Samuel Yoon, MD answers frequently asked questions about heart disease. Dr. Sam Yoon is an interventional cardiologist, medical director of the cardiac catheterization lab at UM BWMC and clinical assistant professor of medicine at the University of Maryland School of Medicine.
What is heart disease?
Heart disease encompasses a wide spectrum of heart conditions that can result in dysfunction or symptoms. These can range from abnormalities in heart rhythm that could cause arrhythmias such as skipping of heart eats or rapid heart beating or slow heart being. There can also be conditions of the heart muscle that can be abnormal and cause weakness or stiffness of the heart muscle, which can also lead to symptoms. There can also be abnormalities of the heart valves, such that the valves of the heart leak and allow blood to flow in the wrong direction, or perhaps don't open adequately and restrict blood flow to the heart. Lastly, is the area of coronary artery disease, in which cholesterol, plaque, and hardening of the arteries that supply blood to the heart muscle, narrow and become blocked.
What are the symptoms of heart disease?
Symptoms of heart disease will depend on the particular aspect of the heart disease. For instance, arrhythmias or abnormalities of the heart's electrical rhythm could result in symptoms of palpitations that can be felt as heart racing or fluttering, or an irregularity of the heart beating. The symptoms that might be related to difficulties with the heart muscle or valves could be things such as shortness of breath, swelling in the legs, or dizziness, severe lightheadedness, or passing out. In abnormalities related to coronary disease, these symptoms might be chest pain or pressure, but often times it could be fairly subtle, like a tightness or burning, or perhaps even a sensation of indigestion that might otherwise be dismissed as something from the stomach or esophagus.
In women in particular, there can be variations on this that might not be classical chest pain. There may be discomfort in the shoulder, jaw, or arms. These symptoms related to coronary disease may be more severe or more persistent in the situation of a heart attack. This arises when a coronary artery completely closes and restricts blood flow to the heart muscle.
How is heart disease diagnosed?
Heart disease can be diagnosed first by bringing to the attention of your primary care physician any physicians you may have. Then, typically, your primary care physician will refer you to an evaluation and consultation with a cardiologist. Beyond that, the appropriate testing can be ordered to evaluate the patient based on their symptoms. These may include testing such as EKG, echocardiogram, heart rhythm monitoring, and stress testing. The abnormalities in these tests may lead to more elaborate testing such as a cardiac catheterization, or electrophysiology testing.
What are the latest advances in treating heart disease?
Advances in treatment of heart disease have been fairly wide in spectrum. There have been great advances in medications that allow patients to become more functional and to have fewer symptoms. On the technological side, there have been advances as well. We offer many of these at UM BWMC.
For patients with severely weakened hearts that might be at risk for a potentially fatal heart rhythm or sudden cardiac death, there is an implantable electronic device called a defibrillator which can monitor a patient's heart rhythm. If a patient were to go into a potentially fatal heart rhythm. pre-programmed electrical therapy can be delivered to the heart to perhaps have that patient from dying.
In the same patient who may be at risk for congestive heart failure that can't be controlled with medications, there is another electronic device called a bi-ventricular pacemaker that may allow that patient to become more functional as well. In the advances of coronary diseases, there have been tremendous strides recently in stenting technology, specifically in relation to drug-eluding stents. These new coatings on the stents can minimize the chance of scar tissue building up that would cause an area to narrow that was previously treated by a stent.
How is a heart attack treated?
When a heart attack occurs, a coronary artery closes suddenly and completely, and stops blood flow to the heart muscle. The consequence of this is that heart muscle starts to die. The needed therapy is to open that artery as quickly as possible. The most effective and prompt way to do this is through a procedure called a balloon angioplasty.
A cardiac catheterization is performed, which is simply an angiogram of the arteries of the heart to identify the closed arteries causing the attack. A balloon angioplasty catheter is delivered to that site and the balloon is inflated to reopen the artery and re-establish blood flow. In certain types of heart attack that are evident on the EKG, this procedure can be done very quickly here at UM BWMC. In fact, we have a team of cardiologist, nurses and technologists who are available at all times to perform this procedure as safely and as quickly as possible.
What are the risk factors for heart disease?
There are many risk factors that come together in increasing a person's risk for heart disease. These include high blood pressure, diabetes, high cholesterol, obesity, family history of heart disease as well as tobacco smoke.
Certainly we can't do anything to control the family genes, but those things that can be controlled should be controlled as best as possible to minimize the chance of developing heart disease. In that light, it would be important to control high blood pressure, to control diabetes, to control your diet and exercise more for weight control, and also to stop smoking.
Working with your physician and making these lifestyle changes would give you the best chance of preventing the development of heart disease.