Stethoscope and forms

Be still my heart. That may sound romantic, but in real life, heart stoppers can be fatal.

“Heart disease is the most common cause of death in the U.S.,” says Dr. Mark Gilbert Braverman, MD, FACC, cardiologist at Memorial Hermann Medical Group Southwest.

The three most common cardiac conditions are intertwined but have some distinctions.

What: Heart Attack

Signs: You don’t have to feel as if an elephant is sitting on your chest to be experiencing a heart attack. That and pain radiating down the arm are classic signals, but women in particular may experience other signs instead. These include pain radiating to the jaw, nausea, hot flashes, fatigue, malaise or chest pain during exercise.

Cause: Clogged arteries are the likely culprit, with possible causes being diabetes, high cholesterol, high blood pressure, excess weight, inactivity and poor diet. Another villain is smoking, which thickens blood and stiffens and clogs arteries not only in the heart, but also the neck (causing stroke) and legs (peripheral artery disease), Dr. Gilbert Braverman says.

Diagnosis: A blood enzyme test can show heart damage and an electrocardiogram (ECG/EKG) can help diagnose acute and chronic cardiac conditions, including electrical problems with your heartbeat. Your doctor may order a stress test, in which an ECG is done while you walk on a treadmill, as the speed and incline increase.

Treatment: Blockages may be treated with minimally invasive angioplasty surgery to widen arteries and possibly a bypass operation, in which vessels from the legs or elsewhere in the body are transplanted to route blood flow around clogged arteries. Often, a change in lifestyle is needed which can include being active, eating fresh produce, quitting smoking and trimming fat, salt and fast food from the diet. “And forget liquid cleanses. You need to eat healthfully consistently to be healthy. If you have a family history of heart disease, you need to be more aggressive with lifestyle changes,” he says. “I’m a big fan of cardiac rehab, which is widely recommended after a cardiac event, where you learn new habits under the supervision of health care professionals. Research shows it can lower risk of recurrent events and prolong and improve your life.” 

Myth: You may have read heart attack pain radiates down the left arm, but it could be either. Also, he says, “some people use wishful thinking, choosing to believe that Kosher or Himalayan salt are healthier for you than table salt, but salt is salt.” Similarly, “smoking cigars can be just as harmful as cigarettes.”

What: Chronic Heart Failure

Signs: Swelling of your limbs and even lower abdomen may be accompanied by exhaustion, shortness of breath, irregular heart rate, arm numbness or chest or jaw pain.

Cause: The pumping of your heart—a muscle—isn’t keeping pace with your body’s needs. Blood backs up in the heart and possibly lungs, leading to fluid buildup. Faulty coronary valves, diabetes, obesity, clogged arteries or long-term hypertension all can contribute. “Rarely, it may be caused by a virus or pregnancy,” Dr. Gilbert Braverman says.

Diagnosis:  An X-ray may show your heart has enlarged, and a blood test can show levels of a blood protein higher with heart failure. Your doctor also may need to order an echo or echocardiogram, which is a painless, noninvasive test that uses ultrasound imaging of your heart to view its pumping and valve function.

Treatment: Take it easy on this major muscle: Lose weight, trim salt and fatty foods and start moving. “If you make only one change, stop smoking,” Dr. Gilbert Braverman says. “It’s the low-hanging fruit of contributors. A healthy diet is another major weapon.”

Medicine can curb swelling, widen blood vessels, thwart clots, regulate your heartbeat or lower blood pressure and cholesterol. Surgery can repair valves, unblock vessels or implant a pacemaker to steady your heartbeats.

Myth: Heart disease is not just a man’s disease, Dr. Gilbert Braverman says. “It’s also the most common cause of death in the U.S. for women. A likely theory is that it may start earlier in men because estrogen protects women to some degree until the onset of menopause. But women catch up as they age.”

What: Irregular Heartbeats

Signs: “Fluttering, racing or palpitations, dizziness, fainting or lightheadedness are the big ones,” Dr. Gilbert Braverman says. 

Cause: A heartbeat is irregular due to abnormalities in the electric signals of the heart. As a result, chambers may fail to contract and push blood out to the body. In this situation, blood may collect, and clots may form. “Some people have genetic abnormalities, but age is the main factor, with arrhythmias happening mostly after age 50,” he says.

Diagnosis: An ECG records the beat, revealing when it’s off. Unsteady rates are also sometimes detected via a Holter monitor or wearable tech devices.

Treatment: If you fix heart disease causes such as obesity, inactivity, high blood pressure, type 2 diabetes, sleep apnea and heart failure, your heartbeat may steady. You may need catheter ablation, a minimally invasive operation to form a fence around abnormal heart tissue that’s triggering misfires.

Myth: The most common of irregular beats, AFib or atrial fibrillation, is not a man’s disease as some believe. “It’s equally common in men and women,” Dr. Gilbert Braverman says.

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