Discovering Heart Disease
What do I do if I think I'm having a heart attack?
If you think you are having symptoms that might mean your having a heart attack, the key thing is to act on those symptoms. It's very tough to do that if you're sitting in a meeting, you're presenting, you're listening in a class, or you're with a group of people at dinner. It's pretty embarrassing to stop all of that and say, 2Wait a minute, I think I'm not feeling well, I think I need to go to the hospital." People are very reluctant to disrupt the activities around them, but it's important to do it if you think you're having a heart attack. Call 911 if you have symptoms that might be a heart attack. It brings help to you and it gets you to the hospital quickly, and it avoids your being alone and uncovered in a circumstance where you might have a sudden cardiac arrest - the greatest risk in those first few hours.
Should I take an aspirin after a heart attack?
Now people often wonder what else they might do while they're waiting for the ambulance to arrive. They know that people are given an aspirin early on their arrival in the emergency room, so they wonder if they should take an aspirin before they leave the place they're at.We don't actually advise people to do that. When the ambulance comes, they often, if they think this is a heart attack, will give you an aspirin. On the other hand, if they think it's a bleeding ulcer, they might not want to do that. And so it really is best to have someone make that medical judgment for you. It also may make you think that the aspirin is going to make your pain go away. We don't want people to take an aspirin and then wait for the pain to go away. The aspirin that you take in the early hours of a heart attack is not there to make the pain go away. It's to treat specific problems that occur in the clotting system when we come and open an artery, in particular. So let's let the emergency room physician or the emergency medical technician in the ambulance help you make the decision about whether an aspirin's the right thing to do.
Are the symptoms of heart attack different for women?
Actually in the best studies that have been done, the symptoms that women have with heart attacks really are the same as the symptoms that men have. However women tend to have their heart attacks when they're about ten years older,and people who are older are more likely to have the less common signs and symptoms of heart attack. At least, the ones that people think of less. So that when you're older, you're less likely to have chest pain with your heart attack. You might only have unusual fatigue or shortness of breath or lightheadedness and you might not really have symptoms in your chest or arm or shoulders. And since women are older, they may fall into the group that is a little less likely to have chest discomfort. But, in fact, the kind of chest discomfort they have when they have chest discomfort is the same as men describe. The mistake we make with both men and women is to ignore the chest discomfort that isn't really very severe, that could be put up with, because we think it couldn't be severe enough to be a heart attack. It doesn't have to be very severe pain to mean that heart muscle is being lost. Time lost is muscle lost and we don't want to lose any heart muscle that we can potentially save. So for both men and women, the key thing is to get to the hospital early.
What are the early symptoms of heart disease?
The early symptoms of heart disease depend on what heart disease we're actually talking about, if we're talking about coronary artery disease or blockages in the arteries that supply the heart. The early symptoms will really be primarily angina pectoris. Angina, the chest pain or discomfort that comes from insufficient blood flow and that will often be there when you try to do something strenuous. So, the most strenuous activity of the day will often bring it on rather than milder activities. In general, that discomfort in the chest, a tightness, a heaviness, a pressure will come on as you begin to exercise and will go away as you rest. It sometimes is pretty subtle. It's not a severe pain but the pain can be in the chest, often right in the middle under the breast bone, but it can also be in the arms. Commonly in the left arm, but it can be in either arm or in the neck, shoulders or even the jaw. People have sometimes had teeth removed because of pain that was thought to be from a tooth and actually was from the heart. For other forms of heart disease the symptoms that we're looking for really relate primarily to how well the heart is pumping and how well it can pump blood around to the body. So we would look for things like early fatigue that seemed unusual. Sometimes shortness of breath that seemed unusual and sometimes fluid retention or ankle swelling, edima in the ankles that you could push your finger into and leave a dent that occurred unusually, not for example at the end of a very long day of standing up all day, but ones that seemed to be a new sort of symptom. Any sort of new symptom ought to be brought to the attention of your doctor, particularly if its angina. You shouldn't wait till the next day to tell your doctor if you think you have chest discomfort that might be from your heart.
How can I examine myself for heart disease?
There are many disorders that you can examine yourself for at home and see if you have them. You can, in fact, examine your skin for skin lesions, although the dermatologist does do it a little more carefully and once a year on your birthday you ought to get your birthday suit examined. But in fact, with heart disease it's pretty tough because heart disease is inside; so we can't really see it. What you can see, and what you can be aware of, are the risk factors for heart disease, and some of those you can see quite easily. You can see, everyday in the mirror, if you're overweight or obese, and we know that that's a risk factor for heart disease, particularly for coronary disease. You can see if you're fit: if you've been exercising and engaging in physical activity. Physical inactivity is a risk factor. You can see if you smoke because the wrinkles on your face are emerging earlier than they would otherwise, and because your clothes smell of smoke. So if you smoke, stop. If you haven't started, don't start -- very important risk factors for heart disease. So those are things that we can check ourselves. We can check our blood pressure at home or in the local pharmacy or the local grocery store, and if the blood pressure is elevated, that's a risk for heart disease and needs to be treated. And it's simple enough these days to get your cholesterol checked at your health care provider. It's very important to work with your health care provider to make sure that you get all of those risks looked for, and that you get them all controlled really perfectly. There's no reason these days not to have all of those risks reduced really to normal, and you can do that by working carefully both on lifestyle and medication with your health care provider.
What are the tests for detecting congenital heart disease?
