Q: What is Coronary Artery Disease? A: Coronary artery disease also known as atherosclerosis is a disease of the heart arteries. This is a build up of plaque or fatty deposits inside the artery. This build up of plaque can block the flow of blood to the heart causing chest pain, heart attack, or other symptoms of heart disease. Coronary artery disease can be reduced by changes in diet and lifestyle as well as with some medications. To diagnose coronary artery disease you may be asked to undergo an angiography procedure (heart catheterization). The angiography is done in the catheterization laboratory at the hospital. During this procedure the patient is sedated and a small sheath (short hollow tube) is inserted through a puncture site in the groin area (femoral artery). Through this sheath a catheter is maneuvered to the heart arteries where a special dye is injected and x-ray pictures can be taken of the heart arteries. If treatment is needed, the interventional or non-surgical procedures can be done through this sheath. Treatment for coronary artery disease can be done surgically by coronary artery bypass graft surgery (CABGS) or non-surgically by percutaneous coronary intervention (PCI). These non-surgical procedures, which can be done in the catheterization laboratory, are listed in Procedures. Q: What is Peripheral Vascular Disease? A: Like the heart arteries plaque can build up in any artery of the body. PVD is plaque build up in the arteries supplying blood to the arms, leg and brain. Risk factors that contribute to PVD are smoking, high blood pressure, family history, high cholesterol, and diabetes. Symptoms of PVD to the legs are claudication (pain in the legs especially when walking that is relieved when resting), numbness or tingling in the legs or feet, coldness in the legs or feet, and/or ulcers of the legs or feet that do not heal. The non-surgical treatment for peripheral vascular disease is balloon angioplasty and stenting. Are You At Risk For Heart Disease? Risk factors can be divided into two categories: * Risk factors you can't do anything about * Risk factors you can do something about Need To Know: People who have more than one risk factor for coronary heart disease may be at much greater risk for CHD than people with no risk factors. For example, a person who has a high cholesterol A fat-like substance needed for the development body cells. Cholesterol is both produced by the body and found in animal foods. Although it is a necessary substance, if levels of cholesterol are too high it can be deposited on the artery wall, narrowing or blocking blood flow and leading to coronary heart disease. level and smokes two packs of cigarettes a day may have as much as a 10 times greater chance of having a heart attack as a non-smoker with normal blood cholesterol. Risk Factors You Can't Do Anything About Some risk factors for coronary heart disease (CHD) are beyond your control. Remember that having an uncontrollable risk factor for CHD does not mean that you are destined to develop CHD. It does mean, however, that you should do what you can to care for your heart's health. * Age: The older you get, the more likely you are to develop CHD * Race: Black individuals are more likely than white individuals to develop CHD because they develop high blood pressure (hypertension) more often. High blood pressure increases risk for CHD. * Gender: Middle-aged men have a higher risk of CHD than middle-aged women do. The risk of CHD is similar in postmenopausal After menopause, or the permanent cessation of menstrual periods in women. women and in men. * Heredity: The genetic make-up of some individuals increases their chances of developing CHD. Risk Factors You Can Do Something About * High cholesterol levels: High levels of blood cholesterol (hypercholesterolemia) contribute to the build-up of plaques When used in regard to atherosclerosis, this term describes the yellow and swollen areas of the inner layer of arteries that are thickened by the deposition of fatty substances (lipids and cholesterol) and fibrous tissue. that can clog the blood vessels leading to the heart, narrowing them and potentially blocking blood flow to the heart. * High blood pressure (hypertension): High blood pressure strains the heart and increases wear and tear on the blood vessels, making blockage more likely. For further information on high blood pressure, go to High Blood Pressure. * Smoking: The Surgeon General of the United States has stated that cigarette smoking is the most important of the known modifiable risk factors for CHD. Nicotine A toxic chemical found in cigarette smoke. in cigarettes speeds up the heart and also narrows the arteries, making it harder for enough blood to get through. * Being overweight: According to the American Heart Association guidelines, obesity is a major risk factor for CHD. Obesity increases blood pressure, blood cholesterol levels, and the risk of diabetes A condition in which the body can't use carbohydrates well. It is caused by a complete (type 1 diabetes) or relative (type 2 diabetes) deficiency of the hormone insulin, which acts as the key that allows sugar to enter cells. Without enough insulin, glucose (sugar) remains in the blood and can't enter the cells to provide energy. , and may directly contribute to CHD. * Inactivity: When you are inactive, your circulation is less efficient, increasing risk of blood vessel A tube conveying blood; an artery, capillary, or vein. blockage. * Stress: Stress can increase blood pressure in some individuals. Need To Know: People who suffer from diabetes - either insulin-dependent or non-insulin-dependent - are also at a higher risk of developing CHD. Diabetes accelerates blockage of blood vessels. People with diabetes are also more likely to have high blood cholesterol levels and high blood pressure. Although diabetes cannot be cured, people with diabetes can significantly reduce their risk of CHD by controlling their diabetes. How Can You Reduce Your Risk For Heart Disease? In order to reduce your risk of coronary heart disease (CHD), you first must identify what may be putting you at risk. Determine if you're at risk by reviewing your lifestyle and diet. Ask your physician to check your blood cholesterol level. If you have only one uncontrollable risk factor, smoking or being overweight could make it worse. Even if you are at risk for coronary heart disease, you can eliminate many of the major risk factors for CHD by making simple changes in diet and lifestyle. These changes are healthy for the entire family and reduce your risk of other diseases as well. They include: * Control your cholesterol level * Control high blood pressure (hypertension) * Stop smoking * Lose weight if you need to * Get active * Manage stress How-To Information: Making changes It is all too easy to hear some suggestions, tell yourself "that makes sense-I'll do it," and then forget all about it. A systematic approach to change can help you make gradual progress towards health, one step at a time: 1. Find your starting point. Keep a diary for a few days to record your normal food intake or patterns of exercise. What needs to change? 2. Once you have identified your problem, make a commitment to change. 3. Develop a plan for change. How will you start to make a change? If many changes are required, which one will you make first? 4. Check up on yourself to see how well you are carrying out and keeping up the changes. Keep a food and exercise diary or schedule weekly weight checks. 5. Ask friends and family for support. Schedule a daily walk with a friend, or plan low-fat, high-fiber meals with your spouse. 6. Reward yourself. When you reach a goal - say, a month without a cigarette, or losing 5 pounds - indulge in that book you've been wanting to buy, a new CD by your favorite musician, or new clothes. Don't expect to embark on four- or five-change campaigns at the same time. However, there is plenty of overlap. For example, a regular exercise program will help improve your health in many ways: exercise also helps lower your cholesterol, reduce blood pressure, and boosts your cardiovascular fitness. When making changes, you need to pace yourself. Make adjustments to your way of living in whatever order is easiest and don't rush. Gradual changes are more likely to be permanent than rapid and drastic ones. If you need more help, check out local libraries, bookstores, and organizations such as the YMCA. Your local chapter of the American Heart Association) can also offer a wealth of resources to help you make the changes you need. Nice To Know: Other Health Benefits Changes such as low-fat eating, regular exercise, not smoking, and maintaining a healthy body weight will help you feel better, look better, and have more energy. Besides reducing your risk for coronary heart disease, you'll also reduce your risk for: * Certain kinds of cancer * Diabetes A condition in which the body can't use carbohydrates well. It is caused by a complete (type 1 diabetes) or relative (type 2 diabetes) deficiency of the hormone insulin, which acts as the key that allows sugar to enter cells. Without enough insulin, glucose (sugar) remains in the blood and can't enter the cells to provide energy. * High blood pressure * Stroke * Osteoporosis (a condition in which the bones become weak and susceptible to fractures) Even if your risk for coronary heart disease is high, you can reduce that risk immediately by changing your diet, exercise, and smoking habits. And since a low-fat diet rich in fruits, vegetables, and whole grains is appropriate for all people 2 years of age or older, your entire family can benefit. What You Should Know About Cholesterol Cholesterol is necessary for our bodies to function, and it is found in every cell in our body. About 80 percent of the cholesterol in our bodies is manufactured by the liver, while the other 20 percent comes from the foods that we eat. However, a diet high in cholesterol can cause our bodies to make too much cholesterol, resulting in high levels of blood cholesterol. When blood cholesterol levels get too high, it can clog arteries and increase our risk for coronary heart disease. What is cholesterol? How does high cholesterol increase your risk of coronary heart disease? The different types of cholestero What affects blood cholesterol levels? Do all types of fats raise blood cholesterol levels? Does cholesterol in foods raise blood cholesterol? What Is Cholesterol? Cholesterol is a waxy substance that is made in our bodies by the liver. Cholesterol forms part of every cell in the body. Our bodies need cholesterol to: * Maintain healthy cell membranes * Make hormones Chemical substances formed in one part of the body that are carried in the blood to another part of the body before they act. * Make vitamin D * Make bile acids Any of several types of acids found in bile (a yellow or greenish alkaline fluid secreted by the liver); it aids in the absorption of fats. , which aid in fat digestion Sometimes, however, our bodies make too much cholesterol. When we eat too much saturated fat - the kind of fat found in hardened fat products like most margarines, vegetable shortening, and animal-based foods such as meat and dairy products - our bodies can make too much cholesterol. We also get cholesterol from the foods we eat. Only animal-based foods such as meat, eggs, and dairy products contain cholesterol. Plant foods do not contain cholesterol A fat-like substance needed for the development body cells. Cholesterol is both produced by the body and found in animal foods. Although it is a necessary substance, if levels of cholesterol are too high it can be deposited on the artery wall, narrowing or blocking blood flow and leading to coronary heart disease. . How Does High Cholesterol Increase Your Risk For Heart Disease? When we get too much cholesterol - either because our body makes too much or because we eat too many foods rich in saturated fat - the surplus cholesterol circulates in the bloodstream. * Deposits of cholesterol and other fat-like substances can build up in the inner lining of these blood vessels and become coated with scar tissue, forming a cholesterol-rich bump in the blood vessel A tube conveying blood; an artery, capillary, or vein. wall known as plaque. * Plaque build-up narrows and hardens the blood vessel; a process called atherosclerosis A narrowing and hardening of blood vessels caused by a build-up of plaque., or hardening of the arteries. Need To Know: A high blood cholesterol level is especially dangerous for smokers and those with high blood pressure. The Different Types Of Cholesterol Cholesterol travels through the body in packages called lipoproteins, which consist of cholesterol and proteins. Some lipoproteins contain another type of fat, called triglycerides Another type of blood fat that can also block blood vessels and lead to coronary heart disease.. * High-density lipoproteins (HDLs) contain mostly protein * Low-density lipoproteins (LDLs) contain mostly cholesterol * Very-low-density lipoproteins (VLDLs) contain mostly cholesterol and triglycerides. Not all cholesterol is harmful. High-density lipoprotein (HDL) cholesterol is a good type of cholesterol that actually helps to remove cholesterol from the walls of arteries and transports it to the liver for elimination. HDL cholesterol helps the body get rid of low-density lipoprotein (LDL) cholesterol and very-low-density lipoprotein (VLDL) cholesterol, the bad types of cholesterol that are most likely to clog blood vessels. LDL and VLDL are commonly known as "bad" cholesterol and HDL as "good" cholesterol. Need To Know: You should also have your blood level of another type of fat, triglycerides, measured at the same time you have your blood cholesterol levels checked. High blood triglyceride levels can also increase risk for coronary heart disease. Fortunately, these levels can be quickly lowered with weight control and more exercise. What Affects Blood Cholesterol Levels? Many things affect the cholesterol A fat-like substance needed for the development body cells. Cholesterol is both produced by the body and found in animal foods. Although it is a necessary substance, if levels of cholesterol are too high it can be deposited on the artery wall, narrowing or blocking blood flow and leading to coronary heart disease. level in your blood: * What you eat: You can lower your cholesterol level by cutting down on animal fat and other fats and eating foods rich in starch and fiber, such as fresh fruits, vegetables, and whole grains. * Your hormones: Women get a natural boost in their HDL cholesterol from their hormones until they reach menopause. After menopause, taking estrogen The general term for the female sex hormone responsible for developing and maintaining female secondary sex characteristics. Estrogen is a key component of women's monthly menstrual cycles. can help maintain higher HDL cholesterol ("good" cholesterol) levels. * Medications: For most people, diet and exercise is the best way to control cholesterol levels. For some individuals, doctors may prescribe medication to reduce blood cholesterol levels, especially if high levels of cholesterol run in your family. * Other factors: Being overweight, inactive, and smoking all increase levels of the harmful type of cholesterol. Do All Types Of Fats Raise Blood Cholesterol Levels? There are three main types of fats in food: * Saturated fat: A type of fat found in animal foods like beef, pork, lamb, and dairy products; in tropical oils such as palm and coconut oil; and in vegetables oils that have been chemically changed to make them solid at room temperature (a process called hydrogenation). * Monounsaturated fat: A type of