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heart disease in women





Contents
  • Causes of heart disease
  • Who is at risk for heart disease?
  • Signs and symptoms
  • Diagnosis
  • Treatment
  • Prevention
  • Living with heart disease
  • The most common type of heart disease in women is a disorder of the heart's blood vessels called coronary heart disease (CHD), or coronary artery disease (CAD), because the vessels involved are the coronary arteries. CHD can lead to serious heart problems, such as heart attack, heart failure, irregular heartbeats called arrhythmias, and sudden cardiac arrest (SCA).


    Overview

    Heart disease is not just a man's disease. In fact, 1 in 4 women in the United States dies from heart disease. CHD, the most common type of heart disease, affects both women and men.

    CHD is a condition in which plaque builds up on the inner walls of the coronary arteries. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood.

    Plaque can affect the heart in two ways:
    • The buildup of plaque can narrow the coronary arteries over time. This reduces blood flow to the heart muscle and can lead to symptoms such as angina. Angina is chest pain or discomfort.


    • Plaque can suddenly rupture or crack, causing a blood clot to form on the plaque's surface. The blood clot rapidly blocks blood flow within the artery. If the clot becomes large enough, it can completely block blood flow to part of the heart muscle. This is the most common cause of a heart attack.

    Figure A is an overview of a heart and coronary artery showing damage (dead heart muscle) caused by a heart attack. Figure B is a cross-section of the coronary artery with plaque buildup and a blood clot resulting from plaque rupture.
    Heart with muscle damage and a blocked artery. Figure A: overview of a heart and coronary artery showing damage (dead heart muscle) caused by a heart attack. Figure B: cross-section of the coronary artery with plaque buildup and a blood clot resulting from plaque rupture

    In women and men who have CHD, plaque usually builds up inside the heart's large arteries, causing them to narrow. Plaque also can develop within the walls of these arteries. In people who have this pattern of plaque, tests that outline the coronary arteries may look normal. Studies are under way to see whether this type of plaque buildup occurs more often in women than in men and why.

    What can differ between women and men is a disease called coronary microvascular disease (MVD). Coronary MVD is heart disease that affects the heart's smallest arteries. Recently, studies have shown that women are more likely than men to have coronary MVD.

    In coronary MVD:
    • The walls of the heart's tiny arteries are damaged or diseased.
    • The heart's tiny arteries don't relax properly and can spasm (tighten).

    coronary microvascular disease
    Coronary microvascular disease. Figure A: the small coronary artery network (microvasculature), containing a normal artery and an artery with coronary MVD. Figure B: a large coronary artery with plaque buildup

    Many researchers think that a drop in estrogen levels in women during menopause combined with traditional risk factors for heart disease causes coronary MVD.

    Although death rates from heart disease have dropped in the last 30 years, they haven't improved as much in women as in men. This may be the result of coronary MVD. Standard tests for CHD don't always detect coronary MVD in women. As a result, women often are thought to be at low risk for heart disease.

    Research is ongoing to learn more about coronary MVD and its causes.

    Women also are more likely than men to develop a condition called broken heart syndrome. In this recently recognized heart problem, extreme emotional stress can lead to reversible heart muscle failure.

    Doctors may misdiagnose broken heart syndrome as a heart attack because it has similar symptoms. However, there's no evidence of blocked heart arteries in broken heart syndrome, and most people have a full and quick recovery. Researchers are just beginning to explore what causes this disorder and how to diagnose and treat it. Often, patients who have broken heart syndrome have been previously healthy.

    This article focuses on CHD, unless otherwise noted.


    Outlook

    Women tend to develop CHD about 10 years later than men. However, CHD remains the #1 killer of women in the United States.

    Women are more likely to die following a heart attack than men. This is in part due to being older and having other significant health problems at the time a heart attack occurs.

    The good news is that steps can be taken to control many CHD risk factors. Risk factors are conditions or habits that raise the risk of CHD and heart attack. Uncontrolled risk factors also can increase the chance that existing CHD will worsen.

    Lifestyle changes, medicines, and/or medical or surgical procedures can help women reduce their risk of CHD. That's why early and ongoing CHD prevention is so important.





    Causes of heart disease

    Research suggests that coronary heart disease (CHD) starts when certain factors damage the lining and inner layers of the coronary arteries. These factors include:
    • Smoking, including secondhand smoke
    • High amounts of certain fats and cholesterol in the blood
    • High blood pressure
    • High amounts of sugar in the blood due to insulin resistance or diabetes
    • Obesity, especially abdominal obesity (a large waistline)
    • Inactive lifestyle
    When damage occurs, the body starts a healing process. The healing may cause plaque to build up where the arteries are damaged.

