According to the American
79,400,000 Americans have
one or more forms of cardiovascular
disease, with high
blood pressure, coronary
heart disease and stroke
rounding out the top three
most common conditions.
Knowing the signs of cardiovascular disease and decreasing your risk factors for developing cardiovascular disease are crucial to helping you live a longer, more active life.
“Cardiovascular medicine has had more explosive changes than any other field of medicine,” says John F. Krahnert Jr., M.D., a cardiothoracic surgeon with Pinehurst Surgical and director of Cardiac Surgery at FirstHealth Moore Regional Hospital.
medicine has had
change than any
other field of
John Krahnert Jr., M.D.
“There have been incredible advances in diagnosis and cardiac imaging, surgical technique, angioplasty and stenting, and medical management. Today, heart surgery is safer than ever, and we are operating on patients we would not have considered surgical candidates 10 years ago.”
The field of cardiovascular medicine is also exploding with patients. One reason is because people are living longer and some heart conditions are more common as we age. It is also true that more young people are developing cardiovascular disease due to obesity, diabetes, lack of exercise and an unhealthy diet full of fat and too much sugar.
Understanding the cardiovascular system helps people prevent and better manage cardiovascular disease.
How the heart, vessels and blood work
The cardiovascular system is made up of the heart, blood vessels and blood. The blood vessels transport blood, which includes oxygen, nutrients, waste products and more, throughout the body. Veins (large blood vessels that carry blood to the heart), arteries (which carry blood away from the heart) and capillaries (smaller vessels in the tissues) are the three types of blood vessels.
Your body’s circulation is the way the blood flows through the body, bringing blood and its vital nutrients to all of the organs. The heart is the hard-working muscle that pumps blood—nearly 4,000 gallons a day—throughout the cardiovascular system.
Due to normal aging, lifestyle factors, hereditary heart disease, congenital heart defects and other causes, many of us will develop cardiovascular disease in our lifetime. Cardiovascular disease includes high blood pressure, high cholesterol, coronary artery diseases, atherosclerosis (hardening of the arteries), peripheral arterial disease (PAD), heart failure, arrhythmias (irregular heart beats), aneurysms (a sac formed by the expanding of a blood vessel or tissue that can burst and be life-threatening) and heart valve disease.
“Recognizing the warning signs of cardiovascular disease and choosing to live a healthy lifestyle could help many people avoid the complications associated with cardiovascular disease,” says Star Mitchell, R.N., MSN, an intensive care nurse at Moore Regional Hospital and chair of the Nursing Department at Sandhills Community College.
Symptoms of cardiovascular disease include chest pain (angina), shortness of breath with normal activity, palpitations of the heart, pain in the leg or hip when walking, increased heart rate, weakness, dizziness, nausea or sweating. Of course, other causes of cardiovascular disease, such as high blood pressure and high cholesterol, have no symptoms and must be checked by a health professional.
The importance of exercising, maintaining an ideal weight, not smoking, reducing stress, maintaining normal blood pressure and cholesterol levels, controlling blood sugar (if you have diabetes) and eating a heart-smart diet cannot be underestimated.
“Not only can these factors help you avoid the possibility of developing cardiovascular disease, once diagnosed with high cholesterol, high blood pressure, poor circulation or other cardiovascular condition—these lifestyle choices can keep you from developing some of the more debilitating or even life-threatening consequences of your illness,” says Jenifir Bruno, M.D., of Moore Regional Hospital’s Hospitalist Service.
Meeting with the cardiologist
“If an individual suddenly experiences fatigue, shortness of breath and chest tightness when walking a few blocks or with exertion, it’s a good indicator that there are some underlying heart disease and heart blockages,” says Peter J. Vassallo, M.D., a cardiologist with Pinehurst Cardiology Consultants.
Peter J. Vassallo, M.D.
In most cases, diagnostic testing, such as a stress test, can be performed. During a stress test, the patient walks on a treadmill, usually with the injection of a radioactive material to examine blood flow to the heart. In a different kind of stress test, the patient exercises and then an ultrasound is performed to look at wall motion, which is an indirect estimate of blood flow to the heart.
If cardiovascular disease is diagnosed, medication is prescribed. Daily aspirin reduces the risk of heart attack and stroke. Drugs that interfere with the liver’s ability to manufacture cholesterol (statin drugs) also help reduce heart attacks and may even cause the artery-clogging plaque to stabilize. Nitroglycerin, which is prescribed for patients with chest pain, allows the arteries in the heart to dilate, which improves blood flow to the heart muscle.
Patients who are found to be high risk based on their stress testing may be candidates to undergo coronary angiography. This involves injecting a dye into the blood vessels and using an X-ray to visualize the blood vessels of the heart and look for cholesterol buildup.
Depending on the severity of the blockages, the patient may be a candidate for further treatment such as angioplasty (with the placement of a stent in the artery) or even coronary artery bypass grafting.
