Lifestyle Modification; Reducing the risk of cardiovascular disease by changing health behaviors is, by far, the most effective way to reduce risk and it is also long-lasting.
Not Smoking; Cigarette smoking kills more than any other health behavior. If you quit smoking, you will halve your chances of developing heart disease.
Follow a heart-healthy diet:
Eat Healthy; Eating healthfully can contribute to lower cholesterol and blood pressure levels, and can reduce the risk of type 2 diabetes by helping to maintain an appropriate weight.
Limit intake of total fat, saturated fat, trans fats, and cholesterol
Eat five or more servings of a variety of fruits and vegetables per day
Reduce servings to one per day of grain products and reduce your intake of refined carbohydrates.
Limit intake of foods that are high in calories, but low in nutrition
Eat six grams or less of salt per day
Exercising Regularly – Regular exercise can help you lose weight, lower cholesterol and blood pressure levels, and reduce you risk of type 2 diabetes. Walking is good exercise
Avoid any alcohol
Heavy drinking actually increases your risk of hypertension and heart disease. Women should limit themselves to one alcoholic drink per day and men to two.
Avoid pollution
The fact is the air we breathe has a lot to do with our health. Poisons in the air enter our blood stream through our lungs and make heart and other disease common place in our lives.
Clean water
Drink clean pollution free water without chlorine or other cleaning additives. Invest in a quality water filtration system for home.
Cardiovascular Disease Signs and Symptoms
Cardiovascular disease can usually be diagnosed by observing symptoms and risk factors from the medical history and signs from the physical exam. Certain symptoms tend to be more or less common in certain conditions. A symptom such as shortness of breath often characterizes heart failure, whereas chest pain is often present in angina. Although not all signs and symptoms are present for all types of cardiovascular disease while some are present only in a few conditions, others are in several different conditions, and all can be indicative of many things other than cardiovascular disease. There may be no symptoms at all until the disease reaches a late stage.
Major symptoms suggestive of cardiovascular conditions
Chest Pain; The specific type and location of pain can tell a lot about its cause. For example, a tightness or squeezing sensation in the chest often indicates angina or heart attack. On the other hand, chest pain that gets worse when lying down and doesn’t worsen with exertion is more likely to be a symptom of pericarditis, an inflammation of the sac surrounding the heart.
Leg Pain; Peripheral vascular disease, often leads to cramping and fatigue in the legs with exertion.
Shortness of Breath; Fluid backing up into the lungs from a failing heart leads to shortness of breath, which is often made worse by laying down. While shortness of breath is common to many types of cardiovascular conditions, it is no by no means limited to CVD. The symptom is very common, for example, in lung disease.
Fatigue; Fatigue is another common symptom of cardiovascular disease, presumably caused by insufficient blood flow to the muscles along with the decreased availability of oxygen due to fluid in the lungs.
Palpitations; A heart that is beating at an unusual force, rate, or rhythm, could just be an indication of anxiety or too much caffeine. However, abnormal heartbeats—especially if they occur in conjunction with other symptoms like fatigue or fainting—could hint at a more serious underlying condition such as an arrhythmia.
Lightheadedness and Fainting; Insufficient blood flow to the brain can cause lightheadedness or fainting. This may be due to abnormal heart rate or rhythm, or to insufficient cardiac output. Of course, fainting may have many other causes ranging from anxiety to epilepsy, and in most individuals is not due to CVD.
Physical exam signs suggestive of cardiovascular conditions
High or low blood pressure
Rapid or shallow breathing
Swollen veins in the neck
Swelling in the feet and ankles
Abnormalities in the retina (back of the eye)
Enlarged heart (measured by placing hand on chest)
Extra or abnormal heart sounds (via stethoscope)
Pale, clammy appearance
Cyanosis (blue tinge to the skin), particularly in the extremities
Rapid and/or irregular heart rate
Fluid in the lungs (via stethoscope)
Abnormal sounds of arterial blood flow throughout the body (via stethoscope)
Pulsating abdominal mass (aortic aneurysm)
Cool extremities
Reduced or absent pulses in the extremities
Cardiovascular disease diagnostic procedures
There are multiple tests to confirm the diagnosis of a cardiovascular condition and determine its severity.