fat found in plant oils such as olive oil and canola oil. * Polyunsaturated fat: A type of fat found in plant oils such as safflower, sunflower, corn, or soybean oil. Although all fats are concentrated sources of calories and can contribute to weight gain (and thus, high blood cholesterol levels), saturated fat is the most harmful. Saturated fat is the main cause of high blood cholesterol levels. When you eat it, your body may react by making more cholesterol than it needs, and the surplus ends up in your blood. Nice To Know: Fish, especially cold water fish, contain a special type of polyunsaturated fat called omega-3 fat that may help protect against coronary heart disease by slowing blood clotting. Does Cholesterol In Foods Raise Blood Cholesterol? Although a diet high in saturated fat is the main cause of high blood cholesterol levels, high cholesterol in the diet can also raise blood cholesterol levels. Like people, animals also make cholesterol and carry cholesterol throughout their bodies. If we eat meat or dairy products, we cannot avoid cholesterol. If you eat modest amounts of lean meats and dairy products, your cholesterol intake will not be too high. However, you should limit foods such as egg yolks and liver, which contain high amounts of cholesterol. Is Your Blood Cholesterol Level Too High? The risk for coronary heart disease (CHD) increases with rising blood cholesterol levels. When blood cholesterol exceeds 220 ml/dl (milligrams per deciliter-the units blood cholesterol is measured in the United States), risk for CHD increases at a more rapid rate. All adults should have their blood cholesterol level measured at least once every five years. If your blood cholesterol level is: * Below 180-then your blood cholesterol level is ideal * 180-199-then your blood cholesterol level is acceptable * 200-219-then your blood cholesterol level is borderline high * 220 or higher-then your blood cholesterol level is too high If your total blood cholesterol level is greater than 200 (and especially if it is over 220), you should have another test to see what type of cholesterol A fat-like substance needed for the development body cells. Cholesterol is both produced by the body and found in animal foods. Although it is a necessary substance, if levels of cholesterol are too high it can be deposited on the artery wall, narrowing or blocking blood flow and leading to coronary heart disease. is high. If your HDL cholesterol level is: * Under 35, then it is too low * 36-50, then it is acceptable * Over 50, then it is ideal If your LDL cholesterol level is: * 130 or less, then it is ideal * 130 to 159, then it is borderline high * 160 or greater, it is too high How much fat and cholesterol are you eating now? How you can eat less saturated fat and cholesterol How you can easily cut your fat intake How you can eat more starches and fiber How Much Fat And Cholesterol Are You Eating Now? Below is a quick self-assessment to help you find out how much saturated fat and cholesterol you eat now and what changes you might need to make. Answer the following questions: How many eggs do you eat weekly? more than 3 2 to 3 1 or less How often do you eat red meat (beef, pork, or lamb) weekly? 5 or more 3 to 5 2 or less What kind of milk do you drink? whole low-fat 1% or skim How often each week do you eat cheese or ice cream that is not low fat? 5 or more 3 to 4 2 or less How often each week do you eat baked goods like doughnuts, pastries, or cookies? 4 to 5 2 to 3 1 or less Including breakfast, lunch, and dinner, how many meals do you eat weekly which do not contain any red meat, eggs, or cheese? 5 or less 6 to 13 14 or more As you can guess, the ideal way of eating is shown in the right-hand column. This type of diet may even be low enough in fat and cholesterol to help reverse artery blockage, and it will certainly help prevent the build-up from starting. The eating patterns of most Americans fall in the center or left-hand columns. For some people, the right-hand column may look almost out of reach, but anything you can do to work toward the goal will be helpful. Remember that gradual change is more likely to be permanent, so don't feel you must make many drastic changes all at once. How You Can Eat Less Saturated Fat And Cholesterol To reduce your fat and cholesterol intake in your diet, start with changes that are relatively easy to make. For example, many people find it easy to switch from 2% milk to 1% or skim milk. Once you have adjusted to one change, pick another change to work on. How-To Information: Here are some simple changes that will help you greatly reduce saturated fat and cholesterol in your diet. Egg yolks: * Eat no more than three eggs yolks weekly * Eat as many egg whites as you like-they contain no cholesterol Meats: * Buy lean meats such as fish, poultry, veal cutlet, pork tenderloin, or flank steak. * Trim as much fat off meat as possible. * Broil, barbecue or roast meat on a rack rather than fry it. This allows some of the fat to escape during cooking. * Limit the amount of hamburger you eat, and buy the leanest type available. * Replace high-fat prepared meats like sausage and luncheon meats with lower-fat meats like lean turkey or chicken. * Remove the skin from chicken or turkey before you cook or eat it. * Try to eat fish twice weekly. Fish contains a type of fat called omega-3 fat that may help prevent CHD. Dairy products: * Use margarine instead of butter, choosing a margarine that has a liquid oil rather than a hydrogenated oil listed as the first ingredient. * Choose lower fat milk. If you use whole milk, switch to 2%. If you use 2%, switch to 1% or skim milk. All types of milks have the same amount of calcium and other vitamins and minerals. * Use non-fat or low-fat yogurt. * Use plain non-fat yogurt instead of sour cream. * Cut down on the amount of regular cheeses you eat. Look for lower fat cheese, which contain less than 3 grams of fat per ounce. * Sprinkle a little Parmesan cheese on food to give it a cheesy taste. Parmesan cheese is strong tasting, so a little goes a long way. Tropical oils and processed oils: * Check food labels to see what the main type of fat in the food is. Limit foods that list contain palm oil, coconut oil, or hydrogenated oil as one of the first type of fats. (Food labels list ingredients in order from greatest to least by weight. * Be suspicious of commercial baked goods such as donuts, sweet rolls, brownies, and cookies, which are a major source of saturated fat. Nice To Know: About 60 percent of the saturated fat in the American diet comes from three food sources: hamburger, cheese, and whole milk. Cutting down on these foods, or cutting them out, can go a long way toward helping you cut down saturated fat and cholesterol. How You Can Easily Cut Your Fat Intake Ounce for ounce, fat contains more than twice the calories that protein or carbohydrate do. So although saturated fat is the type of fat most damaging for your heart, you should limit intake of all fats. Eating too much fat, no matter what kind, can make you put on excess weight. Eating too much fat can also increase your risk of certain types of cancer, such as breast or colon cancer. How-To Information: To limit your total fat intake: * Broil, bake, boil, or roast foods rather than fry. * Use non-stick pans or coat pans with a thin layer of non-stick spray. * Add less fat to food during both cooking and eating. Some examples include jam instead of margarine on toast, a non-fat or low-fat salad dressing instead of a high-fat dressing, lemon juice instead of butter on vegetables, or salsa instead of sour cream on baked potatoes. * Experiment with butter substitutes, spices, and other flavorings as alternative to fat. * Look for low-fat alternatives to foods, such as a bagel instead of a doughnut, pretzels instead of potato chips, or a round steak instead of a T-bone steak * Try new fat-free products like yogurt, cookies, or crackers. * Read labels, which offer excellent information to help you compare fat content of prepared foods. How You Can Eat More Starches And Fiber Including more starches and fiber in your diet can help you lower your cholesterol level as well as reduce your risk for obesity, cancer, high blood pressure, and other diseases. Fresh fruits and vegetables and unprocessed grain products such as whole-grain breads and cereals are naturally low in fat, cholesterol-free, and rich in starches and dietary fiber. For more information about fiber and your diet, go to Fiber: Its Importance In Your Diet. A certain type of dietary fiber, called soluble fiber The type of fiber that can help reduce blood cholesterol levels. Foods such as oat bran, dried beans, and some fruits are high in soluble fiber., may help lower cholesterol levels by sweeping cholesterol out of the body before it gets into the bloodstream. Foods rich in soluble fiber include oat bran, dried beans and peas, some fruits, and psyllium seeds (the main ingredient in the laxative Metamucil). Fruits and vegetables also contain antioxidants Substances in fruits, vegetables, whole grains, nuts, and seeds that can help prevent or slow build up of cholesterol and other fat-like substances in the arteries. Vitamins C and E and beta-carotene are all antioxidants that help protect against coronary heart disease., which are substances such as vitamin C (in citrus fruits), beta-carotene (in carrots), and vitamin E (in vegetable oils) that help protect body cells from damage. Antioxidants help prevent cholesterol from being moved out of the blood and into the lining of the blood vessels. The U.S. Department of Agriculture's Food Guide Pyramid recommends that you eat the following number of servings of these plant foods daily: * 6-11 servings of grains (1 serving equals 1 slice of bread, ½ of a bun, ½ cup of pasta or rice) * 3-5 servings of vegetables (1 serving equals 1 cup of raw leafy vegetables or ½ cup cooked vegetables) * 2-3 servings of fruits (1 serving equals 1 medium apple, peach or orange; ½ cup of berries; or 3/4 cup juice) How-To Information: To include more starches and fiber in your diet: * Keep a food diary showing the number of servings of fruits, vegetables, and grains you get daily. If you are low, gradually try to increase servings of the groups lacking by adding fruits, vegetables, or whole grains as side dishes or snacks. * Buy breads and cereals that list a whole grain as the first ingredient. Whole grains contain more fiber and vitamins and minerals * Whenever possible, choose raw fruits and vegetables rather than processed ones. * Steam vegetables until crisp-tender rather than boiling them to death. * Whenever possible, leave skin on fruits and vegetables. * Add lemon juice, butter flavoring, or other seasoning to vegetables rather than fat. * Include several meatless meals weekly. Start with breakfasts, and then gradually add two or three lunches or dinners weekly. Need To Know: Sometimes these efforts to lower your cholesterol may not be enough. Your doctor may need to add medication. For more detailed information on lowering your cholesterol, go to Lowering Cholesterol. What You Should Know About Reducing Blood Pressure High blood pressure is a major risk factor for coronary heart disease. One in four Americans has high blood pressure, and many of them are unaware of it. Although high blood pressure can usually be controlled with a combination of dietary and lifestyle changes and medication, most people with high blood pressure do not control it. What is high blood pressure? How does high blood pressure increase your risk for heart disease? Is your blood pressure too high? What factors increase your risk for high blood pressure? How you can lower your blood pressure What Is High Blood Pressure? Blood that travels through your body is always under pressure, which is why it keeps circulating. But if blood pressure goes up and stays high, it is called high blood pressure, or hypertension. Usually, the term "hypertension" is used to mean increased pressure in the blood vessels that carry blood from the heart to the rest of the body. High blood pressure can be the result of narrowed arteries and/or excess fluid circulating in the bloodstream. Think of your arteries as a garden hose. If you try to force more water through the hose or put a crimp in the hose, water pressure increases. Likewise, when your arteries are narrowed or more fluid is flowing through them, the blood exerts more pressure on the artery walls, causing high blood pressure. For more information about high blood pressure and how you can control it, go to High Blood Pressure. How Does High Blood Pressure Increase Your Risk For Heart Disease? When your blood pressure is too high, your risk for CHD increases because: * Your heart has to work harder to force blood into the arteries that carry blood to every part of your body. Your heart may become enlarged and less efficient as a result. * The extra pressure on arterial walls can damage them. Cholesterol A fat-like substance needed for the development body cells. Cholesterol is both produced by the body and found in animal foods. Although it is a necessary substance, if levels of cholesterol are too high it can be deposited on the artery wall, narrowing or blocking blood flow and leading to coronary heart disease. and other fat-like substances can catch on the rough surface of the damaged arterial walls, speeding up the process of atherosclerosis A narrowing and hardening of blood vessels caused by a build-up of plaque.. High blood pressure is especially dangerous for people who smoke or who have high blood cholesterol levels. Is Your Blood Pressure Too High? Everyone should have his or her blood pressure checked at least every two years, and more often if it is higher than it should be. Many people have high blood pressure without even knowing it, because high blood pressure usually causes no symptoms. If you can't have your blood pressure measured by a health professional, you can use a blood pressure machine found in many drug stores as an early alert system. Sit quietly for a few minutes before you start the machine and don't talk while the machine is on. If the machine shows that your blood pressure is on the high side, have your blood pressure checked by a health professional. Two numbers express blood pressure. The first and higher number, systolic blood pressure The peak (highest) pressure that occurs in the aorta when the heart contracts. It averages about 120 mm Hg in healthy adults. Blood pressure is usually read as systolic/diastolic. , measures the pressure when the heart is actually beating. The second and lower number, diastolic blood pressure The lowest level of pressure in the aorta that occurs when the heart is in between beats. It ranges between 70-80 mm Hg in healthy adults. Blood pressure is usually read as systolic/diastolic. , measures the pressure between beats of the heart. A typical normal blood pressure is 120/80, or "120 over 80." If your systolic blood pressure is: * Less than 120, your pressure is ideal * 121-140, your pressure is borderline * More than 140, your pressure is high If your diastolic blood pressure is: * Less than 80, your pressure is ideal * 81-90, your pressure is borderline * More than 90, your pressure is high If either type of blood pressure is too high, you need to work with your doctor to bring it down. What Factors Increase Your Risk For High Blood Pressure? Many factors affect your risk of developing high blood pressure. They include: * Heredity: To some extent, the tendency to develop high blood pressure is inherited. Black people are two to three times more likely than white people to develop high blood pressure. * Age: The older you are, the more