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 - Northwestern Memorial Hospital - Chicago

Mini-Med School: The Heart Q & A

Prevention

Question: Please explain why some doctors recommend Aspirin. Is it helpful? And if so, what dose should be taken and what kind?
Answer: Aspirin is effective in relation to the prevention of heart disease and stroke due to its ability to decrease platelet aggregation. If less platelets aggregate or gather in an area of a vessel with plaque or damage the chance of a clot or blockage is reduced. Dosage is usually 81mg-325 mg and should be determined and ordered by your health care provider.

Question: BMI does not reflect the percentage of muscle to fat, but isn’t that information important for assessing cardiac disease risk?
Answer: BMI is a starting point for evaluating where you are on the spectrum of a healthy body weight. It is one of the first steps in assessing cardiac disease risk.

Question: What plays a bigger role in heart health – genetics, exercise, eating habits (i.e. beef vs. veggies)?
Answer: They all play a role. Each person is unique and their unique genetic profile may make them more or less “heart-susceptible” to certain lifestyle choices. The best thing you can do is to see a health care provider regularly, exercise, eat well, manage stress and be alert to changes in your body and well-being.

Question: Why do women have increased lipid levels after menopause? Does it relate to hormones?
Answer: Yes, there seems to be cardioprotective effect that estrogen offers most women. Estrogen production ceases after menopause and therefore post-menopausal women lose this cardioprotective effect and their LDL and HDL especially can rise.

Question: If you haven’t smoked in twenty years, is your risk level for heart disease still increased? (What is the role of a previous history of smoking and risk for heart disease?)
Answer:
One of the most important things you can do to protect your heart and blood vessels (and lungs of course) is to quit smoking! The fewer years and less amount of cigarettes you smoked the better. If you smoked, your risk is never completely erased but it is greatly decreased. The sooner you quit, the better.

Definitions

Question: What is atrial fibrillation?
Answer: Atrial fibrillation is an arrhythmia or a disruption of the normal functioning of the electrical conduction system of the heart. Normally, the atria and ventricles contract in a coordinated manner. In atrial fibrillation and flutter, the atria are stimulated to contract very quickly and differently from the normal activity. This results in ineffective and uncoordinated contraction of the atria which means reduced cardiac blood flow.

Question: Are heart failure, heart attack, and cardiac arrest the same?
Answer: No.

Heart failure means the heart has less pumping ability and cannot meet the body’s demand for blood and the nutrients the blood brings.

A heart attack or myocardial infarction means that part of the heart tissue has been damaged.

Cardiac arrest means stopping of the heart.

Question: Why is there a connection between CAD and diabetes?
Answer: When glucose management in the body is impaired, such as in diabetes, vascular changes and damage can occur. Damage from diabetic related vascular changes can affect many body systems including the cardiac system.

Evaluation and Diagnostic Testing

Question: Without any symptoms, disease, or family history of disease, what heart tests are recommended?
Answer: None are routinely recommended. See your health care provider regularly or sooner if there is a change in your health status.

Question: Should an ultrasound, angiogram, or EKG be done as a routine test?
Answer: For a normal person without cardiac symptoms or history, no.

Question: Other than an echocardiogram, what technologies are helpful for visualizing heart valve problems, and what are the advantages and limitations of each?
Answer: Sometimes a transesophageal echocardiogram (TEE) is ordered. A TEE uses high-frequency sound waves (ultrasounds) to look at the structures of the heart. Pictures are taken by a probe inserted into the esophagus, the tube that carries food from the mouth to the stomach. Since the probe sits directly behind the heart, it allows certain parts of the heart to be seen more clearly than with a standard echocardiogram. Also see the answer to the next question.

Question: Tell me about the 64 slice CT scan (heart scan) and if it can detect early arteriosclerosis in the walls?
Answer: The 64 slice Computes Tomography Angiography (64 slice CTA) is a new, state-of-the-art, non-invasive, diagnostic tool that visualizes the myocardium (heart), aorta, lungs and coronary circulation. It can help to diagnose coronary artery disease (CAD), dissections and aneurysms of the aorta, and atrial fibrillation. The 64 slice CTA produces near perfect, three dimensional, high quality diagnostic images of the heart, aorta, lungs, and coronary circulation.

Question: Is there a relationship between sleep apnea and cardiovascular disease?
Answer: The classic picture of obstructive sleep apnea includes episodes of heavy snoring that are interspersed with periods of silence or apnea. During the apneas, the oxygen level in the blood falls. Persistent low levels of oxygen (hypoxia) can cause many problem in the cardiovascular system. If the condition is severe enough, pulmonary hypertension may develop leading to right sided heart failure (cor pulmonale). Quite often persons with sleep apnea are obese, another risk factor for CV disease. Weight loss is an important factor for management of both sleep apnea and CV disease.

