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Trinity Mother Frances
Neuroscience Institute

FAQ

Frequently Asked Questions

What causes Coronary Artery Disease (CAD)?
What are the symptoms of CAD?
What do the coronary arteries do?
What increases my risk for heart disease?
How can I prevent heart disease?
What is my risk for having a heart attack?
When do I need to see my doctor?
Can a test find heart disease early?
How will my doctor diagnose heart disease?
How can an electrocardiogram help diagnose heart disease?
Should I have a coronary artery calcium scan?
Should I have an angiogram?
How do I know if I really need a heart test?
How is heart disease treated?
Do I need to see a specialist?
How should I exercise for a healthy heart?
What medicines will I need to take?
Do I need surgery?
What are angioplasty and atherectomy?
Should I have angioplasty?
Should I have bypass surgery?
• What is the difference between stable and unstable angina?
How do I know if I'm having a heart attack?
How do I eat a heart-healthy diet?
How do I live well with heart disease?
How do I start a walking program?
How do I take charge of my angina?
How can I lower my stress level?
How do I take medicines properly?
How can I help a loved one with coronary artery disease?
How can I learn from others who have heart disease?
How do I prepare for end-of-life issues?
Should I stop treatment that prolongs my life?


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1. What causes coronary artery disease (CAD)?
Coronary artery disease is caused by hardening of the arteries, or atherosclerosis. Atherosclerosis occurs when plaque builds up inside the arteries. (Arteries are the blood vessels that carry oxygen-rich blood throughout your body.) Atherosclerosis can affect any arteries in the body. When it occurs in the arteries that supply blood to the heart, it is called coronary artery disease. CAD is the number one killer of both men and women in the United States.

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2. What are the symptoms of CAD?
Usually people with coronary artery disease don't have symptoms until after age 50. Then they may start to have symptoms at times when the heart is working harder and needs more oxygen, such as during exercise. The severity of these symptoms varies. The symptoms may get more severe as the buildup of plaque continues to narrow the coronary arteries. Typical first symptoms include:
  • Chest pain, called angina, may feel like pressure or a squeezing pain in your chest. You also may feel it in your shoulders, arms, neck, jaw or back. This pain tends to get worse with activity and go away when you rest. Emotional stress also can trigger the pain.
  • Shortness of breath. When you have heart failure, your heart can't pump enough blood throughout your body. Fluid builds up in your lungs, making it hard to breathe.
  • Heart attack. Too often, a heart attack is the first symptom of coronary artery disease.

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3. What are coronary arteries and what do they do?
Coronary arteries are blood vessels that feed oxygen-rich blood to your heart muscle. Having an adequate supply of blood is important because, like the rest of your body, the heart muscle needs oxygen to stay healthy. With every breath you take, blood absorbs oxygen from the lungs and then the heart pumps the oxygen-rich blood throughout the body. The heart pumps some of that oxygen-rich blood through the coronary arteries back to its own muscle.

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4. What increases my risk for heart disease?
The risk factors that play a role in coronary artery disease can be split into two categories: those you can change and those you can’t. Risk factors that you can't change include:
  • Family History You're more at risk if one or more of your close relatives have or had early CAD.
  • Gender - Men generally develop heart disease 10 years earlier than women. But women who have diabetes may develop heart disease at a younger age. By age 60, heart disease is one of the leading causes of death in both sexes.
  • Age - People over 65 are more likely to have heart disease. Gender, age and family history are factors over which you have no control, but you can mitigate against them with health lifestyle choices.
Risk factors you can control include:
  • Smoking - If you smoke, stop.
  • High Blood Pressure – There are things you can do, and medications you can take to decrease this silent threat to your heart health.
  • High Cholesterol – Your physician can recommend lifestyle changes you can implement to improve your good cholesterol and lower the bad.
  • Diabetes – Over time, this condition can accelerate hardening and narrowing of the coronary arteries, resulting in poor blood flow to the heart muscle. People who have diabetes tend to develop atherosclerosis more frequently and at a younger age than those not affected by the disease. Diabetes may double the risk of death from coronary artery disease.
  • Obesity –There is a strong association between being overweight and the risk of developing coronary artery disease (CAD). The exact risk is still a matter of some debate, but it is known that being very overweight (obese) increases your chances of developing high blood pressure, diabetes, and high cholesterol, all major risk factors for CAD. Adopting a healthy diet and regular exercise can help not only your heart, but your overall health as well.
  • Lack of Exercise – Even if weight isn’t an issue, exercise is important for strong muscles, including the heart
  • Birth Control Pills – Be sure your physician knows if you are using the pill.

