Understanding your heart

The common diagnoses

Coronary artery disease

Cholesterol-rich plaque builds up inside the arteries that feed the heart muscle, narrowing them. When a narrowed artery cannot deliver enough blood during exertion, the result is angina — pressure or tightness in the chest that comes on with activity and eases with rest. If a plaque ruptures and a clot forms, the artery closes and a heart attack follows.

Heart failure

The heart still beats, but it no longer keeps up with the body's demand — either because the muscle has weakened and pumps too little, or because it has stiffened and fills poorly. Fluid backs up, which is why the usual symptoms are breathlessness, swollen ankles, and sudden weight gain. It is a manageable long-term condition, not a death sentence, and treatment has improved substantially.

Atrial fibrillation

The heart's upper chambers quiver instead of beating in an organized way, producing a fast, irregular pulse. Some people feel it as palpitations or fatigue; some feel nothing at all. It matters because blood that pools in a fibrillating chamber can clot, and that clot can travel to the brain — which is why treatment focuses as much on stroke prevention as on the rhythm itself.

High blood pressure

Sustained high pressure inside the arteries. It produces no symptoms for years while quietly stiffening blood vessels and thickening the heart muscle — which is exactly why it gets measured at every visit.

High cholesterol

Too much LDL cholesterol circulating in the blood is the raw material of arterial plaque. It causes no symptoms whatsoever; the only way to know is a blood test.

Heart valve disease

One of the heart's four valves either fails to open fully or fails to close completely, so the heart must work harder to move the same amount of blood. Often first detected as a murmur, then measured with an echocardiogram.

Peripheral artery disease

The same plaque process, in the arteries of the legs. The classic symptom is a cramping ache in the calf that appears after walking a predictable distance and stops with rest. It is also a signal to look closely at the heart.

Tests done in the office

Echocardiogram

You lie on your side while a technologist moves an ultrasound probe over your chest with gel. About 30–45 minutes. No radiation, no needles, no preparation, and nothing to feel beyond cool gel and some pressure.

Nuclear stress test

Two sets of images — at rest and under stress — with a small amount of radioactive tracer given through an IV. Stress is either walking on a treadmill or, if you cannot, a medication that mimics exercise. Plan on two to four hours. You will usually be asked to skip caffeine for 24 hours and to arrive without having eaten.

Event and Holter monitors

A small recorder worn under your clothes for anywhere from 24 hours to a few weeks. You go about your normal day and press a button when you feel a symptom, which lets us match what you felt to what your heart was actually doing.

Vascular ultrasound

The same painless ultrasound technique applied to the arteries and veins of the neck or legs. Typically 30–60 minutes, no preparation.

What you can change

Smoking

The single most valuable change available to anyone who smokes. Risk starts dropping within weeks of quitting and continues to fall for years afterward. Nothing else on this list delivers as much benefit as quickly.

Blood pressure

For most adults the target is below 130/80, though the right number for you depends on your other conditions. Reducing salt, losing weight, moving more, and medication when needed all work — and they work together.

Cholesterol

Diet and exercise help; for many people they are not enough on their own, because most cholesterol is manufactured by the liver rather than eaten. That is not a personal failure, and it is what statins are for.

Diabetes and blood sugar

Diabetes accelerates arterial disease throughout the body, and people with diabetes often have heart attacks with unusually mild symptoms. Good glucose control is cardiac care.

Physical activity

About 150 minutes a week of moderate activity — brisk walking counts. The gap between doing nothing and doing a little is far larger than the gap between a little and a lot.

Weight

Carrying extra weight, particularly around the middle, raises blood pressure, worsens cholesterol, and drives insulin resistance. A loss of even 5–10% measurably improves all three.

Diet

More vegetables, fruit, whole grains, beans, nuts, and fish; less processed meat, refined starch, sugary drinks, and salt. No single food is decisive — the overall pattern is what matters.

Alcohol and sleep

Heavy drinking raises blood pressure and triggers atrial fibrillation. Untreated sleep apnea does the same, and it is common and very treatable — mention loud snoring or daytime sleepiness at your visit.

What you cannot change

Common classes

Statins

Lower LDL cholesterol by reducing how much the liver makes, and stabilize existing plaque so it is less likely to rupture. Muscle aches are the complaint people hear about most; they are far less common than reputation suggests, and there are usually alternatives when they do occur.

Beta blockers

Slow the heart and reduce the force of each beat, so the heart needs less oxygen. Used after heart attacks, in heart failure, for some rhythm problems, and for blood pressure. Names usually end in -olol.

ACE inhibitors and ARBs

Relax blood vessels and reduce strain on the heart. They protect the kidneys in people with diabetes and are a cornerstone of heart failure treatment. ACE inhibitors end in -pril and cause a dry cough in some people; ARBs end in -sartan and generally do not.

Diuretics

Water pills. They help the kidneys clear excess fluid, which lowers blood pressure and relieves the swelling and breathlessness of heart failure. Expect to use the bathroom more, especially at first.

Anticoagulants and antiplatelets

Blood thinners. Anticoagulants such as warfarin and the newer agents prevent the clots that cause stroke in atrial fibrillation. Antiplatelets such as aspirin and clopidogrel keep stents open and prevent clots after a heart attack. Both raise bleeding risk — tell every doctor and dentist you are taking one.

Nitrates

Widen the coronary arteries to relieve angina. Nitroglycerin under the tongue works within minutes. If chest pain does not ease after one dose, call 911 rather than taking a third and waiting.

Two things worth remembering

Call 911 immediately

Chest pain or pressure

Especially if it lasts more than a few minutes, or goes away and comes back. It is often described as pressure, squeezing, fullness, or a weight — not necessarily as pain, and not necessarily severe.

Pain spreading to the arm, jaw, neck, or back

Discomfort radiating to one or both arms, the jaw, the neck, the shoulder, or between the shoulder blades.

Sudden shortness of breath

With or without chest discomfort, particularly if it comes on at rest or wakes you from sleep.

Cold sweat, nausea, or lightheadedness

Breaking out in a cold sweat, feeling sick to your stomach, or feeling faint — especially alongside any of the above.

Signs of stroke — act F.A.S.T.

Face drooping, Arm weakness, Speech difficulty, Time to call 911. Also sudden confusion, sudden trouble seeing, or the worst headache of your life.

Symptoms are not the same for everyone

Call the office instead when