HEART DISEASE

INTRODUCTION
Heart disease describes a range of conditions that affect your heart. Diseases under the heart
disease umbrella include blood vessel diseases, such as coronary artery disease; heart rhythm
problems (arrhythmias); and heart defects you're born with (congenital heart defects), among
others.
The term "heart disease" is often used interchangeably with the term "cardiovascular disease."
Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood
vessels that can lead to a heart attack, chest pain (angina) or stroke. Other heart conditions, such
as those that affect your heart's muscle, valves or rhythm, also are considered forms of heart
disease.
Many forms of heart disease can be prevented or treated with healthy lifestyle choices.
Heart disease is an umbrella term for any type of disorder that affects the heart. Heart disease
means the same as cardiac disease but not cardiovascular disease. Cardiovascular disease refers
to disorders of the blood vessels and heart, while heart disease refers to just the heart.
According to WHO (World Health Organization) and the CDC, heart disease is the leading cause
of death in the UK, USA, Canada and Australia. The number of US adults diagnosed with heart
disease stands at 26.6 million (11.3% of adult population).
23.5% of all deaths in the USA today are caused by heart disease.

Angina
Also known as angina pectoris, angina occurs when an area of heart muscle does not get enough
oxygen. The patient experiences chest discomfort, tightness or pain. Angina is not technically a
disease, but rather a symptom of coronary artery disease. Lack of oxygen to the heart muscle is
usually caused by the narrowing of the coronary arteries because of plaque accumulation
(atherosclerosis).

Arrhythmia
Arrhythmia is an irregular heartbeat.

Tachycardia is when the heart beats too fast

Bradycardia is when the heart beats too slowly

Premature contraction is when the heart beats too early

Fibrillation is when the heart beat is irregular

Arrhythmias are problems with heart-rhythm. They happen when the heart's electrical impulses
that coordinate heartbeats do not work properly, making the heart beat in a way it should not,
either too fast, slowly or erratically.
Irregular heartbeats are common, we all experience them. They feel like a fluttering or a racing
heart. However, when they veer too far from normal heartbeat or occur because of a damaged or
weak heart, they need to be taken more seriously and treated. Irregular heartbeats can become
fatal.
Diagram of the heart. Blue parts indicate de-oxygenated blood pathways while red parts
indicate oxygenated pathways

Congenital heart disease

This is a general term for some birth defects that affect how the heart works. Congenital means
you are born with it. In the UK it is estimated that 1 in every 1,000 babies are born with some
kind of congenital heart disease. Examples include:

Septal defects - there is a hole between the two chambers of the heart. This condition is
sometimes called hole in the heart.

Obstruction defects - the flow of blood through various chambers of the heart is partially
or even totally blocked

Cyanotic heart disease - not enough oxygen is pumped around the body because there is a
defect (or some defects) in the heart.

Coronary artery disease

The coronary arteries, which supply the heart with nutrients, oxygen and blood become diseased
or damaged, usually because of plaque deposits (cholesterol-containing deposits). Plaque
accumulation narrows the coronary arteries and the heart gets less oxygen.

Dilated cardiomyopathy
In this disorder the heart chambers become dilated because the heart muscle has become weak
and cannot pump blood properly. The most common reason is not enough oxygen reaching the
heart muscle (ischemia) due to coronary artery disease. Usually the left ventricle is affected.

Myocardial infarction
Also known as heart attack, cardiac infarction and coronary thrombosis. Interrupted blood flow
(lack of oxygen) damages or destroys part of the heart muscle. This is usually caused by a blood

clot that develops in one of the coronary arteries (blood vessels that supply the heart with blood).
It can also occur if an artery suddenly narrows (spasm).