Question: What is Ejection Fraction?
Answer: Ejection fraction is measurement of the volume of blood ejected from the left ventricle with each contraction or more simply, the percent of blood the heart squeezes out in one beat. A normal ejection fraction is between 50 and 70 percent. A low ejection fraction is often less than 40 percent.

Question: What causes high blood pressure?
Answer: Blood pressure is determined by the amount of blood pumped by the heart, and the size and condition of the arteries. Many other factors can affect blood pressure, including volume of water in the body; salt content of the body; condition of the kidneys, nervous system, or blood vessels; and levels of various hormones in the body. "Essential" hypertension has no identifiable cause. It may have genetic factors and environmental factors, such as salt intake or others. Essential hypertension comprises over 95% of all high blood pressure. "Secondary" hypertension is high blood pressure caused by another disorder. This may include: kidney disorders, metabolic disorders, & medications.

Question: How do blood pressure pills reduce hypertension?
Answer: Medications may include diuretics, beta-blockers, calcium channel blockers, &angiotensin/rennin blockers. They affect volume of water in the body, hormones, and blood vessel tone.

Question: Please compare the effectiveness and efficiency of the ECHO to the ECG in detecting heart ailments or disease
Answer:  An echocardiogram is performed to evaluate the valves and chambers of the heart in a noninvasive manner. The echocardiogram allows doctors to evaluate heart murmurs, check the pumping function of the heart (see ejection fraction above), and evaluate patients who have had heart attacks. It can also identify infection in the heart valves.

An ECG is used to measure the rate and regularity of heartbeats as well as the size and position of the chambers, the presence of any damage to the heart, and the effects of drugs or devices used to regulate the heart (such as a pacemaker).

Treatment

Question: What causes the depression that can follow the diagnosis of heart disease in many people?
Answer: The exact cause is not clear. Again it varies from person to person. Theories include depression can be caused by the stress response to illness and the need for lifestyle change post-illness or as a side effect of some heart medications. It is important to let your loved ones and health care providers know if you feel depressed or down. They can help you through the adjustment phase.

Question: Stents have become a popular way to treat clogged arteries. Is there any safety difference in getting a drug coated stent vs. a regular bare metal stent?
Answer: Drug-eluting stents have greatly reduced the risk of repeat blockage of heart arteries, but researchers from Northwestern Memorial Hospital have found that in some patients the stents can cause allergic reactions that can have serious consequences. They stress that physicians and their patients should be aware of this potential and know the symptoms.

Question: What can be done if a patient cannot take an ACE product due to a persistent cough?
Answer: If a person cannot tolerate a medication because of its side effects, such as a cough with ACE inhibitors, the medication is usually stopped and replaced with a different type of medication.

Question: Does lowering hypertension with medication affect the risk of cardiovascular disease?
Answer: Yes, lowering blood pressure to normal levels decreases one’s risk for heart disease greatly.

Electronic Devices

Question: If a person does not have a pacemaker, where does the electrical “pressure” come from?
Answer: From the electrical conduction system in the heart which consists of the sinoatrial node the atrioventricular node and the purkinge fibers. This essentially is the electrical wiring of the heart!

Question: When would a pacemaker be recommended?
Answer: When a person has too slow of a heart rate, or bradycardia.

Question: How do you know if you are a good candidate for an implantable defibrillator?
Answer: The implantable cardioverter defibrillator (ICD) is a device that can protect you against dangerous abnormal heart rhythms by constantly monitoring your heart rhythm. The ICD is able to detect ventricular tachycardia (VT) or ventricular fibrillation (VF). These two heart rhythms can be life-threatening if they are not treated.

Research:

Question: Does Northwestern do any research on heart failure?
Answer: Yes, there are several current studies. Call 312- 926-4000 for more information.

Websites For Further Study 

Bluhm Cardiovascular Institute at Northwestern Memorial Hospital 
Comprised of cardiologists, cardiac surgeons, vascular surgeons, cardiovascular anesthesiologists, specialists in cardiac behavioral medicine and radiologists, Bluhm Cardiovascular Institute provides innovative care for all aspects of cardiovascular diseases and conditions.

Heart Center Online
http://heart.healthcentersonline.com/)
Includes resources on heart and blood vessels disease including diagnosis, treatment, and prevention.

MedlinePlus: Coronary Disease
(http://www.nlm.nih.gov/medlineplus/coronarydisease.html)
National Library of Medicine's site specifically for consumers, a portal for government-sponsored health information.

American Heart Association
(http://www.americanheart.org/)
Includes eating plans, dietary recommendations, and sample recipes.

Delicious Decisions
(http://www.deliciousdecisions.org/)
A nutrition website by the American Heart Association

For more information, visit or contact the Health Learning Center:

251 East Huron
Galter Suite 3-304
312-926-5465
hlc@nmh.org

Last UpdateMarch 5, 2012
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