Heart Health

Heart Health:
High blood pressure symptoms, heart attack symptoms, heart murmurs, enlarged heart, congestive heart failure, and more

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By Jay Roland • December 10, 2015

Heart Health:
High blood pressure symptoms, heart attack symptoms, heart murmurs, enlarged heart, congestive heart failure, and more

INTRODUCTION

Whether you want to better understand your high blood pressure symptoms or you want to know the signs of heart attack, better heart health begins with better information.

When you experience a tightness in your chest or a pain in your left arm, your first thought may be, “Am I having a heart attack?”

While it’s true that heart disease is still the leading cause of death for men and women in the U.S., the number of actual heart attacks in the country annually is relatively small compared to the general population. The American College of Cardiology reports that every year about 785,000 people in the U.S. have their first heart attack, while an estimated 470,000 individuals who have previously had a heart attack suffer another one.

In most cases, a heart attack is the result of a long process in which the arteries that supply blood to the heart muscle become blocked. When blood stops flowing to that hard-working muscle, it stops beating and the result is a heart attack. The sooner blood flow can be restored, the greater the chances of minimizing heart damage and having a healthier outcome. That’s why it’s so important to recognize the signs of a heart attack and to can get help quickly.

This guide will help you not only to recognize heart attack symptoms, but to take better care of your heart so that you can hopefully avoid a heart attack altogether.

You’ll learn about coronary artery disease (CAD), the condition that can lead to heart attack, and heart failure, the name for a weakened heart that can result from a heart attack. Our guide also covers such other cardiovascular diseases as stroke and cardiomyopathy, an enlargement and thickening of the heart muscle. You’ll read about the risk factors and treatments for these health challenges, as well as for high blood pressure (hypertension), heart rhythm problems (arrhythmias) and atherosclerosis, the gradual narrowing of the arteries due to the build-up of cholesterol and other substances in the blood vessel walls. Our guide will also let you know how some heart attack symptoms and other heart problems differ between men and women.

And, perhaps most important, you’ll learn about how to help prevent these cardiovascular challenges. Keeping your heart working well takes a combination of a healthy lifestyle and strict adherence to your health care provider’s advice on medications and screenings. It’s not complicated, but it takes some know-how. And that’s the kind of information you’ll find in the pages ahead.

Overview: How the Heart Works

In simplest terms, the heart is a pump, and one that’s powered by electrical energy. So most heart problems are either plumbing or electrical. The plumbing system includes arteries that carry blood from the heart to all the organs, muscles and tissues, as well as veins that bring blood back to the heart from the rest of the body.

Inside the heart are four chambers: two upper chambers (atria) and two lower chambers (ventricles). The atria fill with blood during each heartbeat. In between the beats, valves open up between the atria and ventricles and the ventricles fill with blood. During the next contraction of the heart muscle, the heart pumps blood out to the rest of the body.

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Controlling all this circulation is a complex electrical system that triggers each heartbeat, as well as the opening and closing of the valves.

Blood that leaves the heart travels quickly throughout the body’s cardiovascular system, which includes a vast network of veins and arteries. Problems with any of your blood vessels can affect the heart, while heart disease can also impact the function of the arteries and veins throughout the body.

Read on to find out more about how the heart works and what can keep it from working at its best.

I. CORONARY ARTERY DISEASE

Coronary artery disease (CAD), also known as coronary heart disease (CHD) or just heart disease, is a progressive medical condition that reduces or even halts blood flow through the arteries that supply blood to the heart muscle. When blood doesn’t reach the muscle, the result is a heart attack and permanent damage to some heart tissue.

CAD is slightly more common in men than women, but it’s definitely a major health concern for both sexes. And a woman’s risk of heart disease increases after menopause—so much so that among older adults, more women die of heart disease than men. CAD claims the lives of more than 370,000 Americans annually, but the numbers of people dying of CAD have diminished in recent years as more people adopt healthier lifestyles and CAD treatment continues to improve.

Causes of CAD

What causes CAD and heart attacks is a process called atherosclerosis. You may have heard it described as “hardening of the arteries.” That’s because cholesterol, fats and other substances, such as white blood cells, collect in the walls of the blood vessels that keep the heart supplied with blood—the coronary arteries. The cholesterol and other materials form plaques. This can create two problems for the heart.

When plaques are first forming, they’re soft. But they can rupture, releasing the “junk” inside. The rupture can also lead to the production of enzymes that cause blood to clot. If the clot is big enough it can block the flow of blood.

Older plaques present a different danger. After a while, soft plaques turn hard and narrow the affected arteries. If the plaque build-up is too great, blood can no longer flow through a blocked artery.

No matter what causes the stoppage of circulation in the coronary artery, the result is a heart attack.