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5. How can I prevent heart disease?
You can slow down or even prevent coronary artery disease by taking steps toward a healthier lifestyle. Eat right, exercise more and, if you smoke, stop.
  • Quit Smoking - It may be the best thing you can do to prevent heart disease. Smokers who quit cut their risk of heart disease by half after just one year. You can cut your risk even more by staying away from cigarettes for good. After 15 years of not smoking, your risk of death from heart disease is the same as if you had never smoked at all. It’s also important to avoid secondhand smoke.
  • Exercise - There are lots of ways that exercise boosts your health. It can lower cholesterol and blood pressure. It can also help you reach a healthy weight. Try to exercise for at least 30 minutes on most, if not all, days of the week. Talk to your doctor before starting an exercise program.
  • Eat heart-healthy diet. The way you eat can help you control your cholesterol and blood pressure. To find out what's best to eat for a healthy heart see our guidelines for heart-healthy eating.
  • Control your cholesterol
  • Control your blood pressure.

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6. What is my risk for having a heart attack?
Each individual is unique in his or her risk factors for having a heart attack. To find out where you stand take our interactive risk assessment. This interactive tool measures your chance of having a heart attack in the next 10 years. It will calculate your risk score using the values you enter. The calculation is based on information from the Framingham Heart Study. Since 1948 the Framingham Heart Study has studied the progression of heart disease and its risk factors. The data from this study has been used to make a risk assessment. This risk assessment was created by the U.S. National Cholesterol Education Program (NCEP), part of the National Institutes of Health and the U.S. Department of Health and Human Services.

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7. When do I need to see a doctor?
Call 911 or other emergency services immediately if you have any of the following symptoms:
  • Chest pain that has not gone away within 5 minutes after you have rested or taken one nitroglycerin. See “How to Take Nitroglycerin” After calling 911, continue to stay on the phone with the emergency operator. He or she will give you further instructions.
  • Chest pain or discomfort that is crushing or squeezing, feels like pressure on the chest, and lasts more than 5 minutes, especially if it occurs with any of the following symptoms:
    o Sweating
    o Shortness of breath
    o Nausea or vomiting
    o Pain that spreads from the chest to the neck, jaw, or one or both shoulders or arms
    o Dizziness or lightheadedness
    o A fast or irregular pulse
    o Signs of shock
Women are more likely to have symptoms such as shortness of breath, heartburn, nausea, jaw pain, back pain or fatigue.
After calling 911 or another emergency service, chew 1 adult-strength aspirin (325 mg) if you are not allergic to aspirin or unable to take aspirin for some other reason. By calling 911 and taking an ambulance to the hospital, you may be able to start treatment before you arrive at the hospital. If any complications occur along the way, ambulance personnel are trained to evaluate and treat them.
If an ambulance is not readily available, have someone else drive you to the emergency room. Do not drive yourself to the hospital.
If you witness a person becoming unconscious, call 911 or other emergency services and start cardiopulmonary resuscitation (CPR). The emergency operator can coach you on how to perform CPR. You should also inform your doctor if you have episodes of chest pain or discomfort and you work in a field such as a pilot or caregiver, which involves responsibility for the lives of other people.
Never wait if you have symptoms of a heart attack
Many people are unsure whether they are having a heart attack, and so they take a "wait and see" approach. Heart attack symptoms often vary. People sometimes discount their symptoms if they do not fit into the expected "extreme chest pain" scenario. Some people are embarrassed or don't want to bother others by calling for help if they think it may not be a heart attack. Even if you're not sure it's a heart attack, you should still have it checked out. Rapid treatment can save your life.

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8. Can a test find heart disease early?
  • Regular checkups with your doctor, keeping tabs on your “numbers” (cholesterol and blood pressure) will help ensure that your doctor catches any indication of heart trouble early. At that point your physician may order further tests, such as a sonogram of the carotid artery to see if there is build up of plaque on the artery walls that could cause problems down the road.

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9. How will my doctor diagnose heart disease?
Your physician must take many factors into account when determining whether to perform heart tests. For example, there are tests to find out what's causing symptoms like unexplained chest pain, shortness of breath or irregular heartbeats. Heart tests can even be appropriate for a healthy person if his personal history or physical exam points to risk for a heart problem. For example, an athlete may be at risk for a heart problem associated with exercise. So a test such as an exercise electrocardiogram can be done before he or she takes part in competitive sports.

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10. How can an electrocardiogram help diagnose heart disease?
An electrocardiogram records the electrical activity of the heart to determine if the heart is beating in a healthy pattern. It also detects if chest pain is caused by a heart attack or angina.

