Miscellaneous Heart Disease Subjects and Other Heart Conditions

What is an angina attack?
Angina is a lack of blood and therefore oxygen to the heart muscle that does not cause damage. It may be a warning of a future heart attack.

What exactly is the difference between an angina attack and a heart attack?
In angina there is no death of the heart muscle tissue. It is reversible. There is enough blockage to cause pain, but not enough blockage to cause death of the muscle. Often angina, ie chest pain, is a warning signal for a possible heart attack.

What is the difference between a heart attack and congestive heart failure?
Congestive heart failure is an inadequate pumping of the heart. It may be caused by the damage that occurs in a heart attack, but it may also have other causes such as infection of the heart muscle.

Can congestive heart failure develop simply from age?

Yes, as muscles weaken with age.

What are heart arteries?

The coronary arteries are direct branches of the ascending aorta (the major blood vessel arising from the heart. There are 2 major arteries, the right and the left coronary artery. The left one branches into the left anterior descending artery (also known as LAD which is the most frequently occluded vessel in a heart attack) and the circumflex. The circumflex forms a connection with the right coronary artery. The right coronary artery gives rise to 3 branches, the anterior right atrial branch which goes to the sinoatrial node (the natural pacer of the heart), the marginal artery and the posterior descending branch. See this site for diagrams.

Does blood get to the areas of the heart in any other way besides arteries?
Thesbian veins are small and fairly insignificant vessels that empty directly into the left chamber of the heart.

Are there other ways arteries get blocked besides clogging from plaque?
Yes.

How can that happen to an artery?

This happens if there is a tear in the artery.

Who would be at risk for this?

This may especially occur in young women post par-tum,, after the birth of the baby. 

What can be done to prevent this from happening?

Nothing.

How is stress related to heart attacks?

Stress may increase the heart rate and blood pressure which increase the demand on the heart muscles.

What does genetics or family history have to do with heart attacks?

The risk factors such as high cholesterol and high blood pressure may be inherited, but there may be other factors which have not yet been identified.

What are collaterals?

Collaterals are arteries that develop spontaneously in response to an existing blockage as natural bypasses in the heart to help improve blood flow to the heart muscles. Exercising can help improve the development of collaterals.

Heart Disease - Cardiovascular Drugs and Medications FAQ

Why does smoking put a person at more risk for a heart attack?

Nicotine can cause vaso constriction, ie decrease the diameter of the blood vessels. It can also increase the heart rate initially. In addition to nicotine cigarettes may contain other toxic substances which may damage the blood vessels. I mention smoking here in this section because nicotine should be thought of as a drug, and specifically a drug that can complicate cardiovascular disease.

What does taking a baby aspirin each day do to help prevent a heart attack?

Aspirin makes it less likely for the blood to clot.

Platelets and platelet products are needed for blood to clot. This is useful when we have a cut or a nose bleed, but the same process may also facilitate the clot formation which leads to a heart attack. Aspirin blocks the formation of a factor called prostaglandin which is needed to produce another clotting factor called thromboxane A2, a powerful promoter of platelet aggregation. It therefore, indirectly, lowers the platelets ability to clump together to form a clot. Small amounts of aspirin 75-100 mg are needed for this process. Typical baby aspirin measure 81 mg each.

Who should be taking a baby aspirin as a preventative treatment each day?
Not everyone is recommended to take aspirin as a heart medication.

Evidence from basic research has provided strong support for the net benefits of aspirin in decreasing the risk of cardiovascular disease (CVD) in a wide range of patients. People who are at high risk for heart disease or other vascular diseases ( primary prevention) or people who have already suffered a cardiovascular event such as a heart attack, angina, or stroke ( secondary prevention) should take aspirin.

You should not start aspirin therapy without first consulting your physician. The risks and benefits of aspirin therapy vary for each person. If you’re taking aspirin and you must undergo even a simple surgical procedure or dental extraction, you must tell the surgeon or dentist your aspirin dosage.

What is a clot busting drug?

Tissue plasminogen activator (tPA) which is a thrombolytic or clot busting agent.

When would a person be given a clot busting drug?
This is usually done if the patient goes to a hospital that doesn’t have the capability to do angioplasty. The patient is usually then transferred after the tPA treatment to a facility that is able to do the angioplasty procedure.

What are the side effects of clot busting drugs?
Stroke, gastrointestinal bleed.