    The buildup of plaque in the coronary arteries may start in childhood. Over time, as plaque continues to build up, it can narrow or completely block some of your coronary arteries. This reduces the flow of oxygen-rich blood to the heart muscle.

    Plaque also can suddenly rupture. This causes blood cell fragments called platelets to clump together with substances in the blood to form blood clots to seal the cracks. The blood clots narrow the arteries and may suddenly worsen angina. If a clot is big enough to block a coronary artery, it can cause a heart attack.

    In addition to the factors above, low estrogen levels occurring before or after menopause may play a role in coronary microvascular disease (MVD). Coronary MVD is heart disease that affects the heart's smallest arteries.

    The cause of broken heart syndrome isn't yet known. However, stress hormones and sex hormones, such as estrogen, may play a role in causing the syndrome.


    Who is at risk for heart disease?

    Certain traits, conditions, or habits may raise the risk of coronary heart disease. These conditions are known as risk factors. Risk factors also increase the chance that existing CHD will worsen.

    Women have the same CHD risk factors as men. However, some risk factors may affect CHD risk differently in women than in men. For example, diabetes raises the risk of CHD more in women. Also, other factors, such as birth control pills and menopause, may affect women's risk of CHD.

    There are a number of known CHD risk factors. The risk of CHD and heart attack increases with the number of risk factors a person has and their severity. Risk factors tend to "gang up" and worsen each other's effects.

    Having just one risk factor doubles the risk of CHD. Having two risk factors increases your the of CHD fourfold. Having three or more risk factors increases the risk of CHD more than tenfold.

    Also, some risk factors, such as smoking and diabetes, put an individual at greater risk of CHD and heart attack than others.

    More than three-quarters of women aged 40 to 60 have one or more risk factors for CHD. Many risk factors start during childhood; some even develop within the first 10 years of life. Most risk factors can be controlled, but some can't.


    Risk factors that can be controlled

    Smoking

    Smoking is the most powerful risk factor that women can control. Smoking tobacco or long-term exposure to secondhand smoke raises the risk of CHD and heart attack.

    Smoking exposes a person to carbon monoxide. This chemical robs the blood of its needed oxygen and triggers a buildup of plaque in the arteries.

    Smoking also increases the risk of blood clots forming in the arteries. Blood clots can block plaque-narrowed arteries and cause a heart attack. The more a person smokes, the greater her risk of a heart attack. Even women who smoke fewer than two cigarettes a day are at increased risk of CHD.


    High blood cholesterol and high triglyceride levels

    Cholesterol travels in the bloodstream in small packages called lipoproteins. The two major kinds of lipoproteins are low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol.

    LDL cholesterol is sometimes called "bad" cholesterol. This is because it carries cholesterol to tissues, including the heart arteries. HDL cholesterol is sometimes called "good" cholesterol. This is because it helps remove cholesterol from the arteries.

    A blood test called a lipoprotein profile is used to measure cholesterol levels. This test gives information about the total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides (a type of fat found in the blood).

    Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood. A total cholesterol level greater than 200 mg/dL, an LDL cholesterol level greater than 100 mg/dL, or an HDL cholesterol level less than 50 mg/dL increases a woman's risk of CHD.

    A triglyceride level greater than 150 mg/dL also increases a woman's risk of CHD. A woman's HDL cholesterol and triglyceride level predict her risk of CHD better than her total cholesterol or LDL cholesterol level.


    High blood pressure

    Women who have blood pressure greater than 120/80 mmHg are at increased risk of CHD. (The mmHg is millimeters of mercury – the units used to measure blood pressure.)

    Blood pressure should be even lower in women who have kidney disease or diabetes. If a women has one of these diseases, she should talk to her doctor about a healthy blood pressure measurement.


    Diabetes and prediabetes

    Diabetes is a disease in which the body's blood sugar level is high because the body doesn't make enough insulin or doesn't use its insulin properly. Over time, a high blood sugar level can contribute to increased plaque buildup in the arteries.

    Prediabetes is a condition in which the blood sugar level is higher than normal, but not as high as it is in diabetes. Prediabetes puts a person at higher risk for both diabetes and CHD.

    Diabetes and prediabetes raise the risk of CHD more in women than in men. Diabetes doubles women's risk of CHD and counters the protective effect of estrogen in premenopausal women.