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11. Should I have a coronary artery calcium scan? A calcium scan, which checks for calcium build-up in the coronary arteries, can give your physician more information about your risk for heart disease. Calcium in these arteries is a sign of heart disease. A high score on a calcium scan can mean that you have a higher chance of having a heart attack than someone with a low score. A high score might prompt your physician to start or change treatment to help you avoid a heart attack. A coronary calcium scan checks for calcium build-up in the coronary arteries.

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12. Should I have an angiogram?
An angiogram helps your physician determine if you need treatment for coronary artery disease, and if you do, how best to treat it. The test shows if your coronary arteries are clogged, where they are clogged and to what degree they are clogged.
  • Your doctor may recommend that you have an angiogram if:
    o The results of a cardiac stress test suggest that you have severe heart disease.
    o You are having chest pain while you are at rest or during only moderate physical activity. Or you are taking medicines for chest pain, but they do not control it.
    o You have another heart problem that may be caused by heart disease.
If during the test the doctor sees that your arteries are badly blocked, you may need to have an angioplasty or bypass surgery right away. So before you have the test, it's a good idea to talk with your doctor about these treatments. Ask what the test might show and what your choices are in each case.
  • You may not need an angiogram if you can control your chest pain and other symptoms with medicines and are otherwise healthy.

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13. How do I know if I really need a heart test?
Doctors order heart tests for many reasons. For example, the test can find out what's causing symptoms like unexplained chest pain, shortness of breath or irregular heartbeats. Heart tests can be appropriate for a healthy person. This happens when a personal history or physical exam points to risk for a heart problem. For example, an athlete may be at risk for a heart problem associated with exercise. So a test such as an exercise electrocardiogram can be done before he or she takes part in competitive sports.

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14. How is heart disease treated?
Treatment for coronary artery disease focuses on taking steps to manage symptoms and reduce the risk of heart attack and stroke. For example:
  • If your doctor agrees, take a low-dose aspirin each day to reduce your risk of heart attack or stroke.
  • Medication may be prescribed for high blood pressure and/or high cholesterol. They can help you manage these health problems and lower your risk.
  • Your doctor may also suggest medicines if you often have chest pain that makes it hard to do everyday activities.
  • If medicines don't help your chest pain, your doctor may suggest procedures to improve blood flow to the heart.
  • Angioplasty, with or without stent placement is one way to open clogged coronary arteries. Sometimes coronary artery bypass graft surgery may be needed.

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15. Do I need to see a specialist?
Following the diagnosis of coronary artery disease (CAD), you should visit your primary care physician every few months to track your condition and ensure that your treatment is going as planned. If you develop complications or need special procedures (such as cardiac catheterization or open-heart surgery), you may require treatment from a variety of specialists.
Depending on the severity of your CAD and whether you have already developed complications, you may need a team of health professionals to help treat your disease and manage your treatment plan.

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16. How should I exercise for a healthy heart?
When you have coronary artery disease, it is very important to exercise regularly. Even if you can only do a small amount of exercise, it is better than not doing any exercise at all. Here are some things to consider as you look into starting an exercise plan.
  • Talk to your doctor before beginning an exercise program. Your doctor may do an electrocardiogram and possibly an exercise stress test exercise stress test to assess how much activity your heart can safely handle.
  • After you start exercising, stop immediately if you experience chest pain, feel faint or lightheaded, or become extremely out of breath.
  • Try to do moderate activity on most, preferably all, days of the week. Aim for a goal to exercise for at least 2½ hours a week.
  • A complete exercise program consists of aerobic exercise, strength training and stretching.
  • Set attainable goals. If you expect too much, you are likely to become discouraged and stop exercising.

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17. What medicines will I need to take?
Many people have trouble correctly taking their medicines for coronary artery disease. Often, they need to take several medicines at different times of the day. And some people struggle to afford the medicines. But medicines are often a key part of treatment, and people who do not take them as prescribed have an increased risk of complications and death. Here are the most commonly prescribed medications for heart patients:
  • Aspirin and other anti platelet medicines help prevent blood clots in your coronary arteries. This can decrease your risk of heart attack and stroke.
  • Beta-blockers slow your heart rate and lower your blood pressure to reduce the amount of work your heart has to do. They also reduce angina.
  • Statins lower your cholesterol and may reduce your risk of a future heart attack.
  • Nitrates relieve chest pain and other symptoms of angina.
  • Calcium channel blockers slow your heart rate and lower your blood pressure to reduce your heart's workload. They also help dilate (widen) your coronary arteries and reduce angina.
  • Angiotensin-converting enzyme (ACE) inhibitors lower your blood pressure and reduce the strain on your heart. They may also reduce your risk for a future heart attack or heart failure.
  • Angiotensin II receptor blockers (ARBs) lower your blood pressure and reduce the strain on your heart. If you cannot tolerate certain side effects of an ACE inhibitor, your doctor may prescribe an ARB instead.
Anticoagulants may also be used after an angioplasty, atherectomy or bypass surgery. The anticoagulant warfarin may be used if you have heart disease as well as atrial fibrillation or other complications.