likely you are to develop high blood pressure. * Body weight: High body weight and high blood pressure usually go hand in hand. * Activity level: The more inactive you are, the higher your blood pressure usually is. * Diet: For some people, high sodium intake from table salt and other sources can add fluid to the blood and raise blood pressure. Excessive alcohol intake can also raise blood pressure and make drug therapy less effective. * Stress: By itself, stress is not a primary cause of high blood pressure. If you already have high blood pressure, however, constant stress may help keep it high. * Other factors: Smoking, alcohol, and caffeine can all increase blood pressure How You Can Lower Your Blood Pressure If you have high blood pressure, you must work closely with your doctor to bring it down. If your blood pressure is not excessively high, your doctor may want you to try diet and lifestyle changes to control your blood pressure before prescribing antihypertensive medication A drug that is intended to reduce the blood pressure of individuals with high blood pressure (hypertension).. Your doctor may suggest that you: * Lose weight if you are overweight. * Increase your level of physical activity. Exercise helps reduce blood pressure in two ways: it helps you lose weight and it lowers blood pressure independent of weight loss. * Lower your sodium, or salt, intake. For most people, reducing sodium intake from salt and other sources also lowers blood pressure. * Eat plenty of fresh fruits and vegetables. A diet high in potassium (found in fresh fruits and vegetables) can help lower blood pressure. Some evidence shows that a vegetarian or near-vegetarian diet can significantly lower blood pressure. * Manage stress. Need To Know: If your blood pressure is very high, your doctor may prescribe antihypertensive medications to bring your blood pressure down right away. Nice To Know: For most people, losing weight will bring blood pressure down to a safe level. For every one pound you lose, you can expect about a one-point drop in your diastolic blood pressure. How-To Information: How you can reduce sodium in your diet Table salt (sodium plus chloride) provides most of the sodium in the American diet. The average American gets 20 times more sodium than needed each day. To reduce your sodium intake, you must retrain your taste buds. Taste for salt is learned gradually, so it can be unlearned gradually by slowly cutting down salt in your diet. After a few weeks, the high salt foods you used to like will taste too salty. To eat less salt, make the following changes one at a time, starting with the easiest first: * Salt food only after you have tasted it. * Move the salt shaker off the table, so you have to get up to get it if you need it. * Cut down on the salt used in cooking by one-third, then one-half. * Experiment with different flavors as salt substitutes. Try garlic, pepper, lemon, onion, wine, herbs, and spices. * Cut down on highly salted prepared foods such as nuts, chips, and pickles. * Read labels carefully. In general, prepackaged or processed foods such as canned soups, tomato juice, frozen dinners, macaroni and cheese, processed meats, and other foods are higher in sodium than their home made counterparts. What You Should Know About Quitting The Cigarette Habit Of all the known modifiable risk factors for coronary heart disease, cigarette smoking is the most significant. If current smoking patterns continue, more than 24 million people in the United States may die a premature death due to heart disease brought on by smoking, according to the American Heart Association. Still, it's never too late to quit smoking, even if you've smoked all your life. Your risk for heart disease drops dramatically the moment you put down your last cigarette. After a few years, your heart disease risk is the same as that of a nonsmoker, although your risk for developing cancer drops more slowly. How does smoking increase your risk for heart disease? How you can quit smoking A program to help you quit smoking Staying smoke-free How Does Smoking Increase Your Risk For Heart Disease? Smoking increases the risk of coronary heart disease by accelerating blockage of the arteries. Cigarette smoke contains more than 3,000 chemicals, many of which are poisonous. Two of the most dangerous chemicals in cigarette smoke are carbon monoxide, a gas also found in car exhaust, and nicotine A toxic chemical found in cigarette smoke., a powerful insecticide. The body reacts to these toxins by producing an excess of unstable particles that bind with other molecules, called oxygen-free radicals. Inside the arteries, free radicals react with low-density lipoproteins (LDL), and a spongy cholesterol A fat-like substance needed for the development body cells. Cholesterol is both produced by the body and found in animal foods. Although it is a necessary substance, if levels of cholesterol are too high it can be deposited on the artery wall, narrowing or blocking blood flow and leading to coronary heart disease. layer builds up on arterial walls. Eventually, this spongy cholesterol layer hardens into plaques When used in regard to atherosclerosis, this term describes the yellow and swollen areas of the inner layer of arteries that are thickened by the deposition of fatty substances (lipids and cholesterol) and fibrous tissue. . Smoking also increases your risk for coronary heart disease over the short-term: * With each puff, the nicotine in cigarettes speeds up the heart and constricts (narrows) the arteries, increasing the strain on your heart. * The carbon monoxide in cigarettes robs the blood of up to 15 percent of its oxygen. This is especially serious considering the supply of oxygen may already be low because of partial blockages in the arteries. Need To Know: * Smoking cigarettes is especially dangerous for individuals who also have high blood pressure or high blood cholesterol levels. * Women who smoke and take birth control pills are 10 times more likely to die of a heart attack than women who do neither. * Even if you don't smoke, spending time in a smoky environment can increase your risk for heart disease and other smoking-related diseases. Nice To Know: Q: Do other forms of tobacco increase the risk for coronary heart disease? A: Pipes and cigars are less likely than cigarettes to increase the risk of CHD, provided you don't inhale. But ex-cigarette smokers almost always do inhale. Further, pipes and cigars still increase the risk of cancer, as does snuff or chewing tobacco. You'll be better off if you give up tobacco completely. How You Can Quit Smoking Your own determination is the most important ingredient for kicking the smoking habit. Set a quit date and tell yourself that smoking after that date is not an option. Resolution may be enough for some people to quit, but others may be more seriously addicted to nicotine. Nicotine gum or patches can help to blunt withdrawal symptoms such as irritability, digestive upset, light-headedness, and sleep disturbances. Need To Know: The answers to two questions may indicate your level of addiction to cigarettes: * Do you smoke within 20 minutes of waking up? * Do you smoke even when you have a cold? If you answered "yes" to either of these questions and have tried quitting before unsuccessfully, then consider asking your physician for the patches or gum-but use them strictly in accordance with the instructions. And don't think of them as magic-they can supplement a quitting program, not replace it. Nice To Know: It's easier to quit smoking today than it was 10 years ago for several reasons: * When you quit smoking, you're joining the mainstream, since only about one-fourth of Americans adults now smoke. * Many more public places and work sites now prohibit smoking. * New evidence about the harmful effects of second-hand smoke on others, especially children, provides a powerful incentive to quit smoking. * Aids such as nicotine gum and skin patches can help certain people quit smoking when used in the context of a broader quitting program. How-To Information: A program to help you quit smoking If you are not the kind of person who can simply quit smoking cold turkey, you may benefit from a more formal quitting program. Many people find it helpful to join classes such as those run by the American Cancer Society or the American Lung Association. Other people prefer to quit smoking on their own. If you are one of these people, here is a sample program that can help you stop smoking: First, set a date to quit smoking. The week before you quit: * Make a firm commitment to yourself to stop smoking. * Write down the three main reasons that you want to quit smoking. * Make a note of the time and circumstances every time you smoke for a two-day period (for example, 8 am-driving to work, 8:45-with coffee). To help yourself remember to write the notes, wrap a piece of paper around your cigarette pack with rubber bands. * Prepare a first-aid package to help you through hard times when you first quit smoking. This should include things to keep your hands busy (a deck of cards, puzzles, paper clips, or knitting) and things to keep your mouth busy (toothpicks, chewing gum, hard candy, raw vegetable sticks, sunflower seeds, low-fat cookies, or bread sticks). The day before you quit smoking: * Study your two-day record to see when you smoke most often. Then plan how you will cope with situations or times when you normally would have smoked. For example, if you normally smoke while driving to work, take the bus instead. If you normally smoke while having coffee at your desk, go for a short walk instead. * Clear the house of all cigarettes. On the day you quit smoking, when you get the urge to smoke: * Reach for a stick of chewing gum, carrot and celery sticks, or small hard candies or mints. * Keep your hands occupied. Try knitting, crocheting, or woodworking. * Move to a different chair or room. * Breathe deeply. * Squirt the back of your throat with a breath freshener. * Take a one-minute walk. * Look at your watch and time the urge to smoke (it usually won't last more than a minute or so). * Avoid alcohol, which can derail all your good intentions. * Avoid any cues that remind you of cigarettes. Remember that the most important tool in your armory is your determination. You have quit smoking, and the long-term benefits will far outweigh the rough times you may have to put up with for the first week or so after quitting. Staying Smoke-Free After you have quit smoking, the urge to smoke gets progressively weaker, but you still need to stay on your guard. You might be taken by surprise with an urge to smoke you didn't expect, especially during times of stress, when you are drinking alcohol, or when you are around other smokers. When you believe you are no longer dependent on cigarettes, don't be misled into thinking you can try a puff or two-you could easily fall back into the cigarette habit. Don't ever try a cigarette again. If you do find yourself smoking again: * Don't let a minor slip sabotage your progress. Keep thinking of yourself as a non-smoker. * Re-start your quitting program. What works for you and what doesn't? What situations pose a high risk for you? * Don't be hard on yourself-we're all human. Many people need to make two or three serious attempts before they are able to quit smoking for good. Nice To Know: Q: Will I gain weight if I quit smoking? A: Not everyone gains weight when they quit smoking. Some people tend to put on a few extra pounds (the average is about six pounds). The weight gain may be because of a slight slow-down in how fast your body burns calories, or it may be because people tend to eat more simply because food tastes better. If you do put on a few pounds, don't worry about the small weight gain. It's healthier to gain a little weight than to continue smoking, and you can deal with the weight after you have the smoking conquered. What You Should Know About Becoming More Active The American Heart Association considers inactivity to be as much of a risk factor for coronary heart disease (CHD) as high blood cholesterol, high blood pressure, or cigarette smoking. Increased activity reduces the risk of CHD and can help to reduce other risk factors for CHD. Besides, it can be fun! How does being more active lower your risk for heart disease? Are you active enough? Which types of activities are best? Exercising safely How Does Being More Active Lower Your Risk For Heart Disease? When you become more active, you reduce your risk for CHD in several ways. Physical activity: * Increases the proportion of HDL cholesterol (the good kind of cholesterol) in your blood and reduces levels of triglycerides Another type of blood fat that can also block blood vessels and lead to coronary heart disease., another type of blood fat that can clog arteries and promote CHD * Boosts the body's ability to clear away clots in the blood vessels * Improves circulation and makes the heart a stronger and more efficient pump * Can help prevent the development of diabetes A condition in which the body can't use carbohydrates well. It is caused by a complete (type 1 diabetes) or relative (type 2 diabetes) deficiency of the hormone insulin, which acts as the key that allows sugar to enter cells. Without enough insulin, glucose (sugar) remains in the blood and can't enter the cells to provide energy. * Promotes weight loss and weight control even more than dieting * Helps relieve stress * Provides an alternative to harmful addictions such as nicotine A toxic chemical found in cigarette smoke. and alcohol use Are You Active Enough? Although deliberate forms of exercise such as walking, jogging, or swimming are great, smaller periods of less intense physical activity also help reduce your risk for heart disease. The more physically active you are, the better off you'll be. Experts now recommend that all adults accumulate at least 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week. This doesn't mean, however, that you need to jog or swim 30 minutes a day. You also benefit from several shorter periods of physical activity throughout the day. For example, if you walk 10 minutes around the mall while your shopping for clothes, take a 10-minute walk during your coffee break, and take a 10-minute walk around the block after supper (if you live in a safe neighborhood), this counts as your 30 minutes of physical activity. Even activities like gardening or cleaning can add up if done vigorously enough. The bottom line: be more active throughout the day in whatever way you can. Which Types Of Activities Are Best? The best activities for your heart are those that use the large muscles of your body, particularly those in your legs, making them demand more oxygen to do their work. Seek out activities that involve repetitive motion and raise your heart rate for an extended period of time. Examples of such activities include: * Walking * Running * Rowing * Bicycling * Swimming * Skating * Cross-country skiing When your muscles demand more oxygen, you breathe faster to bring oxygen into your lungs, and your heart beats faster to deliver the oxygen to your muscles, giving your whole system a tune-up and making your heart a stronger and more efficient pump. How-To Information: Exercise does not always have to include a sweaty workout. You can benefit by simply including more activity throughout your day: * Park farther from work and walk the extra distance, or better yet, walk to work. * Walk more between stores when shopping. * Take walking breaks at work. * Take the stairs instead of the elevato.r * Clean your own house. * Mow the lawn yourself. * Choose leisure-time activities that get you moving. Golfing, skiing, bowling, dancing, or