Observation

Rheumatic heart disease

Rheumatic heart disease is caused by one or more attacks of rheumatic fever, which then do
damage to the heart, particularly the heart valves. Rheumatic fever usually occurs in childhood,
and may follow a streptococcal infection. In some cases, the infection affects the heart and may
result in scarring the valves, weakening the heart muscle, or damaging the sac enclosing the
heart. The valves are sometimes scarred so they do not open and close normally.
Hypertensive heart disease
High blood pressure of unknown origin (primary hypertension) or caused by (secondary
hypertension) certain specific diseases or infections, such as tumor in the adrenal glands, damage
to or disease of the kidneys or their blood vessels. High blood pressure may overburden the heart
and blood vessels and cause disease.
Ischemic heart disease
Heart ailments caused by narrowing of the coronary arteries and therefore a decreased blood
supply to the heart.
Cerebrovascular disease
Disease pertaining to the blood vessels in the brain. A cerebrovascular accident or stroke is the
result of an impeded blood supply to some part of the brain.
Inflammatory heart disease
Inflammation of the heart muscle (myocarditis), the membrane sac (pericarditis) which surround
the heart, the inner lining of the heart (endocarditis) or the myocardium (heart muscle).
Inflammation may be caused by known toxic or infectious agents or by an unknown origin.
Rheumatic heart disease
Rheumatic heart disease
Rheumatic heart disease is damage caused to the hearts valves by rheumatic fever, which is
caused by streptococcal bacteria.
Valvular heart disease
The hearts valves keep blood flowing through the heart in the right direction. But a variety of
conditions can lead to valvular damage. Valves may narrow (stenosis), leak (regurgitation or
insufficiency) or not close properly (prolapse). You may be born with valvular disease, or the
valves may be damaged by such conditions as rheumatic fever, infections connective tissue
disorders, and certain medications or radiation treatments for cancer.

Hypertensive heart disease

Aneurysm
An aneurysm is a bulge or weakness in the wall of a blood vessel. Aneurysms can enlarge over
time and may be life threatening if they rupture. They can occur because of high blood pressure
or a weak spot in a blood vessel wall. Aneurysms can occur in arteries in any location in your
body. The most common sites include the abdominal aorta and the arteries at the base of the
brain.
Atherosclerosis
In atherosclerosis the walls of your arteries become thick and stiff because of the build up fatty
deposits. The fatty deposits are called plaques. When this happens, the flow of blood is
restricted. Atherosclerosis can happen throughout the body. In the arteries of the heart it is
known as coronary artery disease, in the legs, peripheral arterial disease. Atherosclerosis happens
over a period of time and its consequences can be grave and include heart attack and stroke.
High blood pressure (hypertension)
High blood pressure is the excessive force of blood pumping through your blood vessels. High
blood pressure causes many types of cardiovascular disease, such as stroke and heart failure, and
renal disease.
Peripheral arterial disease
Peripheral arterial disease (PAD) is caused by atherosclerosis, which is the narrowing and / or
blockage of the blood vessels in the legs. PAD manifests as pain in the legs when walking,
which is relieved by rest. If you have PAD you are at greater risk of developing gangrene in your
legs.
Ischemic heart disease
Angina
Angina manifests as pain in the chest that results from reduced blood supply to the heart
(ischemia). Blood carries oxygen around your body and depriving the heart of oxygen has
serious consequences.
Angina is caused by atherosclerosis, that is the narrowing and / or blockage of the blood vessels
that supply the heart.
The typical pain of angina is in the chest but it can often radiate to the left arm, shoulder or jaw.
If you have angina you will have noticed that the pain is related to exertion and is relieved by
rest.
An angina attack is also associated with shortness of breath and sweating. If you are a woman

you may experience angina slightly differently. Women appear to have more pain in their
shoulder and middle back area, and more throat, neck, and jaw pain than men.
If your angina symptoms rapidly worsen and occur at rest this may presage an impending heart
attack (myocardial infarction) and you should seek medical help immediately.

Methodology

AND JUSTIFICATION
In Spain, as in other parts of the Western world, cardiovascular disease is the leading cause of
death in women. One woman dies every 6 minutes in Europe, and every minute in the US, from
cardiovasculardisease1-3. Despite the gravity of these data, women themselves still consider this a
"man's disease". Fortunately, recent years have brought a change in this sentiment, in part
because of the attention devoted to the matter by health professionals and scientific societies,
such as the European Society of Cardiology, the American Heart Association, and others. Such
societies have ongoing clinical and social education programs that will no doubt continue to
increase understanding of this public health concern and foster positive changes in the public's
attitude toward cardiovascular disease. A significant advance has been the publication of
cardiovascular disease prevention literature targeted at female readers.
Over the last 20 years, enormous effort has been invested in cardiovascular research and heart
attack prevention in particular, which has resulted in exciting and encouraging findings.
Although these efforts have led to significant decreases in ischemic mortality overall, women
have not benefited to the same degree as men have.
Heart attack risk factors vary by sex, a fact that has been repeatedly demonstrated by studies
looking at cardiac risk factors, clinical manifestations, results of diagnostic tests, and application
of therapeutic measures. In addition, the prognosis for female patients is worse than for men, in
part because they tend to be older, have more co-morbidities, are diagnosed at later stages, and
tend to infrequently receive some treatments4-11.
We must not forget that the majority of medical action is based on studies with predominantly
male participants. Until a few years ago, databases maintained by research institutes and clinical
trials were largely devoid of female participants. For example, well accepted therapeutic
interventions, such as the use of statins to prevent primary and secondary heart attacks, are based
on clinical trials composed of fewer than 20% female patients, and the bulk of the information
about the management of cardiovascular disease in women derives from studies where females
make up less than 30% of the population being analysed. As a result, studies designed with
women in mind are essential, whether it be through adequate enrolment of women in larger trials
or by undertaking studies exclusively of the female population.