“The specific treatment for a patient’s blockages depends on the patient’s clinical characteristics, the extent of the blockages, heart function and several other factors,” Dr. Vassallo says. “Not every test and/or procedure is appropriate for every patient, and your cardiologist is the best one to discuss the options with you and make the best recommendations for your particular situation.”
Questions to ask your doctor
- What is my risk for developing cardiovascular disease?
- Are there changes I should make to my diet to make it more heart healthy?
- What are my cholesterol levels? Are they normal?
- Does my family history increase my risk for developing cardiovascular disease?
- Am I getting enough exercise to protect my heart and circulation?
The development of cardiovascular disease is a slow process, and many patients don’t go to the doctor until they have chest pain or wind up in the hospital with a heart attack.
“It’s a common misconception that pain with walking or tiredness is a normal part of aging or people think that they are just out of shape,” says Mark F. Medford, M.D., of Moore Regional Hospital’s Hospitalist Service. “Many don’t realize it is because they have poor circulation. The cardiovascular system feeds all of the organs throughout the body. Any condition that affects the organs of the body also affects the cardiovascular system. People with high blood pressure, diabetes and high cholesterol need to be followed extra closely to avoid complications.”
To meet the growing demand for highly specialized cardiac care, the field of cardiology has evolved into distinct subspecialties, each with a unique focus on the cardiovascular system.
Interventional cardiology involves the catheter-based treatment of cardiovascular diseases. These cardiologists frequently perform cardiac catheterizations (when a very thin tube is inserted into a blood vessel in the arm or leg and guided to the heart where contrast dye is injected so the entire heart and vessels can be viewed), angioplasty and stenting, and repair of congenital heart defects such as openings between the walls of the heart.
Arteries can become clogged with the build-up of plaque (cholesterol and other substances) that reduces the flow of blood to the heart and could cause chest pain or even a heart attack. This build-up, which is called atherosclerosis, can also block the flow of blood to the arteries that supply blood to the kidneys, legs, brain and arms.
Angioplasty opens very narrow arteries and allows blood to flow to the heart. During angioplasty, a very small incision is made in the leg or arm and a tube is inserted into the artery. A thin tube (catheter) is threaded through the artery until it reaches the blockage. A tiny balloon is inflated at the site of the blockage and pushes the plaque to the walls of the artery and blood flow is resumed. In many cases a stent (a wire mesh tube) is used to help keep the artery open. Stents are used in vessels that lead to the heart, brain, kidney and vessels to the arms and legs.
In 2003, drug-coated stents (stents coated with a medicine that keeps scar tissue from forming and re-closing the arteries) were approved. Research has shown that in some cases drug-coated stents can reduce the need for repeat angioplasty to prevent heart attacks.
Heart rhythm disorders, or irregular beating of the heart, are caused by electrical disturbances of the heart. An electrophysiology study records the electrical activity of the heart. Patients with an abnormal heart rhythm are treated with medication or with the surgical implantation of a pacemaker or other device inside the body to regulate the heart’s rhythm. These devices have been shown to be very effective in treating patients with congestive heart failure and life-threatening irregular heart rhythms, which are two major causes of sudden cardiac death.
FirstHealth’s cardiothoracic surgeons also use extreme cold or heat to treat atrial fibrillation, a common heart rhythm problem. (FirstHealth’s Andy Kiser, M.D., has developed a new procedure to treat atrial fibrillation. See the story on page 28.)
Cardiothoracic surgeons specialize in the surgical treatment of diseases affecting the organs inside the chest, including the heart, heart vessels and lungs. Commonly performed procedures include coronary artery bypass grafting (CABG) or bypass surgery, surgical repair of congenital heart diseases or diseases of the lungs, and heart or lung transplantation.
CABG involves taking blood vessels from other parts of the body (either veins from legs, arteries from the arms or chest wall), sewing the blood vessels past the blockages and rerouting the blood around the blockages—basically bypassing them. Advances in technology and surgical techniques have allowed cardiothoracic surgeons to perform CABG and other surgeries with smaller and smaller incisions, which often means less pain and a quicker recovery.
“Traditionally for CABG, we removed a vein from the leg, which sometimes required a huge incision from the ankle to the groin,” says John Krahnert Jr., M.D. “Now, via minimally invasive vein harvesting, we can remove the entire vein with just one or two 1-inch incisions.”
Moore Regional Hospital plans to add a new type of operating room that is a combination operating room and catheterization lab. The room is designed for the patient who may have several blockages and would benefit from the placement of a stent and require bypass.
Patients will first undergo angioplasty/ stenting and then CABG allowing them to have two procedures at one time with one recovery. Other minimally invasive cardiothoracic procedures include advances in heart valve repair through a 2- to 3-inch incision compared to the standard open-chest operation.
“Cardiovascular care is a core focus of FirstHealth of the Carolinas, which offers one of the most comprehensive heart programs in the region, from strong community-based heartdisease prevention efforts, to the most dependable and advanced diagnostic, therapeutic and surgical capabilities,” Dr. Krahnert says.