Do You Understand The Risks of Coronary Heart Disease?

How is coronary heart disease detected?

Unfortunately, in one third of all cases the first sign of coronary heart
disease is sudden, unexpected death. The victims are completely unaware of the
blockages in their coronary arteries until it is too late.

In the rest of the cases, coronary heart disease first appears as chest pain
or even a heart attack. Chest pain due to coronary heart disease is usually
brought on by physical exertion. Physical activity increases the demand of the
heart muscle for oxygen; if significant blockage is present in a coronary
artery, the demand cannot be met. This produces pain, usually in the middle of
the chest behind the breastbone. The pain is often pressing or constrictive.
Some people describe it by clinching their fist over their chest. The pain may
radiate up into the throat or jaw.

You may have heard the phrase angina pectoris used to describe such pain
(angina from the latin for throat, pectoris from the latin for chest). The pain
of angina pectoris may also radiate up into the left shoulder and down the left
arm. when triggered by exercise or exertion, angina pectoris is usually relieved
by rest. Occasionally, angina is brought on by tension or emotions; or it may
occur after eating a meal, or even at night when sleeping. Angina that occurs at
rest is an indicator of even more serious atherosclerosis, because the heart is
not getting enough oxygen even when it is not working hard. Angina pectoris may
be the first signal that you have underlying coronary heart disease.

A heart attack develops when a clot forms on top of the blockage in a
coronary artery. This completely prevents blood from flowing through the artery,
and deprives the tissue beyond the blockage of needed oxygen and nutrients. The
cells in the heart muscle (myocardium) then die, producing what is commonly
referred to as a heart attack (myocardial infarction).

Often the first sign of a heart attack is the development of pressing chest
pain. When a heart attack is taking place, the chest pain is often not relieved
by rest. This persistent chest pain is often also accompanied by weakness,
fainting, profuse sweating, nausea, and vomiting. Emergency medical attention is
needed, and hospitalization is required. When a heart attack occurs, the part of
the heart muscle that is injured is left with a scar.

Is your heart being deprived of oxygen without symptoms?

If you have significant blockages in your coronary arteries, you may be
having 'silent' episodes in which your heart muscle is not receiving enough
oxygen (ischemia). Such episodes are transient, lasting only several minutes at
a time, and are termed 'silent myocardial ischemia' by heart doctors
(cardiologists). People with this problem may be totally without symptoms, may
have suffered a heart attack but gone on to be symptom free, or may have attacks
of angina alternating with episodes of silent ischemia.

How common is silent ischemia?

Some doctors estimate that 2 to 3 out of every 100 men have silent ischemia
during exercise; that survivors of heart attacks have one chance in ten of
having silent icshemia; and that of the four million patients with angina
pectoris in this country, about 80% also have episodes of silent ischemia. If
you are having angina attacks, you probably are having more episodes od ischemia
than is suggested by your angina attacks alone.

How is ischemia detected? Your doctor can use several different tests.

Resting electrocardiogram. The electrocardiogram (or EKG) is the best known
test for heart disease. The muscle cells of your heart contract in response to
electrical impulses from the nerves. Electrodes attached to your body detect
these impulses as they travel through the various parts of your heart. The
recording or tracing that results is the EKG. If part of your heart muscle has
been damaged by a heart attack, the electrical impulses do not travel through it
properly, producing an abnormal EKG. A resting EKG can also detect abnormalities
(arrhythmias) in the rhythm of your heart.

The resting EKG has its limitations. For example, about three out of four
patients with angina pectoris have normal resting EKGs. Many patients with with
significant blockages of their coronary arteries have normal EKGs. Having a
normal resting EKG does not mean that you do not have any blockages in your
coronary arteries, nor does it mean you can ignore risk factors you may have for
coronary heart disease.

Other tests to ask your doctor about.

Stress Exercise Electrocardiogram (Stress Test).

Stress Thallium Exercise Electrocardiogram (Stress Thallium Test).

Holter EKG Monitoring.

Coronary Angiography.