Some diagnostic procedures carry a small risk of stroke, heart attack, or death.
Electrocardiography (ECG or EKG); All patients suspected of having a heart attack have an ECG taken. ECGs measure the initiation and conduction of electrical currents in the heart. To take an ECG, doctors place small metal electrodes on a patient’s arms, legs, and chest. The electrodes measure the direction and flow of electrical impulses in the heart and record them on a monitor or moving strip of paper. ECGs can also be used to identify abnormal heart rhythms (arrhythmias), thickening of heart muscle, and inadequate blood flow to the heart (myocardial ischemia).
Electrocardiography (ECG or EKG); ECGs measure the initiation and conduction of electrical currents in the heart. To take an ECG, doctors place small metal electrodes on a patient’s arms, legs, and chest. The electrodes measure the direction and flow of electrical impulses in the heart and record them on a monitor or moving strip of paper. All patients suspected of having a heart attack have an ECG taken. ECGs can also be used to identify abnormal heart rhythms (arrhythmias), thickening of heart muscle, and inadequate blood flow to the heart (myocardial ischemia).
Cardiac Stress Test & Exercise Tolerance Test; This test evaluates for the presence and severity of cardiovascular disorders by measuring the heart’s electrical activity as it responds to additional demand for oxygen during physical activity. Patients pedal on an exercise bike or walk on a treadmill at an increasing pace while the doctor monitors the ECG changes blood pressure, and symptoms.
Echocardiography; Echocardiography a popular noninvasive test that does not use x-rays and can provide moving pictures of the heart’s activity in real time. The procedure uses high-frequency ultrasound waves to visualize the size, shape, and motion of the heart’s four chambers, valves, major blood vessels and it’s surrounding pericardial sac. It is used to diagnose conditions involving the structure or function of the heart, such as heart murmurs and congestive heart failure.
Doppler Ultrasound; Doppler ultrasound is a special echocardiographic technique that uses color coding to illustrate the direction and velocity of blood flow through the heart chambers and vessels. Doctors often use it to assess whether the heart valves are functioning properly.
Cardiac isoenzymes; Suspicion of a heart attack will prompt your doctor to order serial blood tests to check for evidence that the heart muscle as been damaged. This usually requires an overnight stay in the hospital until all of the results are available.
Angiography; This study produces images of large and medium sized arteries throughout the body. A dye that is visible on x-rays is injected into the arteries through a catheter. This permits doctors to see the outlines of the arteries’ interior, and identify irregularities or narrowing due to atherosclerotic plaques, or abnormal widening due to aneurysms.
Cardiac Catheterization; Cardiac catheterization is commonly used in the treatment of coronary heart disease. This procedure examines the major blood vessels and chambers of the heart. The most common use of cardiac catheterization is for coronary angiography, which uses x-ray absorbing dyes to illuminate blood flow through the arteries that feed the heart muscle. The same technique can also be used to study the anatomy and pumping action of the heart’s chambers. In addition, various instruments passed through the catheter can measure blood pressure in the major vessels and heart chambers; draw blood samples to be analyzed for oxygen and carbon dioxide content or for metabolic studies; and obtain heart muscle tissue samples for biopsy.
Duplex Venous Ultrasound; Noninvasive vascular study that uses ultrasound technology to visualize the flow of blood in veins. It is primarily used to diagnose deep vein thrombosis, or blood clots in the major veins of the legs, which can break off and obstruct blood vessels in the lungs.
Venography; Uses injected dyes and x-rays to examine the interior of blood vessels, in this case veins. This procedure can also be used to diagnose deep venous thrombosis, though duplex venous ultrasound is usually more desirable because it is not invasive.