playing tennis or basketball can all add to your overall activity level. Exercising Safely Almost everyone can do some form of exercise, but to exercise safely you must start slowly and build up gradually. Start by finding out how much exercise you are getting now. Look back on the last three days and write down the approximate length of time that you spend being physically active. Then gradually increase the minutes you spend being physically active, adding a few minutes each week. Need To Know: You should check with your doctor before beginning any type of exercise program if you: * Are a man over 40 years of age * Are a woman over 50 years of age * Have risk factors for CHD such as high blood cholesterol levels, high blood pressure, diabetes, or cigarette smoking * Have symptoms of any heart disease (pain in the chest, neck or shoulder during exercise, shortness or breath, faintness, or dizziness) or known heart disease If you experience any of these warning signs, stop exercising and check with your doctor: * Lightheadedness * Headache * Nausea * Shortness of breath * Cold sweat * Pain or pressure in the chest, neck, shoulder, or arms, especially on the left side When you are exercising, check your heart rate periodically by counting your pulse at the neck or wrist. Count your heartbeats for 10 seconds, and then multiply by 6 to get the beats per minute. In the early stages of your exercise routine, try to keep your heart rate within 65 to 70 percent of your maximum heart rate The fastest your heart can beat, estimated by subtracting your age in years from 220. (approximately 220 minus your age). This is a safe range, in which your heart, lungs, and blood vessels benefit from the exercise but are not overtaxed. As you get in better shape you may be able to let your heart rate climb to 75 percent of your maximum heart rate. For example, a 60-year-old man has a maximum heart rate of 160 beats per minute (220 minus 60). Sixty-five to 70 percent of this figure is 104-112 beats per minute. Thus, this man should count 17 to 18 beats during a 10-second pulse check. Be sure to include a five-minute warm-up and cool-down period of light stretching before and after exercise to warm up your muscles and avoid injury and stiffness. How-To Information: Getting started You might want to join your local health club or YMCA so experts can help you get started on an exercise program safely and enjoyably. If you want to start your own program or do it with a friend, pick an activity you enjoy. Walking is an activity that almost anyone can do and only requires a pair of good shoes. Although everyone must move at his or her own pace, you can use the following exercise schedule as a guide: * Week 1: Add at least five minutes of exercise to your daily routine * Week 2: Exercise every day for at least ten minutes * Week 3: Exercise a total of twenty minutes on at least three days of the week and at least 10 minutes on the other days * Weeks 4 and 5: Exercise twenty minutes on most or all days of the week * Week 6 and after: Exercise thirty minutes on most or all days of the week What You Should Know About Losing Weight Safely How does excess body weight increase your risk for heart disease? Do you weigh more than you should? Why do you need to exercise? How you can cut calories How Does Excess Body Weight Increase Your Risk For Heart Disease? Excess body weight increases the risk for coronary heart disease because it: * Raises total blood cholesterol levels, especially levels of LDL cholesterol (the harmful kind of cholesterol that clogs blood vessels) * Decreases levels of HDL cholesterol (the good kind of cholesterol that helps clear blood vessels) * Raises blood triglyceride levels (a type of fat that also clogs blood vessels) * Increases blood pressure * Makes the heart work harder * Contributes to inactivity, since overweight individuals are often reluctant to join an exercise program for fear of ridicule or not being able to keep up Do You Weigh More Than You Should? Most of us can look in the mirror and tell if we are overweight. Generally, if you can pinch an inch at your waist, or if you weigh over 10 to 15 pounds more than you did when you were 20, you probably need to lose weight. Experts now evaluate body weight using a formula called body mass index. Body mass index expresses body weight in relation to height. Body mass index actually equals body weight in kilograms divided by height in meters squared, but you can use the table below to help you figure your body mass index. To calculate your body mass index: * Multiply your weight in pounds by 704.5 * Multiply your height in inches by your height in inches * Divide the first result by the second Or you can use the following table to determine your body mass index: Weight in pounds equal to a BMI of: Height 20 25 27 30 35 4'10" 96 119 129 143 167 4'11" 99 124 133 148 173 5'0" 102 128 138 153 179 5'1" 106 132 143 158 185 5'2" 109 136 147 164 191 5'3" 113 141 152 169 197 5'4" 116 145 157 174 204 5'5" 120 150 162 180 210 5'6" 124 155 167 186 216 5'7" 127 159 172 191 223 5'8" 131 164 177 197 230 5'9" 135 169 182 203 236 5'10" 139 174 188 207 243 5'11" 143 179 193 215 250 6'0" 147 184 199 221 258 6'1" 151 189 204 227 265 6'2" 155 194 210 233 272 6'3" 160 200 216 240 279 6'4" 164 205 221 246 287 Experts consider a person with a body mass index of 25 to 29 to be overweight, and a person with a body mass index of 30 or more to be obese. Nice To Know: Q: Is excess fat in the upper or lower body more harmful? A: Some people carry excess weight in the hips and thighs (referred to as pear shaped, or lower body obesity), while others carry it in the abdominal area (referred to as apple-shaped, or upper body obesity). We now know that upper body obesity increases risk for coronary heart disease much more than lower body obesity. Since the measurement around your waistline reflects your level of abdominal fat, a waist measurement can be a good clue to whether you have too much upper body fat. Generally speaking, you have too much abdominal fat if your waist measurement exceeds: * 40 inches for men * 35 inches for women Need To Know: Q: How can I Iose weight and keep it off? A: Losing weight is hard, but keeping it off is even harder. The most successful way to lose weight and keep it off is to modestly reduce your calorie intake while maintaining a regular exercise program. In fact, people who are most likely to succeed in losing weight and keeping are people who exercise regularly. Why Do You Need To Exercise? For most people, reducing calorie intake alone is not enough to achieve permanent weight loss. When you cut calories, some of the weight you lose comes from muscle tissue. When you severely cut your calorie intake, your body reacts as though it were being starved, slowing down its metabolism The chemical changes in living cells that provide energy for vital processes and activities. Through these chemical changes, new material is incorporated into those living cells. and making it harder to lose weight. Exercising regularly helps you lose weight in several ways: * Exercising while cutting calories helps you maintain muscle tissue and burn a higher percentage of body fat * Exercising re-sets the body's metabolism, countering the effects of calorie restriction * Exercise burns calories * Exercise can keep you out of the kitchen and away from food How-To Information: How you can cut calories Cutting your calories involves changing both the types of food you eat and the way you eat. Fortunately, the types of foods that lower blood cholesterol levels also reduce calories in the diet. Since fat is a very concentrated source of calories, eating more of the low-fat foods that help you lower your cholesterol levels-like fruits, vegetables, and whole grains-will also help you cut your calories. If you tend to eat even when you are not really hungry, you may also need to change the way you eat. To help you cut calories: * Eat three main meals, including breakfast. * Plan for low-fat snacks in the morning and afternoon. * Keep a food diary to help you identify problem areas or situations that trigger overeating. * Always eat in the same place when you are home, which will help keep you from nibbling all the time. * Sit down while you eat. * Keep problem foods out of the house (or at least off the counter and less accessible). * Find substitutes for favorite foods that are high in calories-for example, angel food cake instead of richer types of cakes, pretzels instead of potato chips, bagels instead of doughnuts. Need To Know: Q: Are there any dangers with dieting? A: Although excess weight increases the risk for coronary heart disease and other health problems, repeated cycles of weight loss and gain are even worse for health. Slow and steady weight loss that you can maintain over the long-term is much more healthful than crash dieting. Remember that the extra weight took a long time to creep on, so it will come off slowly too. Try to focus on the positive lifetime changes you are making for your health rather than on what the scales say. If you exercise regularly and adopt healthy, low-fat foods as part of your usual diet, you may be surprised at how easily the weight will come off. What You Should Know About Managing Stress Effectively Life's events are not in themselves stressful, but our reactions to those events can leave us feeling "stressed out." Some people enjoy a fast-paced life with many challenges. For these people, slow, uneventful periods in their lives may be more stressful than challenging ones. Other people can become overwhelmed by a constant stream of pressure, demands, and lack of time. The key appears to be how we view and react to situations. Does stress increase your risk for heart disease? What are the symptoms of stress? Is stress harmful for you? How you can manage stress Does Stress Increase The Risk For Heart Disease? A growing collection of studies indicates that stress adversely affects heart health. It is not yet clear whether stress itself increases the risk of coronary heart disease, or if it simply exacerbates other risk factors. Some people may react to stress by overeating, smoking, or growing depressed and exercising less. Studies show that stress may be especially harmful if it involves the following: * Frequent feelings of hostility, anger, and suspicion of the world around you * Being caught in situations where you have little control over the demands place on you * Having a low level of social support from family and friends * Experiencing major life events such as divorce, illness, or job loss Stress can increase some people's risk for heart disease because it: * Temporarily increases blood pressure or helps to keep blood pressure high * Interferes with the ability to make other healthful changes such as stopping smoking, exercising, or eating a healthier diet What Are The Symptoms Of Stress? Symptoms of stress can include the following: * Sweaty hands, tight muscles, or clenched jaw * Inability to sleep at night or wanting to sleep too much during the day * Increased or decreased appetite * Feeling short-tempered or easily upset * Feeling continually rushed * Decreased social interaction with friends and family Need To Know: Is stress harmful for you? Some people may enjoy a life full of pressure and deadlines. Since stress is not always bad, how do you know if it is bad for you? To help you find out, answer the following questions: * Do you have physical symptoms of stress, such as clenched jaw, sweaty hands, or tight muscles? Do you eat, drink, or smoke to calm down? * Do you often feel that you are short of time? * Do you speak fast and tend to act as if you are in a hurry? * Do you hate losing? * Do you find it hard to forget work? If you answered yes to any of the above questions, stress may be interfering with your ability to adopt a lifestyle that is healthful for your heart. Now, answer the following three questions: * Do you feel angry when people are in your way, for example, in a traffic jam? * Do you feel that a lot of the people you deal with every day are incompetent? * Do you feel that most people act from selfish motives? If you answered yes to any of the last three questions, you may have the type of cynical mistrust and hostility that experts think may increase risk for coronary heart disease. How-To Information: How you can manage stress People who are able to manage stress do three things well: 1. They change stressful situations when possible. 2. They find new ways to look at stressful situations when it is not possible to change them. 3. They find stress-relieving outlets. Here are some suggestions to help you cope with stress in your life: * Keep a stress diary where you can note situations or relationships that make you feel unpleasantly stressed. * Plan to deflect your stress by avoiding a situation, altering it, or adapting to it. For example, if driving to work in busy traffic leaves you tense and angry, you could take a train to work, drive earlier when there is less traffic, or use the time to listen to tapes or music. * Relive stress through exercise. Take a walk, or go for a bicycle ride. * Practice deep muscle relaxation at least once daily. Sit in a comfortable chair in a quiet room and set an alarm for 15 minutes. Then tighten and relax each muscle group in the body in turn, starting with arms, legs, trunk, neck, etc. Close your eyes and imagine a soothing scene such as a beach or clouds as you relax your muscles. * Watch for physical symptoms of stress and make a conscious effort to calm yourself when they appear. For example, if you notice your knuckles turning white as you are gripping the steering wheel, tell yourself to relax. If the above suggestions do not help relieve your stress, or if you frequently feel angry at the world, you may need to seek outside help in dealing with stress. Your physician can refer you to a mental health professional who specializes in dealing with stress-related anxiety, or look for courses in stress management. For more information about managing stress, go to Stress And How-To Manage It. Q: Does a diet high in sugar increase the risk for coronary heart disease? A: There is no evidence that high sugar intake by itself causes coronary heart disease. However, foods high in sugar-such as cakes, cookies, and ice cream are also often high in fat, which does increase risk for heart disease. Further, foods high in sugar displace other more nutritious foods, such as fresh fruits and vegetables, from your diet. Q: Does alcohol decrease the risk of coronary heart disease? A: A a glass or two of wine has been shown to increase HDL cholesterol A fat-like substance needed for the development body cells. Cholesterol is both produced by the body and found in animal foods. Although it is a necessary substance, if levels of cholesterol are too high it can be deposited on the artery wall, narrowing or blocking blood flow and leading to coronary heart disease. levels (the good kind of cholesterol that helps clean out blood vessels). But more than two drinks a day can be harmful, raising blood pressure and throwing off cholesterol balance. Alcohol is also a fairly concentrated source of calories and can contribute to weight gain, which increases risk for CHD. Q: Should I take antioxidant supplements to reduce my risk for coronary heart disease? A: Antioxidants Substances in fruits, vegetables, whole grains, nuts, and seeds that can help prevent or slow build up of cholesterol and other fat-like substances in the arteries. Vitamins C and E and beta-carotene are all antioxidants that help protect against coronary heart disease. help prevent against CHD by slowing the depositing of