    Overweight and obesity

    The terms "overweight" and "obesity" refer to a person's overall body weight and whether it's too high. Overweight is having extra body weight from muscle, bone, fat, and/or water. Obesity is having a high amount of extra body fat.

    The most commonly used measure of overweight and obesity is body mass index (BMI). BMI is calculated from your height and weight. In adults, a BMI of 18.5 to 24.9 is considered normal. A BMI of 25 to 29.9 is considered overweight. A BMI of 30 or above is considered obese.

    Studies suggest that where extra weight occurs on the body may more accurately predict CHD risk than BMI. Women who carry much of their fat around the waist are at greatest risk of CHD. These women have "apple-shaped" figures.

    Women who carry most of their fat on their hips and thighs – that is, those who have "pear-shaped" figures – are at lower risk of CHD than women who are apple shaped.

    To fully know how excess weight affects your CHD risk, it's important to know your BMI and waist measurement. If you have a BMI greater than 24.9 and a waist measurement greater than 35 inches, you're at increased risk of CHD. If your waist measurement divided by your hip measurement is greater than 0.9, you're also at increased risk of CHD.

    Studies also suggest that women whose weight goes up and down dramatically (typically due to unhealthy dieting) are at increased risk of CHD. These swings in weight can lower HDL cholesterol levels.


    Metabolic syndrome

    Metabolic syndrome is the name for a group of risk factors linked to overweight and obesity that increase your risk of CHD. A diagnosis of metabolic syndrome is made if a person has at least three of the following risk factors:
    • A large waistline
    • A higher than normal triglyceride level
    • A lower than normal HDL cholesterol level
    • Higher than normal blood pressure
    • Higher than normal fasting blood sugar (or you're on medicine to treat diabetes)
    Metabolic syndrome is more common in African American women than in African American men and in Mexican American women than in Mexican American men. The condition affects White women and men about equally.


    Birth control pills

    Women who smoke and take birth control pills are at very high risk of CHD, especially if they're older than 35. The risks of birth control pills in women who don't smoke aren't fully known.


    Lack of physical activity

    Inactive people are nearly twice as likely to develop CHD as those who are physically active. A lack of physical activity can worsen other CHD risk factors, such as high blood cholesterol and triglyceride levels, high blood pressure, diabetes and prediabetes, and overweight and obesity.


    Unhealthy diet

    An unhealthy diet can raise the risk of CHD. For example, foods that are high in saturated and trans fats and cholesterol raise LDL cholesterol. Thus, intake of these foods shoule be limited.

    Saturated fats are found in some meats, dairy products, chocolate, baked goods, oils of animal origin, and palm and coconut oils. Deep-fried and processed foods often contain saturated fats.

    Trans fats are found in some fried and processed foods. Cholesterol is found in eggs, many meats, dairy products, commercial baked goods, and certain types of shellfish.

    It's also important to limit foods that are high in sodium (salt) and simple sugars. A high-salt diet can raise the risk of high blood pressure. Added simple sugars will give you extra calories without nutrients like vitamins and minerals. This can cause you to gain weight, which raises the CHD risk. Added sugars are found in many desserts, candies, canned fruits packed in syrup, fruit drinks, and nondiet sodas.

    You also should try to limit how much alcohol you drink. Too much alcohol will raise your blood pressure. It also will add calories, which can cause weight gain.

    Women should have no more than one alcoholic drink a day. If you're pregnant, if you're planning to become pregnant, or if you have another health condition that could make alcohol use harmful, you shouldn't drink.


    Stress or depression

    Stress may contribute to the development of CHD. Stress can trigger the arteries to narrow. This can raise the blood pressure and the risk of a heart attack.

    A commonly reported trigger for a heart attack is an emotionally upsetting event, especially one involving anger. Stress also may indirectly raise your risk of CHD if it makes you more likely to smoke or overeat foods high in fat and sugar.

    People who have depression are two to three times more likely to develop CHD than people who don't. Depression is twice as common in women as in men.


    Anemia

    Anemia is a condition in which your blood has a lower than normal number of red blood cells. The condition also can occur if the red blood cells don't contain enough hemoglobin. Hemoglobin is an iron-rich protein that helps red blood cells carry oxygen from the lungs to the rest of the organs.

    If you have anemia, your organs don't get enough oxygen-rich blood. This causes your heart to work harder, which may raise your risk of CHD and coronary microvascular disease.


    Sleep apnea

    Sleep apnea is a common disorder in which you have pauses in breathing or shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

    When you stop breathing, the lack of oxygen triggers your body's stress hormones. This causes blood pressure to rise and makes the blood more likely to clot.

