Cardiovascular disease ranks as number one killer, claiming the lives of more than 40% of those who die each year.

What does this mean to you? What can you do to protect your health? Here are answers to frequently asked questions about cardiovascular disease.

What exactly is cardiovascular disease, and what are the risk factors?

The term cardiovascular disease covers both heart and blood vessel disorders. To prevent these diseases, you must understand and be willing to modify the risk factors for them. These include:

• Cigarette smoking.
• High blood cholesterol.
• High blood pressure.
• Diabetes.
• Obesity.
• Lack of exercise.

What can I do to prevent heart disease?

First of all, don’t smoke! Quit smoking on your own or with the support of a physician. Ask your doctor to screen you regularly for cardiovascular risk factors, such as diabetes and hypertension. Cut cholesterol, trim the fat from your diet, exercise and maintain a healthy weight. It’s best to understand risk factors now so you can avoid cardiovascular disease 20, 30 or 40 years down the road. Prevention is better than waiting for the warning signs of heart disease that happen after damage already has been done.

If I’m concerned about my risk for heart disease, when should I see a doctor?

No matter what your age, you should talk with a cardiologist if you’re concerned about heart disease or feel uncomfortable about your family history. Tell your doctor about any family history of high cholesterol, heart attacks in immediate family members at young ages, enlarged heart or congestive heart failure. Remember, the earliest symptoms of heart disease may not be chest pain. They may be fatigue or shortness of breath.

If someone in my family has heart disease, what are some of the things I can do to protect myself?

Talk to your doctor. He or she should evaluate your family history and lifestyle. You might receive counseling on improving your diet and making exercise a regular part of your life. If your cholesterol levels are high, your physician may recommend medications to help lower cholesterol and decrease your risk of a first heart attack. In addition, some people may benefit from an ultra fast CT, which may be helpful in assessing people at higher risk who require a more aggressive approach to prevention.

What levels of exercise are considered best to help prevent heart disease?

Aerobic activity, such as swimming, brisk walking, running or biking, strengthens the heart. Cardiovascular disease ranks as number one killer, claiming the lives of more than 40% of those who die each year. So do regular exercise and a balanced diet.

What is congestive heart failure, and what are the treatment options?

Congestive heart failure happens when the heart cannot pump well enough to distribute blood and oxygen to the tissues of the body. It can be caused by a number of factors. The most common is chronic hypertension, or high blood pressure. Other conditions that may lead to heart failure are coronary artery disease, congenital heart disease, valve disease and either very fast or very slow heart rhythms. There are many treatment options for heart failure, including:

• Medical management with drugs such as ACE (Angiotensin Converting Enzyme)
• inhibitors.
• Repair or replacement of damaged valves.
• Coronary artery bypass graft.
• Cardiomyoplasty, or the use of skeletal muscle to assist the heart.
• Heart transplantation, reserved as a last mode of therapy.

Is there only one type of heart failure?

The term congestive heart failure is often used to describe all patients with heart failure. In reality, congestion (the build up of fluid) is just one feature of the condition and does not occur in all patients. There are two main categories of heart failure–Systolic and Diastolic. However, within each category, symptoms and effects may differ from patient to patient.

The two categories are.

Systolic heart failure
This occurs when the heart’s ability to contract decreases. The heart cannot pump with enough force to push a sufficient amount of blood into the circulation. Blood coming into the heart from the lungs may back up and cause fluid to leak into the lungs, a condition known as Pulmonary congestion.

Diastolic heart failure
This occurs when the heart has a problem relaxing. The heart cannot properly fill with blood because the muscle has become stiff, losing its ability to relax. This form may lead to fluid accumulation, especially in the feet, ankles, and legs. Some patients may have lung congestion.

Heart Failures are common
Between 2 to 3 million Americans have heart failure, and 400,000 new cases are diagnosed each year. The condition is slightly more common among men than women and is twice as common among African Americans as whites.

Heart failure causes 38,000 deaths a year and is a contributing factor in another 225,000 deaths. The death rate attributed to heart failure has doubled since 1968, in contrast to a greater than 50 percent decrease in coronary disease mortality during the same period. Heart failure mortality is twice as high for African Americans as whites for all age groups.

In a sense, heart failure’s growing presence as a health problem reflects the Nation’s changing population: More people are living longer. People aged 65 and older represent the fastest growing segment of the population, and the risk of heart failure increases with age. The condition affects 1 percent of people aged 50–59, but 10 percent of people aged 80–89.


