By: Sweta Chandela, MD
Brandywine Valley Cardiology

What were you doing in 1984? This was the year women surpassed men in the number of cardiovascular deaths, a trend that continues even today. Although, surveys show women fear breast cancer the most, heart disease is actually the number one killer of women in the United States.  According to 2006 data, focused on cause of death in the American female population, Cardiovascular Disease killed almost twice as many women as all forms of cancer combined.

Although breast cancer is an equally devastating disease, it is time to focus on the organ of your body that you rely on day in and day out.

What is the heart & how does it work?
Think of the heart as a muscular organ.  The most important muscle you want to work on is your heart, not your biceps, triceps, or your gluteus maximus!
It is the main center of the body’s circulation system and it has an electrical network of cells that help it contract and relax in a synchronized way.  The picture of the heart is shown for your reference.  Think of the heart as having a right and left side.  Each side has an atrium (receiver chamber) and a ventricle (pump chamber). There are four valves which function like revolving doors that direct blood in and out.

Blood returns to the right atrium after delivery of oxygen to all the organs in the body.  From the right atrium, the blood passes thru a valve into the right ventricle.  The right heart ventricle pumps this blood to the lungs, so the blood can pick up more oxygen.  The lungs send the blood with new oxygen back to the heart, into the left heart atrium.  From the left atrium, the blood passes thru a valve into the left ventricle.  The left heart ventricle pumps this newly oxygenated blood to the rest of the body.  This all happens in 1 beat, and the heart continues this cycle every second, of every minute, of every hour, of every day! This amounts to about 100, 000 beats total each day.

In order to work this hard and continuously, the heart muscle needs its own blood supply.  The coronary arteries do just that. These are the blood vessels that provide blood to the heart itself.

What is Coronary Artery Disease (CAD)?
CAD is the most common type of heart disease.  It is the leading cause of death in the United States for both women and men.

CAD is a result of plaque in the coronary arteries.  Plaque is composed of cholesterol, fat, calcium and some other particles.  The build up of plaque in the coronary arteries is termed atherosclerosis.  Atherosclerosis can occur in any of four coronaries and as it progresses, it causes narrowing in the coronary arteries.  The narrowing is like having a pipe that is partially clogged.  So, the blood is unable to reach and provide oxygen to the heart muscle.

If the heart muscle does not get the oxygen rich blood, the heart cells suffer causing chest pain, or angina.  Sometimes, this is because the plaque becomes unstable and it can rupture.  It is like a very mini-volcano eruption, which causes the body to immediately react.  The body senses an injury/inflammation and sends healing factors to the area.  One of these healing factors are the platelets.  These are the cells that cause our blood to clot when we get cut.  The platelets try to help heal the area of rupture, but because there are so many in the area of injury, a clot forms inside the coronary artery.  This is called a thrombus.

A plaque rupture and thrombus formation cause a severe blockage in the coronary artery and this is a myocardial infarction, or, more commonly a heart attack.

What are the symptoms of a heart attack?
Typical symptoms include chest pain or pressure, left arm pain, jaw pain and shortness of breath.

Associated symptoms include nausea, vomiting, sweating, clammy skin and light headed/dizziness.

It is very important to know that some people never even have symptoms of a heart attack or angina.  Silent CAD occurs mostly in women and people with diabetes. Women may present with less classic symptoms like no chest pain/pressure, but feeling sudden onset of weakness, fatigue, shortness of breath and discomfort in the back, chest, arm, neck or jaw.

What are the risk factors?
Modifiable:
Elevated Cholesterol
Elevated Blood Pressure
Smoking
Diabetes
Metabolic Syndrome (abdominal obesity, elevated triglycerides, low HDL, high blood pressure, elevated blood sugar level)
Obesity

Nonmodifiable:
Age
Family History early CAD
Sex

Emerging:
Homocysteine
Elevated Lipoprotein (a)
Markers of  Inflammation

What should you do if you feel you have the risk factors or symptoms?

• Tell your primary doctor about your symptoms and DO NOT ignore them.
• Control your modifiable risk factors and take charge of your heart.
• Ask to be tested for your cholesterol level and go over the results with the doctor.  Ask whether your levels and your risk factors require medical therapy, lifestyle modifications, or both.
• Ask your doctor if you should be on a daily dose of baby aspirin for primary prevention.
• If you are having symptoms, get an electrocardiogram and ask your doctor whether you should see a Cardiologist.  Ask if you should get a stress test, echocardiogram, CT scan of the heart, or cardiac catheterization.
• Be physically active.

I would further like to offer myself as a resource for any questions you may have:

Sweta Chandela, MD
Brandywine Valley Cardiology
3025 C.G. Zinn Road
Thorndale, PA 19372
610-384-2211
sweta_chandela@chs.net