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A nonprofit independent licensee of the Blue Cross Blue Shield Association Understanding Coronary Artery Disease Table of contents Introduction....................................................................................................1 You and your doctor: A heart-healthy partnership...........................................1 Signs and symptoms of coronary artery disease...............................................2 Risk factors of coronary artery disease ............................................................2 What is blood pressure?..................................................................................2 Understanding cholesterol..............................................................................3 Smoking and heart disease.............................................................................3 Being overweight and heart disease................................................................3 Know your numbers.......................................................................................3 Prevention and control of risk factors..............................................................4 w Exercise......................................................................................................4 w Heart-healthy diet.......................................................................................5 w How to read a nutrition label......................................................................6 w Quit smoking..............................................................................................7 Managing depression......................................................................................7 How is coronary artery disease diagnosed?.....................................................8 How is coronary artery disease treated?..........................................................8 Complications of coronary artery disease........................................................8 Stroke.............................................................................................................9 Important points to remember........................................................................9 Resources.......................................................................................................9 Type of medication........................................................................................10 Body mass index chart..................................................................................11 Personal Medication List................................................................................13 Introduction Coronary artery disease is a disease of the blood vessels of the heart. It is the most common type of heart disease. The heart needs a constant supply of oxygen and nutrients to work properly. These are carried by the blood through the arteries. A buildup of plaque, which is made of cholesterol deposits, can cause the arteries to narrow. A narrow or blocked artery prevents oxygen and nutrients from getting to the heart. You and your doctor: A heart-healthy partnership Heart disease is a lifelong illness. Despite that fact, people are able to live a long, full life with proper care. The first step in determining your risk for heart disease is to see your doctor for a thorough checkup. Your doctor is an important partner in helping you set and reach your goals for a healthy heart. Here are some tips for good, clear communication between you and your doctor: w Speak up – Tell your doctor that you want to keep your heart healthy and would like help in achieving that goal. You should ask questions about your heart disease and how to lower the risks of complications. w Monitor your treatment – If you are already being treated for heart disease or have risk factors, regularly review your treatment plan with your doctor. w Be open – When your doctor asks you questions, answer them honestly and as fully as you can. w Keep it simple – If you do not understand something your doctor says, ask for an explanation in simple language. Follow-up visits to your doctor’s office are needed to help you and your doctor know if your medications, diet and exercise are working for you. 1 Signs and symptoms of coronary artery disease Some people who have coronary artery disease may have very noticeable symptoms. Others may have no signs or symptoms at all. Some of the most common signs and symptoms: Chest discomfort, also called angina – This may feel like a squeezing pain in your chest. You may also feel it in your shoulders, arm, neck, jaw or back. Shortness of breath – This happens when your heart cannot pump enough blood throughout your body. This could happen with regular activity. Fatigue with activity – This results in being unable to perform your work as you used to. Exercise may also become difficult. Arrhythmia – This is a sudden problem with the speed or the rhythm of your heart. You may notice your heart is skipping beats or beating too fast. It is important to treat symptoms early to prevent permanent damage to your heart. If you have any of these symptoms, call your doctor. Risk factors of coronary artery disease Anyone can develop heart