Since heart disease, peripheral artery disease, and stroke share the same risk factors, a patient who is diagnosed with one of the three has increased risk of having or developing the others.
Factors that increase the risk of developing atherosclerotic heart disease include the following:
- High cholesterol
- Family history
What causes heart disease?
Heart disease is the leading cause of death in the United States and can be attributed to the lifestyle factors that increase the risk of atherosclerosis or narrowing of arteries. Smoking, along with poorly controlled hypertension, and diabetes, causes inflammation and irritation of the inner lining of the coronary arteries. Over time, cholesterol in the bloodstream can collect in the inflamed areas and begin the formation of a plaque. This plaque can grow and as it does, the diameter of the artery for blood flow narrows. If the artery narrows by 40% to 50%, blood flow is compromised or decreased enough to potentially cause the symptoms of angina.
In some circumstances, the plaque can rupture or break open, leading to the formation of a blood clot in the coronary artery. This prevents oxygen-rich blood from being delivered to the heart muscle beyond that blockage and that part of the heart begins to die. This is a myocardial infarction or heart attack. If the situation is not recognized and treated, the affected muscle cannot be revived and is replaced by scar tissue. Long term, this scar tissue decreases the heart's ability to pump effectively and efficiently and may lead to ischemic cardiomyopathy (ischemic=decreased blood supply + cardio=heart + myo=muscle + pathy=disease).
Heart muscle that lacks adequate blood supply also becomes irritable and may not conduct electrical impulses normally. This can lead to abnormal electrical heart rhythms including ventricular tachycardia and ventricular fibrillation. These are the heart arrhythmias associated with sudden cardiac death.
What are the symptoms of heart disease?
The classic symptoms of angina, or pain from the heart, are described as a crushing pain or heaviness in the center of the chest with radiation of the pain to the arm (usually the left) or jaw. There can be associated shortness of breath or sweating. The symptoms tend to be brought on by activity and get better with rest. Some patients may complain of indigestion and nausea while others may have upper abdominal, shoulder, or back pain.
Unfortunately, not all pain from coronary artery disease presents in this manner. The more we learn about heart disease, the more we realize that symptoms can be markedly different in different groups of people. Women, people who have diabetes, and the elderly may have different pain perceptions and may complain of overwhelming fatigue and weakness or a change in their ability to perform routine daily activities like walking, climbing steps, or doing household chores. Some patients may have no discomfort at all.
Most often, the symptoms of heart disease become worse over time, as the narrowing of the affected coronary artery progresses over time and blood flow to that part of the heart decreases. It may take less activity to provoke symptoms and it may take longer for those symptoms to resolve with rest. This change in exercise tolerance is helpful in making the diagnosis.
Too often, however, the first presentation of heart disease may be a myocardial infarction, where a plaque ruptures causing one of the coronary arteries to occlude and prevent blood flow to the heart. This can lead to crushing chest pressure, shortness of breath, sweating, and perhaps sudden cardiac death.
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