cholesterol in the lining of the blood vessels. Foods rich in antioxidants such as vitamins C and E and beta-carotene include fresh fruits and vegetables, whole grains, nuts and seeds. Because these foods contain many different antioxidants, dietary fiber, and other vitamins and minerals, it is best to get your antioxidants from food rather than the health food store. These foods are also low in fat and should provide the foundation for your diet. Q: Once cholesterol-rich deposits form in my arteries, do they ever go away? A: The artery-clogging deposits of cholesterol and other fat-like substances that cause heart disease can begin as early as childhood and continue to form as we grow older. New research, however, has shown that a very low-fat diet combined with regular exercise and other healthy lifestyle changes can actually help shrink and clear out these deposits in the blood vessels, reversing CHD. What Is Angina? Angina literally means "choking pain," and angina pectoris refers to a painful or uncomfortable sensation in the chest that occurs when part of the heart does not receive enough oxygen due to disease in the coronary arteries that supply blood to the heart. The coronary arteries supply the heart muscle with oxygen and nutrients. The word "coronary" means a crown and is the name given to the arteries that circle the heart like a crown. Coronary artery The arteries that deliver blood to the heart itself. There are three major coronary arteries. disease (CAD) is the most common form of heart disease. Coronary heart disease develops when one or more of the coronary arteries that supply the blood to the heart become narrower than they used to be, due to the buildup of cholesterol A fat-like substance needed for the development body cells. Cholesterol is both produced by the body and found in animal foods. Although it is a necessary substance, if levels of cholesterol are too high it can be deposited on the artery wall, narrowing or blocking blood flow and leading to coronary heart disease. and other substances in the wall of the artery, affecting the blood flow to the heart muscle. Without an adequate blood supply, heart muscle tissue can be damaged. Deposits of cholesterol and other fat-like substances can build up in the inner lining of these blood vessels and become coated with scar tissue, forming a cholesterol-rich bump in the blood vessel wall known as plaque Bulging yellow mass (atheroma) that forms within the walls lining the arteries. Plaque contains a mix of fat, cholesterol, inflammatory cells, and fibrous scar tissue and, when deposited on the inner wall of an artery, reduces its inner diameter.. Plaque buildup narrows and hardens the blood vessel, a process called atherosclerosis Gradual buildup and hardening of atheromas within the arterial walls. , or hardening of the arteries. Eventually these plaque deposits can build up to significantly reduce or block blood flow to the heart. A person may experience chest pain or discomfort from inadequate blood flow to the heart, especially during exercise when the heart needs more oxygen. Angina is the body's warning sign that the heart is being overworked. It can be experienced in a variety of ways. * Angina usually manifests as a feeling of pain, pressure, or tightness in the middle chest, especially behind the sternum (breastbone). * The sensation may spread to the left shoulder, arm, and hand, or to the neck, throat, and jaw. * The attack typically lasts for only a few minutes An attack of angina does not cause permanent damage to the heart muscle. This is the main difference between angina and a heart attack, during which part of the heart muscle suffers permanent damage (unless the new clot-busting drugs are given in time). Stable versus unstable angina It is very important to distinguish between two types of angina: stable angina and unstable angina. Both types result from problems within the coronary arteries. * Stable angina results from a fixed obstruction of blood flow to the heart. It occurs when there is not enough blood for a fast-pumping heart, but sufficient blood can get through when the heart slows down and the individual is at rest. Stable angina typically is caused by widespread, irregular disease throughout the coronary arteries. The blockages that result may not seriously hinder the flow of blood, and they usually do not damage the heart unless a plaque (atheroma; fatty deposit within a blood vessel) suddenly ruptures. * Unstable angina is due to a sudden interruption of blood flow to the heart due to a partial or complete blockage of the artery. Unstable angina comes on when a person is resting, asleep, or undergoes physical exertion (unlike stable angina, which usually comes on with a physical exertion). Symptoms of moderate or severe discomfort suddenly may develop in a person who has never experienced angina before, and attacks may become more frequent or increase in intensity. Unstable angina can be dangerous, while stable angina Term for choking pain (LATIN, throat pain or choking). When coupled with the word pectoris (LATIN, of the chest), angina refers to a painful, constricting sensation in the chest. Angina is caused by coronary artery disease, which reduces the supply of blood to the heart muscle. generally is less serious. In order to identify which condition is present, a physician looks at when the angina pain occurs: * Stable angina usually occurs during physical exertion or emotional stress or excitement. Stable angina doesn't lead to a heart attack in most people. * Unstable angina can occur during rest, can awaken a person from sleep, and can appear suddenly during physical exertion. Unstable angina may quickly progress to a heart attack. Need To Know: About unstable angina Unstable angina is a much more serious condition than stable angina because it may quickly progress to a heart attack. Some physicians regard unstable angina as a heart attack (until tests prove definitely that it is not a heart attack) because it is difficult to distinguish with early tests whether or not there has been damage to the heart muscle. In unstable angina, cracks develop in the bulging plaque inside the coronary artery. These cracks, or partial ruptures of the plaque, are called plaque fissuring. It sets off an inflammatory reaction that dissolves the layer of tissue separating the plaque from the flowing blood. When the blood comes into direct contact with the plaque, it begins to form a clot around the damaged plaque. Three things can happen: * The clot gets bigger. Depending on how much of the artery it blocks, it will either cause the pain of angina or develop into a heart attack if it completely blocks the artery. * The clot moves to another part of the artery and blocks it, causing a heart attack. * The clot may simply be washed away after the crack in the plaque has healed. What was previously a reasonably "stable" narrowing of the coronary artery has become "unstable," reducing the blood flow through the affected coronary artery and causing symptoms even at rest. Some interesting facts about unstable angina: * The plaques that develop the crack, or rupture, are usually not the same ones that cause the critical narrowing of the coronary arteries. * We do not know why a plaque suddenly ruptures. * Because the clot that forms is formed by platelets The smallest cells in the blood; they are disk-shaped and are essential for blood to clot. , the treatment initially is to give antiplatelet treatments. This is a very different treatment from the "clot-busters" given for a heart attack. * Unstable angina is considered as part of a spectrum called "acute coronary syndrome," which includes unstable angina and heart attack (known as myocardial infarction, either q-wave or non-q-wave types). What these conditions have in common is that symptoms result from rupture or erosion of a clot with obstruction of the coronary artery. * A heart attack (known as a q-wave myocardial infarction) generally results from a more extensive rupture of a plaque, in which the whole clotting system, not just platelets, becomes involved. The treatment then uses "clot-busters" (called thrombolytics), which are very different drugs from antiplatelet drugs used for unstable angina. It is vitally important for the doctor to make the distinction between stable angina, unstable angina, and a heart attack. This cannot always be done immediately. Angina may occur during everyday activities such as: * Rapid walking or running * Lifting or carrying a weight * Becoming angry or excited * Shoveling snow * Physical stress after eating (when food is still being digested) * Sexual intercourse (rarely) The sensation of stable angina usually wears off after the angina-causing activity ends. Attacks typically last for only a few minutes. Symptoms may be worse in cold weather. Because the sensation of angina Term for choking pain (LATIN, throat pain or choking). When coupled with the word pectoris (LATIN, of the chest), angina refers to a painful, constricting sensation in the chest. Angina is caused by coronary artery disease, which reduces the supply of blood to the heart muscle. is alarming, many people believe they are having a heart attack the first time they experience it. But stable angina is NOT a heart attack. In fact, most people with stable angina respond well to modern treatments and live full lives for many years - if they follow their physician's advice, take medication as prescribed, and learn to look after their hearts. Although angina therapy is better than ever before, successful treatment depends upon close cooperation between the individual and the healthcare team. The person with angina must assume a lifestyle that minimizes the risk of further heart trouble. Facts about angina * According to recent U.S. health statistics, more than six million Americans have angina. * Each year, there are about 350,000 new cases of angina in the U.S. * Many people believe angina to be a "man's disease." Yet angina actually affects more women than men (13.9% versus 9.4%), and it is most widespread among women who are black (5.2%) or Mexican-American (4.6%). What Causes Angina? The coronary arteries are small arteries that carry blood to the heart muscle. This blood flow provides the oxygen and nutrients needed by the heart itself so that it can keep pumping. If the heart has to speed up (for example, during exercise or periods of excitement) and cannot get the blood it needs, it will send out a signal in the form of angina. The three major coronary arteries are the: * Left anterior descending artery * Left circumflex artery * Right coronary artery The arteries that deliver blood to the heart itself. There are three major coronary arteries. Most people with angina have blockages in one or more of these arteries and/or their branches. A cardiologist (heart specialist) will perform various tests to determine the location and extent of the blockage. The two major causes of angina are: * Coronary artery disease (CAD) * Coronary artery spasm Coronary artery disease (CAD) In almost all cases, the underlying cause of angina is the critical narrowing of one or more of the coronary arteries that supply blood to the heart. Coronary artery disease - also known as coronary heart disease (CHD) or ischemic heart disease (IHD) - affects most people as they age. The coronary arteries become constricted or blocked by atheromas - bulging masses or "plaques" that form within the walls lining the arteries. Nice To Know: "Atheroma Bulging yellow mass or plaque that forms within the walls lining the arteries. Atheromas (ITALIAN, porridge) contain a mix of fat, cholesterol, inflammatory cells, and fibrous scar tissue and, when deposited on the inner wall of an artery, reduce its inner diameter. " is ITALIAN for porridge, because it resembles porridge when viewed under a microscope. It contains a mix of cholesterol-filled cells, inflammatory cells, and fibrous scar tissue. Atherosclerosis Gradual buildup and hardening of atheromas within the arterial walls. is the term used to describe the gradual buildup and hardening of atheromas within the arterial walls. It is commonly referred to as "hardening of the arteries." The more atheromas that line the coronary arteries, the narrower the pathway for blood. Atherosclerosis often restricts as much as 70% of the blood that flows through the coronary arteries. Although the heart muscle receives enough blood for routine activities like walking or sitting, myocardial ischemia Lack of blood in the heart muscle. (insufficient blood in the heart muscle) results when the narrow arteries do not allow enough blood to reach the heart during periods of physical or emotional stress. This lack of blood will trigger an episode of angina. Need To Know Stable angina itself is not dangerous, but it does indicate the presence of underlying coronary heart disease. The plaques and narrowed coronary arteries that cause angina significantly increase the risk of a heart attack. A heart attack occurs if a clot sticks in the narrowed part of a coronary artery and no blood can get through at all. Part of the heart muscle will die since it will not be supplied with the necessary oxygen to survive. The exact cause(s) of coronary artery disease remains unknown. Yet experts have identified some of the risk factors that increase a person's chance of getting this disease. They include: * Aging * High blood pressure (hypertension) * Cigarette smoking * High blood cholesterol A fat-like substance needed for the development body cells. Cholesterol is both produced by the body and found in animal foods. Although it is a necessary substance, if levels of cholesterol are too high it can be deposited on the artery wall, narrowing or blocking blood flow and leading to coronary heart disease. * Being overweight * Lack of exercise * Family history of angina or heart attack at a young age * Diabetes Certain individuals, though, develop angina without having any of the above common risk factors for CAD. Coronary artery spasm A more unusual type of angina is caused by spasm (sudden contraction [squeezing response]) of the smooth muscle within the coronary arteries. This condition is called variant angina pectoris Angina caused by spasm (sudden contraction [squeezing response]) of the smooth muscle within the coronary arteries (also known as Prinzmetal's angina or angina inversa). Variant angina occurs almost exclusively when a person is at rest or asleep, often between the hours of midnight and 8 a.m. (also known as "Prinzmetal's angina" or angina inversa). Variant angina pectoris does not occur when the heart has been overworked. Instead, variant angina comes on almost exclusively when a person is at rest or asleep, often between the hours of midnight and 8 a.m. The attacks can be extremely painful. Variant angina is associated with coronary artery disease (CAD). About 65% of all sufferers have atherosclerosis in at least one major vessel of the heart. The coronary artery spasm that causes this form of angina typically occurs very near the atherosclerotic blockage. People with variant angina often experience an active phase of the disease in which they are at particular risk for: * Serious cardiac arrhythmias (heart rhythm disturbances), such as ventricular tachycardia Rapid rate of the left ventricle (pumping chamber) of the heart. (rapid rate of the left, pumping chamber of the heart) and fibrillation Rapid, uncoordinated contraction (squeezing) of the heart muscle. (rapid, uncoordinated contraction [squeezing] of the heart muscle) * Myocardial infarction (MI; a heart attack) * Sudden death During this phase - which can last three to six months or more - an individual may experience