    Major signs of sleep apnea are snoring and daytime fatigue (tiredness). Untreated sleep apnea can raise your chances of having high blood pressure, diabetes, and even a heart attack or stroke.

    Women are more likely to develop sleep apnea after menopause.


    Risk factors that can't be controlled

    Age and menopause

    As you get older, your risk of CHD and heart attack rises. This is in part due to the slow buildup of plaque inside your heart arteries, which can start during childhood.

    Before age 55, women have a lower risk of CHD than men. After age 55, however, the risk of CHD increases in both women and men. This is in part because before menopause, estrogen provides women with some protection against CHD.

    You may have gone through early menopause, either naturally or because you had your ovaries removed. If so, you're twice as likely to develop CHD as women of the same age who aren't yet menopausal.

    Another reason why women are at increased risk of CHD after age 55 is that middle age is when you tend to develop other CHD risk factors.
    Being postmenopausal also increases your risk of broken heart syndrome.


    Family history

    Family history plays a role in CHD risk. Your risk increases if your father or brother was diagnosed with CHD before 55 years of age, or if your mother or sister was diagnosed with CHD before 65 years of age.

    However, having a family history of CHD doesn't mean that you'll have CHD too. This is especially true if your affected family member smoked or had other CHD risk factors that were not well treated.

    Making lifestyle changes and taking medicines to treat risk factors often can lessen genetic influences and stop or slow the progress of CHD.


    Preeclampsia

    Preeclampsia is a condition that develops during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine. These signs usually occur during the second half of pregnancy and go away after delivery. However, your risk of developing high blood pressure later in life increases after having preeclampsia.

    Preeclampsia is linked to an increased lifetime risk of heart disease, including coronary heart disease, heart attack, heart failure, and high blood pressure. (Likewise, having heart disease risk factors, such as diabetes or obesity, increases your risk of preeclampsia.)

    If you had preeclampsia, you're twice as likely to develop heart disease as women who didn't have the condition during pregnancy. You're also more likely to develop heart disease earlier in life.

    Preeclampsia is a heart disease risk factor that you can't control. However, if you've had the condition, you should take extra care to try and control the heart disease risk factors that you can.

    The more severe your preeclampsia was, the greater your risk of heart disease. Let your doctor know that you had preeclampsia so he or she can better assess your heart disease risk and how to reduce it.


    Emerging risk factors

    Some research suggests that the body's response to injury or infection (inflammation) plays a role in causing CHD. Damage to the arteries' inner walls seems to trigger inflammation and help plaque grow.

    High blood levels of a protein called C-reactive protein (CRP) are a sign of inflammation in the body. Research is ongoing to see whether CRP or other signs of inflammation can predict CHD risk in women.

    Some studies suggest that women who have migraine headaches may be at greater risk of CHD. This is especially true for women who have migraines that are accompanied by auras (visual disturbances), such as flashes of light or zig-zag lines.

    Researchers are just starting to learn which factors increase the risk of broken heart syndrome. Most women who develop this disorder are White and postmenopausal.

    Many of these women have other heart disease risk factors, such as high blood pressure, high blood cholesterol, diabetes, and smoking. However, these risk factors tend to be less common in women who have broken heart syndrome than in women who have CHD.


    Signs and symptoms of heart disease

    The signs and symptoms of coronary heart disease (CHD) may differ between women and men. Some women who have CHD have no signs or symptoms. This is called silent CHD.

    Silent CHD may not be diagnosed until a woman shows signs and symptoms of a heart attack, heart failure, or an arrhythmia (irregular heartbeat).


    Major signs and symptoms of coronary heart disease

    A common symptom of CHD is angina. Angina is chest pain or discomfort that occurs when your heart muscle doesn't get enough oxygen-rich blood.

    In men, angina often feels like pressure or a squeezing pain in the chest. This feeling may extend to the arms. Women also can have these angina symptoms. But women also tend to describe a sharp, burning chest pain. Women also are more likely to have pain in the neck, jaw, throat, abdomen, or back.

    In men, angina tends to get worse with physical activity and go away with rest. Women are more likely than men to have angina while they're resting or sleeping.

    In women who have coronary microvascular disease, angina often occurs during routine daily activities, such as shopping or cooking, rather than while exercising. Mental stress also is more likely to trigger angina pain in women than in men.

    The severity of angina varies. The pain may get worse or occur more often as the buildup of plaque continues to narrow the coronary (heart) arteries.