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18. Do I need surgery?
Many people with heart disease can be treated by lifestyle changes and medicine or angioplasty. But sometimes coronary artery bypass graft surgery is needed. It uses healthy blood vessels to create detours around narrowed or blocked arteries. Traditional bypass surgery is an open-chest procedure. For some patients, minimally invasive or robot-assisted surgery is an option, offering less pain, faster recovery and no cracked chest. At the Louis & Peaches Owen Heart Hospital, our cardiothoracic surgeons are leaders in minimally invasive techniques, including robot-assisted bypass surgery using the daVinci Robotic Surgical System®.Your treatment will depend in part on:
  • How many arteries are blocked
  • How badly the arteries are blocked, and where
  • Other heart problems you may have
  • Your feelings about treatment
Surgery isn't right for everyone. Making lifestyle changes and taking medicine or having angioplasty carry fewer risks than surgery and can work just as well for some people. No matter what treatment you receive, you'll still need to make changes in the way you eat and how much you exercise. These changes, along with not smoking, will give you the best chance of living a longer, healthier life.

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19. What are angioplasty and atherectomy?
It is a procedure done to open a partially blocked blood vessel so that blood can flow through it more easily. It is most often done on arteries that deliver blood to the heart (coronary arteries) when they are narrowed by plaque buildup (atherosclerosis) or blood clots. Angioplasty is not surgery. It doesn't use large incisions or require anesthesia to make you sleep.
During the angioplasty procedure, a thin flexible tube (catheter) is inserted through an artery in the groin, arm or wrist and is carefully guided into the narrowed artery. At that point a small balloon at the end of the tube is inflated. The balloon may remain inflated for a short time. The pressure from the inflated balloon presses fat and calcium deposits (plaque) against the wall of the artery to improve blood flow.
After the fat and calcium buildup is compressed, a small, expandable wire-mesh tube called a stent is sometimes inserted into the artery to hold it open. The artery is less likely to get narrow again (restenosis) after angioplasty with stenting than after angioplasty alone. See a picture of angioplasty with stents.
Atherectomy involves techniques similar to those used for angioplasty. The difference is that atherectomy uses a cutting device (a blade or a whirling blade) to remove the plaque buildup from the artery wall.
Another treatment for people with long-term chest pain is enhanced external counterpulsation (EECP). Most of the time, this is done only if you are unable to have angioplasty or surgery.
Your treatment will depend in part on:
  • How many arteries are blocked
  • How badly the arteries are blocked, and where
  • Other heart problems you may have
  • Your feelings about treatment
No matter what treatment you receive, in order to maintain long term benefits you'll need to make changes in the way you eat and how much you exercise. These changes, along with not smoking, will give you the best chance of living a longer, healthier life.

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20. Should I have angioplasty?
There is no evidence to show that angioplasty for stable angina heart disease will help you live any longer than medical therapy. Angioplasty can get rid of chest pain if medical therapy has not stopped your pain. This may help you have a more active life. If you choose angioplasty, you will still need to make lifestyle changes. This will give you the best chance for a longer, healthier life. Whatever your decision, here are some things to consider:
  • Angioplasty carries the risk of heart attack, stroke and even death. These rarely happen. But you may not want to take even the small risk of dying from the procedure if you have an equally small risk of dying without it.
  • If you decide to try medical therapy now, you can still have angioplasty later if your chest pain bothers you too much.
  • The benefits of angioplasty may not last. The repaired artery can become blocked again over time and you may need another procedure.
Here’s a guide to help you determine what course of treatment is best for you.

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21. Should I have bypass surgery?
There are many good reasons to have bypass surgery:
  • Most people who have bypass surgery report immediate relief from chest pain.
  • Bypass surgery can improve your chances of living a longer life. It may also lower your risk of heart attack.
There are, however, as with any medical procedure, some drawbacks as well.
  • Traditional bypass surgery is open-chest surgery. It carries the rare risk of heart attack, stroke and even death. Many patients, however, are candidates for minimally invasive, robot-assisted coronary artery bypass surgery, which offers many patient benefits, with no sternotomy (cracked chest), less pain and faster recovery.
  • Bypass surgery can't cure coronary artery disease.
  • You will still need to make changes in the way you eat and how much you exercise. These changes, along with not smoking, will give you the best chance of living a longer, healthier life.
  • You will probably need to take medicines.
The decision of whether or you should undergo bypass surgery may depend on the number of arteries that are blocked or which arteries are blocked. The best treatment for you may also depend on your age, your health and how much your chest pain is affecting your quality of life. Bypass surgery is just one treatment for coronary artery disease. Others include angioplasty with stents, medicines and lifestyle changes. Ask your doctor what you can expect to happen if you have bypass surgery compared with using these other treatments.