What is nitro glycerin?

It is a vasodilator that dilates all blood vessels and not just the heart blood vessels. This is why a common side effect is headache.

Is that the same nitro glycerin that explodes like dynamite?
Yes.

What does nitro do to your heart that helps?
It drops the blood pressure and the heart beats more effectively.

When should you take a nitroglycerin pill?
It should be taken for chest pain that occurs on exertion, or any typical cardiac chest pain with which the patient is familiar and recognizes as heart pain as opposed to muscular pain.

Why do you put nitro under your tongue instead of swallowing them?

Absorption into the arterial system occurs faster thus providing better treatment.

Does nitro lose it’s potency over time?
Yes. Monitor the expiration date on the bottle and keep your nitroglycerin prescription updated regularly.

What kinds of things make nitro loose potency faster?
Heat and sunlight. It should be kept in an airtight sealed container in a cool dark place.

Who should carry nitro with them all the time?

Any one with a history of heart attack or angina.

What is the best way to carry nitro?

In the brown bottle that it comes in which reduces the light exposure.

Should a heart attack patient take erectile dysfunction medication?

Yes, they may as long as the patient is stable and he is not taking nitroglycerin type medications. There are some nitroglycerin type medications that are taken regularly or there are circumstances where nitroglycerin may have been taken on that day.

Are there common non-prescription drugs that a heart attack patient should avoid?
In general it is best to check with your doctor about over the counter medications. There are certain medications such as Sudafed which may increase the heart rate or blood pressure and therefore increase the demand on the heart. If the patient is on aspirin or other blood thinner then ibuprofen or other non-steroidal anti-inflammatory medications should be avoided.

What is a beta blocker drug?
Beta blockers are a class of medications which is used after heart attacks and in treatment of arrhythmias. Their main cardio protective effect is to lower the heart rate. 

Why would a patient want their heart rate lowered?
This reduces the oxygen supply and demand ratio in favor of the patient.

Are there different types of beta blockers?
The 2 main types of beta blockers are cardio-selective which mainly effect the heart cells and to a smaller extent the lung, and the non-cardio-selective B-blockers which effect the body in general. Examples of the cardio-selective blockers are atenolol, bisoprolol, and metoprolol. Non-cardio-selective blockers include propranolol, carvedilol, and nadolol.

What are the side effects of beta blocker drugs?

Some common side effects of beta blockers are Fatigue, depression, erectile dysfunction, or asthma exacerbation.

Why would a person take the drug Plavix after a heart attack?

Plavix (clopidrogel) is taken to reduce the risk of another heart attack by reducing blood clot formation.

What does Plavix do that makes it different from taking asprin?

There are multiple stages to the clotting process. While aspirin effects this process indirectly as described in the previous question, Plavix works directly on the platelet.

Clopidogrel works by preventing a natural substance called ADP (adenosine diphosphatase) from binding to its receptors on platelets. ADP is one of the chemicals in the body that cause platelets to clump together and start the process of blood clotting. As clopidogrel stops ADP from binding to platelets, it reduces the likelihood of clots forming in the blood.

Life After A Heart Attack

Does a person ever recover from a heart attack?

Yes, but the level of activities that they may resume depends on the degree of the heart attack. Daily life after a heart attack may look just as before the heart attack with no negative effects. A heart attack that caused more damage to the heart muscle tissue may result in a more limited list of activities for daily life. In any case, anyone suffering a heart attack needs to pay attention to their diet, exercise and other aspects of their post heart attack life to insure that they do not experience another heart attack. This may start by making sure any cigarette smokers use their heart attacks as a wake up call to quit smoking!

What sports can a person take part in after a heart attack?

This depends on the size of the heart attack. Work closely with your doctor, but exercise after a heart attack becomes an important part of recovery and resuming a normal life.

What sports should be avoided after a heart attack?

Scuba diving may need to be avoided because it causes a vagal reaction which causes a decrease in blood pressure.

Which heart disease patients should still scuba dive?
It depends on the severity of the heart attack. If the blocked artery has been corrected such as through bypass surgery or angioplasty and if the patient then has a normal stress test then diving is permitted in warm waters. However, in a person who has had extensive muscle death after a heart attack, then diving is not permitted due to the inability of the muscles to keep up with the pumping requirement needed. It is not recommended for most people with coronary artery disease who have not corrected the problem to dive.