Symptoms of CAD

Before you get to the stage of CAD that ends up with a heart attack, you should learn about these symptoms of CAD, the signs that suggest heart disease is developing and a heart attack could be in your future:

• Angina Symptoms: The most noticeable and serious symptom of CAD is angina, the clinical term for chest pain caused by reduced blood flow to the heart. When your heart muscle isn’t getting quite enough oxygenated blood from the coronary arteries, you may feel pressure or tightness in your chest. You can have angina for years without ever having a heart attack. But it’s important to pay attention to the frequency and intensity of angina episodes because they can signal a change in your condition. Angina exists in two forms: stable and unstable angina. Stable angina is pain that is fairly predictable. If your chest starts to feel tight after you do some yard work or exercise, but you seldom if ever feel pain when you’re resting, it’s probably stable angina. Unstable angina can appear at any time. You might be sitting in your favorite chair watching TV and suddenly feel a smothering sensation in your chest. That’s unstable angina and it’s much more dangerous than stable angina. Unstable angina puts you at a higher risk for a heart attack, so it’s vital that you discuss your symptoms with your doctor.
• Shortness of breath: Shortness of breath may also indicate CAD. If you’re having trouble catching your breath after walking up a flight of stairs or doing any kind of exertion, don’t hesitate to tell your health care provider. This can also indicate respiratory problems, not just CAD, so it’s especially important not to ignore.
• Heart attack: Of course, the most obvious symptom of CAD is a heart attack. You’ve no doubt seen movies or television shows in which a character clutches his or her chest for a moment and then collapses because of a heart attack.

Or maybe you’ve actually seen someone experience such an event, or suffered a heart attack yourself. If so, it’s possible that your symptoms included chest pain. But you may have been one of the many victims who experienced other symptoms of heart attack.

Signs of a heart attack vary from person to person. And the symptoms you had during one heart attack may not be the same ones you experience if you’re unfortunate enough to have a second. Typical symptoms also differ somewhat between men and women. Men, for instance, are more likely to feel a sudden pressure in the chest, while a woman’s symptoms of a heart attack may be more likely to include pain in the upper back and dizziness.

Another atypical symptom of a heart attack is a vague feeling that you’re not quite right. You feel ill, but without specific pains or other complaints. This can make it difficult to know how to react, but if this feeling persists, trust your instinct. If you sense that something is wrong, see a doctor.

And even if the signs of a heart attack you’re experiencing are mild or hard to define, the heart attack itself may be quite serious. Your heart can experience just as much injury from a heart attack with no chest pain as one with that “elephant sitting on your chest” feeling.

If you are at high risk for a heart attack, it’s vital that you take your risks seriously and respond quickly when symptoms appear. The sooner you respond to signs of a heart attack, the more likely it is that you can receive treatment that will minimize damage to the heart muscle and give you a greater chance of having a healthy recovery.

If you experience one or more of those risk factors, then you should memorize the symptoms of a heart attack and make sure those who live and work with you know them, too. If a heart attack occurs, you may be able to explain your symptoms and call 911, but you may not. A family member or someone else close to you may be the one who has to call the paramedics. In general, it’s best to call 911 rather than be driven to the hospital. And under no circumstances should you try to drive yourself to the hospital if you suspect you’re having a heart attack.

Diagnosing CAD

If you experience angina or shortness of breath, or if you have serious risk factors, such as high cholesterol, hypertension, obesity, smoking or a family history of heart trouble, you should talk with your doctor about a screening for CAD.

If you have no symptoms, your doctor may do a routine exam that includes listening to your heart. But you may be advised to make lifestyle changes to help lower your risks of CAD.

If your physician suspects CAD or some other kind of heart disease you may be advised to undergo one or more of the following tests:

• Electrocardiogram (EKG), which measures the heart’s electrical activity. An EKG may help detect an arrhythmia or if parts of the heart are working too hard.
• Echocardiogram (echo), which uses sound waves to create a picture of the heart. It can reveal information about how the heart’s valves are working, how well the heart is pumping, the presence of any blood clots and the health of the heart’s outer lining and the large arteries that exit the heart.
• Exercise stress test, which measures how well the heart handles exertion. In this test, you’ll walk on a treadmill or ride a stationary bicycle while hooked up to monitors that measure your blood pressure and your heart function. During exercise, the body demands more oxygenated blood, so the heart has to pump harder. If blood flow is limited during a stress test, that can help the doctor make a diagnosis of CAD.

Treating CAD

As with most heart conditions, lifestyle changes are often necessary with a CAD diagnosis. Regular exercise, losing weight, and quitting cigarettes are among the most important changes you can make.