Recently, in the United States, the National Heart, Lung and Blood Institute has initiated an
ambitious study of ischemic heart disease in women known as WISE (Women's Ischemic
Syndrome Evaluation)12, with the three-fold aim of optimising clinical evaluation and diagnostic
testing for coronary disease, investigating the mechanism of myocardial ischemia in the absence
of coronary stenosis, and evaluating the influence of hormones in clinical and diagnostic
findings. Based on the results obtained from the study, some general recommendations and
objectives were issued:
1. Improve the understanding of the pathology and pathophysiology of the differences in heart
attack: metabolic syndrome, physiology of reproductive hormones, role of the endothelium,
genetic factors, proteomics, the hormone cycle, pain threshold, environmental and psychosocial
factors.
2. Improve the understanding of symptoms and diagnostic tools, including understanding the
diverse manifestations of chest pains associated with coronary illness caused by obstruction or
lack of obstruction, the development and validation of better diagnostic methods for the detection
of ischemia, and the development of studies to evaluate prodromes in patients without acute
coronary syndrome.
3. Promote sex-specific clinical research (basic data, clinical studies designed to evaluate
diagnostics tests and their differences, natural history, treatment, and evolution). It is essential
that new studies be stratified by gender.
4. Investigate the mechanisms leading to adverse cardiovascular events during the early phase
of hormone therapy: genetic and pharmacological factors, alternative formulations of hormone
therapy and effects of estrogens.
5. Promote the translation of research into clinical practice: stimulate research and its clinical
application to more effectively influence community education as well as scientific enterprise.
Recently, the following noteworthy data were released from the WISE study:
- Role of hormones: The elevated concentrations of estrogens before menopause and the reduced
estrogen and progesterone levels after menopause influence the risk of heart attack in women. In
younger women, it appears that estrogen deficiency caused by dysfunction of the ovaries is an
important risk factor. In addition, women who experience an interruption in ovulation, and
consequently the reduced production of oestrogens, are at higher risk for coronary disease.
- Diagnostic tests: The use of isotope studies is recommended. Single Photon Emission
Computed Tomography (SPECT) has greatly improved diagnostic efficiency.
- Prognostics: Functional capacity is a powerful and consistent prognostic indicator. Since it is
not feasible to carry out conventional strength tests in all women, practitioners should consider

pharmacological stress tests. In addition, questionnaires, such as the Duke Activity Status Index
(DASI), that evaluate daily activities offer valuable prognostic information. The results can be
expressed in METs, and a clear relationship has been observed with clinical events.
- Obesity: Overweight women are at higher risk of coronary disease compared to women of
normal weight, not simply due to the added weight but also to the metabolic alterations that
accompany the condition.
- Specific factors: the possibility that other pathophysiological factors, such as inflammation,
anaemia, or dysfunction of the microvasculature, affect the risk of heart attack in women has
brought about the development of new diagnostic and prognostic tools. Examples include Creactive protein and haemoglobin levels and the evaluation of arterial narrowing in the retinas or
the detection of coronary calcifications.
Data Analysis Heart Disease

Coronary artery disease (CAD) is a complex disease with many possible treatment options.
Because of this complexity, we increasingly find risk modeling useful in tailoring treatment plans
for each patient.
In risk modeling, we collect a large pool of data from different types of completed procedures.
Then we analyze the success of each.
After that, we use specialized computers to run the data through several analytical programs.
This analysis takes many factors into account, such as the patients age, gender and medical
history.
The data analysis gives us a summary and overarching view of treatment options, including
which might best suit a particular patient group.
Risk modeling research