frequent attacks of angina and arrhythmia Disturbance of the heart's normal rhythm. and, therefore, should be followed closely by his or her physician. Fortunately, most people who survive the rhythm disturbances and/or heart attacks in the active phase have an excellent prognosis (expected outcome). At five years, the majority (89% to 97%) of affected individuals is alive and leading normal lives. What Are The Symptoms Of Angina? The discomfort of angina is different in different people. Some people have angina when they overexert themselves, whereas others feel symptoms when they get very upset or excited. Most individuals eventually learn to anticipate which activities will cause distress. Chest pain is the major symptom of angina. People who have angina often experience: * Crushing pain, * "Heaviness," or * Tightness in the middle of the chest. It may feel as if someone is squeezing or pressing on the heart, or it may feel like a stabbing pain or numbness. The sensation: * Ordinarily lasts from one to 10 minutes * May spread to the left shoulder, arm, and hand or to the neck, throat, and jaw Sometimes there are additional symptoms such as: * Sweating * Nausea * Breathing difficulties The features of a heart attack - which include chest pain, sweating, and nausea - resemble those of angina, although there are major differences between the two conditions. Heart attack occurs when there is blockage of a coronary artery The arteries that deliver blood to the heart itself. There are three major coronary arteries., and it may lead to permanent heart injury or death. In addition, heart attack lasts much longer than angina, and its symptoms generally continue even after a person rests. Nice To Know: What is the difference between a heart attack and angina? ANGINA HEART ATTACK Partial narrowing of the artery Partial or total blockage of the artery from a blood clot No permanent heart muscle damage Permanent damage of the heart muscle, unless the blockage can be removed quickly by "clot-buster" medicine or other means Lasts one to 10 minutes Lasts at least 20 minutes Goes away with rest May continue after rest Does chest pain always mean a heart problem? Chest pain does not always mean that there is a problem with the heart. Other conditions can be confused with angina. For example: * Anxiety and tension are common causes of sharp chest pain, especially in the area under the left breast. These sensations differ from those of angina, which seldom is concentrated in this region. Anxiety-related chest pain may be accompanied by tenderness or made worse by movement. * Gallbladder disease or indigestion also can cause pain in the chest, although such pain is associated with food rather than exercise. When is angina an emergency? Usually there are specific signs that angina is very serious or, indeed, an emergency. Whether or not a person has stable or unstable angina, it is important to go to the hospital IMMEDIATELY if anginal pain or discomfort is: * More severe than previously experienced * Getting worse or lasting longer than 20 minutes * Accompanied by weakness, nausea, or fainting * Unchanged after taking three nitroglycerin tablets * Happening at an unusual time (for example, during rest) If ambulance service is not available locally, a person should be driven to the nearest hospital and should NOT attempt to drive there alone. The individual's family or friends should be made aware of the location and names of any angina medicines that are being used. They also should be familiar with warning signs of an anginal emergency. How Is Angina Diagnosed? A diagnosis of angina pectoris is based upon a number of factors, including the person's symptoms, his or her medical history, and a physical examination. The physician will want to make sure that the individual's chest pain is caused by angina and not some other condition, such as indigestion. In addition, the physician will want to determine how far coronary artery disease (CAD) has progressed. Tests used to diagnose angina include: * Electrocardiography (EKG, ECG) * Chest x-ray * Exercise (stress) test * Coronary angiography/cardiac catheterization * Ergonovine test * Blood tests Electrocardiography (EKG, ECG) Electrocardiography (EKG, ECG) measures the electrical activity of the heart. To do this, a number of electrodes (small metal plates) are placed on the skin of the arms, legs, and chest. The electrodes detect the electrical signals that are produced by the heart muscle. The signals then are sent by wires to the EKG machine, which records them as "waves" that are printed out on paper. The EKG provides information on new acute changes or damage to the heart muscle as well as clues to previous changes or damage to the heart muscle. It can reveal previous damage of the heart muscle, such as a mild heart attack that a person may have had without even knowing it. Unfortunately, the EKG does not reliably detect narrowing of the coronary arteries. For this information, the physician must perform additional tests, such as coronary angiography. The EKG often is normal in people with angina when they are at rest, although it usually changes during an anginal attack. For this reason, EKG testing also may be conducted while the individual is exercising on a stationary bicycle or treadmill or while he or she performs daily activities over a 24-hour period (24-hour EKG). Chest x-ray A chest x-ray may be performed to rule out lung disease or other chest abnormalities that may be causing pain. In addition, a chest x-ray will reveal enlargement of the heart, which may be associated with heart muscle damage due to heart attack. Chest x-ray, like an EKG, cannot identify narrowing within the coronary arteries. Exercise (stress) test The exercise tolerance test Procedure used to measure the heart's response to exercise (also known as a stress test). During exercise tolerance testing, the individual is asked to ride a stationary bicycle or walk on a treadmill while a physician takes an electrocardiogram. , also known as a "stress" test, is a method used to measure the heart's response to exercise. During this procedure, the individual is asked to ride a stationary bicycle or walk on a treadmill while a physician takes an electrocardiogram. * If a treadmill is used, the pace and steepness of the track will increase every few minutes so that the EKG can detect any changes in heart function during physical stress. * If a fixed bicycle is used, the principle is exactly the same. The physician or trained personnel will ask about angina symptoms during the test to ensure that the person does not overwork his or her heart. In addition, the person may receive an injection of a radioisotope (a radioactive material) such as thallium, which makes the heart and its vessels visible to a special, computer-linked camera. The camera records how the heart moves and which parts of the heart muscle are short of blood during exercise. The stress test Procedure used to measure the heart's response to exercise (also known as an exercise tolerance test). During stress testing, the individual is asked to ride a stationary bicycle or walk on a treadmill while a physician takes an electrocardiogram. is the only investigation needed for many people, since it is accurate nearly 90% of the time. But, although this method is useful, it cannot identify exactly where or how severely the coronary arteries are blocked. Therefore, in some cases, the physician may request additional tests such as coronary angiography Procedure used to make an x-ray picture (angiogram) of the heart's blood vessels after injecting a contrasting dye into the bloodstream.. Coronary angiography/cardiac catheterization Coronary angiography - an outpatient procedure that is performed under local anesthesia by a cardiologist (heart specialist) - shows the precise size and location of blockages within the coronary arteries. The blood pressure within the heart can be measured at the same time. * A catheter (fine tube) is inserted into an artery in the forearm or groin, and it is snaked through the blood vessels until it reaches the coronary arteries. * Then, dye is pumped through the catheter, so that the heart itself and the coronary arteries are visible on a special video screen. Coronary angiography can pinpoint narrowing, obstruction, and other abnormalities of the coronary arteries. It is an essential test if the cardiologist is considering angioplasty An invasive procedure to enlarge a narrowed artery. Coronary angioplasty is an operation to enlarge a narrowed coronary artery. (blood vessel repair) or coronary artery surgery. Coronary angiography takes about 30 minutes to perform, and it is quite safe. Most individuals are given antianxiety medication before the procedure, so that they feel calm throughout. Because of the anesthetic (painkiller) used during angiography, there is generally no discomfort. Ergonovine test The ergonovine test Test performed if angina may be caused by coronary artery spasm (also known as a provocation test). The artery-narrowing drug ergonovine(or, alternatively, acetylcholine) is injected to provoke coronary artery spasm during coronary angiography. The person's response to ergonovine is then measured. - otherwise known as a "provocation test" - is not done often, but can be performed if angina is thought to be caused by coronary artery spasm. The procedure is conducted during coronary angiography. * The artery-narrowing drug ergonovine (or, alternatively, acetylcholine) is injected to provoke coronary artery spasm. * The person's response to the ergonovine is then measured. * If the individual experiences severe arterial spasm in response to ergonovine, he or she probably has variant angina. Blood tests The physician will order blood tests that gauge the amount of lipids Group of fatty substances that are stored in the body and can be measured in the blood; they include high-density lipoproteins (HDL; good cholesterol), low-density lipoproteins (LDL; bad cholesterol), and triglycerides, among other compounds. (fatty substances) within the blood. High blood lipid can be a risk factor for coronary artery disease, which, in turn, increases the risk of angina. The tests will create a "lipid profile" by measuring blood levels of * high-density lipoproteins (HDL; "good cholesterol A fat-like substance needed for the development body cells. Cholesterol is both produced by the body and found in animal foods. Although it is a necessary substance, if levels of cholesterol are too high it can be deposited on the artery wall, narrowing or blocking blood flow and leading to coronary heart disease.") * low-density lipoproteins (LDL; "bad cholesterol") * triglycerides * other lipid markers Recent research has shown that a blood test that measures the level of C-reactive protein in the blood may be predictive of the mortality from heart disease. Other studies are also showing that the resting ESR (the "sedimentation rate" - how quickly the red blood cells settle to the bottom in a test tube) also has some predictive value about the mortality of heart disease. What Type Of Treatment Is Available? The first step in angina treatment is to eliminate risk factors that are likely to hasten the progression of heart disease. This means that people with angina should stop smoking, lose excess weight, eat a "heart-healthy" diet, and exercise regularly, if possible. Although physicians do not know everything about the causes of angina and atheroma (fatty deposits, or plaques, within the blood vessels), they do know enough to offer effective medical therapy. Such therapy will depend upon the results of exercise tolerance and other tests, the presence or absence of symptoms, and the individual's personal preferences. In general, most angina treatment involves medication, with or without an operative procedure such as * Angioplasty An invasive procedure to enlarge a narrowed artery. Coronary angioplasty is an operation to enlarge a narrowed coronary artery. (blood vessel repair) or * Coronary artery The arteries that deliver blood to the heart itself. There are three major coronary arteries. bypass surgery (surgically made arterial pathways that bypass [go around] diseased arteries in the heart) Individuals with angina may consider: * Smoking cessation * Weight loss and proper nutrition * Regular exercise * Medication * Surgery Smoking cessation If the person with angina is a smoker, the most important thing that he or she can do is to stop smoking. Smoking damages the heart in many ways. Tobacco smoke contains substances that speed up the heart, prevent oxygen from binding to the red blood cells, make the arteries tighten up, and hasten the development of atherosclerosis Gradual buildup and hardening of atheromas within the arterial walls. (gradual buildup and hardening of fatty deposits within the arterial walls). Research indicates that heart attack survivors who stop smoking live longer and have fewer complications than those who continue to smoke. Therefore, it is never too late to stop smoking! All types of cigarettes are dangerous. There is no good evidence that low-tar products are any safer than those with high tar. Anyone who wants to quit smoking should ask a physician for help. Nicotine gum and nicotine patches can be very beneficial, especially when the individual participates in other supportive measures, such as smoking cessation programs or counseling. Weight loss and proper nutrition Many people with angina are overweight. Weight loss is recommended, since it can: * reduce symptoms * improve a person's overall sense of well-being * decrease the likelihood of developing diabetes (which may lead to heart disease) A nutritionist can help to develop a diet that is "heart-healthy," but does not take all the pleasure out of food. Most nutritional programs have the objectives of cutting down on saturated fats, while increasing polyunsaturated fats in the diet. Eating habits generally can be improved by following a few simple steps, such as: Eat fewer portions of * Fatty dairy products (such as butter, margarine, cream, cheese). These foods are rich in saturated fatty acids. Saturated fats are a type of fat that has been linked with high cholesterol A fat-like substance needed for the development body cells. Cholesterol is both produced by the body and found in animal foods. Although it is a necessary substance, if levels of cholesterol are too high it can be deposited on the artery wall, narrowing or blocking blood flow and leading to coronary heart disease. levels in the blood and also with the development of atheroma. Substitute low-fat dairy products (skim milk, low-fat cheese, etc.) whenever possible. * Red meat (such as beef, lamb) Eat more portions of * Unsaturated cooking fats (such as canola oil, sunflower oil, corn oil) * White meat (such as chicken, turkey) * Fish * Grains, cereals, fruits and vegetables Nice To Know: Although fish contains fat, it is rich in polyunsaturated fatty acids known as omega-3 fatty acids Polyunsaturated fatty acids found in certain cold water fish and vegetable oils. Omega-3s may help to reduce the risk of heart attack by preventing blood from clotting and sticking to the artery walls. . Omega-3s may help to reduce the risk of heart attack by preventing blood from clotting and sticking to the artery walls. Some types of fish - especially cold water varieties like herring, mackerel, and salmon - are very high in omega-3s. Soybean and canola oils contain some omega-3s, too. For the most benefit, fish should be eaten two or three times a week. Regular exercise Many people with angina can and should exercise regularly, provided that exercise is not carried out to the point of exhaustion. Exercise