    Signs and symptoms of heart problems linked to coronary heart disease


    Heart attack

    The most common symptom of heart attack in men and women is chest pain or discomfort. However, only half of women who have heart attacks have chest pain.

    Women are more likely to report back or neck pain, indigestion, heartburn, nausea (feeling sick to the stomach), vomiting, extreme fatigue (tiredness), or problems breathing.

    Heart attacks also can cause upper body discomfort in one or both arms, the jaw, or the stomach. Other symptoms of heart attack are lightheadedness and fainting, which occur more often in women than men.

    Men who are having a heart attack are more likely to break out in a cold sweat and to report pain in their left arms than women.


    Heart failure

    Heart failure is a condition in which your heart weakens and can't pump enough blood throughout your body. Heart failure doesn't mean that your heart has stopped or is about to stop working. It means that your heart can't cope with the demands of everyday activities.

    Heart failure causes shortness of breath and fatigue that tends to increase with activity. Heart failure also can cause swelling in your feet, ankles, legs, and abdomen.


    Arrhythmia

    An arrhythmia is a problem with the rate or rhythm of your heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.

    Some people describe arrhythmias as fluttering or thumping feelings or skipped beats in their chests. These feelings are called palpitations.

    Some arrhythmias can cause your heart to suddenly stop beating. This condition is called sudden cardiac arrest (SCA). SCA causes loss of consciousness and death if it's not treated right away.


    Signs and symptoms of broken heart syndrome

    The most common signs and symptoms of broken heart syndrome are chest pain and shortness of breath. In this syndrome, these symptoms tend to occur suddenly in people who have no history of heart disease.

    Arrhythmias or cardiogenic shock also may occur. Cardiogenic shock is a state in which a weakened heart isn't able to pump enough blood to meet the body's needs.

    Broken heart syndrome has several signs and symptoms that distinguish it from a heart attack:
    • Symptoms occur suddenly after having extreme emotional or physical stress.
    • The EKG (electrocardiogram) results for a person who has broken heart syndrome don't look the same as the EKG results for a person having a heart attack. (An EKG is a test that records the heart's electrical activity.)
    • Blood tests show no signs or mild signs of heart damage.
    • Tests show no signs of blockages in the coronary arteries.
    • Tests show unusual movement of the lower left heart chamber (left ventricle).
    • Recovery time is quick, usually within days to weeks (compared to the recovery time of a month or more for a heart attack).

    Diagnosis of heart disease

    Your doctor will diagnose coronary heart disease (CHD) based on your medical and family histories, your risk factors, a physical exam, and the results from tests and procedures.

    No single test can diagnose CHD. If your doctor thinks you have CHD, he or she may recommend one or more of the following tests.


    EKG (electrocardiogram)

    An EKG is a simple, painless test that detects and records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through each part of the heart.

    Certain electrical patterns that the EKG detects can suggest whether CHD is likely or whether the heart muscle is abnormally thickened. An EKG also can show signs of a previous or current heart attack.


    Stress testing

    During stress testing, you exercise (or are given medicine if you're unable to exercise) to make your heart work hard and beat fast while heart tests are done.

    When your heart is working hard and beating fast, it needs more blood and oxygen. Plaque-narrowed coronary arteries can't supply enough oxygen-rich blood to meet your heart's needs.

    A stress test can show possible signs and symptoms of CHD, such as:
    • Abnormal changes in your heart rate or blood pressure
    • Shortness of breath or chest pain
    • Decreased exercise tolerance
    • Abnormal changes in your heart rhythm or your heart's electrical activity (as shown on an EKG)
    Some stress tests take pictures of your heart when you're at rest and when you exercise. These imaging stress tests can show how well blood is flowing in various parts of your heart and/or how well your heart pumps blood when it beats.


    Echocardiography

    Echocardiography (echo) uses sound waves to create a moving picture of your heart. The test provides information about the size and shape of your heart and how well your heart chambers and valves are working.

    Echo also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by lack of blood flow.


    Chest X-ray

    A chest X-ray takes pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels. A chest X-ray can reveal signs of heart failure, as well as lung disorders and other causes of symptoms that aren't due to CHD.


    Blood tests

    Blood tests can detect disorders such as anemia and check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels of these substances may show that you have risk factors for CHD.

    During a heart attack, heart muscle cells die. When they die, they release certain proteins into the bloodstream. Blood tests can measure the amount of these proteins in the bloodstream. Higher than normal levels of these proteins in the bloodstream is evidence of a recent heart attack.


    Electron-beam computed tomography

    Your doctor may recommend electron-beam computed tomography (EBCT). This test finds and measures calcium deposits (called calcifications) in and around the heart arteries. The more calcium detected, the more likely you are to have CHD.