disease. Some risk factors can be controlled; others cannot. For example, you can take measures to control high blood pressure and high cholesterol. You cannot control a family history of heart disease, race, normal aging and gender. In women, menopause may also be a risk factor. Major risk factors • High blood pressure • High cholesterol • Lack of exercise • Cigarette smoking • Poor dietary habits Many people do not know they have high blood pressure. Blood pressure is the force of blood against your artery walls as it circulates through your body. High blood pressure is when the systolic and diastolic numbers are greater than 140 over 90. High blood pressure is also called hypertension. Blood pressure is measured using two numbers: • The first number is the systolic. It represents the pressure in your blood vessels when your heart beats. • The second number is the diastolic. It represents the pressure in your blood vessels when your heart rests between beats. High blood pressure has no warning signs or symptoms. The only way to know if you have high blood pressure is to have it checked. Talk with your doctor about how often you should have your blood pressure checked. • If the measurement reads 120 systolic and 80 diastolic, you would say “120 over 80”. ategory C Top Number (Systolic) Bottom Number (Diastolic) • Diabetes Normal Blood Pressure Less then 120 Less then 80 It is important to check with your doctor about which risk factors may apply to you. Prehypertension 120 - 139 80 - 89 140 and above 90 and above • High levels of alcohol intake • Being overweight 2 What is blood pressure? Hypertension Understanding cholesterol Smoking and heart disease Cholesterol is a waxy, fat-like substance that your body needs. If you have too much in your blood, it can stick to the walls of your arteries. Over time, this “plaque” can narrow your arteries and allow less blood to pass through. This can lead to heart disease and stroke. Quitting smoking is the most important thing you can do to improve your health. There are no symptoms of high cholesterol. A simple blood test can tell you if your cholesterol is too high. This test measures several kinds of cholesterol as well as triglycerides. LDL – Low density lipoproteins – “Lousy” or “Bad” cholesterol that can clog the arteries. Lower LDL numbers are best. HDL – High density lipoproteins – “Healthy” or “Good“ cholesterol helps keep cholesterol from building up in the arteries. High levels of HDL can reduce the risk of heart disease and stroke. Triglycerides – another form of fat in the blood that can raise the risk of heart disease. Desirable Cholesterol Levels Total Cholesterol under 200 mg/dL LDL under 100 mg/dL HDL above 40 mg/dL Triglycerides under 150 mg/dL Your individual goals may vary. Discuss your goals with your doctor. Overall, it is important to keep your: • HDL or “healthy cholesterol” high. • LDL or “lousy cholesterol” low. Facts: • Smoking increases blood pressure and the risk of blood clots. Know your numbers It is important to see your doctor regularly. This helps your doctor keep track of you and how you are responding to your treatment plan. This is the time to review your: • Smoking increases the risk of heart attack and stroke. • Blood pressure • Smoking decreases HDL (healthy) cholesterol. • Triglycerides • Women who smoke and use birth control pills dramatically increase their risk of heart disease. • HDL • There is no safe amount of smoking. It is never too late to quit smoking. Being overweight and heart disease Maintaining a healthy weight can also help decrease your risk for heart disease. Try to keep your waist circumference less than 35 inches if female; and less than 40 inches if male. A larger waist circumference puts you at a higher risk for health problems. • Cholesterol • LDL • Weight (refer to Body Mass Index Table for Adults) • Waist circumference It is important to talk to your doctor about what your blood pressure and cholesterol numbers should be and what steps you need to take to reach your goals. It is helpful to write your numbers down to keep track of your progress. Body mass index is a measurement of your weight in relation to your height. It also gives an estimate of your total body fat. A BMI between 25 and 29 is considered overweight. A BMI of less than 25 is the goal for treating heart disease. To figure out your BMI, see the “Body Mass Index Table for Adults.” If your BMI is 25 or above, talk to your doctor about diet and activity changes that may help you lose weight. See BMI Chart on page 11. 