helps to keep weight down, reduces clotting tendencies, improves heart function, and improves the blood lipid profile (fatty substances in the blood). Perhaps most importantly - exercise lessens depression and anxiety, since people feel better when they are fit. Very inactive or sedentary individuals should begin to exercise slowly. To avoid injury, it is important to stretch the muscles before exercise. The easiest form of exercise is simple: brisk walking. Other suitable activities include swimming, slow jogging, golf, or bicycling. A typical cardiorespiratory (heart/lung) fitness program calls for 15 to 30 minutes of low-intensity aerobic exercise Exercise that uses up oxygen in the blood by working large muscle groups and increasing the heart rate; endurance-building exercise. (oxygen-using, endurance-building exercise) every other day. Alternative programs may recommend more frequent exercise (for example, five days a week). Need To Know: Isometric exercise Exercise in which the muscles are contracted (squeezed) against resistance over a period of time, for example, weight-lifting. - in which the muscles are contracted (squeezed) over a long period of time - is not suitable for people with angina. Common forms of isometric exercise include weight-lifting and push-ups. Isometric exercise should be avoided, since it can cause decompensation (inability to maintain circulation) in the heart's left ventricle (pumping chamber), as well as a sudden increase in blood pressure. Unfortunately, angina is so severe in some individuals that their ability to exercise is greatly limited. Specifically, people with severe myocardial ischemia Lack of blood in the heart muscle. (insufficient blood in the heart muscle) should not begin exercise training until their coronary arteries have been repaired. Medication A variety of medicines now are available for the treatment of angina. There are five main types of medication, which help to control symptoms and increase blood flow to the heart muscle: 1. Aspirin 2. Nitrates 3. Beta-blockers 4. Calcium channel blockers 5. Statin drugs In addition, a physician may prescribe medicine for conditions such as high blood pressure (hypertension), arrhythmia Disturbance of the heart's normal rhythm. (abnormal heart rhythm), high cholesterol, or other disorders (for example, lung disease) that can contribute to heart disease. 1. Aspirin Aspirin is used to prevent blood clots within the coronary arteries or other blood vessels. Physicians advise most people with angina to take a small dose of aspirin every day, unless they cannot tolerate it because of allergy or gastrointestinal (GI) complaints such as stomach ulcer. Such patients may be able to tolerate other medications such as clopidogrel (Plavix). Note: Pain relievers like ibuprofen (Advil) and acetaminophen (Tylenol) donot have the same clot-preventing properties as aspirin and should not be taken for this purpose. 2. Nitrates Nitrates - such as nitroglycerin - have been used to treat angina for many years. Nitrates open up the arteries, improving blood flow to the heart and the rest of the body. This makes the heart's work easier, since it can pump blood without as much resistance from narrow blood vessels. The reduced workload makes it less likely that angina will occur. Nitrate medications comes in a variety of forms: * Pills that dissolve under the tongue * Pills that are swallowed * Mouth sprays * Ointments or creams * Skin patches or plasters Nitroglycerin (also known as glyceryl trinitrate, or "GTN") often is administered as a pill that is placed under the tongue (for example, Nitrostat). The medication passes rapidly into the bloodstream and relieves angina symptoms within a few minutes. The individual may feel a "tingle" under the tongue and a slight "fullness" in the head, which indicates that the blood vessels are opening up. Nitroglycerin is used for sudden attacks of angina Term for choking pain (LATIN, throat pain or choking). When coupled with the word pectoris (LATIN, of the chest), angina refers to a painful, constricting sensation in the chest. Angina is caused by coronary artery disease, which reduces the supply of blood to the heart muscle.. It is also used as a preventive medicine to be taken before an individual engages in an activity known to bring on an attack. Longer-lasting sublingual (mouth-dissolving) pills are available for extended therapy (for example, Nitrogard). How To Information: How to take nitroglycerin tablets for sudden angina * Take one tablet as soon as angina-related discomfort occurs. * Wait five minutes. If discomfort does not go away, take a second tablet. * Wait five minutes. * If the discomfort persists, take a third tablet. * Wait five minutes. * If after taking three tablets in 15 minutes discomfort continues, go to the hospital immediately. Long-lasting discomfort that does not go away after 15 minutes may signal an approaching heart attack. Isosorbide dinitrate and all mononitrates (Imdur, Isordil, Sorbitrate) are other nitrate medicines that come in tablet form to be swallowed whole or chewed for extended prevention of angina attacks. Nitrate sprays (such as Nitrolingual) are fast-acting products that are used to relieve sudden angina attacks. The mouth should be closed after each dose, and care should be taken not to shake the container; it is flammable. Ointments, like Nitro-Bid, are used for preventive therapy. They are not suitable for sudden attacks of angina. Skin patches and plasters (for example, Transderm-Nitro, Minitran) slowly deliver medicine through the skin (the skin of the chest is the preferred site). These drug-delivery systems are used to prevent angina, especially in individuals who experience symptoms at night. All nitrate products have a limited shelf life, after which they will no longer work effectively. A pharmacist can provide information about how long each product lasts and when it should be replaced. Nitrates may cause headaches and faintness especially when first used, although these side effects usually diminish over time. Need To Know: Nitrate tolerance - the ineffectiveness of a nitrate drug after it has been used for a while - is a well-known hazard of angina therapy. Researchers suggest that nitrate tolerance is caused by the depletion of certain chemicals within the body's cells. These chemicals are needed to convert the drug into its active form. * Sublingual products (pills or sprays that dissolve under the tongue) are less likely to cause nitrate tolerance because of the limited length of time that they are active. * By contrast, longer-acting products (such as pills that are swallowed, skin patches) may cause or provoke tolerance when used with sublingual preparations. Nitrate tolerance usually can be prevented by intermittent delivery of the lowest effective dosage and is generally avoided by ensuring a 12-hour nitrate-free interval. 3. Beta-blockers Beta-blockers have been used for over 35 years to treat both angina and high blood pressure (hypertension). These medications act as a "brake" that slows down the heart rate. Beta-blockers reduce the heart's work, so that it needs less oxygen and fuel. When taken regularly, beta-blockers can reduce the frequency of angina attacks. * "Combination therapy" with a beta-blocker and nitrate is a good choice for people who suffer from high blood pressure as well as angina. * Beta-blockers also are a good choice for people who have tachycardia (rapid heart rate). Sometimes beta-blockers cause side effects like cold hands, cold feet, or fatigue. About one in ten men may experience erectile dysfunction, or impotence (inability to achieve or maintain an erection), which sometimes is remedied by lowering the beta-blocker dose. Because of their effects on the respiratory system, beta-blockers are unsuitable for angina sufferers who have asthma or bronchitis. Cardiologists (heart specialists) generally advise against beta-blocker use by people who have variant angina. Beta-blockers are not to be used if the heart rate is excessively slow (or, if necessary, need to be used with great caution). 4. Calcium channel blockers Calcium channel blockers (CCBs), also known as calcium antagonists, are muscle relaxants that also relax arteries. They are particularly beneficial if angina is caused by arterial spasms rather than blockage. Calcium channel blockers act like nitrates by opening up the arteries in the heart. They improve the blood supply in the heart muscle and relax the arteries within the body, making it easier for the heart to pump blood. Some calcium channel blockers also slow the heart like beta-blockers. Calcium channel blockers, when combined with nitrates, provide excellent control of angina and hypertension. They also are useful in angina patients who have lung disease. Certain calcium channel blockers are preferred when a person with angina experiences bradycardia - an abnormally slow heart beat. * In such cases, calcium channel blockers like amlodipine (Norvasc) or nifedipine (Procardia) are preferred. * The calcium channel blockers verapamil HCl (Calan, Isoptin) and diltiazem HCl (Cardizem) are not recommended when there is a slow heart rate (bradycardia). 5. Statin Drugs Statins are the newest and the most powerful of the prescription drugs used to lower cholesterol. They work by interrupting the final step in the chemical pathway that creates cholesterol in the liver. Recent research shows statins can dramatically reduce the risk for a heart attack, stroke, or death, even in people who have normal cholesterol levels and do not have heart disease. In people with heart disease, statins prevent a first or second heart attack. Statins are safe and well tolerated. Their mild side effects include headaches, abdominal pain, constipation, diarrhea, and gas. They occasionally can cause muscle or joint pain. In rare cases, they can cause liver damage. Common statins are atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), and simvastatin (Zocor). Surgery Some people with angina have extensive narrowing of the heart's blood vessels. If atheromas (plaques; fatty deposits within an artery) block an individual's coronary arteries by more than 70%, the physician usually will recommend surgery to improve blood flow to the heart muscle. Surgical procedures relieve angina symptoms and also help to prevent heart attack. The two main surgeries for angina are: 1. Angioplasty 2. Coronary artery bypass 1. Angioplasty Angioplasty is an interventional procedure to widen a blood vessel. It is commonly used for individuals who have short obstructions within one or two coronary arteries. People with three-vessel disease (obstructions in three coronary arteries) also may benefit from angioplasty if they do not have high-risk features such as severe impairment of the heart's ventricle (pumping chamber). To perform angioplasty, a physician makes an incision in a major artery of the forearm or leg and then threads a catheter (fine tube) through the blood vessels until it reaches the heart. A special dye is pumped into the bloodstream via the catheter, so that the coronary arteries are visible and the entire process can be watched on a video screen. Once the catheter reaches the blocked coronary artery, the physician removes the obstruction or flattens it against the inside of the artery by different methods. These methods include: * "Balloon angioplasty Angioplasty in which a tiny balloon is attached to the end of a catheter and is inflated against the arterial walls to flatten plaque (also known as percutaneous transluminal coronary angioplasty [PTCA]). " (also known as percutaneous transluminal coronary angioplasty, or PTCA), in which a tiny balloon is attached to the end of a catheter. When the catheter reaches the blockage, the balloon is inflated, the plaque Bulging yellow mass (atheroma) that forms within the walls lining the arteries. Plaque contains a mix of fat, cholesterol, inflammatory cells, and fibrous scar tissue and, when deposited on the inner wall of an artery, reduces its inner diameter. is flattened against the arterial lining, and the coronary artery is effectively widened. * Stent deployment, a newer technique being used to keep the coronary arteries open. A small, expandable metal sheath is slipped over the catheter and placed at the site where the artery has just been widened, to prevent it narrowing again. * Microsurgery, in which tiny surgical instruments are used to cut through plaque. * Laser surgery, in which a small laser (high-intensity, focused light beam) is used to clear out the obstruction. This procedure is known as transmyocardial revascularization, or TMR. Both angioplasty and bypass surgery are designed to achieve the same goal - that is, to increase blood flow within the heart muscle. Depending upon the severity of angina, an individual may have the opportunity to choose between the two procedures. Need To Know: Angioplasty or bypass surgery? In comparison to coronary artery bypass, angioplasty: * Is less invasive. Angioplasty is a much less complicated operation that involves comparatively small surgical incisions. Usually it is carried out under local anesthesia. * Requires a shorter hospital stay. The length of hospitalization for angioplasty is one to two days versus five to seven days for bypass surgery. * Results in a quicker recovery. Most people are back at work within a week. However, angioplasty: * Does not work in about 5% of cases, and emergency bypass surgery is necessary. * Must be repeated within six months in about 40% of cases. The coronary arteries become blocked again, and the individual must undergo another angioplasty or have bypass surgery. 