Electrophysiology Study; Used to assess serious electrical conduction abnormalities that predispose to life threatening arrhythmias. Small electrodes are inserted through the veins or, less often, the arteries, and directly into the chambers of the heart. The electrodes are used to stimulate the conduction pathways and record the direction and flow of their electrical activity. It is often used in preparation for the implantation of an artificial pacemaker.
Computed Tomography (CT) Scan; Computed tomography, a computer creates cross-sectional images from serial x-ray scans. These images allow doctors to detect abnormalities in the brain, such as a stroke.
Magnetic Resonance Imaging (MRI); Magnetic resonance imaging uses a powerful magnet and radio waves, and to create detailed computerized images of inside the body. Like a CT scan it is often used to diagnosis abnormalities in the brain, such as a stroke, but it is also used examine structures in the chest, such as the heart and surrounding blood vessels. A specialized technique called magnetic resonance angiography (MRA) can create images of blood flow within arteries. While this technology has promising applications, it is still not routinely used clinically.
Myocardial Perfusion Imaging – This imaging procedure uses radioactive isotopes (unstable substances that continuously emit small amounts of radiation) to assess how well blood is reaching the heart muscle. It is commonly combined with an exercise tolerance test (see above) to help determine whether there is sufficient blood flow to meet the demands of the heart during exercise. It is also used to detect areas of the heart that have died due to a previous heart attack.
Positron Emission Tomography (PET); PET scans are highly specialized studies that use radioactive substances that emit particles called positrons. Individual scans can be assembled into three-dimensional color-coding images that illustrate the levels of metabolic activity in different parts of the heart. Due to its expense and the availability of cheaper alternatives, PET scanning is not widely used in clinical settings.
Medications
Medications should only be prescribed when lifestyle modifications have proved ineffective.
Medications are convenient to take but they suffer from some major drawbacks causing adverse effects and they tend to compensate for, rather than solve, the underlying problem.
Antihypertensives – A doctor will prescribe an antihypertensive to reduce high blood pressure and to lower overall cardiovascular disease risk. Antihypertensives work in several ways: by ridding the body of excess fluids, by slowing down the pace of the heart, by dilating blood vessels or by blocking the effects of chemicals that cause them to constrict. You may have to go through a trial period with different medications to find out which work best for you.
Examples
Alpha 1-selective adrenoceptor blockers, such as doxazosin and prazosin
Angiotensin-converting enzyme (ACE) inhibitors, such as enalapril and lisinopril
Angiotensin receptor blockers, such as candesartan and losartan
Beta blockers, such as atenolol and pindolol
Calcium-channel blockers, such as nicardipine and nisoldipine
Centrally acting sympathoplegic drugs, such as clonidine and guanfacine
Diuretics, such as acetazolamide and hydrochlorothiazide
Ganglion-blocking agents, such as mecamylamine
Postganglionic sympathetic nerve terminal blockers, such as guanethidine and reserpine
Vasodilators, such as diazoxide and hydralazine
Antiplatelets – Antiplatelets interfere with the formation of blood clots that can lead to heart attack, stroke or gangrene.
Aspirin is most commonly prescribed antiplatelet agent used to reduce the risk of CVD. Other more expensive drugs (ex. clopidogrel) are often used in patients already diagnosed with CVD.
Cholesterol-lowering agents – Based on your overall cardiovascular risk and your success with dietary changes, your doctor may recommend drugs to lower cholesterol. Some drugs are better than others at lowering high LDL or total cholesterol, raising low levels of HDL cholesterol, or lowering triglyceride levels.
Examples
Bile-acid sequestrants, such as cholestyramine and colestipol
Fibrates, such as gemfibrozil and fenofibrate
Nicotinic acid drugs, such as niacin
Statins (HMG-CoA Reductase Inhibitors), such as pravastatin and simvastatin
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