How soon after a heart attack can a person fly in an airplane?

A person may fly in an airplane as soon as there is recovery from the heart attack.

How often can a person fly after a heart attack?

There is no restriction.

Should a person who has had a heart attack avoid saunas or steam showers?

They should be careful in these circumstances as they may cause a drop in blood pressure which may effect blood flow to the brain and to the heart. This may cause the patient to pass out or lose consciousness.

Should a person try to live a normal life after a heart attack or should they restrict certain regular activities?
The level of activity depends on the severity of the heart attack. If a large part of the heart muscle is involved and rendered ineffective then there may be more limitations on the physical activity. However, if the heart attack is mild and it is not complicated by heart failure then normal life activity may be resumed.

When can a heart attack patient drive a car again?

A heart attack survivor may drive in 2-4 weeks depending on how severe the heart attack was and if there were any complications.

How long until a heart attack victim can go back to work?

Depending on the type of work, patients can go back to work very soon after discharge from the hospital.

What if they have a physically demanding job?
A physically demanding job will need a longer time and will be evaluated based on follow up stress tests.

Are there some things I should never eat again ever for my whole life?
It depends on many variables such as your weight, cholesterol, blood pressure, and sugar levels. In general it is best to avoid fats, especially animal fats and saturated fats, desserts that are high in sugar and butter. Restrictions on diet for patients with a history of heart disease may remain in effect for the rest of their life.

I’ve talked to people who feel depressed after a heart attack, what is the relationship between depression and a heart attack?
It is believed to be mainly situational.

What can help a heart attack patient through any depression?
Cardiac rehab and anti-depressants may help through depression. In the January 24, 2007 issue of JAMA1 a study was published that showed that “citalopram or sertraline plus clinical management should be considered as a first-step treatment for patients with coronary artery disease and major depression” and that interpersonal psychotherapy did not add any benefit to the treatment.

Can a heart attack patient ever have sex again?

Yes. Sex is usually ok when a person can achieve 4-5 mets on a treadmill test without symptoms or other complications such as arrhythmia or significant ST changes (some people use ability to climb two flights of stairs without problems as their guideline for resuming sex). Usual heart rate with sex is 110-120 so when this heart rate can be achieved safely sex is usually ok. Interesting however is that the data on death and sex is from a study on business men who died suddenly - the study was from Japan. Additional circumstances included being with an unfamiliar partner, having eaten a large meal, having had an excess of alcohol and sex is added to this mix - not a generally good thing to do! It is appropriate to treat sex just like any other physical activity with the exception of adding the emotional environment to the mix! Really important is to also address the concerns of the "spouse or significant other" often the patient is ready to resume sex and the partner is scared to death!

Heart Disease

Heart attacks kill thousands of people each day. Knowing how to react properly can save your life or the life of someone you love. Learning ways to avoid a heart attack or any form of heart disease in the first place may add even more years to your future. This website combines the efforts of doctors, featuring Dr. Tareneh Razavi the in-house doctor at Google, heart attack survivors and web site professionals to educate you about everything you might what to know about a heart attack and heart disease in an easy to follow format. Sections include warning signs prior to a heart attack, recognizing symptoms of a heart attack, what to do while having a heart attack, expectations in the hospital as a heart attack patient, heart disease treatments, recovery post heart attack, and heart disease prevention.

In a perfect world we would love every young person to read this site thoroughly regarding heart disease prevention and follow a lifestyle resulting eliminating the need for the sections on having a heart attack. In reality, people should find helpful information here no matter what stage they may be at in the time line of a heart attack or how they may be related to the heart attack patient.

Heart attack and heart disease information pages take the form of FAQs commonly known as Frequently Asked Questions. Most questions came from actual heart attack survivors with answers from medical doctors including Dr. Razavi.

We hope you find the answers you may be searching for here on our heart attack and heart disease information pages, but remember these sites should supplement what your own doctor may say and make you a more informed patient or caretaker. Never ignore your own physician’s advice to follow a suggestion made here. Each heart attack and each heart attack patient presents a unique situation. You and your doctor together should plan what works best for you. The more you know, however, the more you may take an active part in that process and the more you understand about heart attacks and heart disease the more likely you may be to follow procedures to improve your condition. Enjoy reading our heart attack and heart disease pages and best of luck to you!