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Ask the Geriatrician: Heart Disease
Ask the Expert
Eric G. Tangalos, MD, FACP, AGSF, CMD
Professor of Medicine
Chair, Emeritus, Primary Care Internal Medicine
Mayo Clinic
Rochester, Minnesota
Heart disease is the nation's number one cause of death among older adults. The disease takes many forms in its effect on the human body, such as heart attack, heart failure, and sudden death. Although the risk of dying from many of these conditions has been reduced, it is necessary for older adults to be aware of heart disease and its warning signs.
Q: What is coronary artery disease?
A: CAD is the hardening of the vessels that supply blood to the muscles of the heart. The hardening is most often caused by a buildup of plaque (deposists of fat-like substances) in the arteries. This condition reduces the blood supply to the heart and can cause a heart attack. When permanent damage occurs to the heart muscle it is called a myocardial infarction (MI).
Q: As I get older, what is my risk of heart disease?
A: Over 83 percent of people who die of coronary heart disease are 65 or older. Men have a greater risk of heart attack than women do, and they have attacks earlier in life. However, women after menopause continue to catch up to men in death rates from this serious disease and the number climbs with each passing year. At older ages, women who have heart attacks are more likely to die from them within a few weeks. A number of simple tools are now readily available to help you determine your own risk of coronary disease and heart attack--the two biggest killers. These risk assessments can be done on-line in just a couple of minutes (at www.americanheart.org) or can be conducted in your physician's office. They take into account your age and your specific risk factors including diabetes, blood pressure, high cholesterol, smoking history and lifestyle. Since each one of these items is modifiable it will give you a good idea of what you can do for yourself right now. It is never too late.
Q: What is cholesterol? Should I be concerned if my cholesterol level is high?
A: Cholesterol is a soft, waxy substance found among the fats in the bloodstream and in all your body's cells. Cholesterol is produced by the body, but also comes to us from animal products we eat, such as meats, poultry, fish, eggs, butter, cheese and whole milk. Low-density lipoprotein, or LDL, is known as the "bad" cholesterol. Too much LDL cholesterol can clog the arteries to your heart and increase your risk of heart attack. High-density lipoprotein, or HDL, is known as the "good" cholesterol. There is strong evidence that we should reduce our LDL cholesterol when it is abnormally high.
Q: What are the symptoms of a heart attack?
A: Common warning signs of a heart attack include:
- An uncomfortable pressure, fullness, squeezing or pain in the center of the chest that lasts more than a few minutes, or goes away and comes back;
- Pain that spreads to the shoulders, neck or arms;
- Chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath.
Chest pain associated with the heart is often called angina or angina pectoris. Less common warning symptoms of a heart attack include: back or shoulder pain; stomach or abdominal pain; nausea or dizziness (without chest pain); shortness of breath and difficulty breathing (without chest pain); unexplained anxiety, weakness or fatigue; and palpitations, cold sweat or paleness. Women and people with diabetes mellitus should be particularly alert to these less common symptoms.
Q: Should I take aspirin to reduce my risk for a heart attack?
A: Aspirin diminishes the clotting action of blood platelets, which in turn protects arteries already narrowed by accumulated plaque. The decision to take aspirin to prevent a heart attack should be made with your physician so that he or she can weigh your risk of heart disease against the potential for adverse reactions to prolonged aspirin use.
Q: What is heart failure?
A: Heart failure is a condition in which the heart cannot pump enough blood to meet the body's needs. This condition occurs when the heart muscle has been damaged by a past heart attack or other conditions, such as high blood pressure or diseased heart valves. People with heart failure cannot exert themselves because they become short of breath and tired. Other common signs of heart failure are swollen legs or ankles and weight gain due to a buildup of fluid in the body.
Q: My doctor tells me I have high blood pressure. What steps can I take to reduce it?
A: To help control mild to moderate high blood pressure, your doctor may prescribe dietary and lifestyle changes such as: reducing your salt intake; eating more fruit, vegetables, and fat-free and low-fat dairy products; reducing alcohol consumption; incorporating exercise into your daily activities; and maintaining a healthy weight. In some cases, lifestyle changes are not enough to bring blood pressure down and your doctor must prescribe medication to help control your blood pressure.
Q: What does it mean if I get lightheaded when I stand up in the morning?
A: Having low blood pressure can cause a dizzy feeling upon rising. As we age, blood vessels become less responsive to change in position and the body takes longer to adjust to gravity. To help alleviate this feeling and to avoid a possible fall, take your time when getting up so that your system can adjust to an upright position. Certain medications can also cause a lightheaded feeling. You should speak with your doctor to determine the exact cause of your feeling.
Q: Why does my heart occasionally skip a beat and sometimes beat really fast?
A: Occasional missed heartbeats are fairly common, even in young people. When the heart takes up a persistent irregular rhythm it may be a sign of atrial fibrillation or another abnormality. If the rhythm disturbance is accompanied by symptoms of weakness, fatigue, dizziness, chest pain or tightness, fainting or shortness of breath, seek medical attention immediately.
Updated: March 2012
Posted: March 2012