Along with making healthier choices, you may also be advised to follow a medication regimen that involves several different types of medications. Some of the more common meds for CAD include:

• Statins to help control cholesterol. Statins are taken daily, and are generally well-tolerated, along with being very effective for most people. Some side effects may include muscle soreness and a slight increase in blood sugar levels.
• Antihypertensives to help lower blood pressure. Among the most widely used blood pressure-lowering medications are ACE inhibitors, ARBs, diuretics, beta blockers, alpha blockers, and calcium channel blockers. The type of antihypertensive that’s right for you depends on the underlying cause of your hypertension (if that can be determined), as well as any other health problems you might have, such as diabetes, heart failure or kidney disease.
• Aspirin to help prevent blood clots. Daily aspirin therapy is a somewhat controversial issue. Most doctors agree that it’s helpful for people who have already had one heart attack and want to avoid a second. But medical experts are split about whether an aspirin a day is right to prevent a first heart attack, primarily due to the risk of internal bleeding or gastrointestinal irritation that can accompany aspirin use.
• Blood thinners to help prevent blood clots. In addition to aspirin, other antiplatelet and anticoagulant medications are prescribed to patients at high risk for heart attack or stroke.
• Nitroglycerin to relieve angina by opening the coronary arteries and veins throughout the body. Blood flow to the heart muscle increases. At the same time the heart’s workload diminishes. This can help bring an angina episode to an end.

Stenting and Surgery

Sometimes medications aren’t enough. Serious cases of CAD require interventional procedures to help restore blood flow in blocked arteries. Depending on the severity of the blockage and its location, your doctor may recommend stenting or bypass surgery.

A stent is a flexible mesh scaffold-like device, which can fit inside a coronary artery. A stent is usually placed at the site of the blockage with a catheter that is inserted into an artery in the leg or wrist and then guided to the heart. Once at the narrowed or blocked part of the blood vessel, the collapsed stent is opened from within by inflating a tiny balloon. The stent pushes the plaque against the inner wall of the artery, and blood flow resumes in a much healthier manner.
Sometimes, however, a stent is not the answer. This could be because the blockage is so severe, or because it’s in a Y-shaped part of an artery that can’t easily be helped with a stent. In these situations, you may need to undergo coronary artery bypass grafting (CABG).

CABG is usually done with open-heart surgery. A blood vessel is taken from another part of the body and grafted on to the blocked artery so that blood can move through the newly attached artery, bypassing the blockage altogether.

Both procedures have their risks and benefits, but in any event, a healthy lifestyle is essential for anyone following stenting or CABG. And those same healthy choices may also help lower the risk of developing CAD in the first place.

Preventing CAD

Because you can’t control advancing age or the genes you inherit, some CAD risk factors are unavoidable. However, most risk factors are manageable. Following your doctor’s advice may help you avoid the need for interventions or a long list of medications.

Blood sugar or glucose control is essential, because too much of it circulating in your bloodstream indicates diabetes. Your risk of heart disease and other heart complications rises dramatically if you have diabetes. If you ever get a diagnosis of pre-diabetes, you should be especially mindful of losing weight and adjusting your diet and exercise levels to keep your condition from advancing to diabetes. Pre-diabetes is diagnosed, in part, with a special type of blood test called an A1C test. An A1C result between 5.7 and 6.4 percent indicates pre-diabetes.

CAD prevention also depends on keeping your blood pressure and cholesterol levels under control. Discussing your target levels with your doctor and developing a strategy for managing your blood pressure and cholesterol.

Summary

While coronary artery disease can lead to fatal heart attacks or major surgery, don’t forget that CAD is also a very treatable condition. The keys to surviving and thriving with CAD include:

• Recognize heart attack symptoms and know how to respond.
• See your physician regularly and follow his or her advice about diet, exercise, and medications.
• Remember that CABG or stenting are not “cures,” but treatments that require ongoing monitoring and a heart-healthy lifestyle.

II. HEART FAILURE

One of the possible results of a serious heart attack is heart failure. It sounds like a condition in which the heart fails to work. But in reality, heart failure simply means the heart has weakened and can’t pump as efficiently as it once did. The result, however, is that blood doesn’t circulate as vigorously as it should throughout the organs, tissue and other parts of the body. It can also mean that proteins and other substances can build up in the blood. These can damage the heart and other organs. A weakened heart also tries to work harder to meet the body’s demand for oxygenated blood, and all that additional work can make heart even weaker.

While heart failure treatment has improved in recent years, the prognosis for people with the condition can be grim. About 5 million people in the U.S. have heart failure, according to the Centers for Disease Control, and about half of the people with heart failure die within five years of diagnosis.

Types of Heart Failure

There are actually a few different types of heart failure. The most common is left-sided heart failure. That’s because the left ventricle has the biggest pumping job, sending blood through the aorta and out to most of the body. Within left-sided heart failure, there are two kinds of heart failure: systolic and diastolic.

Systolic heart failure means the left ventricle can’t contract properly, so a reduced amount of blood is pumped with every heartbeat. Diastolic heart failure means the left ventricle no longer relaxes properly in between heartbeats. As a result, less blood fills the left ventricle, so less blood is pumped out of the heart.

