The arteries in your heart (coronary arteries), which are about the size of a strand of spaghetti, are blood vessels that carry oxygen and nutrients that feed the heart muscle. At birth the inside walls of the arteries are smooth, like the inside walls of a new water pipe, allowing blood to flow easily through the vessel.

Just as water pipes may gradually develop a buildup of minerals and debris on the inside surface causing the water to flow more slowly, the arteries may gradually develop a buildup of plaque on the inside surface of the arteries, restricting the blood flow. Plaque is made up of cholesterol, which is fatty deposits, and fibrous tissue, which is scar tissue that forms where an artery has been damaged. Plaque may have begun to build up in your arteries when you were young; however you may not notice any problems or effects until later in life. Usually symptoms begin when there is at least a 75 percent blockage in your artery. Plaque may also build up in more than one place in your artery.

Angina affects each person differently, but if you experience angina you may feel one or more of the following symptoms:

• pain, pressure or a burning sensation under your breastbone
• pain, pressure or a burning sensation extending to your shoulders, back, neck, jaw or down your arm (typically your left arm)
• shortness of breath
• nausea
• profuse sweating

Angina is not the same as a heart attack and will not cause any permanent damage to the heart. In addition, although patients with angina are at risk of a heart attack, experiencing angina does not necessarily mean that a heart attack is about to happen. However, if your angina episodes become more frequent, last longer or occur without exertion, your risk of a experiencing a heart attack within the next few days or weeks becomes higher.

A heart attack also can be caused by a blood clot lodged in a coronary artery. This event is sometimes called a coronary thrombosis or coronary occlusion. If the blood supply is cut off drastically for a long time, muscle cells suffer irreversible injury and die.

If you have signs of a heart attack, doctors may elect to do several tests, all of which are performed at Health Alliance hospitals. The two most common procedures, electrocardiograms and cardiac catheterizations, are performed upon admittance to the hospital at the first sign of a heart attack. If these tests are inconclusive or fail to produce the desired results, angioplasty or bypass surgery may be performed. The Christ Hospital, The University Hospital, and The Jewish Hospital are Tristate leaders in such procedures.

• Angina is only a temporary reduction of the flow of the blood to the heart; a heart attack is a sudden, permanent stopping of the flow of blood to the heart.
• Heart attack chest pain is more severe and lasts longer
• Angina pain will go away with rest or medication; heart attack pain does not.
• Both angina and a heart attack can be accompanied by indigestion, sweating or nausea, however, heart attack symptoms are typically milder.
• Angina does not cause permanent damage to the heart muscle; a heart attack causes permanent damage.

Heart disease often runs in families. The genes that carry the blueprints for our bodies may carry heart disease from parents to children. Habits and customs practiced by a family also may increase a person's risk Although you cannot control this factor, you can be aware of your family's history of heart disease. If your family has a history of heart disease, you may be more likely to develop it as well.

Gender

Men are more likely than women to develop heart disease and are more predisposed to getting into trouble at an earlier age. This is probably related to the protective effect of female hormones. is is supported by the fact that heart disease in women increases dramatically after menopause when women's bodies stop producing the hormone estrogen. However, this does not mean that women are immune to heart disease. The risk of heart attacks in African-Americans is higher than in any other race. The reason may be that African-Americans are twice as likely to have high blood pressure as others.

Age

Nicotine from cigarette smoking makes the heart work harder by temporarily increasing blood pressure and heart rate. Furthermore, the carbon monoxide from cigarette smoke gets in the blood stream and reduces the amount of oxygen delivered to the heart and other parts of the body. Cigarette smoking also causes platelets (clotting agents) in the blood to become sticky and cluster, shortens their survival, reduces the clotting time and makes blood thicker. All of these factors are harmful to the cardiovascular system and put you at higher risk for a heart attack.

Giving up smoking is the only way to decrease this risk factor. For those that have given up the habit, the risk of heart attack eventually declines almost to the same level as that of people who have never smoked. There are many over-the-counter medications to help a person quit smoking. However, you should always check with your physician before starting these, since many can contain nicotine and have some of the same effects on the heart as smoking can. Your physician, nurse and exercise physiologist can help you develop an individual plan to help kick the habit.

Cocaine

Cocaine causes constriction of the coronary arteries, which decreases the flow of blood, and hence oxygen, to the heart muscle. At the same time, it increases the heart rate, which increases the heart's need for oxygen. These combined reactions can result in angina, heart attacks and sudden death. These effects can happen in individuals who use cocaine for the first time or repeatedly.