3 Prevention and control of risk factors A good start would be living a healthy lifestyle (this should include the whole family) by exercising, quitting smoking, eating the proper diet and managing stress. Lowering your cholesterol and your blood pressure are also very important. Exercise When you have heart disease, it is very important to exercise. Exercising should become part of your daily routine. Even if you can only do a small amount of exercise, it is better than doing none at all. Talk to your doctor about exercising. If your doctor says its okay, try to do at least 30 minutes of exercise a day most days of the week. Begin your exercise program at a low level and increase the amount of exertion gradually. Avoid overexertion on days of extreme temperatures. Always be alert for signs of heart problems. These signs include chest pain, tiring easily, shortness of breath, dizziness, lightheadedness and palpitations. Some good ways to get exercise are to: • Take a brisk walk outside or mall walk on very hot or cold days. Here are some other ideas for being more active every day: • Park the car farther away from your destination. • Get on or off the bus several blocks away from your stop. • Take the stairs instead of the elevator or escalator. • Exercise while watching TV. • Walk around while you talk on the phone. • Play with the kids. • Go dancing. • Take the dog for a walk. • Take a low-impact aerobics class. • Get up to change the TV channel instead of using the remote control. • Swim or do water aerobic exercises. • Ice-skate or roller-skate. • Ride a bicycle outdoors or a stationary bicycle indoors. • Work in the garden or rake leaves. • Clean the house. • Wash the car. • Stretch out your chores. For example, make two trips to take the laundry downstairs instead of one. • Park at the far end of the grocery store lot and walk to the store. • At work, walk over to see a co-worker instead of calling or e-mailing. • Stretch or walk around instead of taking a coffee break and eating. Always talk to your doctor before starting an exercise program. Younger adults who smoke, are overweight, have diabetes, high blood pressure and/or high cholesterol should get a pre-exercise physical exam. 4 Heart-healthy diet Most people know that to maintain heart health, they need to eat healthy. It is not always clear how to translate that into our daily eating habits. To prevent heart disease, a diet that is high in fiber and low in saturated fat and cholesterol is the best. Talk to your doctor to discuss the best diet for you. Fats Fiber Fats in our food affect our cholesterol level. There are good fats and bad fats. Fiber is the part of the plant that cannot be digested. It is known as bulk or roughage. Fiber helps the body by lowering your risk of heart disease. It also helps in digestion. It makes you feel full longer, which can help in weight loss. Good fats are unsaturated fats, polyunsaturated fats and monosaturated fats. These fats lower the risk of heart disease. Bad fats are saturated fats and trans fats. These fats increase your cholesterol level. Cholesterol It is a waxy, fat-like substance made in the liver and found in all cells of the body. Cholesterol is important for good health. However, too much cholesterol in the body may build up in the blood vessel walls and increase the risk of developing heart disease and stroke. Sodium (Salt) Using less sodium in your food can help lower your blood pressure. Some low-fat foods contain a large amount of salt. Most packaged and canned foods, especially soups, are high in sodium. Potassium vegetables. Do not take potassium supplements or use salt substitutes without talking to your doctor. Alcohol If you do drink alcohol, moderation is the key. Too much alcohol can lead to high blood pressure and can increase your triglyceride level. Having one or two drinks a day for a man, and one drink a day for a women may be acceptable. What is considered a drink? • 12 ounces of beer • 4 ounces of wine • 1.5 ounces of 80-proof liquor If you don’t drink alcohol, don’t start. Potassium is important in controlling high blood pressure. The main sources of potassium are fruits and Cholesterol is found in: • Dairy products • Egg yolks Examples of good fats Examples of bad fats • Fatty meats Plants Peanut oil Fatty meats Margarine • Liver Nuts Olive oil Shortenings • Shrimp Seeds Omega-3 fatty acids such as salmon and walnuts Whole milk products Sunflower oil Corn oil Soybean oil Chicken skin Sweets (cakes, cookies) Coconut oil Butter Palm oil Fast food Canola oil 5 How to read a nutrition label Serving size First look at the serving size and the number of servings in the package. All the information on this label is based on this serving or portion size. So, if you eat double the serving, you will consume double the calories, carbohydrate, fat and other nutrients. Calories Calories provide a measure of how much energy you get from a serving of this food. This gives the total calories per serving. The portion of the total calories that comes from fat is also given. A good rule of thumb is to look for foods that show one-third or fewer of the total calories coming from fat. Total carbohydrate and sugars This shows the amount of Carbohydrate per serving that comes from sugar. This includes both natural sugar and added sugar. Vitamins and minerals Eating enough of these nutrients can improve your health and help reduce the risk of some diseases and conditions. Nutrition Facts Serving Size 1 cup (228g) Servings Per Container 2 Amount per Serving Calories from Fat 118 Calories 250 % Daily Value* 18% Total Fat 12g Saturated Fat 3g 15% Trans Fat 3g 10% Cholesterol 30mg 20% Sodium 470mg 10% Total Carbohydrate 31 Dietary Fiber 0g 0% Sugars 5g Protein 5g Vitamin A 4% Vitamin C 2% Calcium 20% Iron 4% * Percent Daily Values are based on a 2,000 calorie diet. Your Daily Values may be higher or lower depending on your calorie needs. Calories2,000 2,500 Total Fat Less than 65g 65g Sat