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22. What’s the difference between stable and unstable angina?
Angina (chest pain) can be stable or unstable.
  • Stable angina occurs at predictable times with a specific amount of exertion or activity. It is relieved by rest and may continue without much change for years. Stable angina usually is relieved by rest within 1 to 5 minutes.
  • Unstable angina may occur as:
    o A change in the usual pattern of stable angina.
    o Chest pain that occurs at rest or with less and less exertion, which may be more severe and last longer, or that is less responsive to nitroglycerin.
    o The onset of angina in a person who previously did not have it.
Unstable angina means that blood flow has gotten worse because of increased narrowing or small blood clots that form in the coronary arteries. Unstable angina is a warning sign that a heart attack may soon occur, and immediate medical evaluation is required.
Signs of unstable angina
  • Chest pain began within the past 2 months and has suddenly become more frequent or severe
  • New chest pain occurs 3 or more times per day
  • Chest pain develops after less and less exertion
  • Chest pain occurs at rest (with no obvious exertion or stress); it may awaken you from sleep
  • Chest pain is less responsive to nitroglycerin

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23. How do I know if I’m having a heart attack?
The pain of a heart attack can vary greatly. In fact, some heart attacks are never recognized (silent infarctions) because the symptoms are mild, not typical, or even absent. This is a major reason why some people don't come to the hospital when they have a heart attack. If you have angina and notice that it is happening more often or lasting longer, you should contact your doctor.
Call 911 or other emergency services immediately if:
  • Chest pain, called angina, may feel like pressure or a squeezing pain in your chest. You also may feel it in your shoulders, arms, neck, jaw or back. This pain tends to get worse with activity and go away when you rest. Emotional stress also can trigger the pain.
  • Shortness of breath. When you have heart failure, your heart can't pump enough blood throughout your body. Fluid builds up in your lungs, making it hard to breathe.
  • Heart attack. Too often, a heart attack is the first symptom of coronary artery disease. The severity of these symptoms varies. The symptoms may get more severe as the buildup of plaque continues to narrow the coronary arteries.
With both a heart attack and angina, part of your heart muscle is not getting enough oxygen because of reduced or blocked blood flow in your coronary arteries. With angina, the lack of oxygen is temporary, and permanent heart damage does not occur. During a heart attack, the lack of oxygen lasts longer and causes permanent heart damage.
With stable angina, you may notice the problem only when your heart is working harder and needs more oxygen, such as during exercise. The pain or discomfort goes away when you rest because your heart no longer needs as much oxygen.
With unstable angina, a clot partly blocks your coronary artery or completely blocks it for a short period of time. Then the clot either breaks up by itself or breaks up after treatment with medicines, so permanent heart damage does not occur. During a heart attack, the blockage lasts long enough to permanently damage part of your heart muscle. The longer your heart muscle goes without oxygen, the larger the heart attack. Your doctor will think about three important things in deciding whether you are having a heart attack:
  • Your description of your symptoms
  • Your electrocardiography (EKG, ECG) results
  • Your blood tests (cardiac enzymes)

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24. How do I eat a heart healthy diet?
The way you eat can help you control your cholesterol and blood pressure. To find out what's best to eat for a healthy heart see our guidelines for heart-healthy eating for general tips and special diets to help lower cholesterol and blood pressure.

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25. How do I live well with heart disease?
If you have heart disease, but are not yet experiencing the symptoms, it can be hard to realize the importance of healthy living. Talk with your doctor to learn about the disease and what you can do to help manage it and prevent it from getting worse.
Healthy habits
Making healthy lifestyle changes can delay and maybe even reverse heart disease. Quitting smoking, eating a low-fat and low-cholesterol diet and getting regular exercise are the most important steps you can take to keep your disease from getting worse.