You can also have right-sided heart failure, though it often develops after left-sided heart failure. When the left ventricle can no longer pump enough blood throughout the body, blood and fluid can back up into the veins. This puts more pressure on the right side of the heart, which accepts blood (into the right atrium) and pumps it to the lungs (from the right ventricle) to become oxygenated. All that added pressure makes the right side of the heart work harder, resulting in right-sided heart failure.

About Congestive Heart Failure

You may have heard the phrase “congestive heart failure” used interchangeably with “heart failure.” That’s because the symptoms of heart failure usually involve congestion throughout the body. Less blood being constantly circulated means less excess fluid being filtered by the kidneys into urine. That additional fluid is known as congestion, and it can start to collect in the lungs and other tissues of the body. You may notice swelling in the legs, feet and even around the eyes. This kind of swelling is called edema, and it’s serious. If swelling increases—this is often noticed by weighing yourself daily—it’s usually a sign your heart failure is worsening and immediate treatment is needed.

What is Congestive Heart Failure? Heart failure can develop without there having been a heart attack, though that is often a cause. The damage done to the heart muscle by the heart attack can leave it weaker than before.

But there are many other causes, too. High blood pressure, for example, can lead to heart failure. Elevated pressure in the arteries forces the heart to work extra hard to keep blood moving.

The heart must also pump harder if the valves don’t open and close properly. Valve disease often means a reduced amount of blood is circulating throughout the heart, so less blood is being pumped to the body. In an effort to keep up with demand, the heart works harder… and grows weaker.

Diseases of the heart muscle, such as cardiomyopathy or myocarditis, can also injure the heart and leave it unable to pump as it once did. The bottom line with all these causes is that any damage to the heart, even if you don’t notice any symptoms, can make the heart weaker.

One other cause of heart failure that isn’t related to a heart condition you develop over time is a congenital heart problem. If the structure of the heart isn’t normal and healthy at birth, the heart muscle may have to work harder to compensate.

Congestive Heart Failure Symptoms

Unlike a heart attack, which can present suddenly and with obvious symptoms, heart failure usually develops slowly. However, a condition called acute decompensated heart failure (ADHF) includes a sudden worsening of symptoms.

You may have had heart failure and not been aware of the condition until ADHF appears. Suddenly, you may have difficulty breathing and experience sudden edema, or fluid buildup. Obviously, if any such symptoms develop quickly, you should call 911, especially if you’ve had a heart condition such as a previous heart attack or valve disease or high blood pressure.

But in chronic heart failure, unlike ADHF, symptoms tend to get worse over a period of months or years.

If the coughing or shortness of breath worsen or you notice an abnormal heartbeat, you should see a doctor soon. And if any of these symptoms are accompanied by chest pain, you should definitely seek emergency medical care.

Diagnosing Heart Failure

A combination of tests and an evaluation of symptoms will help a physician diagnose heart failure. It starts with a standard physical exam. Your doctor should listen to your heart and lungs with a stethoscope to pick up indications of an irregular heartbeat or congestion in the lungs. A chest X-ray can also provide a doctor a picture of what’s going on in the heart and lungs.

If heart failure is suspected, a blood test will likely be ordered to check for certain indicators, such as the chemical N-terminal pro-B-type natriuretic peptide. It’s a substance produced by the heart when it is being overworked.

Another helpful screening is an echocardiogram, which uses sound waves to create a picture of the heart’s shape, size and the functioning of its valves. An echocardiogram can be particularly helpful in discerning between systolic and diastolic heart failure. The test also helps your doctor measure your ejection fraction, which is the percentage of blood from the left ventricle that is actually pumped out of the heart with each contraction. A diminishing ejection fraction usually indicates worsening heart failure.

Treating Heart Failure

Depending on the severity and cause of your heart failure, treatment can range from medications and lifestyle adjustments to artificial pumps implanted in the chest to compensate for the heart’s declining pumping ability. A heart that has grown too weak may need to be removed in favor of a transplanted heart.

In its early stages, heart failure is usually treated with medications, including angiotensin-converting enzyme (ACE) inhibitors. These drugs widen arteries to make blood flow easier. This helps reduce blood pressure and lessens the heart’s workload.

Beta blockers, which slow the heart down, can also be helpful. Diuretics, which help the body reduce fluid levels to lower blood pressure, are also commonly prescribed to heart failure patients. A powerful drug called Digoxin is also a mainstay of heart failure treatment. It strengthens each heart contraction, and is often used when the source of heart failure is an arrhythmia.

Treating the underlying cause of heart failure can sometimes be enough to halt symptoms and essentially reverse the heart failure. But for many people heart failure is a chronic condition that can’t be cured. Medications are part of an effective treatment, but certain procedures may also be necessary.

For example, coronary artery bypass graft (CABG) may help improve heart failure symptoms if CAD is the problem. Heart valve repair or replacement may also be helpful.

