Understanding heart disease

What the term covers

Heart disease is an umbrella term for several conditions affecting the heart and its blood vessels. The most common is coronary artery disease, in which the arteries supplying the heart muscle gradually narrow with fatty deposits, reducing blood flow.

Other forms include heart failure (the heart pumps less effectively than it should), heart rhythm problems (arrhythmias), valve disease, and conditions people are born with (congenital heart defects). They differ in cause and treatment, but they share many risk factors and many of the same prevention strategies.

How coronary artery disease develops

Coronary artery disease develops over years. Cholesterol and other material build up in the artery walls, forming plaques that narrow the channel blood flows through. Symptoms may not appear until the narrowing is substantial.

A plaque can also rupture suddenly. When that happens, a clot can form and block the artery, cutting off blood to part of the heart muscle: that is a heart attack, and it is a medical emergency.

Angina - chest pain or pressure brought on by exertion or stress and eased by rest - is the classic warning symptom of narrowed arteries, though some people have no warning at all before a heart attack.

What raises the risk

The major risk factors are well established: high blood pressure, high LDL cholesterol, smoking, diabetes, physical inactivity, unhealthy diet, excess weight, and chronic stress. Age, male sex, and a family history of early heart disease add risk that cannot be changed.

Most of the list can be changed. Risk factors cluster and multiply each other, so improving several at once - stopping smoking while lowering blood pressure and moving more - pays off far more than addressing one in isolation.

Prevention, treatment, and emergencies

Prevention rests on not smoking, regular physical activity, a diet built around vegetables, fruit, whole grains, and lean proteins, keeping a healthy weight, and managing blood pressure, cholesterol, and diabetes - with medicines when lifestyle measures are not enough.

Treatment depends on the condition: medicines to control blood pressure, cholesterol, rhythm, or fluid buildup; procedures to open or bypass blocked arteries; devices for rhythm problems; and surgery for some valve and structural diseases.

Possible heart attack symptoms - chest pressure or pain spreading to the arm, neck, or jaw, shortness of breath, cold sweat, nausea, or sudden extreme fatigue - warrant emergency help immediately, not a wait-and-see approach. Minutes of delay cost heart muscle.