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26. How do I start a walking program?
Walking is a form of aerobic exercise and is one of the easiest ways to increase your physical activity and improve your health. Physical activity increases your heart rate, strengthens your heart and increases blood circulation through your body, bringing more oxygen and nutrients to your organs. Exercise also increases your lungs' ability to take in oxygen, lowers blood pressure, helps to reduce body fat and improves blood sugar and cholesterol levels.
When starting any exercise program, remember:
  • Have a checkup before beginning an exercise program. If you have heart problems, your doctor may want to do tests to find out how much activity your heart can safely handle.
  • Start out slowly at first, with a warm-up in the beginning, a faster pace in the middle and a cool down at the end.
  • To stay motivated, walk with friends, coworkers or pets. Set goals you can reach.
  • Use a pedometer to count your steps. Wear it all day and try to take at least 2,000 more steps a day than you normally do, and gradually increase your steps over time.
  • Try to do at least 2½ hours of moderate exercise a week. One way to do this is to be active 30 minutes a day, at least 5 days a week.

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27. How do I take charge of my angina?
Most people who have stable angina can control their chest pain by taking medicines as prescribed and nitroglycerin when needed.
Staying active is also important. But if these things don't help you manage your angina, try these tips:
  • If an activity causes angina, slow it down.
  • Ease into your day. Warm up slowly before activity.
  • Give yourself time to rest and digest right after meals.
  • Change the way you eat. Eat smaller meals more often during the day instead of two or three large meals.
Controlling severe angina
When angina is more severe and you are having a hard time managing it, you can:
  • See if family members or hired help can assist with heavy chores such as shoveling snow or mowing lawns. If it makes sense to do so, think about moving to a different home to avoid the physical stress caused by climbing stairs or doing heavy chores.
  • If your job involves heavy labor, think about changing the kind of work you do.
  • Try taking nitroglycerin before you start a stressful activity that can cause angina, such as walking uphill or having sex.
  • If you are not taking nitroglycerin for chest pain, ask your doctor if it could help you.
Call your doctor
Tell your doctor right away if:
  • There is a sudden change in your angina symptoms.
  • You begin to get angina at unexpected times.
  • You get angina when you are resting.
Dealing with depression and stress
Depression and heart disease are linked. People with heart disease are more likely to get depressed. Depression can make heart disease worse. Before it becomes a vicious cycle, talk to your doctor to find out if you have depression. In the meantime, you can take this short quiz to check your symptoms.
A moderate amount of stress is part of normal living, however, stress and anger can also hurt your heart if not handled correctly. How we choose to control and manage our stress determines whether it has a positive or negative effect on us.
Stress can be short-term (acute) or long-term (chronic). Acute stress is a "fight-or-flight" reaction to an immediate threat. Triggers of acute stress include crowds, noise and dangerous situations. Chronic stress requires you to suppress your natural "fight-or-flight" reaction over hours, days or even years. Chronic stress triggers include demanding jobs, family or marital problems, money worries, feelings of inadequacy or loneliness.
Try different ways to reduce stress such as exercise, deep breathing, meditation or yoga. More tips on how to manage stress.
How your body reacts to acute stress
  • Your brain sends out various hormones, including cortisol and adrenaline.
  • Your immune system prepares for attack.
  • Your heart, lungs, and circulatory system kick into high gear:
    o Your heart rate and blood pressure increase.
    o Your breathing becomes more rapid and your lungs take in more oxygen.
    o Your blood flow increases 300% to 400% to get your muscles, lungs and brain ready for any added demands.
    o Your spleen releases more red blood cells so that your blood can carry more oxygen. Stress can be both good and bad
The acute stress reaction is important to protect your body and improve your performance. For example, your stress reaction helps you maneuver through a dangerous traffic situation or play well in the championship game. However, chronic stress can have a harmful effect on your body.
Physical damage caused by stress
Stress can negatively affect your heart in many ways.
Stress and the Heart
What stress does Why it's bad for your heart
Can narrow your arteries
Could reduce blood flow through your coronary arteries, which could cause angina or a heart attack Increases your blood pressure
Could increase the workload on your heart and rupture a plaque in your coronary artery, causing a heart attack
Increases your heart rate
Could cause a potentially dangerous irregular heartbeat (arrhythmia); increases your heart's workload
Stress may also cause or worsen sleep, concentration, and/or stomach problems; headaches; and back and neck pain.
Psychological damage caused by stress
Stress is associated with depression and anxiety disorders and can reduce the amount of pleasure you get out of life. Chronic stress can numb you to feelings of satisfaction and accomplishment. Eventually, this numbness could have a negative impact on your work and your relationships. People suffering from stress sometimes turn to unhealthy habits to deal with their stress. For instance, many people eat when they are stressed out, which can mean that they eat too much or eat unhealthy foods. Some people react to stress by leading sedentary lifestyles or doing passive activities, such as watching television. Other people abuse caffeine, tobacco, alcohol, or illegal drugs to escape their stress. All of these methods of dealing with chronic stress are extremely unhealthy and can cause serious health problems, which may lead to even further stress.
You may be feeling stress if you have one or more of the following symptoms.
Symptoms of Stress
Physical symptoms Psychological symptoms
Behavioral symptoms
  • Headaches
  • Heartburn
  • Muscle tension
  • High blood pressure
  • Rapid heartbeat
  • Changes in bowel movements
  • Weight gain or loss
  • Cold hands and feet
  • Irritability
  • Preoccupation
  • Depression or anxiety
  • Crying for no reason
  • Feeling useless
  • Nightmares
  • Sleep problems
  • Confusion or trouble concentrating
  • Decreased productivity
  • Aggressive behavior
  • Talking too fast
  • Abuse of drugs, alcohol, sex or gambling

