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Top 3 Heart Conditions: CAD, Heart Failure, & Afib

Heart disease is the leading cause of death for both men and women worldwide. In fact, it kills one person every 34 seconds in America alone. 

The good news is you can improve your chances of avoiding heart disease. A healthy diet and regular exercise are key, but there’s even more you can do. Read on for the top 3 heart conditions and ways to protect your heart from this number one killer. 

Coronary Artery Disease (CAD)

Nearly 20 million adults aged 20 and older have CAD, making it the most common type of heart disease. 

This condition is most commonly caused by a buildup of fat and cholesterol in the inner walls of your arteries (blood vessels). This process is called atherosclerosis and occurs over the years of your life, causing arteries to narrow or become blocked. Heart attack or myocardial infarction is a form of CAD, which happens when the heart’s blood supply is suddenly cut off from sudden rupture or erosion of a cholesterol plaque. Do you know a heart attack occurs every 40 seconds in America?

What CAD does is prevent your heart muscle from getting the blood and oxygen it needs. This can cause chest pain (angina) or a heart attack and also can lead to heart failure and heart rhythm problems. 

Symptoms of Coronary Artery Disease

  • Chest pain or pressure/discomfort 
  • Shortness of breath
  • Fatigue
  • Discomfort or tingling in arms, back, neck, shoulder or jaw 
  • Nausea and vomiting can be signs of heart attack
  • Women can have atypical symptoms such as a heartburn-like feeling, sudden dizziness, anxiety or cold sweats 
  • Heart attacks can sometimes occur silently in elderly and those with diabetes 
  • Heart attack can also manifest as sudden cardiac arrest which happens when the heart suddenly stops beating 

Risk factors For CAD

Prevention and Treatment of CAD

  • Lifestyle changes and risk factor modification such as:
    • Quitting smoking
    • Adopting a heart healthy diet
    • Managing stress
    • Exercising regularly
    • Maintaining healthy body weight
    • Controlling blood pressure, blood sugar and cholesterol levels, 
    • Seeking medical attention early without delay and having regular follow up with your doctor.

In the event of a suspected heart attack, call 911 immediately (within minutes of onset of symptoms), because every second counts to salvage the heart muscle from damage and save your precious life or your loved one. Emergency CPR (cardiopulmonary resuscitation) within the first few minutes of sudden cardiac arrest can greatly improve the chances of survival. 

  • Take medications as directed. Medication adherence is very important. 
    • Take your medicines as prescribed in the right doses, at the right time and the right way. 
    • Bring a list of all your medicines to every health visit. 
    • Always talk to your physician or pharmacist if you have questions about your medications. 
  • In some cases, a procedure/surgery aimed at coronary artery revascularization may be needed, such as:
    • Angioplasty or coronary artery bypass surgery
    • Placing a stent (a metallic scaffold) to prop the artery open
    • Open heart surgery or coronary artery bypass surgery to reroute blood around the blocked or narrowed area
    • Cardiac rehabilitation plays a vital role during recovery after heart attack or after coronary artery revascularization

Heart Failure

More than 6 million Americans have heart failure, which simply means their hearts aren’t functioning as well as they should. It’s the leading cause of hospitalizations in people aged 65+. 

It might sound scary to be diagnosed with heart failure. Heart failure doesn’t mean that your heart has stopped working. Your heart still works, but is weaker or stiffer than before.

Types of Heart Failure

There are two types of heart failure. 

  • When the weak heart can’t pump or squeeze enough blood out to the body, it is called heart failure with reduced ejection fraction(HFrEF). Ejection fraction is a measure of how much blood your heart is pumping out with each heartbeat. 
  • When the heart can’t fill with enough blood due to stiffened heart muscle, that’s called heart failure with preserved ejection fraction(HFpEF). 

Heart failure is a chronic lifelong condition. It is a complex, yet manageable disease. You can learn to live with heart failure and lead a normal life. Early detection and treatment gives you the best chance to preserve heart function and  live a longer, more active life. You can turn heart failure into heart success.