Certain cardiac devices, including a pacemaker and an implantable cardioverter device (ICD), may be needed to help keep the heart in a healthy rhythm and make sure it pumps as efficiently as possible.

And when these treatments are no longer enough to keep blood circulating sufficiently, the next step is a ventricular assist device (VAD)—an artificial pump that takes over for the left ventricle. A VAD is surgically implanted in either the abdomen or the chest, and is attached to the heart to circulate blood throughout the body. VADs used to be temporary measures to help patients get by while they waited for a heart transplant. But with improvements in technology, some heart failure patients are relying on VADs for long-term use.

A heart transplant is still a possibility for some people, but there are restrictions. These include the availability of donor hearts and the overall health of the recipient. Patients who are too frail to handle a heart transplant may not be eligible for this dramatic procedure.

Preventing Heart Failure

Because heart failure can develop from any of several heart conditions, the key to prevention is to strive for the best cardiovascular health possible. This means controlling risk factors, such as quitting smoking, maintaining a healthy weight, exercising most days of the week, eating a low-fat and low-sodium diet, reducing stress, getting enough sleep, and managing blood pressure, cholesterol and blood sugar levels.

It’s also important to see your doctor on a regular basis and follow his or her instructions when it comes to screenings, medications and other healthcare maintenance. If you have had a heart attack or you have a heart condition of any kind, it’s vital that you work with your doctor to try to keep heart failure from developing.

But remember that heart failure can be a treatable condition. Medications and medical devices are helping people with heart failure live longer and with a greater quality of life. But if your heart grows weaker, it’s up to you to take a strong and optimistic approach to your treatment.

III. CARDIOMYOPATHY

Along with heart failure, cardiomyopathy is another potential outcome of a heart attack. Cardiomyopathy is sometimes referred to as an “enlarged heart,” because the main sign of cardiomyopathy is a heart muscle that has become thicker and more rigid.

Bigger muscles might be what athletes want in their arms and legs. But a bigger heart isn’t a good thing, as it actually becomes weaker rather than stronger. And as you just read, a weaker heart leads to heart failure.

There are actually several different types of cardiomyopathy. They include:

• Hypertrophic cardiomyopathy: An enlargement of the heart muscle without an obvious cause.
• Dilated cardiomyopathy: An enlargement and weakening of the ventricles, which can lead to heart failure, arrhythmias and blood clots.
• Restrictive cardiomyopathy: Reduced blood volume filling the ventricles, which become stiff but not thick.
• Arrhythmogenic right ventricular dysplasia: A rare, but serious disease, in which the right ventricle’s muscle is replaced with more fibrous and fatty tissue. It often leads to arrhythmias.

There are other types of cardiomyopathy, usually categorized under “unclassified cardiomyopathy.” Some people with mild cardiomyopathy may never experience any symptoms, while others develop very serious complications. Typically, the cause of your cardiomyopathy determines the severity of symptoms and the type of treatment that you’ll need.

Causes of Cardiomyopathy

There are two basic origins of cardiomyopathy. It can either be inherited or acquired. Inherited, as you might surmise, means the condition is part of the genes you inherit from your parents. Hypertrophic cardiomyopathy is often inherited, though it can develop in older adults.

Dilated cardiomyopathy is sometimes inherited, but is usually the result of CAD, high blood pressure, a heart attack or other heart condition. A viral infection that causes inflammation of the heart can also lead to dilated cardiomyopathy. The condition in women is also sometimes related to complications during the last months of pregnancy.

The causes of restrictive cardiomyopathy range from connective tissue disorders, such as Marfan syndrome and cellulitis, to cancer treatments, such as chemotherapy and radiation. Other health problems, such as amyloidosis (a buildup of certain proteins in the heart and other organs), can also result in restrictive cardiomyopathy.

Arrhythmogenic right ventricular dysplasia is thought to be an inherited condition.

Symptoms of Cardiomyopathy

In the early stages of cardiomyopathy, you may not notice any symptoms. But as the condition develops, you may experience heart failure-like symptoms, such as shortness of breath, fatigue, and swelling in the legs and feet (and possibly in the neck and abdomen). Dizziness or lightheadedness may also occur, and arrhythmias may also develop over time.

Diagnosing Cardiomyopathy

The tests and evaluations used to diagnose cardiomyopathy are similar to those used to identify heart failure. But sometimes using a stethoscope to listen to the heart can help diagnose a particular types of cardiomyopathy.

Certain kinds of heart murmurs may suggest hypertrophic cardiomyopathy. A rattling sound in the lungs could indicate cardiomyopathy has also brought on heart failure.

Screenings including a chest X-ray and an echocardiogram can show changes in the heart’s structure. An electrocardiogram (EKG) measures the heart’s electrical activity, and is helpful if an arrhythmia is also suspected.

In addition to an evaluation of your symptoms, one other very important aspect of cardiomyopathy diagnosis is a look at your family history. Because cardiomyopathy can be an inherited condition, a detailed knowledge of your family’s heart health history can be very helpful to your health care provider.