    EBCT isn't used routinely to diagnose CHD because its accuracy isn't yet known.


    Coronary angiography and cardiac catheterization

    Your doctor may recommend coronary angiography if other tests or factors show that you likely have CHD. This test uses dye (contrast material) and special X-rays to show the insides of your coronary arteries.

    To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization. A long, thin, flexible tube called a catheter will be put into a blood vessel in your groin (upper thigh), arm, or neck.

    Your doctor will thread the tube into your coronary arteries, and the dye will be released into your bloodstream. Special X=rays will be taken while the dye is flowing through your coronary arteries. These X-rays are called angiograms.

    Coronary angiography detects blockages in the large coronary arteries. However, the test doesn't detect coronary microvascular disease (MVD). This is because coronary MVD doesn't cause blockages in the large coronary arteries. If the results of your coronary angiography are normal, but you still have chest pain or other CHD symptoms, talk to your doctor about whether you might have coronary MVD.

    Your doctor may ask you to fill out a questionnaire called the Duke Activity Status Index. This questionnaire measures how easily you can do routine tasks. It gives your doctor information about how well blood is flowing through your coronary arteries.

    Other tests that measure blood flow in the heart also can detect coronary MVD. These tests include a cardiac MRI (magnetic resonance imaging) stress test and a test done during cardiac catheterization that shows blood flow in the heart's small arteries.


    Tests used to diagnose broken heart syndrome

    If your doctor thinks you have broken heart syndrome, he or she may recommend coronary angiography. Other tests also are used to diagnose this disorder, including blood tests, EKG, echocardiography, and cardiac MRI.

    Cardiac MRI uses radio waves, magnets, and a computer to created pictures of your heart as it's beating. The test produces both still and moving pictures of your heart and major blood vessels.


    Treatment of heart disease

    Treatment for coronary heart disease (CHD) usually is the same for both women and men. Treatment may include lifestyle changes, medicines, medical and surgical procedures, and cardiac rehabilitation (rehab).

    The goals of treatments include:
    • Relieving symptoms.
    • Reducing CHD risk factors in an effort to slow, stop, or reverse the buildup of plaque.
    • Lowering the risk of blood clots forming. Blood clots can cause a heart attack.
    • Widening or bypassing plaque-clogged coronary arteries.
    • Preventing CHD complications.

    Lifestyle changes

    Making lifestyle changes often can help prevent or treat CHD. Lifestyle changes may include following a heart healthy diet, doing physical activity regularly, maintaining a healthy weight, quitting smoking, and managing stress and depression.


    Following a heart healthy diet

    A heart healthy diet is an important part of a healthy lifestyle. To lower your risk of CHD, follow a diet:
    • That's low in saturated and trans fats. Saturated fats are found in some meats, dairy products, chocolate, baked goods, oils of animal origin, and palm and coconut oils. Deep-fried and processed foods often have saturated fats. Trans fats are found in some fried and processed foods. Both types of fat raise your LDL cholesterol level.

    • That includes the types of fat found in fish and olive oil. These fats are rich in omega-3 fatty acids. Omega-3 fatty acids lower your risk of heart attack, in part by helping prevent blood clots.

    • That's high in fiber, whole grains, fruits, and vegetables. A diet that's rich in these elements not only helps lower your LDL cholesterol level, but also provides nutrients that may help protect against CHD.

    • That's low in salt and sugar. A low-salt diet can help you manage your blood pressure. A low-sugar diet can help you prevent weight gain and control diabetes and prediabetes.
    Research suggests that drinking small to moderate amounts of alcohol regularly also can lower your risk of CHD. Women should have no more than one alcoholic drink a day. One drink a day can lower your CHD risk by raising your HDL cholesterol level. One drink is a glass of wine, beer, or a small amount of hard liquor.

    If you don't drink, this isn't a recommendation to start using alcohol. If you're pregnant, if you're planning to become pregnant, or if you have another health condition that could make alcohol use harmful, you shouldn't drink.

    Also, too much alcohol can cause you to gain weight and raise your blood pressure and triglyceride level. In women, even one drink a day may raise the risk of certain types of cancer.


    Doing physical activity regularly

    Regular physical activity can lower many CHD risk factors, including high LDL cholesterol, high blood pressure, and excess weight.

    Physical activity also can lower your risk of diabetes and raise your HDL cholesterol level. (HDL cholesterol helps prevent CHD.)

