Heart Attack vs. Heart Failure
Would you explain the difference between heart attack and heart failure?
Cardiovascular disease (which includes heart failure and heart attack) is the most common cause of death in the United States. Approximately 71 million Americans have one or more type of cardiovascular disease, with 40% of them over age 65 years. Each year 450,000 deaths due to heart attack and heart failure occur before patients can reach a hospital or emergency room.
Coronary artery disease (blockage of the arteries supplying blood to the heart) can result in a myocardial infarction (commonly known as a "heart attack"). The blockage is a result of multiple factors including narrowing of the arteries from plaque (calcium and cholesterol), inflammation of the arteries, and a blood clot in the area of the narrowing, leading to blockage of blood flow. The result can be death of heart tissue or as it's commonly called, a heart attack. Medicine now has numerous treatments for a heart attack, from drugs that can break up a clot and open an artery, to placement of a stent in the coronary arteries (a small tube that is inserted in the area of narrowing to open blood flow). These treatments frequently can stop a heart attack or minimize damage to the heart.
Congestive heart failure is a form of cardiovascular disease that results in the decreased ability of the heart to pump blood forward or the ability to fill the heart with blood in a cyclical manner. Heart failure can result from a heart attack, but also from chronic uncontrolled high blood pressure, or heart valve disease. The incidence of heart failure has tripled in the past decade, partly related to our aging population and the treatment of chronic cardiovascular disease. If the heart cannot effectively pump blood out of the arteries and to the vital organs, these organs will be damaged. In addition, fluid will start to collect in the lungs, leading to shortness of breath and loss of good air exchange (oxygen for carbon dioxide) that leads to tissue damage. Modern medicine has multiple medications, defibrillators, pacemakers and other assist devices available to stabilize congestive heart failure.
Cardiovascular disease is more common in certain ethnic groups like American Indians and African Americans. Other major risk factors include smoking, high blood pressure, obesity, diabetes and high cholesterol.
The common symptoms of a cardiac event may include chest pain or pressure and shortness of breath. The key is to get treatment early by getting to a hospital as soon as possible after the onset of symptoms.
Q. Why am I reading so much about the importance of women paying attention to their heart health? Doesn't heart disease affect men and women equally? Are there difference that put women at greater risk?
A. Women are subject to the same risk factors as men and need to pay equal attention to their heart health, but cardiovascular deaths account for more total deaths in women than in men! This may be because the clinical presentation of coronary artery disease in women can be different from men, with more atypical symptoms of chest pain or shortness of breath. Also, women tend to make the decision to get to the hospital later than men after the onset of symptoms, which limits some treatment options.
The incidence of heart disease in women increases with age, though women lag about ten years behind men in onset due the protective effects of hormones. For women, death due to coronary artery disease is 2.5 times more likely than death from stroke, 3-4 times more likely than death from lung cancer and five times more common than breast cancer.
Q. I come from a family with a history of heart attacks. Is there anything I can
do to improve my heart health and protect myself from having a heart attack?
A. Family history is clearly not within our control, but if you are aware of cases of premature heart disease in your relatives, you can and should pay closer attention to your behavior. (The most important "family history" for you to share with your doctor is that of an immediate relative (parents or siblings) with heart disease at a relatively early age, 65 year or younger).
Other important factors that increase your risk and that you can control include smoking, obesity, and high blood pressure. If you have diabetes, good blood sugar control is essential to preventing heart disease. Finally, controlling cholesterol is important through diet, exercise and possibly medication. (The level of cholesterol control varies with the clinical situation, but in general you should try to lower your total cholesterol to less than 200 mg/dl, keep your HDL cholesterol high and lower the LDL cholesterol to less than 130 mg/dl.)
The importance of prevention cannot be over emphasized. February is "Heart Health Awareness Month," which offers an opportunity for all of us to pay attention to the importance of controlling and preventing heart disease.