The most important thing to do in terms of detecting coronary artery disease is to have a relationship with a healthcare provider who will work to reduce your risk. If you have your risk reduced, and you develop symptoms of heart disease (chest discomfort, shortness of breath, fatigue,) then your healthcare provider will choose tests to see if coronary artery disease is the reason for those, and very commonly we use exercise testing. Exercise testing can be as simple as having you walk on a treadmill while we look at the electrocardiogram. And that test both helps us find coronary artery disease and helps us understand what the prognosis might be in you: is this a severe problem that's likely to cause you difficulty soon or is it a mild problem that's not likely to be such a difficulty and can be treated simply with medications? It's important that we get the tests that will define coronary disease and we make those specific for the person. For example, simple treadmill testing is less effective in women than it is in men, and often extra scanning tests of various kinds, whether with echocardiography or radionuclide's, will give us additional information that helps us be more specific in women than we could be if we did simple treadmill testing. But you want your healthcare provider to pick the test that will give you the greatest cost benefit that will cost the least and give you the greatest likelihood of finding a problem if it's there, and knowing what to do about it. Finally, if those tests suggest that there is a problem with the coronary arteries, then getting pictures of the coronary arteries, what we all an angiogram, is a very useful thing to do, and helps us know what the next steps should be, accompanied by the symptoms and the exercise tests we've had. For pictures of what an angiogram looks like, the American Heart Association has those on their web site, you can look up definitions and actually see pictures of what it looks like to get those tests done, but they're done very commonly and they're very helpful.
What questions should I ask my doctor if I am diagnosed with a heart condition?
If you're diagnosed with heart disease, you want to be certain that you get the information from your doctor that will let you do the best possible job in managing heart disease. There are many people living with heart disease in this country who are participating fully in the activities of normal daily life, and you wouldn't even know that they had heart disease if they didn't tell you that. You want to know specifically what your diagnosis is, and you want to know what your physician thinks will happen to you in the future. Almost always, with that information, he'll give you advice about how to take advantage of both lifestyle and medications that can help you to do the best possible with your heart disease, and to have it affect you as little as possible. You'll want to also ask your doctor if your particular form of heart disease will affect others in the family. Is this a heart disease that has inherited aspects to it, where there's a genetic predisposition to the disease, so that you can give the best advice possible to other family members, in particular, your children. And in some cases, depending on the kind of heart disease, it may be important to have your children tested as well, so that they can do the best they can to prevent having any complications of, or early events of heart disease as they live out their lives.
How do I learn more about my heart condition?
It's common to have more questions about your heart condition than you can get answered in today's brief office visits. Even if your physician takes time to talk with you, often questions arise after you've left the office, things you wish you asked and didn't have time to, or that occurred to you only after you left. There's a great deal of information about heart conditions on the Internet, some of it on other portions of Videojug. You can also go to other parts of the web where there are reliable providers. The American Heart Association has a good bit of information on americanheart.org that will give you information that is reliable and trustworthy, about specific risk factors, about your specific heart conditions, and an A-Z encyclopedia of data about heart disease. You can also call the American Heart Association at 1-888-MYHEART and talk to people who can direct you in the right direction to get the information you need about your heart condition.
How does a person's general health affect their heart disease treatment?
When your physician decides on the treatments that are best for you in terms of heart disease, one of the things they will always consider is other conditions you have. Those are called comorbid conditions, just a term for any other diseases or risk factors or conditions that might be present in you that would affect either treatments that are prescribed or advised or medications you might take or your ability to participate in a particular regimen. For example, if you have a serious orthopedic problem, a problem with your back or a problem with joints, then your ability to participate in physical exercise is going to be affected by that. It might be that exercising in a swimming pool is better for you than trying to take up a walking or running regimen. So your physician will want to think about all of your health history as they design your regimen and you'll wanna make sure that your physician has all the information they need as they work with you to design to design the best possible care plan.
Who should I have on my healthcare team if I have a heart disease?
Having someone help you with rehabilitation and physical exercise can also be very helpful. Sometimes that's done in a cardiac rehab facility. Sometimes it's done within the doctor's office by other members of the healthcare team. And sometimes it's done by referral. Some physicians are well-versed in those modalities and will in fact be able to give you that advice themselves. The key thing is to have a healthcare provider who is accessible, who understands your problem, and is willing to take the time to talk with you about it.
What research holds promise for treating heart disease?
One area of advance that I think will clearly benefit the patient in the future is the whole area of our ability to look at a patient's own genetics and decide what treatments will be best for them. We know that people vary tremendously in terms of their genetic predisposition for disease, but they also vary in terms of how they respond to medications. We know, for example, already, using information from the Human Genome Project, that patients with one form of a gene versus another will take and require very different doses of a commonly-prescribed blood thinner in atrial fibrillation, a blood thinner called Warfarin. We expect that that kind of information will be applied to many different medications in the future. We'll be able to asses very quickly which genes a person has that will affect their response to medications, and then pick a medication regimen for them that will be really, truly personalized medicine--medicine that will give them the greatest benefit and the least risk of side-effects.
Are clinical trials available for people with heart disease?
Clinical trials are a critical part of the advances we've made in heart disease. Our treatment now, the treatment that we know is beneficial for people, comes from clinical trials that have been done in the past. If you have a problem with your heart disease that isn't being well-managed in terms of what we know now, using all of the available information and medication and choices that we have now, then being a part of a clinical trial may be the best possible thing you can do. Not only will your care be very good, you'll also benefit people who come after you in terms of the information that is gathered. Your physician can find out about clinical trials in your area, by talking to academic medical centers and research institutes in the area. You can also contact the National Institutes of Health for you to find out what clinical trials might be available in your area of concern.