Common Symptoms of Heart Failure

  • Extreme weakness or fatigue
  • Rapid changes in weight
  • Feeling lightheaded
  • Swelling in ankles, feet, legs or stomach
  • Rapid or irregular heartbeat
  • Shortness of breath
  • Trouble breathing or coughing when lying down
  • Waking up breathless at night
  • Frequent urination at night time
  • Cold legs and arms
  • Decreased appetite, problems concentrating

Common Risk Factors for Heart Failure

  • Diabetes
  • Heart rhythm problems
  • Valve problems
  • Congenital heart defects
  • Obesity
  • High blood pressure 
  • Coronary artery disease
  • Heart attack
  • Sleep apnea
  • Heavy alcohol or substance abuse
  • Family history of an enlarged heart (familial cardiomyopathy)
  • Severe lung disease (Cor Pulmonale)

Treatments for Heart Failure

Treatment depends on the type and stage of the condition. Typically, a combination of medications, lifestyle changes and procedures are part of the treatment plan. 

  • Lifestyle changes
    • Limit how much salt you eat and watch how much fluid you drink daily. Your dietician or provider can help you create a diet that works best for you and your heart. Exercise helps your heart. 
    • Try to get at least 30 minutes per day, most days of the week. Talk to your doctor before beginning to exercise. In some instances, your doctor might refer you first to a cardiac rehabilitation program. 
    • Weigh yourself daily. Changes in weight could signal that it’s time for a change in your treatment plan. 
  • Medications
    • Take medications as directed. Many people with heart failure use more than two to three medications. 
    • Never stop taking medication without discussing it with your provider. If you are having problems with adverse effects, talk to your provider as soon as possible. 
    • Many of the medications used for heart failure require blood work (labs) to monitor kidney function and electrolytes.
  • Procedures -  Several devices and procedures can help the heart work better in people with heart failure. 
    • Implantable cardioverter defibrillator (ICD): Harmful heart rhythms are common in people with heart failure with reduced ejection fraction and they are dangerous because they can lead to cardiac arrest. ICDs deliver an electrical shock to terminate the dangerous heart rhythm.
    • Cardiac resynchronization therapy (CRT): Sometimes the left and right sides of the heart don’t beat simultaneously and in such instances this type of a pacemaker can help to synchronize the two sides which can help reduce the symptoms.

Atrial Fibrillation (AFib)

More than 3 million people in the U.S. are affected by atrial fibrillation or AFib. That means instead of keeping a regular beat, the heart beats at irregular or offbeat times. It might feel like the heart is racing, fluttering or skipping beats. 

The biggest concern with AFib is stroke because it can result in blood clots forming in the heart. In fact, people with AFib are five times more likely to have a stroke. Each person’s risk of stroke varies based on other comorbidities and other variables such as age, sex, hypertension, heart failure, prior stroke, diabetes, etc. If heart rates are not well controlled over a long period of time, it can lead to weakening of the heart muscle. AFib is a risk factor for heart failure. That’s why it’s important to detect and treat this condition as early as possible. 

Symptoms of AFib

  • Fatigue
  • Shortness of breath
  • Dizziness or lightheadedness
  • Palpitations
  • Chest pain
  • Nothing or asymptomatic 

Risk Factors

  • Advancing age
  • High blood pressure
  • Obesity
  • Family history
  • Diabetes
  • Underlying heart disease such as heart failure, coronary artery disease, cardiomyopathy
  • Hyperthyroidism
  • Chronic kidney disease
  • Moderate to heavy alcohol use
  • Smoking
  • Sleep apnea
  • Chronic lung disease

Treatment for AFib

  • Control the heart rate to make sure the heart doesn’t beat too quickly. This is usually achieved with medications. Assessment of effective heart rate control might require use of ambulatory heart monitors. 
  • Reset the rhythm to the heart’s normal state and try to maintain a regular rhythm. 
    • This is accomplished with certain medications called anti-arrhythmic drugs and with electrical cardioversion procedure. 
    • Catheter ablation procedure is a treatment option when medications are unable to adequately control symptoms or are not tolerated. 
    • Even with successful treatment, AFib can recur. And treatments that worked for a while may need to be adjusted, or new treatments might need to be tried over time. 
  • Prevent stroke with blood thinner medications or an implant a device in the heart.
  • Get regular exercise, eat a heart-healthy diet, don’t smoke, manage to decrease stress levels, limit alcohol intake and treat sleep apnea.

Everyone can benefit from a heart healthy lifestyle, but if you have risk factors for these or other types of heart disease, I urge you to take action. Seeing your provider is a great start to being on track with your heart health. 



American College of Cardiology

Ram Balasubramanian, MBBS
Ram Balasubramanian, MBBS

Ram Balasubramanian, MBBS is a Cardiologist with CHI Health.

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