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28. How can I lower my stress level?
Luckily, there are several steps you can take to help reduce your stress level. Doing so will have a positive impact on your health and your life.
No single method of "stress-busting" works for everybody. You may need to experiment with several different methods to find one that works for you. You may need to combine a few methods to get the best results.
When you find one or more methods that work for you, your mission is not yet accomplished. You also will need to change the situation that is causing you stress, if you can, or perhaps change your reaction to that situation.
Cognitive-behavioral methods can be the best way to lower your stress level.
Here are some suggestions for dealing with stress:
  • Identify your stress triggers. You may want to keep a journal to record them. For example, does running late make you stressed? Or is it feeling like no one listens to you at work? Bouncing a check? Coming home to a messy house? After you identify your stress triggers, you will be able to plan for them.
  • You should also recognize activities that have a positive effect on your stress level, such as meeting a deadline, riding your bike, or reading before going to bed.
  • Think of solutions for dealing with your stress triggers. These solutions include both ways to prevent stressful situations from happening as well as alternative reactions to them.
  • Add stress-busting activities to your day
You need to shift your focus onto stress-reducing activities as opposed to stress-producing activities. One study about stress showed that adding enjoyable activities to your day can help you even more than eliminating or dealing with your stress triggers. Even small changes can have big effects on your stress level.
  • Set aside some time for yourself each day to do something you find relaxing. The more of these types of activities you work into your daily life, the more your stress level is likely to improve. The following are examples of stress-reducing, enjoyable activities.
  • Stay connected to your family, friends, and other supportive people in your life.
    o Talk about your problems and your feelings. When you don't express feelings of anger or frustration, it can lead to a sense of helplessness, depression, and even hostility.
    o Join a support group in your community to share your feelings.
  • Exercise is one of the best ways of distracting yourself from your stress triggers. It can help you clear your mind and work off anger and frustration. Also, exercise has many other great benefits, such as:
    o Lowering your blood pressure
    o Contributing to weight loss
    o Improving your cardiovascular health
  • Try deep breathing, meditation, or yoga. These techniques can help quiet your mind and counteract your body's physical stress reactions. You can check local fitness centers and community centers for classes or instructors.
Other tips for managing stress
  • Keep your perspective. Take a moment to think about what's bothering you. Ask yourself, "Is this really that important?" or "Is it reasonable to become so stressed out about this?" You'll find that the answer is usually "no."
  • Identify which of your stress triggers are within your control and which are beyond your control.
  • Keep a sense of humor about life. If you can laugh and look on the bright side of a stressful situation, you can affect your stress level. Your body and mind both will be calmed by even a chuckle.
  • Seek help if you feel overwhelmed. Psychiatrists, psychologists, social workers, counselors, and many other mental health professionals are trained to help people deal with problems in their lives. If you feel that you cannot effectively deal with your stress by yourself, find a professional to help. Ask your doctor, friends, and family for references, or check your phone book for a listing of professionals in your area.

