Questions and Answers about The Human Heart

How do you recognize heart disease and what are its causes? Is a woman as likely to be affected as a man? What about diet, exercise, housework, drinking and smoking after an attack? The answers to these questions and more may prevent serious harm and relieve anxiety.

Much confusion, anxiety and even harm may occur because a heart attack victim and his family fail to get sufficient guidance.

Their doctor may not have briefed them properly or they may have failed to remember everything told to them after visiting their doctor or after discharge from hospital. This article gives practical advice on heart disease – how to take away some of the fear and help the patient and his or her family comprehend more about it.

The questions you will find here have been asked by patients and are based on medical reports.

Heart attacks are often sudden and unexpected. Not uncommonly, they occur at an early age such as the mid-40s, even though the highest incidence is in the mid-60s.

They affect, and often disrupt, not only the life of the victim, but also the lives of the victim’s family. Angina pectoris – the chest pain that comes on effort, indicative of coronary heart disease – may also be devastating when severe.

Although for a long time coronary heart disease has been epidemic among us the toll has begun to decline. There is hope that the decline in deaths will continue to accelerate, not only because of better methods of treatment now available, but also because of a growing public awareness of the factors that cause death and how they can be minimized or eliminated.

To what extent are chest pain and heart disease related?

Pain in the chest can, and often does, accompany coronary heart disease. It is, in effect, the cry of an overburdened heart having to strain too hard in the face of the disease. But not by any means does all chest pain mean something is wrong with the heart. Many conditions – a wide variety – can produce a chest pain.

What is angina like?

Anginal pain may be felt as a vice-like, constricting sensation of the whole chest or of only the area behind the breastbone in the middle of the chest. Only rarely is it restricted to just one side of the chest. Often the pain travels to the neck, jaw, lower gums, cheeks, either shoulder, arms or hands, the middle of the abdomen or that part of the back between the shoulders.

There are variations. Occasionally there is no chest pain, and the pain occurs only between the shoulder blades or in the left hand or wrists, left arm or shoulder, pit of the abdomen, jaws or teeth or portions of the right arm. Sometimes the pain may go from chest to elbow or fingers. Sometimes it may Start in the arm and then be felt in the chest.

When does angina occur?

Usually after such activities as walking up a hill or up stairs. It may also occur while walking on a very cold winter day or carrying a load, during sexual intercourse, while watching an exciting television show or movie, raking leaves, vacuuming, making beds or during other strenuous activities. The pain may first be noticed under situations of strain, stress, anxiety, excitement, effort, after a heavy meal, or in cold windy weather.

How long does it last?

Angina usually lasts from less than a minute to 10 to 20 minutes, rarely more than 20 minutes. It almost always subsides within a minute if one stops the activity associated with its onset, unless it occurs during rest or sleep.

Where does the trouble lie?

The trouble lies with the nourishment supply for the heart. Though sufficient under routine circumstances, the supply isn’t adequate when there is a special demand on the heart because of vigorous activity or any kind of stress or strain.

When angina appears, it’s because the heart’s supply lines have been affected. The coronary arteries, which feed the heart itself with nourishing blood, have been attacked, narrowed – their blood carrying capacity diminished – by a process called atherosclerosis. Athero means soft swelling. Coronary artery disease starts with a soft swelling of the artery’s inner lining and progresses to hardening.

A healthy coronary artery is relatively small – a wooden matchstick would fit snugly inside. As atherosclerosis progresses, shrinking the internal diameter of an artery, there may be no symptoms for years. Enough blood flows through to meet the needs of the heart.

But at some point during the progression of the disease, the channel within the artery may be so narrowed and the blood flow reduced just enough to bring on the first attack of angina pectoris.

How could I know if I have atherosclerosis if I don’t have angina?

