American Medical Association Family Medical Guide - American Medical Association [317]
• Family history of heart disease A family history of heart disease increases your risk, especially if your father or brother had heart disease before age 55, or your mother or sister had heart disease before age 65.
• High blood pressure High blood pressure makes the heart pump harder, increasing both the size of the heart muscle and the chances of heart failure.
• High total cholesterol and LDL cholestero An excess of cholesterol in the blood, especially LDL (bad) cholesterol, leads to the formation of fatty deposits called plaque on artery walls (atherosclerosis). Plaque can rupture, producing blood clots that can block the flow of blood, causing a heart attack or stroke.
• Low HDL cholesterol HDL (good) cholesterol removes harmful LDL cholesterol from the blood, reducing plaque buildup in artery walls.
• High C-reactive protein levels Inflammation (which contributes to atherosclerosis) leaves a chemical by-product in the blood called C-reactive protein (CRP); the higher a person’s CRP level, the greater his or her risk of a heart attack or stroke.
• Smoking Smoking raises blood pressure. Free radicals from cigarette smoke damage LDL cholesterol, making it more likely to collect as plaque on artery walls. Also, toxic chemicals in smoke damage arteries directly.
• Diabetes Most people who have diabetes die of some form of blood vessel disease or heart disease.
• Race Blacks have a higher risk of heart disease than people of other races.
• Being overweight Being overweight makes the heart work harder, increases the chances of developing high blood pressure and type 2 diabetes, and worsens blood cholesterol levels.
• Lack of exercise An inactive lifestyle leads to weight gain, obesity, high cholesterol levels, and type 2 diabetes.
• Stress Although the precise mechanism is unclear, in some people unmanaged stress can lead to heart disease.
• High homocysteine levels Too much of a body chemical called homocysteine in the blood may damage artery walls and promote formation of blood clots, significantly increasing the risk of heart attack and stroke. Taking 400 micrograms of the B vitamin folic acid every day can help keep homocysteine at a healthy level.
Warning Signs of Heart Disease
The main symptom of heart disease is temporary mild to severe chest pain (angina). See your doctor as soon as possible if you have any of the following symptoms:
• Pain or pressure in the chest while resting
• Pain or pressure in the chest during physical activity (such as climbing stairs or running)
• Shortness of breath during physical activity
• Chest pain that stops after a brief rest
• Dizziness, nausea, sweating, or difficulty breathing
Symptoms
Heart disease often does not produce symptoms, and for some people the first sign of heart disease is a heart attack. Others, however, may experience angina, a type of chest pain that results from an inadequate supply of oxygen to the heart muscle. Healthy coronary arteries can easily supply the heart with as much oxygen as it needs. Arteries that have been narrowed or damaged by atherosclerosis cannot provide sufficient oxygen, especially during times of increased demand, such as when a person exercises or is under emotional stress.
Angina can be temporary moderate to severe pain or pressure in the center of the chest that sometimes radiates to the left shoulder and down the left arm or to the throat, jaw, and lower teeth. Sometimes the pain spreads to the right shoulder and down the right arm. Angina usually occurs when a person is active and subsides when he or she stops and rests. Other symptoms that sometimes occur along with angina include difficulty breathing, sweating, nausea, and dizziness.
Location of angina pain
WARNING!
Chest Pain
If an episode of chest pain lasts longer than about 15 minutes and does not subside with rest (or with medication if you have been diagnosed with heart disease), you could be having a heart attack (see page 567). Call 911 or your