    Talk to your doctor before you start a new exercise plan. Ask him or her how much and what kinds of physical activity are safe for you.

    People gain some health benefits from as little as 60 minutes of moderate-intensity aerobic activity per week. Walking is an excellent heart healthy exercise. The more active you are, the more you will benefit.


    Maintaining a healthy weight

    Following a healthy diet and being physically active can help you maintain a healthy weight. Controlling your weight helps you control CHD risk factors.

    If you're overweight or obese, aim to reduce your weight by 5 to 10 percent during your first year of treatment. This amount of weight loss can lower your risk of CHD and other health problems. Your health care provider may refer you to a dietitian to help you manage your weight.

    After the first year, you may have to continue to lose weight. A BMI of less than 25 and a waist circumference of 35 inches or less is the goal for preventing and treating CHD.

    To measure your waist, stand and place a tape measure around your middle, just above your hipbones. Measure your waist just after you breathe out. Make sure the tape is snug but doesn't squeeze the flesh.



    Quitting smoking

    If you smoke or use tobacco, try to quit. Smoking can damage and constrict (tighten) blood vessels. It also can raise your risk of CHD and heart attack and worsen other CHD risk factors. Talk to your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke.


    Managing stress and depression

    Research shows that a common "trigger" for a heart attack is an emotionally upsetting event梡articularly one involving anger. Also, some of the ways people cope with stress, such as drinking, smoking, or overeating, aren't heart healthy.

    Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health.

    Having supportive people in your life with whom you can share your feelings or concerns can help relieve stress. Physical activity, yoga, and relaxation therapy also can help relieve stress. You may want to consider participating in a stress management program.

    Depression doubles or triples you risk of CHD. Depression also makes it hard to maintain a heart healthy lifestyle.

    Talk to your doctor if you have symptoms of depression, such as feeling hopeless or not taking interest in daily activities. He or she may recommend counseling or prescribe medicines to help you manage the condition.


    Medicines

    If lifestyle changes aren't enough, you also may need medicines to prevent or treat CHD. Medicines can:
    • Decrease the workload on your heart and relieve CHD symptoms
    • Decrease your chance of having a heart attack or dying suddenly
    • Lower your LDL cholesterol, blood pressure, and other CHD risk factors
    • Prevent blood clots
    • Prevent or delay the need for a medical or surgical procedure, such as angioplasty or coronary artery bypass grafting (CABG)
    Women who have coronary microvascular disease and anemia may benefit from taking medicine to treat the anemia.

    Women who have broken heart syndrome also may need medicines. Doctors may prescribe medicines to relieve fluid buildup, treat blood pressure problems, prevent blood clots, and manage stress hormones.

    Take all of your medicines as prescribed. If you have side effects or other problems related to your medicines, talk to your doctor. He or she may be able to provide other options.


    Menopausal hormone therapy

    Recent studies have shown that menopausal hormone therapy (MHT) doesn't prevent CHD. Some studies have even shown that MHT increases women's risk of CHD, stroke, and breast cancer. However, these studies tested MHT on women who had been postmenopausal for at least several years. During that time, they could have already developed CHD.

    Research is ongoing to see whether MHT helps prevent CHD when taken right when menopause starts. While questions remain, current findings suggest MHT shouldn't be used routinely to prevent or treat CHD.

    Talk with your doctor about other ways to prevent or treat CHD, including lifestyle changes and medicines.


    Medical and surgical procedures

    You may need a medical or surgical procedure to treat CHD. Both angioplasty and CABG are used as treatments.

    Angioplasty opens blocked or narrowed coronary arteries. A thin, flexible tube with a balloon or other device on the end is threaded through a blood vessel to the narrowed or blocked coronary artery.

    Once in place, the balloon is inflated to push the plaque outward against the wall of the artery. This widens the artery and restores the flow of blood.

    Angioplasty can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. Often, a small mesh tube called a stent is placed in the artery to keep it open as a part of the procedure.

    In CABG, a surgeon removes arteries or veins from other areas in your body and uses them to bypass (that is, go around) narrowed or blocked coronary arteries. CABG can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack.


    Cardiac rehabilitation

    Your doctor may prescribe cardiac rehabilitation for angina or after angioplasty, CABG, or a heart attack.

    Cardiac rehab, when combined with medicine and surgical treatments, can help you recover faster, feel better, and follow a healthier lifestyle. Almost everyone who has CHD can benefit from cardiac rehab.

    Your cardiac rehab team may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians, and psychologists or other behavioral therapists.

    Cardiac rehab has two parts:
    • Exercise training. This part of rehab helps you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your individual abilities, needs, and interests.