Fat Less than 20g 25g Cholesterol Less than 300mg 300mg Sodium Less then 1,500mg Potassium 3.500mg Total Carbohydrate 300g 375g Dietary Fiber 25g 30g Limit these nutrients Sodium This shows the amount of sodium (salt) in one serving. This is important if you are on a lowsodium diet or if you have high blood pressure. Dietary fiber This shows the portion of the total carbohydrate per serving that is fiber. Eating a diet high in dietary fiber promotes healthy bowel function. Protein This shows the total grams of protein in one serving. Protein is an essential nutrient for growth and health. Total fat This gives the total grams of fat in one serving of that food. 6 Saturated, trans fat and cholesterol Unsaturated fat Eating too much fat may increase your risk of certain chronic diseases, such as stroke, and some types of cancers. You can find the amount of unsaturated fat by subtracting the amount of saturated and trans fats from the total fat. Eating more unsaturated fats than saturated fats can help lower blood cholesterol levels. Most unsaturated fats come from plant sources and include canola, vegetable and olive oil. Quit smoking Shortly after you quit smoking, your circulation begins to improve and your blood pressure starts to return to normal. Your sense of smell and taste improve and breathing will become easier. There may be increased coughing at first, but this will go away shortly. Quitting is not easy. You may experience weight gain, irritability and anxiety. This will also go away after a short time. Most people try several times before succeeding. Do not stop trying. How to stop smoking: • Some people stop “cold turkey.” Pick a day. Get rid of all tobacco. Don’t let anyone smoke in your home. Change your routine. Spend time in places where smoking is not allowed. • Talk to your doctor about medicines, nicotine patches, gum or lozenges to help decrease cravings. The more help you have, the better your chance of quitting. • Support groups and counseling can also be helpful. Call your local health department about available programs. • Talk to your doctor about the best way for you to quit. • Tell people you want to quit. Ask them not to smoke around you or leave tobacco products in sight. For help in quitting smoking, contact: New York State Quitline 1 (866) NY-QUITS, 1 (866) 697-8487 Serving size First look at the serving size and the number of servings in the package. All the information on this label is based on this serving or portion size. So, if you eat double the serving, you will consume double the calories, carbohydrate, fat and other nutrients. Calories Calories provide a measure of how much energy you get from a serving of this food. This gives the total calories per serving. The portion of the total calories that comes from fat is also given. A good rule of thumb is to look for foods that show one-third or fewer of the total calories coming from fat. Total carbohydrate and sugars This shows the amount of Carbohydrate per serving that comes from sugar. This includes both natural sugar and added sugar. 7 How is coronary artery disease diagnosed? How is coronary artery disease treated? Along with checking your blood pressure and cholesterol, your doctor will diagnose you with the following: 1. Lifestyle changes (See section on prevention). 1. Medical and family histories • Angioplasty – A thin tube with a balloon on the end is inserted into the artery. Once in place, the balloon is inflated and blood flow is restored. Complications of coronary artery disease • Stent – a small mesh tube placed in the artery to keep it open. A heart attack happens when an artery becomes totally blocked. This blockage prevents oxygen and nutrients from getting to the heart. A heart attack can cause permanent damage to the heart muscle. The more time that passes without treatment to restore blood flow, the greater the damage to the heart. High blood pressure, high cholesterol or diabetes may increase the chance of a heart attack. A previous heart attack and smoking are also risks. 2. Review of risk factors 3. Physical exam 4. Diagnostic tests • Blood tests • Chest X-ray – Creates a picture of the heart, lungs and other organs in the chest. • ECG or EKG (electrocardiogram) – this test measures the electrical activity of the heart. An EKG can also show signs of an old or new heart attack. 2. Medical procedures such as: • Coronary artery bypass grafts – Arteries or veins from other areas of the body are used to go around (bypass) the narrowed artery. • Echocardiogram – uses sound waves to create a moving picture of the heart. 3.Cardiac rehabilitation – A team of doctors, nurses, physical therapists and dieticians works together to help develop a treatment plan to modify unhealthy behaviors. • Exercise stress test – measures the EKG when exercising to look for changes consistent with heart disease that are not seen at rest. • The first part of cardiac rehabilitation is exercise training. This will help you learn how to exercise safely. • Nuclear cardiac imaging (also known as Spect MPI) – may be performed at rest or under the stress of exercise or drug stimulation. • The second part of cardiac rehabilitation is education. This helps you understand your heart condition and find ways to reduce your risk of future heart problems. • Cardiac catheterization – uses dye and special X-rays to check the inside of your arteries for a blockage. It can monitor the blockage and flow of blood through the heart. 