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Heart Failure and Your Circulation

Two important causes of heart failure are Coronary Artery Disease and Hypertension.

Coronary Artery Disease (also known as CAD)

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Cause

Coronary Artery Disease is a condition where fatty deposits and cell-proliferation build-up in the arteries supplying the heart muscle. These plaques form commonly in a condition called atherosclerosis. Genetic factors or a diet of foods high in cholesterol or saturated fat that result in high blood cholesterol can increase your risk for this disease. Fatty deposits form silently; no symptoms arise until they are large enough to significantly restrict blood flow to an area of heart muscle. When this occurs, angina pectoris (chest tightness or discomfort) usually results. Normally a 70% or greater blockage in the diameter of a coronary artery will cause symptoms of chest discomfort or pain with exercise. An abrupt closure of a coronary artery due to a blood clot forming (associated with a fissure of a plaque) can cause a heart attack (or myocardial infarction).

Symptoms

Angina Pectoris – A constricting chest discomfort or pressure that can radiate outward in the torso, left arm, neck and jaw. Sustained symptoms at rest could represent a heart attack.

Diagnosis

Screening tests for CAD are treadmill testing, stress echocardiograms and tracer studies. Coronary arteriography is the gold standard for diagnosing CAD. In this procedure a catheter is inserted into the leg or arm and guided toward the opening of the blood vessels that supply the heart. A dye is then injected directly into the coronary arteries while x-ray movies are recorded.

Treatment

Medical management includes:

  • drugs to reduce the heart’s need for oxygen
  • drugs to lower blood pressure
  • drugs that dilate the coronary arteries
  • drugs to reduce the amount of cholesterol in the body

Other alternatives are coronary angioplasty and stent implantation or coronary artery bypass grafts.

Hypertension (High Blood Pressure)

Cause

Blood pressure refers to the pressure of blood against the walls of arteries and is measured in units of millimeters of mercury (mmHg), which is a reference to the fluid historically used with blood pressure cuffs. Blood pressure is always measured by two numbers on this scale. The range of the first number is usually 100-140 mmHg, which is referred to as systolic (the peak pressure in the arteries after the heart contracts). The range of the second number is usually 60-90 mmHg and is referred to as diastolic (the minimum pressure reached in the arteries when the heart relaxes just before the next contraction). The usual cause of hypertension is not known – the brain’s “set-point” for a usual BP increases. Uncommonly, renal artery stenosis (a blockage of the arteries) going to the kidneys or hormone producing tumors can also be causes. For a more thorough explanation, click here.

Symptoms

Usually none, but headaches and flushing are sometimes evident.

Diagnosis

Blood pressure cuff (sphygmomanometer), chest X-ray and echocardiogram (to observe hypertrophy).

Treatment

Hypertension is managed with a combination of hygienic approaches and medication. A low salt diet, exercise, weight loss when obesity is present, and stress reduction may all help. Most individuals also require medication to maintain a blood pressure lower than 140/90. If the blood pressure has caused cardiac remodeling (see diagram) reducing blood pressure can encourage the heart to return to its former shape and function.