Diabetes

People with diabetes have a higher risk of heart disease than those who are not diabetic. Diabetes is a condition that occurs when the pancreas is unable to make enough insulin or when the body is unable to use its own insulin. It is often associated with a fatty buildup in the arteries. If you are diabetic and also suffer from heart disease, it is doubly important that you follow your doctor's advice in managing your controllable risk factors. Regular checkups, a balanced diet and exercise are important in treating diabetes as well as in treating heart disease.

High blood pressure

High blood pressure hypertension) places a greater-than-normal demand on the heart muscle. It is generally agreed that blood pressures consistently greater than 140/90 should be treated. In most cases, the cause of hypertension is unknown. A person with mild elevation of blood pressure often begins treatment with a program of:

• weight reduction, if needed
• salt reduction
• exercise
• elimination of cigarette smoking
• modification of stressful habits
• medication

Behavioral characteristics

Having a "Type A" personality is thought by some experts to be a risk factor for heart disease. This personality type is characterized by an intense time pressure, chronic impatience and hostility or anger. Hard work and long hours are not necessarily features of this type of behavior. All human beings feel stress; life without it would be dull, indeed. Each of us reacts to stress differently. Excessive stress over a long period may create health problems in some people. Ask your cardiac rehab specialist for stress management techniques and programs available.

Blood cholesterol levels

Cholesterol is a blood fat or lipid. Our bodies make cholesterol, and it is found in some foods. Cholesterol is essential to health. It enables the body to build cells, repair tissues and make sex hormones and vitamin D. Unfortunately, too much cholesterol can build up in the arteries, reducing blood flow and leading to heart disease. Cholesterol is carried in the blood by proteins. The blood fat and protein together are called lipoproteins. High-density lipoprotein, the so-called "good" cholesterol, is the part of cholesterol that leaves the body and does not build up deposits.

HDLs help transport cholesterol from the body's cells to the liver where it is broken down. HDLs also may keep LDLs from entering cells. Low-density lipoprotein LDL, the so-called "bad" cholesterol, is the type of cholesterol that can damage your health.

LDLs are mostly fat and tend to break down as they move through the blood. They leave behind deposits of cholesterol, which builds up in the arteries.

Both HDL and LDL components are considered in the evaluation of a person's risk for heart disease. If LDL elevation is the only risk factor present, a person should try to keep the LDL level under 160. If additional risk factors are present, the target LDL level should be less than 130. If a person has already developed symptoms of heart disease, the target LDL level should be 100.

Attempts should be made to bring the HDL and triglyceride levels into the desirable range. Triglycerides are the chemical form in which most fat exists. HDL levels in men should be greater than 35, and in women, greater than 45. Triglyceride levels should be less than 200. Smoking cessation, exercise, diet and weight loss can help increase the number of HDLs and decrease the LDLs in your blood. Sometimes, though, medication may be needed to help you achieve your target cholesterol level.

In addition to HDLs, LDLs and triglycerides, Lipoprotein(a) or "Lp little a," a specific form of LDL cholesterol, has begun getting more attention from physicians. Many studies have shown that higher levels of Lp(a) are associated with an increased frequency of coronary heart disease. Doctors are increasingly looking at Lp(a)levels when evaluating a person's risk for heart disease.

Obesity

Extra weight puts extra strain on your heart. In most cases, being overweight simply results from eating too much and exercising too little. Excess body fat (20 percent overweight) makes the heart work harder and increases the risk of hypertension, diabetes and elevated cholesterol levels. In addition to weight itself, it appears that weight distribution is associated with cardiac risk. When weight is mostly in the abdominal area, the so-called "apple distribution", the risk for heart disease is increased. When the weight is mostly in the hips and buttock area, the "pear distribution", the risk does not appear to be as great.

The Jewish Hospital Weight Management Center can help you control this risk factor by helping you create your own balance of smart eating, attitude and activity that can last a lifetime. The St. Luke Hospitals also offer a weight management program. For more information, call (859) 572-3382

Lack of exercise

Exercise and diet are the best ways to lose body fat and weight. For every 3,500 calories you either don't eat or you burn up with increased activity, you lose one pound. If you cut 425 calories out of your daily diet and use up an extra 450 calories in exercise, it would take four days to lose one pound. A balanced diet containing the number of calories needed to maintain an ideal weight will help reduce the risk of heart attack. Weigh yourself weekly and follow your physician's advice for weight reduction. A hospital dietitian can help you.