February, not suprisingly, is American Heart Month. The human heart is about the size of a clenched fist and weighs between 8 and 12 ounces, depending on gender and body size. Heart disease is the leading cause of death in the United States, killing more than 600,000 Americans each year. That’s one out of every four deaths.

There are many types of heart disease – from rhythm disorders to genetic defects to valve conditions to blood vessel diseases. But this blog will focus on the most common type: coronary artery disease, or CAD.

CAD is very common in this country. More than 18 million adult Americans suffer with it. According to the Cleveland Clinic, that’s roughly the combined populations of New York City, Los Angeles, Chicago and Houston.

The coronary arteries are blood vessels that wrap around the outside of the heart and supply it with oxygen-enriched blood and nutrients. With CAD, the coronary arteries become narrowed by a buildup of plaque, which is made up of fat, cholesterol and other substances floating around in your blood. This process of plaque buildup in the arteries is called atherosclerosis.

Atherosclerosis occurs over many years, and you may experience no symptoms while it is happening. But as your arteries become increasingly narrow, you may begin to notice symptoms such as pressure or tightness in your chest (angina), shortness of breath and fatigue.

The buildup of plaque in coronary arteries can eventually block the flow of blood to the heart, leading to a heart attack. Symptoms of a heart attack include chest pain or discomfort; feeling weak, lightheaded or faint; pain or discomfort in the jaw, neck or back; pain or discomfort in one or both arms or shoulders; and shortness of breath.

If you experience these symptoms, seek medical help right away.

Over time, CAD can weaken your heart and cause complications such as heart failure, a condition in which your heart can no longer pump blood efficiently; abnormal heart rhythms; and cardiac arrest, the sudden and unexpected loss of heart function.

There are multiple risk factors for CAD, some you can’t control and some you can. Risk factors you can’t control include age. Men face a higher risk after age 45, and women are at a higher risk after age 55. Another uncontrollable risk factor is family history. Your risk increases if one of your family members has heart disease.

Risk factors you can control include being overweight and physically inactive, eating an unhealthy diet that is high in saturated fat and complex carbohydrates, smoking, and drinking more alcohol than is recommended.

If you’re at high risk for CAD or already have symptoms, your doctor may recommend one or more tests to assess your heart function and make a diagnosis. These tests include:
• Electrocardiogram, which records your heart’s electrical activity.
• Echocardiogram, which uses sound waves to evaluate your heart’s structure and function.
• Exercise stress test, which evaluates how your heart responds to vigorous activity.
• Cardiac catheterization, which involves inserting tubes into your coronary arteries to view the plaque and confirm CAD.

The first step in treating CAD is making positive changes to your lifestyle. Don’t smoke, eat a heart-healthy diet, exercise for 30 minutes most days of the week, limit your alcohol intake, get seven to nine hours of sleep a night and work to control any chronic conditions you may have, such as high blood pressure, high cholesterol and diabetes.

Some people need a procedure or surgery to treat their CAD. Coronary angioplasty is an interventional procedure in which a small balloon is used to widen your narrowed coronary arteries. Your doctor may place small mesh tubes called stents to help keep the arteries open.

Coronary artery bypass grafting (CABG) is a surgery that takes a blood vessel from another part of your body and attaches it to the coronary artery above and below the narrowed area or blockage. This “bypass” restores blood flow to your heart.

CAD can’t always be prevented because some of its risk factors are out of your control. But the positive lifestyle changes used to treat the disease can also be used to lower your risk.

Patti DiPanfilo

A sudden cardiac arrest, or SCA, is sometimes referred to as a “massive heart attack,” but that moniker is not quite accurate. It’s true that SCA affects the heart, but it’s not a true heart attack. A heart attack occurs when blood flow to a part of the heart is stopped or slowed, generally due to a blockage in the coronary arteries, causing the death of heart muscle tissue.

Generally, there are signs and symptoms signaling a heart attack, and in most cases those hearts continue to beat after the event. But with SCA, people just collapse and discontinue breathing, and their hearts simply stop beating. A very serious heart attack can lead to SCA, but most SCAs are caused by problems in the rhythm of the heartbeats.

