Understanding Heart Disease -- Diagnosis and Treatment

How Do I Know If I Have Heart Disease?

In diagnosing heart disease, a doctor will first ask you for a description of symptoms and your medical history. Your physical condition also will be assessed through a standard medical exam. Listening to the heart for swishing or whooshing sounds, collectively known as heart murmurs, may provide important clues about heart trouble. If heart disease is suspected, further tests are done to find out what is actually happening inside the heart.

An electrocardiogram, or ECG, is usually the first test to be performed. By recording electrical activity within the heart, the ECG quickly reveals any electrical abnormalities that may be a source of trouble or may indicate that the heart muscle has been or is being injured by ischemia (lack of oxygen-rich blood).

Further details can be gathered by taking images of the heart using X-rays, a variety of of other scans using CT, MRI or nuclear technology, or via angiography, a special technique that allows for detailed imaging of blood vessels. Echocardiograms (ultrasound evaluations of the heart) can also determine how well the heart and valves are working.

Other tests may include stress testing, with or without additional imaging of the heart, and sophisticated testing for arrhythmias (such as electrophysiology testing or EP testing).

 

What Are the Treatments for Heart Disease?

Medical care is essential once heart disease is diagnosed. The goals of treatment are stabilizing the condition, controlling symptoms over the long term, and providing a cure when possible.

Stress reduction, diet, and lifestyle changes are key in managing heart disease, but the mainstays of conventional care are drugs and surgery.

 

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Lifestyle and Your Heart

If you smoke, quit. You should also get in the habit of exercising, because exercise strengthens the heart and blood vessels, reduces stress, and has been shown to reduce blood pressure while also boosting HDL (good) cholesterol levels. Numerous studies done in recent decades indicate that drinking alcohol in moderation may actually reduce the risk of heart disease. But more than one drink a day for women, or more than one to two a day for men, is not recommended.

Learning to relax may help prevent and treat heart disease. While success varies from person to person, stress-reduction techniques have been shown to reduce high blood pressure, heart arrhythmias, and emotional responses such as anxiety, anger, and hostility that have been linked to coronary heart disease, angina, and heart attack. The choice of relaxation technique is up to you. Some that have proved beneficial are meditation, progressive relaxation, yoga, and biofeedback training.

 

Nutrition, Diet, and Your Heart

Even modest changes in diet and lifestyle can significantly reduce the risk of heart disease. Being overweight, especially in the mid-section, can lead to high blood pressure and diabetes. If you are 20% or more over the ideal weight for your age, height, and sex, you put a strain on your heart's ability to pump blood efficiently. Although lowering sodium and trans fat consumption are important for lowering blood pressure and reducing the risk of coronary heart disease, equally vital is increasing intake of fresh fruits and vegetables, and healthy sources of fats and proteins (as from fish, nuts, seeds, soy-based items, avocados, etc.) whole unprocessed high-fiber grains, and healthy sources of fats and proteins such as those from from fish, nuts, seeds, soy-based items, and avocados. 

A number of studies have found that a high intake of total fiber, from foods or supplements, lowers the risk of heart disease.

Although it’s best to get fiber from food sources, fiber supplements can also help you get the daily fiber you need. Examples include psyllium and methylcellulose.

Increase your fiber intake slowly to help prevent gas and cramping. It’s also important to also increase the amount of liquids that you drink.

 

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Treatment for Coronary Artery Disease

Drug treatments may include daily aspirin, and drugs such as ACE inhibitors and beta-blockers. Treatments may also target high blood pressure and high cholesterol -- two major risk factors for coronary disease. In addition, your doctor may recommend surgical treatments such as balloon angioplasty (usually using a stent to prop open the vessels) or open heart surgery to bypass blocked heart arteries.

Treatment for Heart Failure

Treatment usually depends on the cause of heart failure, but often includes drugs to help control symptoms, such as diuretics or water pills to flush the body of fluids, beta-blockers to block adrenaline’s action, and ACE inhibitors to help modulate sodium and potassium balance and improve blood pressure levels. Devices such as pacemakers and defibrillators are sometimes implanted to improve the heart's function and/or prevent deadly arrhythmias. In very advanced cases, heart transplantation may be a consideration.

 

Treatment for Heart Arrhythmias

Treatment depends on the type of arrhythmia you have, but can include drugs to normalize the heart rate, such as beta-blockers, many newer drugs to help convert your rhythm to normal, drugs to prevent blood clots (such as warfarin and dabigatran), and "cardioversion," a treatment that involves sending a strong electrical shock to the heart to convert the heart rhythm back to normal.

 

Treatment for Heart Valve Disease

In severe cases, patients may require medications to deal with heart failure, or surgery to repair or replace the abnormal valve.

Treatment for Pericardial Disease

Pericarditis often subsides on its own, but it also can be treated with anti-inflammatory drugs such as aspirin or, in severe cases, corticosteroid hormones. Occasionally, fluid must be drained from the pericardium using a long, thin needle inserted carefully through the chest. If a chronic condition develops, a pericardial window may need to be created surgically to permit this fluid to drain.

In the rare circumstance that pericarditis becomes a chronic condition, surgery may be needed to either create a pathway for the extra fluid to drain internally or remove the pericardial sac altogether.

Treatment for Cardiomyopathy (Heart Muscle Disease)

Treatment for cardiomyopathy will depend upon the underlying cause, but often includes the same measures used for patients with heart failure. The outcome is also dependent upon the underlying cause. In selected cases, heart transplant surgery may be recommended.

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Treatment for Congenital Heart Disease

Some minor conditions can actually clear up on their own, or can be treated easily with medications. Those that are more complex can often be treated surgically, if necessary. Very rarely, the heart problem is so severe that it cannot be corrected.

 

Dietary Supplements for Heart Disease

Several dietary supplements are being studied to determine if they effectively treat coronary heart disease. They include L-carnitine, coenzyme Q10, and garlic. So far, these are not recommended for use in treating or preventing heart disease.

Vitamins E and C have been studied extensively and do not appear to lower the risk of developing heart disease. In general, a person will derive the greatest benefits from vitamins and other micronutrients if they are consumed as part and parcel of whole foods.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on May 14, 2016

Sources

SOURCES: 

Myers, R., Heart Disease: Everything You Need to Know, Firefly Books Ltd, 2004. 

Verheugt, F.; Tonkin, A., "Artherosclerosis and Heart Disease," Taylor & Francis Group; 1st edition, 2003. 

WebMD Medical reference: "Heart Disease."

Uptodate.com: “Patient information: High-fiber diet (Beyond the Basics),” Arnold Wald, MD.

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