Treating Cardiomyopathy

If you’re not experiencing any symptoms, you may not need any treatment for your cardiomyopathy. You should, however, strive for a heart-healthy lifestyle. This includes:

• A heart-healthy diet, such as the Mediterranean-style eating plan or the Dietary Approaches to Stop Hypertension (DASH) diet.
• At least 150 minutes of exercise a week.
• Smoking cessation.
• Reducing stress through meditation, breathing techniques and other methods.
• Maintaining a healthy weight.

This advice also applies whether you have been diagnosed with cardiomyopathy or not. If a healthy lifestyle isn’t enough, you may be prescribed medications.

These includes medicines to help balance electrolytes in the body, maintain a healthy heart rhythm, lower your blood pressure (including diuretics to also help remove excess fluid from the body), prevent blood clot formation, lower inflammation, and slow your heart rate (beta blocks, calcium channel blockers and digoxin are among the drugs that work on the speed and strength of your heartbeat).

Nonsurgical and Surgical Procedures

When cardiomyopathy symptoms begin to severely interfere with your quality of life and your overall health, some type of interventional therapy may be necessary.

One nonsurgical procedure that is sometimes effective is alcohol septal ablation. In this treatment, your doctor will inject a type of alcohol into a tube connected to an artery that supplies blood to the enlarged or thickened part of the heart muscle. The alcohol destroys some of the cells, which helps shrink that portion of the muscle back to a more normal thickness.

Sometimes, however, surgery is necessary. But the options are limited. For some hypertrophic cardiomyopathy patients a procedure called septal myectomy may be helpful. In this operation, a surgeon will remove part of the tissue of the enlarged septum—the wall that separates the two ventricles. This can make it easier for the ventricles to fill with blood and pump it out.

Another surgical procedure that helps certain patients is the implantation of a cardiac device. If you have cardiomyopathy and an arrhythmia, an implantable cardioverter defibrillator (ICD) may be placed in the chest or abdomen to help keep the heart’s rhythm steady. A left ventricular assist device may also be implanted if cardiomyopathy has led to heart failure and a heart too weak to pump on its own.

Prevention

The steps needed to prevent cardiomyopathy are similar to that needed to prevent heart failure or any heart condition. These include a healthy diet, regular exercise, no smoking and management of your weight, blood pressure, cholesterol and blood sugar.

And, of course, there’s nothing you can do to prevent inherited cardiomyopathy.

Summary

Cardiomyopathy affects an estimated 1 in 500 people, but many never notice symptoms because their condition is mild. It tends to be more common in men than in women, but it can affect anyone at any age. Because of that, cardiomyopathy can be viewed as yet another reminder to follow a heart-healthy lifestyle for as long as you can.

IV. HIGH BLOOD PRESSURE

As you have read, high blood pressure (hypertension) can be a factor in CAD, heart failure and cardiomyopathy. And as you’ll learn, hypertension is also a major risk factor for stroke.

But what is hypertension? Well, blood pressure is just the force of blood against the inside walls of the arteries. It’s measured in two parts: systolic and diastolic pressure. Systolic pressure is the force of blood against the artery walls when the heart contracts. Diastolic pressure measures that force when the heart relaxes and fills with blood for the next contraction.

Your blood pressure is given as the systolic pressure over the diastolic pressure. For example, a blood pressure of 120 mmHg/70 mmHg is considered normal blood pressure. The mmHg measurement refers to millimeters of mercury.

Hypertension is a condition in which that force is greater than normal. According to the American Heart Association rates hypertension by stages: prehypertension, Stage 1 hypertension, and Stage 2 hypertension.

Prehypertension is, of course, the stage just below the level at which a person is considered to have high blood pressure. It should be looked at as a warning sign that steps should be taken to avoid advancing into Stage 1 high blood pressure. Prehypertension is defined as having a systolic pressure of 120 to 139 mmHg and a diastolic pressure of 80 to 89 mmHg.

Stage 1 hypertension is defined as systolic blood pressure of 140 to 159 mmHg and a diastolic pressure of 90 to 99 mmHg. Stage 2 hypertension is a systolic pressure of 160 mmHg or higher, or a diastolic pressure of 100 mmHg or higher.

Causes of High Blood Pressure

Blood pressure is dependent on several bodily processes. The kidneys, for example, must maintain the proper balance of sodium and fluid in the body for blood pressure to remain normal. If the kidneys don’t excrete enough fluid, the volume of blood expands and places more pressure on the arteries.

Another cause of hypertension is due to a change in the renin-angiotensin-aldosterone system. The hormone angiotensin helps widen or narrow blood vessels. Constricted blood vessels lead to higher blood pressure. Aldosterone affects the kidneys’ ability to balance fluid and sodium levels.