Most of the body’s electrical activity is handled by nerves, but the heart has its own unique electrical system. In the heart, electricity is generated in special pacemaker cells in the atrium, or upper chamber, and is then carried through designated pathways to the heart muscle cells. The cells then all contract at once to produce a heartbeat.

If there is an interruption anywhere along that electrical pathway, the heartbeat can become faster, slower or erratic. The most common cause of SCA is ventricular fibrillation, a very fast or chaotic heart rhythm, or arrhythmia. While ventricular fibrillation is most common, any arrhythmia can cause the heart to stop beating.

Most people at risk for SCA have coronary artery disease (CAD), although some don’t even know they have it. There are other pre-existing heart conditions that can lead to SCA, including cardiomyopathy, or an enlarged heart, valvular heart disease and a congenital heart condition, a problem that is present since birth.

Some other factors that put you at risk for SCA include the risk factors for CAD. These include being a smoker; having diabetes, high blood pressure and/or high cholesterol; being overweight or obese; and living a sedentary lifestyle. Drinking more than two drinks a day is another CAD risk factor, as is having a family history of the disease.

Other risk factors for SCA include having had a previous SCA or having a family history of SCA. If you’ve had a heart attack or have a family history of heart disease, your risk for SCA increases. The risk also goes up with getting older, being male, using recreational drugs like cocaine and amphetamines, and having low levels of potassium or magnesium in your system.

Blunt force trauma, like what can occur in a car accident or after taking a direct blow to the chest, can also trigger SCA. This is called commotio cordis. Strenuous physical activity can trigger SCA, but in most cases, there is an underlying heart problem that the people doing the activity may or may not be aware of. This is often the case when athletes in top physical condition experience SCA.

Most people with SCA, about 95 percent, die, often within minutes. Rapid treatment of someone suffering SCA is critical not only for that person’s survival, but also to minimize damage to the brain from being without oxygenated blood. Because when the heart stops beating, blood flow to the rest of the body ceases.

The chances of a positive outcome increase dramatically if the person’s receives CPR and treatment with a defibrillator within minutes. Automated external defibrillators (AEDs) are available in more and more public places, including shopping malls, busses, parks and schools. You can even get an AED for your home, but talk to your doctor before you buy.

AEDs are devices that analyze the heart and if they detect a problem deliver an electrical shock to restore the heart’s normal rhythm. They are designed for use by laypeople and provide visual and voice prompts. They will only shock the heart when necessary to restore normal rhythm.

If you witness someone experiencing SCA, call, 911 immediately, then check to see if the person is breathing. If they’re not, begin chest compressions. If an AED happens to be available, use it on the unconscious, unbreathing person. Follow the instructions and prompts provided with the AED. Use the AED once, then continue chest compressions until emergency personnel arrive.

SCAs happen without notice, so they can’t be diagnosed until after they occur. There are, however, tests to diagnose contributory disorders and steps to reduce the impact of some risk factors. Having routine appointments and physicals with your doctor and getting appropriate screenings when required can help alert you to potential risk factors for SCA.

If you survive SCA or are at very high risk for SCA, your doctor may choose to place an implantable cardioverter defibrillator (ICD). An ICD is placed under the skin in your chest wall, with wires that attach to the heart. The ICD works like a pacemaker. When it detects a dangerous arrhythmia, it sends a shock to the heart to restore the natural rhythm.

Your doctor may also prescribe medication, especially if you’ve had a heart attack or if you have heart failure or an arrhythmia. Types of medications include ACE inhibitors, beta blockers, calcium channel blockers and other anti-arrhythmia drugs. If you’ve got high cholesterol and CAD, your doctor may also prescribe a statin medication for lowering your cholesterol levels.

If you’re aware of a heart condition or other risk factors for SCA, you can help yourself by making some lifestyle changes to reduce your risk of CAD and SCA. Lifestyle behaviors to put into practice in your life include quitting smoking, maintaining a healthy weight, exercising regularly, eating a low-fat diet and managing diabetes, high blood pressure and other chronic conditions.

For the best outcome in the case of SCA, treatment must be started within minutes of the event. If someone you love is at high risk for SCA, do them a favor and learn the proper techniques for CPR. The American Heart Association and many hospitals and health organizations routinely offer classes you can sign up for.

Think about learning CPR. You can save someone’s life.