4. Medication is also used . See page 10 for type of medication and page 13 for personal medication records. • The list below includes some of the heart medications that may be prescribed by your doctor. Not all heart medications are included in this list. • Take your medications the way your doctor instructs you to. 8 • You may also discuss questions about your medications with your pharmacist as well as your doctor. • Do not stop medication without talking to your doctor. Heart attack The five major symptoms of a heart attack are: • Pain or discomfort in the jaw, neck or back. • Feeling weak, light-headed or faint. • Chest pain or discomfort. • Pain or discomfort in the arms or shoulder. • Shortness of breath. Other symptoms may include breaking out in a cold sweat, nausea or lightheadedness. Do not wait for an emergency to happen. Talk to your doctor about having a plan in place. If an emergency does occur and you think that you or someone is having a heart attack, call 911 or your emergency response number right away. Stroke A stroke, sometimes called a “brain attack,” occurs when a blood clot blocks the blood supply to the brain. Some strokes are called mini-strokes or transient ischemic attacks. A TIA produces stroke-like symptoms but no lasting damage. Recognizing and treating TIAs reduce your risk of having a major stroke. Symptoms of stroke appear suddenly and without warning. The symptoms of a stroke include: Important things to remember: • Sudden numbness or weakness, especially on one side of the body. • Check the time your symptoms develop; your doctor will ask. • Confusion or trouble speaking or understanding speech. • Seek treatment right away. DO NOT WAIT! • Trouble seeing in one or both eyes. • Call an ambulance. Do not drive yourself to the hospital. • Trouble walking or loss of balance. • Feeling dizzy. • Severe headache with no known cause. The most common symptoms of a stroke can be remembered by the word FAST: F = Face: Is one side of your face drooping down? A = Arm: Can you raise both arms, or is one arm weak? S = Speech: Is speech slurred or confusing? T = Time: Is critical!!! Call 911 immediately! 10 Important Points to Remember • Do not ignore any stroke symptom. You need to call your doctor or call 911. Resources American Heart Association Centers for Disease Control and Prevention National Heart, Lung, Blood Institute (NHLBI) WomenHeart: The National Coalition for Women with Heart Disease National Institute of Health (NIH) 1. Stay active. 2. Make healthy food choices. 3. Maintain a healthy weight. 4. Take medication as directed by your doctor. 5. Have your blood pressure and cholesterol levels checked regularly. 6. Do not smoke. 7. Avoid excessive alcohol intake. 8. See your doctor regularly. 9. Find healthy ways to cope with stress. 10. Be aware of the warning signs of a heart attack or stroke. 9 10 Type of medication Why it is used Things to remember Beta Blockers • Used for most types of heart problems. • Lower heart rate and blood pressure. • Relieve and prevent chest pain. • Diabetics should report low blood sugars to their doctor. • Report dizziness. Calcium Channel Blockers • Lower heart rate and blood pressure. • Control an irregular heartbeat. • Help the heart muscle function better. • Relieve and prevent chest pain. • Report any swelling in your ankles, feet or legs, weight gain, shortness of breath or constipation to your doctor. Angiotensin II receptor blockers (ARBs) • Reduce blood pressure. • Do not take NSAIDs, (arthritis pain medications), antacids, potassium supplements, diuretics, and lithium without talking to your doctor. Angiotensin converting enzyme (ACE) inhibitor • Reduce blood pressure. • A cough is a commom side effect. If coughing is severe, talk to the doctor. Statins (cholesterol pills) • Lower bad cholesterol (LDL) levels. • Tell your doctor if you have severe muscle aches. • Do not drink grapefruit juice. • See your doctor regularly for blood work. Diuretics (Water pills) • Reduce blood pressure. • Treat heart failure. • A high-potassium diet may be recommended. • Tell your doctor if you are allergic to sulfa medications. Aspirin • Reduce the risk of heart attack. • Reduce the severity of a heart attack if chewed immediately when symptoms begin. • Coated aspirin helps prevent stomach upset. • Do not take pain relievers without talking to your doctor. Anticoagulant • Blood thinner. • Prevent blood clots. • Avoid activities that have a high risk for injury or bleeding. • Immediately tell your doctor if you have any bruising or bleeding. • Talk to your doctor before taking any pain relievers, vitamins, supplements or any natural products. • Do not make any sudden changes in how much vitamin K rich foods you eat. When you have blood work, contact your doctor for medication instructions. Digoxin • Slow and strengthen heart contractions. • If you take too much medication, get emergency medical attention. • Drink fluids to avoid becoming dehydrated in hot weather or during activity. 11 12 13 14 15 excellusbcbs.com B-3426/6970-13MCM 16