Researchers are also looking at whether high blood pressure might be caused by the sympathetic nervous system, the “fight or flight” part of the nervous system that controls things like blood pressure, heart rate, breathing rate and other processes. There also appears to be a genetic component to hypertension, but that’s not entirely understood. Research continues in that area, too.

An unhealthy lifestyle is also a major risk factor for high blood pressure. Obesity and a diet high in sodium are common culprits, as are smoking and drinking alcohol to excess. A lack of regular physical activity can also lead to high blood pressure.

Symptoms of High Blood Pressure

You can’t count on high blood pressure symptoms to alert you to this serious cardiovascular problem. You may have heard high blood pressure described as “the silent killer.” That sounds ominous, but it simply refers to the fact that hypertension can lead to deadly complications while never presenting with any symptoms.

In fact, unless your high blood pressure is well into Stage 2 you probably won’t notice anything except the numbers on your blood pressure reading. That’s why it’s important to have your blood pressure checked regularly. Hypertension can sneak up on you. One year your numbers may be fine. At your next annual physical, you’ve got high blood pressure.

If, however, your blood pressure is severely high (usually well above 160/100 mmHg), you may experience symptoms such as a headache, nosebleed and fatigue. It’s possible you could experience those high blood pressure symptoms at an earlier stage. It’s also possible that you may not even notice any signs, even in a hypertensive emergency.

Diagnosing High Blood Pressure

So if there are no symptoms to respond to, how do you know if you should be tested for possible high blood pressure? Hypertension can be identified with a simple check of your blood pressure. If a blood pressure check reveals hypertension, you’ll likely be checked again to confirm your numbers. You may have two or three separate checks on different days to confirm the diagnosis.

You will probably have your blood pressure checked in both arms to rule out any problems specific to the blood vessels in one arm. Your doctor may also order a 24-hour blood pressure monitor to note changes. Blood pressure changes throughout the day and night, depending on your sleep stages, when you eat, when and how much you exercise, and various other stimuli.

If high blood pressure is diagnosed, there should be further tests to get a comprehensive look at your cardiovascular health. Your cholesterol levels should be checked, as well as your blood sugar levels. You may also be advised to undergo screenings such as an echocardiogram and electrocardiogram to reveal more about the structure and function of your heart.

Treating High Blood Pressure

Hypertension treatment almost always includes medications. The usual approach is to be conservative, starting with one medication at a moderate dose. But a higher dose may be necessary. Or multiple drugs may be required to get your blood pressure under control.

You should also know that the drug or drugs that help you manage your blood pressure at first may need to change over time as your cardiovascular health changes.

But along with taking medications, successful hypertension treatment depends on lifestyle adjustments. And among the most important steps you can take are regular exercise and weight management. If you’re overweight or obese, dropping even 10 pounds can bring down your blood pressure by a few mmHg. You can also help lower your blood pressure by exercising daily, or at least most days of the week.

Follow a heart-healthy diet that focuses on fruits, vegetables, whole grains, lean proteins and low-fat or nonfat dairy, and you should be on your way to lower blood pressure.

It also goes without saying, though we’ll say it here, that you should stop smoking immediately. Smoking damages the blood vessels, and that injury increases blood pressure.

Preventing High Blood Pressure

Following the heart-healthy behaviors above may also help prevent you from developing high blood pressure. And if you are ever diagnosed with prehypertension, you should discuss with your doctor all steps necessary to bring your blood pressure back down. Medications usually aren’t prescribed for prehypertension, but a healthy lifestyle may be enough.

The key with hypertension is to prevent it from getting worse. That means following the advice of your healthcare provider and not assuming that once medications and a healthy lifestyle bring your numbers under control that you are “cured.” High blood pressure is a chronic problem, so if you’re being treated, figure that you’re going to be on antihypertensive medications for life.

Weight loss, smoking cessation and other positive changes may reduce the number of medications you need. But taking some drugs to control blood pressure may be necessary to prevent a worsening of your condition.

Summary

High blood pressure affects about one out of every three American adults, according to the Centers for Disease Control. Many of those with hypertension don’t know it. And even many of the individuals who know they have high blood pressure don’t have it under control.

Your odds of developing hypertension increase with age, but it can develop at any time. That’s why it’s essential to keep track of your blood pressure with regular doctor visits (and with a home monitor if you’re at risk for hypertension) and to take steps now to minimize your odds of developing high blood pressure:

• Cut back on the salt, lose those extra pounds.
• Walk (or swim or bike or…) more.
• Get enough sleep.

Poor quality sleep and too much stress can also raise your blood pressure, so relax and talk with your doctor about a blood pressure target that’s right for you.

V. STROKE

Stroke is one of the leading causes of death in the U.S., claiming the lives of more than 130,000 people annually. It’s also a leading cause of disability for those who survive a stroke. But surviving a stroke and minimizing the disability is often possible if you react fast to the early signs of what is sometimes referred to as a “brain attack.”