2. Coronary artery bypass surgery Coronary artery bypass surgery, like angioplasty, increases the amount of blood flow to the heart and eases discomfort. People with angina Term for choking pain (LATIN, throat pain or choking). When coupled with the word pectoris (LATIN, of the chest), angina refers to a painful, constricting sensation in the chest. Angina is caused by coronary artery disease, which reduces the supply of blood to the heart muscle. usually are candidates for coronary artery bypass surgery if they have: * Widespread obstruction to the left main coronary artery * "Three-vessel disease" (obstructions in three main coronary arteries) * Obstruction that is more diffuse and not felt suitable for angioplasty. Bypass surgery is especially recommended if the individual has significantly decreased heart function, or hazardous changes in the ECG (electrocardiogram). During the bypass operation: * A piece of blood vessel - usually a vein from the leg or an artery from the chest - is removed from the patient and is used to "bypass" the section of coronary artery that is blocked. * One end of the graft (transplanted vessel) is connected below the blockage in the coronary artery. * The other end is sewn into the aorta Great artery that arises from the left ventricle (pumping chamber) of the heart and is the starting point of the body's arterial system. (major artery that carries blood away from the heart and into the body). * The bypass procedure is repeated for each obstructed coronary artery (for example, "triple bypass" means that three grafts have been made to skirt arterial blockages). * Increasingly, the artery from the chest (called the internal mammary artery) is being used, because this is easily accomplished and results are better. Bypass operations are now commonplace, but some risks remain. A cardiologist (heart specialist) will be able to explain the possible risks and benefits in each particular case. In many people, the surgical risk is less than that for gallbladder removal. After surgery, bypass patients need to spend a few days in intensive care, but they usually can go home in about a week. Most people can return to work after a few weeks, although the length of recovery is determined by factors such as age and the person's overall health and fitness. Bypass surgery does not completely cure angina, but most people experience total relief of discomfort for years. Also, specialists feel that the risk of a heart attack is reduced in many individuals. Living With Angina Most people can resume a normal or near-normal life after treatment of angina. Some lifestyle changes will be necessary, but life can still be good. Simple angina can be kept under control by * Following medical advice * Taking necessary medication * Keeping in good physical condition * Eating well Even if angina is complicated by other health problems, it should be controllable. Angina is not a disease of the "fragile." In fact, most angina sufferers lead extremely busy, stress-filled lives. Their disease provides a warning sign that they need to make adjustments in an otherwise full life. Notify a physician if angina attacks become more frequent or more severe. This is especially important if angina comes on while a person is resting, or if nitrate tablets seem to become less effective. Work In spite of having angina, most people are able to continue working. Yet individuals with angina often have fast-paced schedules that could benefit from some improvement. A diagnosis of angina is a good reason to cut down on commitments and to examine one's lifestyle. For example: * Do you have to hurry to the train or bus in the morning? * Would you be less harassed if you planned your work better? * Do you do unnecessary things? If "yes" is the answer to these questions, a slower, more efficient schedule should relieve stress and lessen the chance of an attack. Intense physical labor is inappropriate, and special regulations apply to people who are licensed for heavy goods vehicles or public service vehicles. Driving a car is generally allowed, provided that angina does not occur while driving. Sex The combination of physical activity and sexual excitement may bring on an angina attack. But individuals need not avoid sexual activity, unless it produces angina. Attacks usually can be prevented by taking a nitrate or beta-blocker beforehand. Need To Know: Nitrates and Viagra If you are taking nitrate medication such as nitroglycerin, you should not take Viagra. The deaths that have been reported for people using Viagra are those with coronary heart disease who are also taking nitrates. Alcohol In small amounts, alcohol does not harm the heart. In fact, it might help to relieve tension. But people must be careful to ensure that alcohol does not increase body weight. Here are some recommended guidelines from the U.S. Department of Health and Human Services: * Women - No more than one standard drink per day * Men - No more than two standard drinks per day A standard drink is the equivalent of: * 12 oz. regular beer (5% alcohol), or * 1.5 oz. 80% distilled spirits (40% alcohol), or * 5 oz. wine (12% alcohol) Eating habits If the coronary arteries are partly blocked, the chances are that the individual has been eating too many fatty foods and has a high level of cholesterol A fat-like substance needed for the development body cells. Cholesterol is both produced by the body and found in animal foods. Although it is a necessary substance, if levels of cholesterol are too high it can be deposited on the artery wall, narrowing or blocking blood flow and leading to coronary heart disease. in the blood. Therefore, it is advisable to avoid fats in general and saturated fats in particular (such as dairy products and fatty meat). People with high blood pressure (hypertension) should limit sodium (salt) intake (for example, aim for a target of under 1,500 milligrams of sodium a day) and learn to use other seasonings such as garlic, lemon, and onion. Eat lean meats, use little or no butter, and switch to skimmed or semi-skimmed milk. Grill food rather than frying it. Eat plenty of fruit and fresh vegetables. Weight gain Avoid weight gain. Keeping close to the recommended weight for one's height and age will keep blood pressure down and reduce the heart's workload. Stress Avoid activities that cause mental and emotional turmoil. People with angina must learn to relax more. Some hobbies help people to relax, but it is most important to identify and eliminate unnecessary stresses at home and at work. Exercise Many people with angina can and should exercise regularly, provided that exercise is not carried out to the point of exhaustion. Smoking The most important thing that a smoker with angina can do is to stop smoking. Vacations Vacations and holidays are important and are recommended. But, when traveling, it is essential to organize trips and allow plenty of time. Also, avoid carrying heavy pieces of luggage. Keep your angina Term for choking pain (LATIN, throat pain or choking). When coupled with the word pectoris (LATIN, of the chest), angina refers to a painful, constricting sensation in the chest. Angina is caused by coronary artery disease, which reduces the supply of blood to the heart muscle. medication in your carry-on luggage, not in the suitcases you check at the gate, so that it is easily accessible. Air travel in a modern, pressurized aircraft should cause no problems. It is advisable to rest in the airport departure lounge so that an angina attack is less likely when walking to the departure gate. If angina is brought on by hectic activity, tell the airline staff in advance. They can provide help so that the flight is boarded with as little stress as possible. Avoid travel at high mountain altitudes, although people with mild or moderate angina should be unaffected at heights up to about 6,600 feet (2,000 meters). Here are some frequently asked questions related to angina. Q: My doctor says that my chest pain may be angina, but more tests are needed. When my EKG was taken, it was normal. Do I really need to have a stress test Procedure used to measure the heart's response to exercise (also known as an exercise tolerance test). During stress testing, the individual is asked to ride a stationary bicycle or walk on a treadmill while a physician takes an electrocardiogram.? A: Unfortunately, a simple EKG does not reliably detect angina. Therefore, the physician must perform additional tests, like an exercise stress test. The stress test is the only investigation needed for many people, since it is accurate most of the time. But even this test cannot identify exactly where or how severely the coronary arteries are blocked. So, in some people, additional tests like coronary angiography Procedure used to make an x-ray picture (angiogram) of the heart's blood vessels after injecting a contrasting dye into the bloodstream. may be required. Q: I am frightened by the idea of having to walk on a treadmill during my exercise tolerance test Procedure used to measure the heart's response to exercise (also known as a stress test). During exercise tolerance testing, the individual is asked to ride a stationary bicycle or walk on a treadmill while a physician takes an electrocardiogram. . Won't that trigger my angina - or a heart attack? A: Your physician or other trained personnel will ask about your angina symptoms during the test to make sure that you don't overwork your heart or otherwise put it at risk. Although it may seem frightening, a treadmill is simply a machine with a band that continuously rotates during the test. Every few minutes, the band moves faster and becomes a little steeper. From your heart's response to these stages, a lot of information is obtained on the EKG. If you are tested on a stationary bicycle, the principle is exactly the same. Q: My wife is scheduled to have angiography. She was told that a plastic tube will be inserted through a blood vessel until it reaches her heart. Won't that be painful - and dangerous? A: No. Because of the anesthetic (painkiller) used during angiography, there generally is no discomfort. And people usually are given antianxiety medication before the procedure, so that they feel calm throughout. Coronary angiography only takes about 30 minutes to perform, and it is very safe. Your wife's physician can explain any risks before the procedure. Q: I've been told that I should exercise regularly for my angina. But aren't some types of exercise dangerous? A: Regular aerobic exercise Exercise that uses up oxygen in the blood by working large muscle groups and increasing the heart rate; endurance-building exercise. (oxygen-using, endurance-building activity like walking, swimming, etc.) is beneficial for most people with angina. However, isometric exercise Exercise in which the muscles are contracted (squeezed) against resistance over a period of time, for example, weight-lifting. (weight lifting, push-ups, etc.) should be avoided. Isometric exercise involves contraction [squeezing] of the muscles over a long period of time. This can stress the heart by causing decompensation (inability to maintain circulation) in the left ventricle (pumping chamber), as well as a sudden increase in blood pressure. Also, people with severe myocardial ischemia Lack of blood in the heart muscle. (insufficient blood in the heart muscle) should not begin exercise training until their coronary arteries have been repaired by angioplasty An invasive procedure to enlarge a narrowed artery. Coronary angioplasty is an operation to enlarge a narrowed coronary artery. or bypass surgery. Q: My nutritionist says that I should eat more fish and try to cook with vegetable oils like canola. Why? A: Cold-water varieties of fish (such as salmon, herring, tuna) - as well as certain vegetable oils like canola oil and soybean oil - are rich in polyunsaturated fatty acids known as omega-3 fatty acids Polyunsaturated fatty acids found in certain cold water fish and vegetable oils. Omega-3s may help to reduce the risk of heart attack by preventing blood from clotting and sticking to the artery walls. . Omega-3s may help to reduce the risk of heart attack by preventing blood from clotting and sticking to the artery walls. Fish should be eaten two or three times a week to get the most advantages from omega-3s. Q: How do you tell the difference between angina and a heart attack? A: Some angina symptoms - such as chest pain, sweating, and nausea - may seem like a heart attack. Yet there are significant differences between these two conditions. Heart attack lasts much longer than angina (more than 20 minutes versus 1 to 10 minutes), and, unlike angina, heart attack symptoms continue even after a person rests. Heart attack is a very serious condition that results when a coronary artery The arteries that deliver blood to the heart itself. There are three major coronary arteries. in the heart is completely blocked. Heart attack can be deadly, so you should go to the hospital immediately if chest pain is: * Getting worse or lasts longer than 20 minutes, * Severe than previously experienced, * Accompanied by weakness, nausea, or fainting, * Unchanged after taking three nitroglycerin tablets, or * Happening at an unusual time (for example, during rest). Q: What does "unstable" angina mean? A: "Unstable" angina is a form of angina that is much more serious than stable angina. Unstable angina occurs when a person is resting, asleep, or undergoes physical exertion. Severe discomfort may come on suddenly in someone who has never had angina before. Attacks may intensify or happen more often. Unstable angina is caused by blood clots that form around damaged plaque Bulging yellow mass (atheroma) that forms within the walls lining the arteries. Plaque contains a mix of fat, cholesterol, inflammatory cells, and fibrous scar tissue and, when deposited on the inner wall of an artery, reduces its inner diameter. (fatty deposit) within a coronary artery. Sometimes the clot washes away after the damage has healed. But sometimes the clot enlarges and prevents blood flow to the heart muscle, putting the person at risk of a heart attack. Q: How do nitroglycerin pills stop angina? A: Nitroglycerin tablets are "vasodilators" - that is, they increase the diameter of the arteries, improving blood flow to the heart and the rest of the body. They also dilate (open up) the veins and temporarily decrease the return of blood to the heart, and this eases the workload of the heart. Once enough blood returns to the heart muscle, angina Term for choking pain (LATIN, throat pain or choking). When coupled with the word pectoris (LATIN, of the chest), angina refers to a painful, constricting sensation in the chest. Angina is caused by coronary artery disease, which reduces the supply of blood to the heart muscle. symptoms stop. The heart's workload also becomes easier, since it can pump blood without as much resistance from narrow blood vessels. Q: I have high blood pressure as well as angina. Do any medications treat both problems? A: To treat both high blood pressure and angina, physicians often rely on "combination therapy" consisting of nitrate medicine plus a beta-blocker, or nitrate medicine plus a calcium channel blocker (CCB). Q: Isn't bypass surgery less risky than it used to be? A: Coronary artery bypass is now commonplace and even less risky than gallbladder surgery in most people. In addition, the recovery time for bypass surgery is much shorter than it was a decade ago. All bypass patients need to spend a few days in intensive care, but they usually are discharged home after about five to seven days. Most people can return to work within a few weeks. Of course, every form of heart surgery has risks, which can be explained by a cardiologist (heart specialist) for each individual. Cardiac rhythm disturbances.
There are statements from various corners of world.
Radiofrequency ablations treated cardiac rhythm disturbances with complete success.
Make sure you don't rename and present already existing and recognized effective medical or surgical procedures.
They must answer the following questions.
Radiofrequency ablation.
What is it?
How is it done?
What resources are required?
What type of cardiac rhythm disturbances are treated with this type of treatment.

What is radiofrequency ablation? Radiofrequency ablation is a nonsurgical procedure used to treat some types of rapid heart beating. It's most often used to treat supraventricular tachyarrhythmias. These are rapid, uncoordinated heartbeats. They start in the heart's upper chambers (atria) or middle region (AV node or the very beginning portion of the heart's electrical system). How is radiofrequency ablation done? A physician guides a catheter with an electrode at its tip to the area of heart muscle where there's an accessory (extra) pathway. The catheter is guided with real-time, moving X-rays (fluoroscopy) displayed on a video screen. The procedure helps the doctor place the catheter at the exact site inside the heart where cells give off the electrical signals that stimulate the abnormal heart rhythm. Then a mild, painless radiofrequency energy (similar to microwave heat) is transmitted to the pathway. This destroys carefully selected heart muscle cells in a very small area (about 1/5 of an inch). That stops the area from conducting the extra impulses that caused the rapid heartbeats. How common is this procedure? Radiofrequency ablation is widely used. It's the preferred treatment for many types of rapid heartbeats. It has a success rate of over 90 percent and a low risk of complications. Patients who have this done can resume normal activities in a few days. It causes little or no discomfort and is done under mild sedation with local anesthesia.