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29. How do I take medicines properly?
The treatment of most heart conditions requires the use of prescription drugs. In fact, many people need to take many different pills, several times each day, to treat their heart conditions.
Follow your doctor's instructions
Medicines only work if they are taken properly. So it is very important to understand how many times per day each medicine should be taken and exactly which dosage you should be taking. It is also extremely important that you take these drugs at the prescribed times and in the prescribed dosages. If you do not take your medicines the way they are prescribed, they may not work properly. Not following your doctor's instructions may result in ineffective treatment that may lead to serious complications of your condition.
Adding a medicine regimen into your lifestyle can be a challenge and requires a strong commitment on your part. Your medicine schedule needs to become a routine part of your daily activities. If you have trouble remembering when to take your medicines, you may find the following tips useful.
Managing your medicines
  • Organize your medicines in a pillbox so that you do not mistakenly skip any doses.
  • Set a watch or cell phone alarm to avoid missing scheduled medicine times.
  • Schedule medicine times on a handheld computer or in an appointment book.
  • Ask a friend or family member to help you organize your medicines and remind you when it is time to take them.
  • Keep a detailed list of all medicines you are on, including a description of their color and shape. If your doctor changes your medicines, it will be easier to tell them apart.
  • Take medicines at the same time every day in order to incorporate them into your regular schedule.
  • Carry an extra dose of medicines with you when leaving the house, just in case you are unable to return home in time for the next dose.
Keeping good records
You should keep detailed records of your medicine treatment, including:
  • A notebook with an up-to-date list of the names and dosages of your medicines
  • A list of medicines that you used to take and notes about why they were discontinued
  • A list of any medicines you are allergic to or had an adverse reaction to and descriptions of each allergic or adverse reaction
  • The name and phone number of your pharmacy
  • The names, phone numbers, and addresses of all your doctors
  • Charts of your weight, blood pressure, and heart rate (as often as they are measured)
What if I miss a dose of my medicine?
If you miss a dose of one of your medicines, you should discuss the situation with your doctor or a nurse. For some medicines, missing one or two doses does not cause a major problem. For other medicines, missing a single dose can cause serious problems. You should NOT assume that if you miss a single dose, the next dose should be doubled. Many medicines can cause significant problems and even long-term health concerns if taken in a double dose.
Changes in your medicine treatment
It may also take some trial and error for you and your doctor to find a medicine or combination of medicines that effectively manages your condition and symptoms. For this reason, you may end up trying a range of medicines within one medicine class or across a number of medicine classes. Make sure that you discuss any changes in your medicines with your doctor. Your medicine regimen has been prescribed for a reason, and even slight changes can greatly affect its effectiveness. Interactions with other medicines
The medicines your doctor prescribes may sometimes interact with other prescription or nonprescription medicines as well as any other dietary supplements or herbal remedies. It is therefore important to be aware of which substances will interfere with your treatment regimen. You should tell your doctor about every substance you are taking on a regular basis, whether it is a prescription medicine, an over-the-counter remedy, or an illegal drug.
What important facts should I know about medicines for heart conditions?
The treatment of most cardiac conditions requires the use of prescription medicines. The amount of time that you will be required to take medicines will vary depending upon your specific medical condition. Some people will stop taking medicines when an appropriate level of rehabilitation has been reached. Other people will be required to take medicines for the rest of their lives.
Your doctor may prescribe many medicines for you. Your ability to know and understand the purpose of each medicine is important. For each medicine, you should be able to answer the following questions:
  • What are the generic and pharmaceutical names?
  • What is the correct dosage?
  • When and how often should I take it?
  • What is it supposed to do inside my body?
  • What side effects can I expect?

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30. How can I help a loved one with coronary artery disease?
Coronary artery disease is not just hard on the patient, it’s also difficult for loved ones who feel helpless in the face of this illness. It is hard to see someone you love struggle to perform routine tasks. They will require a great deal of encouragement and emotional support. Learn how you can help.

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31. How can I learn from others who have heart disease?
Sometimes just knowing you’re not alone in unknown territory helps. Read one of our many success stories and learn how another person's expereience can help you.

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32. How do I prepare for end-of-life issues?
Although treatment for coronary artery disease is increasingly successful at prolonging life and reducing complications and hospitalization, the disease can lead to a heart attack, stroke or other fatal conditions. It's a good idea to think about end-of-life decisions before these events happen, while you are still able to decide for yourself and communicate your wishes. If, at some point, your heart disease is advanced and your life will most likely be shortened by the illness, your doctor may talk to you about whether you want to be revived (resuscitated) when your illness progresses and your breathing stops. Learn more about aggressive life-sustaining medical treatment and whether it is right for you.

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33. Should I stop treatment that prolongs my life?
Even though treatment focuses on helping you live longer, it may cause side effects that can greatly affect your quality of life and your ability to spend time with your family and friends. For that reason, some patients decide to stop treatment.
If you decide to stop treatment, you will receive only care that focuses on your comfort and quality of life. This is known as palliative care. If you still have personal goals that you want to pursue, you may want treatment that helps you live long enough to achieve them.
The decision to stop treatment is a personal one and doesn’t have to be made alone. You can consult with your family, doctor and spiritual counselor before making a decision. The Pastoral Care Department at the Louis & Peaches Owen Heart Hospital is always available. Our chaplain can be reached at (903) 531-4567 ,or for urgent needs, please page (903) 510-1759.
It’s important to remember that the decision to stop treatment that keeps you alive doesn't have to be permanent. You can always change your mind and resume treatment if your health starts to improve or you so choose.

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