Siva Gummadi, MD – Cardiovascular Institute of Central Florida
Cardiovascular disease is the most common cause of death in men and women. It is a broad term used to describe a disease process that occurs within the heart and the blood vessels of the body. The heart is a muscle and can be thought of as a pump that perpetually pumps blood with each heart beat to the entire body. The left side of the heart pumps oxygenated blood throughout the body through the arteries. After all the organs have extracted the oxygen from the blood, the blood flows back into the right side of the heart through veins where it is pumped into the lungs to become oxygenated after which it flows back into the left heart and the process starts again. The heart muscle gets its own oxygenated blood via the coronary arteries. Fatty plaque deposits can develop within the coronary arteries resulting in obstruction of flow. This process is called atherosclerosis and can occur due to multiple reasons. These include having high blood pressure, diabetes, high cholesterol, smoking, age and male gender.
Angina is a term used to describe symptoms that occur when there is significant obstruction of flow in the coronary arteries. Most commonly the patient will feel heaviness or tightness in the center or left side of the chest that often radiates to the left arm or jaw. It can be associated with nausea, sweating, or shortness of breath. “Stable angina” occurs when symptoms occur with exertion and resolve at rest. When the plaque tears or ruptures, the body tries to mend it by forming a clot. In doing so, there is further obstruction in flow in the coronary artery and this results in a heart attack. In certain at-risk patients, a daily aspirin is recommended to prevent this clot formation, thereby preventing a heart attack.
When a heart attack occurs, the angina symptoms can occur at rest and usually do not resolve without further medical attention. It is best to dial 911 to facilitate treatment. If the heart attack involves the blood clot causing a total or 100% blockage, the patient is rushed to the cardiac catheterization laboratory where an interventional cardiologist will perform an invasive procedure to open up the blockage using balloons and stents to prevent or reduce damage to the heart muscle. The earlier the blockage can be opened, the less damage to the heart muscle. If there is significant damage to the heart muscle then the patient will be at risk for congestive heart failure. Regardless of the outcome, a cardiologist will prescribe medications to help prevent future heart attacks as well as help remodeling of the heart muscle and improve heart function.
Similar to having plaque in the coronary arteries, plaque can build up in other arteries of the body. This is known as peripheral artery disease (PAD). Symptoms of PAD are manifest depending on which vessels are involved. The carotid arteries supply oxygenated blood to the brain and obstruction of flow can result in a transient ischemic attack (TIA) or stroke. Having disease in the arteries to the legs can result in discomfort in the muscles of the legs and can limit a patient’s ability to walk. If a patient has PAD, he or she is at very high risk of developing coronary artery disease and heart attack. Thus, appropriate preventative measures need to be taken.
Patients that are at risk for cardiovascular disease or are having worrisome symptoms are referred to a cardiologist for diagnostic evaluation. The initial evaluation of a patient usually involves a visit with a cardiologist during which pertinent questions are asked by the cardiologist and a physical examination is performed. Following this, diagnostic testing may include electrocardiogram, echocardiogram, and nuclear stress test. Depending on the findings, further testing may include cardiac catheterization and medical therapy.
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