterial disease or PAD.

What causes atherosclerosis and cardiovascular disease?
There are many factors that contribute to the development of atherosclerosis. Very rarely, individuals may be born with conditions that may predispose them to atherosclerosis. However, most individuals who develop either CAD or PAD do so because of a combination of factors such as poor diet, lack of physical activity and smoking. These are called cardiovascular risk factors. The more risk factors you are exposed to, the higher the chance of developing cardiovascular disease. The major cardiovascular risk factors include diabetes, hypertension, hyperlipidemia, smoking and most importantly, a family history of cardiovascular disease.

What are some common symptoms of cardiovascular disease and heart attack?
Unfortunately, all too frequently, individuals may present with a heart attack or stroke as the first symptom of cardiovascular disease. Symptoms to be concerned about include chest pain, difficulty breathing at rest or with activity, excessive perspiration (diaphoresis), palpitations, unexplained nausea, and dizziness or lightheadedness.

The chest pain of a heart attack is usually described as a burning, heavy and crushing sensation in the center of the chest. The discomfort can sometimes radiate to the jaw and down the left arm. Heart attack chest pain usually occurs while at rest. Women tend to present with non-typical cardiac symptoms including generalized fatigue and malaise. Women tend to have more diffuse discomfort, spreading to the shoulders, neck, arms and even to the back.

Is heart disease hereditary?
There is an increase in the risk of heart attack if a first-degree relative (parent or sibling) has had a heart attack or stroke. That is mainly seen when the relative has had a heart attack before the age of 45 if they are male, 55 if they are female. A positive history should suggest the need to improve all the other risk factors like stopping smoking and decreasing cholesterol.

How is coronary artery disease diagnosed?
The initial evaluation of a person suspected of having atherosclerosis should include a thorough history and physical examination performed by a health care provider. The initial examination is then followed by an electrocardiogram. An electrocardiogram is a test of the electrical activity of the heart. It sometimes can provide clues to the presence of coronary artery disease and other disorders of the heart.

What is a stress test?
A stress test is a test where the electrical activity of the heart is monitored using an electrocardiogram (ECG or EKG), while the patient exercises on a treadmill. It can give information about blood flow to the heart and can suggest whether there are narrowed blood vessels. There are 2 major stress test modalities that are used frequently. The first, and most commonly used stress test, is called a stress echo. Echocardiographic images, or ultrasound images, of the heart are taken both at rest and after peak exercise. This test can also be done without the use of a treadmill. This is referred to as a pharmacologic stress echo. During a pharmacologic stress test, a medication is infused to mimic exercise. The second commonly performed stress test is referred to as a nuclear stress test. During a nuclear stress test, a radioactive tracer is used to outline the blood flow of the heart muscle, both at rest and after exercise. This also can be done as a pharmacologic stress test. Your doctor or cardiologist will choose the best test for your particular symptoms and risk profile.

What is a cardiac CT scan?
CT scanning can be used to evaluate the presence of calcium buildup in the coronary arteries as well as detecting the presence of coronary artery disease. The test is considered non-invasive but still carries the risk of radiation exposure.

What is a cardiac catheterization?
The "gold standard" test for diagnosing coronary artery disease is called a cardiac catheterization or coronary angiogram. During this test, a small plastic catheter is inserted and radio opaque contrast is injected in the coronary arteries while being recorded on x-ray.

What is an ejection fraction and why is it important?
An ejection fraction is the fraction of out bound blood pumped from the heart with each heartbeat. Normally, the heart will pump 55-65 percent of the blood in the left heart chamber. Therefore, a normal ejection fraction is between 55% and 65%. In general, the lower the ejection fraction, the poorer the cardiovascular prognosis. Individuals with an ejection fraction of less than 35% are at risk for sudden cardiac death. These individuals may be considered a candidate for an implantable cardioverter defibrillator to protect them from sudden cardiac death. Your cardiologist can determine whether you or a loved one are suited for such therapy.

What is the connection between diabetes, heart disease, and stroke?
If you have diabetes, you are at least twice as likely as someone who does not have diabetes to have heart disease or a stroke. People with diabetes also tend to develop heart disease or have strokes at an earlier age than other people. Woman of all ages with diabetes have an increased risk of heart disease because diabetes cancels out the protective effects of being a woman in her child-bearing years. People with diabetes who have already had one heart attack run an even greater risk of having a second one. In addition, heart attacks in people with diabetes are more serious and more likely to result in death.

How can aspirin benefit the heart?
Aspirin benefits the heart in several ways:

bullet Decreases inflammation, which is a component of plaque build-up and inflamed plaque is more likely to cause a heart attack or stroke.

bullet Inhibits blood clots. Some factors in the blood trigger a series of events that cause blood platelets to clump together and form blood clots. Aspirin inhibits these factors, and therefore inhibits the formation of blood clots as well. Blood clots are harmful because they can clog the arteries supplying the heart muscle and brain, increasing the risk of heart attack and stroke. Aspirin has been shown to reduce the risk of heart attack and stroke.

What is the cardiovascular risk after quitting smoking?
If you are able to stop smoking, your risk of a heart attack or stroke decreases within a few weeks. The risk goes down to that of a nonsmoker within about 2 years. In addition, a lot of patients comment that they feel healthier and have more energy after they've stopped smoking.

Is vitamin E good for your heart?
Recent clinical trials have suggested that Vitamin E is not effective in reducing the risk of heart disease, at least in patients who've already had one heart attack. There have now been two clinical trials involving more than 20,000 patients with placebo or 400 units of vitamin E a day.

There was no benefit of vitamin E in either trial.

February is American Heart Month, let's celebrate together! Marcus Daly Memorial Hospital and the International Heart Institute of Montana have teamed up to provide you with the next class in the Healthcare Education Series about Heart Health. Join us Thursday, February 11, 2016 from 5:30pm to 6:30pmin the Blodgett and Canyon View conference rooms as Anthony Navone, MD, from Marcus Daly Cardiology Services, talks about the nation's leading cause of death, heart disease. He will explain how you can improve your heart health through prevention and treatment. Learn about the differences in men and women in the symptoms of heart attacks and other areas, and new strategies for combating heart disease. You will leave this session with advice on how to keep your heart well! Come a few minutes early to get your blood pressure checked and register to win a fabulous prize.

Questions and or comments regarding this week's health column please contact, Anthony Navone, MD at Marcus Daly Cardiology Center, a service of Marcus Daly Memorial Hospital, 1200 Westwood Drive, Hamilton, MT 59840. Working together to build a healthier community!


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