Because symptoms may not be obvious, you should have periodic examinations by your doctor. You – and your doctor – can be particularly watchful if certain risk factors are present. One of these risk factors is elevated blood pressure – hypertension. Another is excess weight. And others include elevated blood lipids or fats, excessive smoking, diabetes mellitus, sedentary living, personality factors that cause stress and possibly excess uric acid (gout) in the blood.

As I grow older is atherosclerosis more likely to be present?

Evidence that atherosclerosis is not only associated with advancing age came during the Korean War. Physicians performed postmortem studies on many soldiers killed in battle. The average age of these men was 22. Yet when the coronary arteries were opened and examined, atherosclerosis was found to be present. In 10 percent, the process had already narrowed by 70 percent or more the channel in one or both arteries.

Is a woman as likely to be as affected as a man?

Up to the age of 45, men have 13 times as many attacks as do women. Between that age and 62, men still have more – about twice as many. But after the age of 62, women are just as susceptible. Recent studies indicate that some younger women, particularly those who smoke and/or use oral contraceptives, may have increased susceptibility.

Isn’t the pain of angina much like that of a heart attack? Does it differ in any way? Can I know which is which?

The pain of a heart attack may be very similar to that of angina. Typically the pain that occurs with a heart attack – it may range from a feeling of pressure to a feeling that the chest is being crushed in a vice – lasts for hours and does not subside until a narcotic such as morphine is administered. So if you have angina and have been under medical treatment for it, and are using nitroglycerin pills, you can suspect – and should suspect in order to be safe – that you are experiencing a heart attack if stopping something you have been doing doesn’t help and if the symptoms persist even after taking the third nitroglycerin pill.

Reference: Angina (Chest Pain) at http://www.heart.org/en/health-topics/heart-attack/angina-chest-pain

Are there other symptoms with the pain?

Commonly there is a feeling of great anxiety, even of impending death. Also there is often a cold sweat and the face turns almost grey. There may be retching, belching or vomiting and sometimes these may cause a heart attack to be confused with a stomach upset.

Shortness of breath is not inevitable but is common. Sometimes a patient will gasp for air during an attack. In some cases, there are palpitations – sensations that the heart is beating abnormally hard and fast.

Why is immediate medical attention so important?

There is only one safe way to tell what is causing your chest pain or other symptoms – have a physical check right away. Medical attention without delay can be absolutely vital. In some cases, a few minutes have meant the difference between life and death – which is why most doctors urge patients to go immediately to hospital rather than wait for medical help at home.

Reference: Chest pain at https://www.mayoclinic.org/diseases-conditions/chest-pain/diagnosis-treatment/drc-20370842

How long will I be flat on my back?

Not nearly as long as you might suppose. Your heart of course has suffered some damage. Since it has to go on beating and pumping blood, it can’t have complete rest. But it is possible and desirable to give it some rest, to minimize demands on it and to help it recover and heal.

As soon as the pain of the attack subsides, you should – and you probably will be encouraged to – start on mild exercises. You should do them regularly and frequently – just moving your feet up and down, bending and unbending your knees, moving your arms.

How soon before I can engage in more vigorous activities?

After an uncomplicated heart attack, you should wait for about four weeks to two months before attempting more vigorous activities such as brisk walking and light calisthenics.

How long will I have to stay in hospital?

Usually for two or three weeks.

Is it all right to exercise or work after meals?

No. After meals, blood is needed by the organs that digest your food. The blood vessels supplying your stomach and intestines dilate and some of the blood that otherwise would be available to supply your heart muscle goes to the digestive system.

What about jogging?

It has become a popular form of exercise for cardiac patients, but you should try jogging only under the close supervision of a doctor.

When can I go back to work?

It’s usually advisable to wait for about two months until your heart muscle is adequately healed.

Can I return to the same job?

Chances are good that you can. As a rule, it’s best that you go back to the job you had before the heart attack if possible. By doing so, you return to a known situation and to friends on the job. At some point however, you should discuss the daily routine of your job with your doctor.