I was part of a research team that studied how risk modeling can help us to further refine
treatment protocols for all patients. We devised a decision-support tool for physicians that
incorporates risk modeling, and identified the tools potential usefulness by comparing two
approaches to treatment: coronary artery bypass grafting (CABG) and percutaneous coronary
intervention (PCI).
CABG is a surgical procedure in which we bypass blocked or clogged coronary arteries and
replace them with healthy blood vessels, usually taken from a vein or artery in the leg, chest or
arm. Surgeons have used CABG for many decades, successfully operating on thousands of
patients.

PCI is a non-surgical procedure in which doctors prop open narrowed arteries using stents or
balloons that surgeons thread into place via catheters.
After using the tool to analyze results from almost 25,000 patients, we found patterns and trends
that predicted which patients did better with CABG versus PCI.
We know that certain patients do better with one or the other based on their individual medical
history. In this case, the risk score can help steer us in the direction of the most appropriate
therapy.
A place to begin

As valuable as risk modeling may be, it is merely a starting point. Your doctors consultation
with a team of cardiac specialists, focusing on the individual patient, is a key part of the process.
A team approach looks at all the information, including the patients unique background and
medical history, to come up with a plan to ensure the best possible outcome.
Each surgical and non-surgical technique has its benefits and drawbacks. Risk modeling helps us
to detect trends and predictors that will aid us in deciding which patient groups will best benefit
from a particular procedure.
Its important to remember that risk modeling works for a group. It doesnt assess an individuals
specific risk factors. It gives us a ballpark idea for risk.
Risk modeling is an important tool and we use it to complement our traditional medical and
surgical care. It should be part of the discussion. Using the risk model, we can enter a patients
characteristics and use the risk score as one factor in deciding what procedure is best.
The risk models take into account a list of specific factors to calculate risk. However, additional
medical conditions not considered in the formula may actually make a patient high risk.
What this means to you
Our study suggests that patients should be more engaged in their health care decisions. When
you meet with the surgeon or physician, ask how the treatment strategy was determined. For
example, did the physician consult with a heart team, and did the team consider all options for
treatment ?
We know that not all treatments fit all patients. But there can be a structured way in which heart
physicians and surgeons can decide the best therapy for you. Risk modeling can provide a good
first step for a heart teams evaluation of medical conditions and characteristics that are specific
to each patient.

Conclusion

Although the diagnosis of heart disease is frightening, there are many lifestyle choices you can
make to help prevent this disease. Quitting smoking, nutrition, exercising, and reducing stress
and high blood pressure can have a significant impact on preventing heart disease.
The good news is that your choices can influence your heart health. Through lifestyle changes
like smoking cessation, healthy eating, exercise, and managing diabetes, blood pressure and
stress, you can greatly reduce your chance of heart disease.
Heart disease is a debilitating condition for many Americans. According to the
Centers for Disease Control and Prevention (CDC), its the leading cause of death in
the United States. Certain risk factors make some individuals more likely to have
heart disease. Risk factors fall into two categories. modifiable risk factors are ones
you can control such as weight. non-modifiable risk factors are ones you cant
control, like genetics.

The most crucial step you can take to lower your risk of heart disease is to quit smoking.
Smoking is one of the leading risk factors for coronary heart disease, heart attack, and stroke.
Smoking causes a buildup of a fatty substance (plaque) in the arteries, which eventually leads to
a hardening of the arteries (atherosclerosis). Smoking damages organs and worsens many other
risk factors for heart disease. It reduces your amount of good cholesterol (HDL) and raises blood
pressure, which can cause increased stress on your arteries.
Smoking cessation has been proven to reduce heart disease. According to the National Heart,
Lung, and Blood Institute, many states have begun programs to limit or reduce smoking in the
general population. In the states where smoking reduction programs have been successful, theres
been a decrease in hospitalizations for heart disease.
The effects of quitting smoking are quite sudden. Your blood pressure will decrease, your
circulation will improve, and your oxygen supply will increase. These changes will boost your
energy level and make exercise easier. Over time, your body will begin to heal itself. After one
year of being smoke-free, your risk for heart disease will be reduced by 50 percent. In addition to
quitting smoking, you should avoid others who smoke, as secondhand smoke can also negatively
impact your health.