Causes of Heart Failure
As stated, the heart loses some of its blood–pumping ability as a natural consequence of aging. However, a number of other factors can lead to a potentially life–threatening loss of pumping activity.

As a symptom of underlying heart disease, heart failure is closely associated with the major risk factors for coronary heart disease: smoking, high cholesterol levels, hypertension (persistent high blood pressure), diabetes and abnormal blood sugar levels, and obesity. A person can change or eliminate those risk factors and thus lower their risk of developing or aggravating their heart disease and heart failure.

Among prominent risk factors, hypertension (high blood pressure) and diabetes are particularly important. Uncontrolled high blood pressure increases the risk of heart failure by 200 percent, compared with those who do not have hypertension. Moreover, the degree of risk appears directly related to the severity of the high blood pressure.

Persons with diabetes have a three–to–eight–fold greater risk of heart failure than those without diabetes. Women with diabetes having a greater risk of heart failure than men with diabetes. Part of the risk comes from diabetes’ association with other heart failure risk factors, such as high blood pressure, obesity, and high cholesterol levels. However, the disease process in diabetes also damages the heart muscle.

The presence of coronary disease is among the greatest risks for heart failure. Muscle damage and scarring caused by a heart attack greatly increase the risk of heart failure. Cardiac arrhythmias, or irregular heartbeats, also raise heart failure risk. Any disorder that causes abnormal swelling or thickening of the heart sets the stage for heart failure.

In some people, heart failure arises from problems with heart valves, the flap–like structures that help regulate blood flow through the heart. Infections in the heart are another source of increased risk for heart failure.

A single risk factor may be sufficient to cause heart failure, but a combination of factors dramatically increases the risk. Advanced age adds to the potential impact of any heart failure risk.

Finally, genetics contributes to the risk for certain types of heart disease, which in turn may lead to heart failure. However, in most instances, a specific genetic link to heart failure has not been identified.

What are the symptoms?

A number of symptoms are associated with heart failure, but none is specific for the condition. Perhaps the best known symptom is shortness of breath (“Dyspnea”). In heart failure, this may result from excess fluid in the lungs. The breathing difficulties may occur at rest or during exercise. In some cases, congestion may be severe enough to prevent or interrupt sleep.

Fatigue or easy tiring is another common symptom. As the heart’s pumping capacity decreases, muscles and other tissues receive less oxygen and nutrition, which are carried in the blood. Without proper “Fuel”, the body cannot perform as much work, which translates into fatigue.

Fluid accumulation, or edema, may cause swelling of the feet, ankles, legs, and occasionally, the abdomen. Excess fluid retained by the body may result in weight gain, which sometimes occurs fairly quickly.

Persistent coughing is another common sign, especially coughing that regularly produces mucus or pink, blood–tinged sputum. Some people develop raspy breathing or wheezing.

Because heart failure usually develops slowly, the symptoms may not appear until the condition has progressed over years. The heart hides the underlying problem by making adjustments that delay–but do not prevent–the eventual loss in pumping capacity. The heart adjusts, or compensates, in three ways to cope with and hide the effects of heart failure:

• Enlargement (“Dilatation”), which allows more blood into the heart.
• Thickening of muscle fibers (“Hypertrophy”) to strengthen the heart muscle, which allows the heart to contract more forcefully and pump more blood.
• More frequent contraction, which increases circulation.

What treatments are available?

Heart failure caused by an excessive workload are curable by treating the primary disease, such as Anemia or Thyrotoxicosis. Also curable are forms caused by anatomical problems, such as a heart valve defect. These defects can be surgically corrected.

However, for the common forms of heart failure–those due to damaged heart muscle–no known cure exists. But treatment for these forms may be quite successful. The treatment seeks to improve patient’s quality of life and length of survival through lifestyle change and drug therapy.

Patients can minimize the effects of heart failure by controlling the risk factors for heart disease. Obvious steps include quitting smoking, losing weight if necessary, abstaining from alcohol, and making dietary changes to reduce the amount of salt and fat consumed. Regular, modest exercise is also helpful for many patients, though the amount and intensity should be carefully monitored by a physician.

