2014-02-12 / News

Matters of the heart

How to head off the nation’s deadliest killer – heart disease
By Nicole Cohen

To help prevent heart disease, doctors recommend patients undergo regular cholesterol screenings beginning at age 20. 
HCA Virginia To help prevent heart disease, doctors recommend patients undergo regular cholesterol screenings beginning at age 20. HCA Virginia It’s the No. 1 cause of death in the United States. The month is the shortest of the year. It’s perhaps not proportional to the cause, but February has been designated as American Heart Month for the last 50 years.

Much has changed since President Lyndon B. Johnson proclaimed February as American Heart Month in 1964. This was three years before the first successful human heart transplant. Bypass surgery – now an almost routine surgical procedure – had yet to enter the American lexicon. Still, as far as medicine has come, heart disease is a national epidemic.

There are a number of actions one can take to prevent or control heart disease, but sometimes symptoms go unnoticed. In the absence of annual checkups, often the first sign of advanced heart disease is a heart attack.

So how can you be sure you’re not a candidate for heart disease?

There are a number of basic and advanced heart screenings available, but the first step in determining your risk for heart disease is to visit your doctor.

“See your doctor on a regular basis,” said Dr. Michael Menen, cardiologist and chief medical officer for CJW Medical Center. “Talking to them about your risk factors from the time you’re seeing your pediatrician and forward is the best bet.”

Primary care physicians can screen for things such as high cholesterol levels and diabetes, which often translate to greater risk of heart disease.

The American Heart Association recommends regular cholesterol screenings beginning at age 20, said Dr. Vikas Rathi, cardiologist at Bon Secours St. Francis Medical Center and director of cardiovascular MRI at Bon Secours Heart and Vascular Institute.

“Every five years if the cholesterol work-up has been normal, and if it is abnormal then every year and so forth,” Rathi said.

So what happens if you find you’re at risk for heart disease?

Generally, your doctor will refer you to a heart specialist. The specialist then determines if more advanced testing is necessary.

This may include what doctors call “stress tests.” For example, having patients walk or run on a treadmill while hooked up to an electrocardiogram (EKG), an angiogram or cardiac catheterization, wherein a small tube is inserted to take X-ray-like photos of the heart. Patients may also need a CT heart scan or MRI of the heart.

“Those [tests] are generally reserved for patients that have multiple risk factors and have symptoms of cardiac disease,” Rathi said.

Rathi explained that calcium buildup within the heart’s arteries is what typically causes blockage and leads to heart attacks. This is the most common heart disease, Rathi said, but there is also valvular heart disease and cardiac-muscle-related diseases, such as cardiomyopathy, which may require different kinds of testing.

The CT heart scan is just one form of advanced testing that may shed some light on how advanced an individual’s heart disease is. It basically determines how much calcium is built up in the heart’s arteries by using a CT imaging system.

Dr. William Coble, a cardiologist at Virginia Cardiovascular Specialists at Harbourside Medical Center, explained the higher the calcium score, the bigger the problem. A patient’s calcium score, Coble said, is what determines the next course of action.

Coble recently saw an asymptomatic patient with high heart-risk factors. The patient underwent a CT heart scan and received a high calcium score. After discussing his options, the patient opted for the heart catheterization and ended up receiving bypass surgery.

“This all happened in a matter of several days and this was someone who wasn’t having any symptoms at all,” Coble said.

It’s important to note that this patient had high risk factors prior to opting for the CT heart scan. But every case is different, Coble said.

“The way I look at the calcium score is it’s another good heart risk factor,” Coble said. “It gives us more in-depth details as to what’s going on with someone’s risk-factor profile. For instance … [if] the calcium score is elevated, then we know we have a lot more work to do with controlling their cholesterol.”

So what are some options if you’re diagnosed with heart disease?

Once you go through the steps of seeing your doctor, a heart specialist and testing, Menen said there are generally three things that your heart specialist will recommend for treatment. The first is regulation through medication. The second is having an angiogram and an angioplasty or heart stint, which keeps clogged arteries open. The third is having an angiogram and bypass surgery.

Even still, physicians agree that prevention is the best medicine.

“You’re never too young to take care of yourself,” Menen said.

The key is a healthy diet and exercise. Rathi said that a general diet consists of appropriate portions of protein, fat and carbohydrates. He also recommends staying active with at least 20 minutes of exercise five days a week. Moderating stress levels, avoiding smoking and drinking alcohol in moderation are also important.

While heart screenings are good at determining the next course of action for those with heart disease, Menen noted that it’s a common misconception that testing will determine if a person with no symptoms and low risk will develop heart disease.

“The most important thing in heart care is to go see your doctor at least on an annual basis, talk with them about the risks of heart disease, which are very well known,” Menen said. “Make sure your doctor checks you, and then to do any prevention that you can to slow down or lower the risk.”

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