A stroke is a disruption of healthy blood flow to the brain. There are two main types of stroke. An ischemic stroke is the most common, and it occurs when there’s a blockage in an artery supplying blood to brain tissue. A hemorrhagic stroke results when a blood vessel in the brain ruptures, spilling blood into the brain.

Causes of Stroke

The most common cause of an ischemic stroke is atherosclerosis, a narrowing of the arteries due to plaque buildup. When this occurs in the carotid arteries—those that carry blood up the right and left sides of the neck to the brain—your risk of an ischemic stroke goes up dramatically. But a clot can also block blood flow within one of the tiny arteries inside the brain, too.

If you have an arrhythmia, you face a greater risk of a blood clot forming in the heart. That’s because blood can pool in a heart that isn’t beating properly. Pooled blood can turn into a clot that eventually leaves the heart and travels toward the brain.

A hemorrhagic stroke can stem from high blood pressure straining the walls of an artery in the brain. Or, it be the result of an aneurysm—a bulge in an artery. If an aneurysm ruptures in the brain, the bleeding can be severe and the consequences quite serious.

Symptoms of a Stroke

The symptoms of a stroke vary from person to person. They can come on suddenly or develop over a period of hours or even days. The most important and obvious signs of stroke include:

• Numbness or paralysis of the arms, legs or face—often on only one side of the body, though it can present on both sides.
• Sudden, severe headache.
• Loss of balance and coordination.
• Difficulty speaking or understanding others’ speech.
• Confusion.
• Vision problems in one or both eyes.

Those same symptoms can be experienced during a “mini-stroke” called a transient ischemic attack (TIA). Stroke signs may only be felt for a few minutes and then you may feel fine after a TIA, which is simply a temporary disruption of blood flow to the brain. But even if the symptoms are fleeting, you should take a TIA seriously, as it can often be a sign that a full-fledged stroke is coming soon.

A person having a stroke may also lose consciousness, but that doesn’t happen all the time. In any event, stroke symptoms should trigger a 911 call.

Diagnosing a Stroke

Healthcare providers can diagnose a stroke, first by looking at all the symptoms. In some cases, the symptoms are so obvious and are textbook examples of a brain attack that there is little doubt what’s happening. But a physical and neurological exam are necessary to confirm the diagnosis.

The physical exam will include a blood pressure check and blood tests. A neurological exam may include magnetic resonance imaging (MRI) and/or computed tomography (CT) to help determine what type of stroke is occurring.

A blood flow test, known as a cerebral angiography or cerebral arteriography, can also reveal the location and size of the problem. In this test, dye is injected into the bloodstream and a special X-ray is taken to locate the site of the blood flow disruption. The test is especially helpful if the problem is an aneurysm or some other type of blood vessel problem.

Treating a Stroke

If an ischemic stroke is diagnosed within four hours of the start of symptoms, you may be able to receive a drug called a tissue plasminogen activator (tPA). This drug, when injected into the arm, travels through the bloodstream and helps dissolve blood clots. But it shouldn’t be given too long after the onset of symptoms or in the case of a hemorrhagic stroke, because it can lead to major bleeding problems.

But because tPA can be so effective at minimizing the impact of an ischemic stroke, fast action is needed when symptoms first appear.

There are also clot retrievers that can be used with a catheter to remove clots. If the blockage is in a carotid artery, your doctor may perform a procedure such as a carotid endarterectomy (surgery to open up the artery and remove the blockage) or a carotid artery angioplasty (the insertion and inflation of a tiny balloon in the artery to squeeze the plaque buildup against the inside walls of the artery to improve blood flow).

If it’s a hemorrhagic stroke, surgery on the ruptured artery may be needed to stop the bleeding.

Preventing a Stroke

Blood pressure and cholesterol control are the most important preventive steps you can take to avoid a stroke. Eating a Mediterranean-style diet or a DASH diet and exercising every day may help with both blood pressure and cholesterol control.

If your doctor prescribes cholesterol-lowering and blood pressure-lowering medications, use them as directed. Consistent use of evidence-based heart medications is known to increase the chance of long-term survival, yet some people don’t take them properly or don’t take them properly or at all. For example, a high percentage of patients on statins stop taking the medication after around two years, thereby increasing their heart attack risk. Researchers are testing different ways to improve compliance with prescriptions—including the development of medications that can be taken once or twice a year.

VI. FINAL THOUGHTS

Our Heart Health guide has touched on some very important aspects of cardiovascular health and the risks of heart attack. But there is much more to learn. Even if you’re in good health now, the risks of hypertension, heart disease and other conditions grow as you age.

Following a heart-healthy lifestyle starting now and following your doctor’s advice are two of the most important preventive steps you can take to avoid a heart attack or other medical problem. Arming yourself with information is the third important aspect of cardiovascular health.

Be heart-smart to live a long, healthy life. It’s not complicated, but it means you have to make good choices every day.