But, even with lifestyle changes, most heart failure patients must take medication. Many patients receive two or more drugs.
Several types of drugs have proven useful in the treatment of heart failure:

• Diuretics help reduce the amount of fluid in the body and are useful for patients with fluid retention and hypertension.
• Digitalis increases the force of the heart’s contractions, helping to improve circulation.
• Results of recent studies have placed more emphasis on the use of drugs known as Angiotensin Converting Enzyme (ACE) inhibitors. Several large studies have indicated that ACE inhibitors improve survival among heart failure patients and may slow, or perhaps even prevent, the loss of heart pumping activity.

Patients who cannot take ACE inhibitors may get a nitrate and/or a drug called Hydralazine, each of which helps relax tension in blood vessels to improve blood flow.

Listed below are some of the medications prescribed for heart failure. Not all medications are suitable for all patients, and more than one drug may be needed.

ACE Inhibitors
These prevent the production of a chemical that causes blood vessels to narrow. As a result, blood pressure drops and the heart does not have to work as hard to pump blood. Side effects may include coughing, skin rashes, fluid retention, excess potassium in the bloodstream, kidney problems, and an altered or lost sense of taste.

Digitalis
Increases the force of the heart’s contractions. It also slows certain fast heart rhythms. As a result, the heart beats less frequently but more effectively, and more blood is pumped into the arteries. Side effects may include nausea, vomiting, loss of appetite, diarrhea, confusion, and new heartbeat irregularities.

Diuretics
These decrease the body’s retention of salt and so of water. Diuretics are commonly prescribed to reduce high blood pressure. Diuretics come in many types, with different periods of effectiveness. Side effects may include loss of too much potassium, weakness, muscle cramps, joint pains, and impotence.

Hydralazine
This drug widens blood vessels, easing blood flow. Side effects may include headaches, rapid heartbeat, and joint pain.

Nitrates
This drug is used mostly for chest pain, but may also help diminish heart failure symptoms. It is a smooth–muscle relaxer and widens blood vessels. It acts to lower primarily systolic blood pressure.

Side effects may include headaches.
Sometimes, heart failure is life–threatening. Usually, this happens when drug therapy and lifestyle changes fail to control its symptoms. In such cases, a heart transplant may be the only treatment option. However, candidates for transplantation often have to wait months or even years before a suitable donor heart is found. Recent studies indicate that some transplant candidates improve during this waiting period through drug treatment and other therapy, and can be removed from the transplant list.

Transplant candidates who do not improve sometimes need mechanical pumps, which are attached to the heart. Called left ventricular assist devices (LVADs), the machines take over part or virtually all of the heart’s blood–pumping activity. However, current LVADs are not permanent solutions for heart failure but are considered bridges to transplantation.

An experimental surgical procedure for severe heart failure is available at a few U.S. medical centers. The procedure, called Cardiomyoplasty, involves detaching one end of a muscle in the back, wrapping it around the heart, and then suturing the muscle to the heart. An implanted electric stimulator causes the back muscle to contract, pumping blood from the heart.

Can a person live with heart failure?

Heart failure is one of the most serious symptoms of heart disease. About half of all patients die within 5 years of diagnosis. However, half live beyond 5 years, many well into old age. The outlook for an individual patient depends on the patient’s age, severity of heart failure, overall health, and a number of other factors.

As heart failure progresses, the effects can become quite severe, and patients often lose the ability to perform even modest physical activity. Eventually, the heart’s reduced pumping capacity may interfere with routine functions, and patients may become unable to care for themselves. The loss in functional ability can occur quickly if the heart is further weakened by heart attacks or the worsening of other conditions that affect heart failure, such as diabetes and coronary heart disease.

Heart failure patients also have an increased risk of sudden death, or cardiac arrest, caused by an irregular heartbeat.

• To improve the chances of surviving with heart failure, patients must take care of themselves. Patients must.
• See their physician regularly.
• Closely follow all of their physician’s instructions.
• Take any medication according to instructions.

Immediately inform their physician of any significant change in their condition, such as an intensified shortness of breath or swollen feet.

• Patients with heart failure also should:
• Control their weight.
• Watch what they eat.
• Not smoke cigarettes or use other tobacco products.
• Abstain from or strictly limit alcohol consumption.

Even with the best care, heart failure can worsen, but patients who don’t take care of themselves are almost writing themselves a prescription for poor health.

The best defense against heart failure is the prevention of heart disease. Almost all of the major coronary risk factors can be controlled or eliminated: smoking, high cholesterol, high blood pressure, diabetes, and obesity.