Can I resume housework after recovering from a heart attack?

Yes you can, but wait seven or eight weeks before doing so. Then if your doctor finds you well enough and if your heart attack was uncomplicated, it is perfectly all right. But start slowly, avoid sudden strains and do not work when you are upset. Should you get angina, sit down for a while and take a nitroglycerin tablet.

Are there household activities I should avoid?

Some heavy activities should be avoided, since they frequently trigger angina: scrubbing floors, turning mattresses, vacuuming, carrying heavy bundles, toting laundry baskets. Do not work for half an hour to an hour after a meal.

Work outdoors only when the temperature is moderate. If it is very cold or very hot, you are better off remaining indoors with heat or air conditioning until the outdoor temperature becomes intercourse should be as calm and restful as possible. Take it easy; don’t work too hard; don’t feel a need to prove something to your spouse.

May I drive after a heart attack?

If you have to drive in heavy traffic or in very cold or very hot, humid weather, or for long distances, your heart could be taxed. Otherwise you can probably start driving in 10 to 12 weeks.

May I drink alcohol?

There is little doubt that heavy drinking is bad for your heart as well as for most of the body. In the past few years, some cardiologists have come to believe that alcohol, even in small quantities, is bad for the heart.

May I go to parties, dance, resume a social life after recovering from a heart attack?

Your own reactions will guide you. If in the beginning you come home from work feeling fatigued, it’s wise to relax, have dinner and go to bed early. As you become accustomed again to work, fatigue is likely to diminish and finally disappear.

And when you can tolerate a day’s work and an evening of social activity, there is no reason why you shouldn’t enjoy doing so.

Can I smoke?

If you have had a heart attack or suffer from angina, smoking is not just hazardous but suicidal.

Should I change my diet?

If it was leading to excess weight or was high in saturated fats and cholesterol or both, you should definitely make changes. Eat small meals, never heavy, full course ones. Eat less, more often. Restrict salt intake, especially if you have high blood, sugar or congestive heart failure. Avoid excessive sugar too. Substitutes for sweets and salt can be used in moderation.

See: Cardiac Diet Guidelines For Your Heart

How much does inheritance really count?

If one or both of your parents, your brothers or sisters, or one or both of your grandparents had heart attacks at early ages, the odds are greater that you will have a similar experience unless you do something to reduce them. But it’s hardly a pure and simple matter of inheritance. It can be a matter of environment – acting on its own or interacting with inherited predispositions.

If I have hypertension will I know it?

Not necessarily because there may be no symptoms at all.

Why is hypertension dangerous?

For one thing, excessive pressure is a direct burden on the heart which has to pump harder against the pressure. To meet the task, the heart may enlarge.

See: What is Hypertension?

Can’t exercise be dangerous?

Any all-out, sudden burst of activity after many years – even just many months – of relative inactivity can be lethal, placing sudden great strain on the heart. Exercise that unduly elevates blood pressure and heart rate may be particularly dangerous.

What’s the significance of diabetes in heart disease?

Researchers have found that cholesterol levels tend to be higher in diabetics, that high blood pressure is nearly twice as frequent, and that about four out of five newly discovered adult diabetics are overweight. 46.5 percent of deaths in diabetics have been found to be caused by coronary heart disease.

Of what use are pacemakers?

Electronic pacemakers are now keeping the hearts of thousands of people beating well and regularly despite chronic heart disease. The electronic device starts the contraction or pumping action of the heart by sending a small electrical signal into the heart muscle by means of a small insulated wire called an electrode.

Under what conditions should by-pass surgery be considered?

When you suffer from intolerable anginal pain, with very frequent and severe attacks, with poor response to adequate medical care.

What are the limitations?

It would be nice if surgery could cure coronary artery disease. But it doesn’t. The underlying disease process – which leads to the development of clogging deposits in the arteries – is not something surgery can do anything for or about.

Oscar Roth

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