    • Education, counseling, and training. This part of rehab helps you understand your heart condition and find ways to reduce your risk of future heart problems. The cardiac rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and with your fears about the future.

    Prevention of heart disease

    Your risk of coronary heart disease (CHD) increases with the number of CHD risk factors you have. Taking action to control your risk factors can help prevent or delay CHD and its complications.

    One step you can take is to adopt a heart healthy lifestyle. A heart healthy lifestyle should be part of a lifelong approach to healthy living.

    Following a healthy diet is an important part of a healthy lifestyle. A healthy diet includes a variety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish, beans, and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar.

    If you're overweight or obese, work with your doctor to create a reasonable weight-loss plan that involves diet and physical activity. Controlling your weight helps you control CHD risk factors.

    Try to do physical activity regularly. Physical activity can improve your fitness level and your health. Talk to your doctor about what types of activity are safe for you.

    If you smoke, quit. Smoking can damage and constrict (tighten) blood vessels. It also can raise your risk of CHD and heart attack and worsen other CHD risk factors. Talk to your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke.

    Know your family history of CHD. If you or someone in your family has CHD, be sure to tell your doctor.

    If lifestyle changes aren't enough, you also may need medicines to control your CHD risk factors. Take all of your medicines as prescribed.


    Living with heart block

    If you have coronary heart disease (CHD), you should take steps to manage the condition, reduce CHD risk factors, and prevent complications. You can do this by making lifestyle changes, getting ongoing care, and knowing the warning signs of heart problems.

    Having CHD raises your risk of a heart attack. If you have signs and symptoms of a heart attack for more than 5 minutes, you should call 9𢴏. These signs and symptoms may include chest pain, upper body discomfort, shortness of breath, and nausea (feeling sick to your stomach).

    For more detailed information about the warning signs of heart attack, see the section on warning signs below.


    Lifestyle changes

    Adopting a heart healthy lifestyle can help you control CHD risk factors. However, making lifestyle changes can be a challenge.

    Try to take things one step at a time. Learn about the benefits of lifestyle changes, and make a plan with specific, realistic goals. Reward yourself for your progress.

    The good news is that many lifestyle changes help control several CHD risk factors at the same time. For example, physical activity lowers your blood pressure and LDL cholesterol level, helps control diabetes and prediabetes, reduces stress, and helps control your weight.


    Ongoing care

    Your CHD risk factors can change over time, so it's important to get ongoing care. Your doctor will track your blood pressure, blood cholesterol, and blood sugar levels with routine tests. These tests will show whether your treatment needs to be adjusted.

    Talk to your doctor about how often you should schedule followup visits or blood tests. Between visits, call your doctor if you develop any new symptoms or if your symptoms worsen.

    You may feel depressed or anxious if you've been diagnosed with CHD. You may worry about heart problems or making lifestyle changes that are necessary for your health.

    Your doctor may recommend medicine, professional counseling, or relaxation therapy if you have depression or anxiety. It's important to treat depression and anxiety because they raise your risk of CHD and heart attack and make it harder to carry out lifestyle changes.


    Warning signs

    It's important to learn the signs and symptoms of a heart attack. Call 9𢴏 if you have any of these symptoms for more than 5 minutes:
    • Chest pain or discomfort梪ncomfortable pressure, squeezing, fullness, burning, or pain in the center of the chest that can be mild or strong. This discomfort or pain lasts more than a few minutes or goes away and comes back.

    • Upper body discomfort in one or both arms, the neck, jaw, throat, abdomen, or back.

    • Shortness of breath, which may occur with or before chest discomfort.

    • Nausea, vomiting, lightheadedness or fainting, or breaking out in a cold sweat.
    Early treatment can prevent or limit damage to your heart muscle. If you think you're having a heart attack, don't drive yourself or have friends/family drive you to the hospital. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room.

    If your symptoms last for less than 5 minutes, you should still call your doctor. Also, let the people you see regularly know you're at risk of a heart attack. They can seek emergency care if you suddenly faint, collapse, or develop other severe symptoms.


    Living with broken heart syndrome

    Most people who have broken heart syndrome make a full recovery within weeks. The risk of another episode of broken heart syndrome is low.

    To check your heart health, your doctor may recommend echocardiography about a month after you're diagnosed with the syndrome. Talk with your doctor about how often you should schedule followup visits.


    Related categories

       • HEART TOPICS
       • HEALTH AND DISEASE

    Source: U.S. National Heart, Lung and Blood Institute