Ask the Expert: Heart Disease

Ask the Expert - Atrial Fibrillation: Mike Rich

Michael W. Rich, MD, FACC, AGSF
Professor of Medicine
Washington University School of Medicine
St. Louis, Missouri

Heart disease is the nation's number one cause of death among older adults. Heart disease takes many forms, such as heart attack, heart failure, heart valve disease, atrial fibrillation, and sudden death. Although the risk of dying from many of these conditions has been reduced, older adults should be aware of heart disease and its warning signs. 

Q:  As I get older, what is my risk of heart disease?

A:  Over 80 percent of people who die from heart disease are 65 or older, and increasing age is one of the strongest predictors of heart disease. Other factors that contribute to the risk of heart disease include high blood pressure (hypertension), diabetes, high cholesterol, smoking, obesity, and lack of exercise. The number and severity of these risk factors affect an individual’s risk of heart disease. Compared to women, men have a greater risk of some types of heart disease, such as heart attack and atrial fibrillation.   

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 in the body, but it is also obtained from animal products we eat, such as meats, poultry, fish, eggs, butter, cheese, and 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 reducing LDL cholesterol lowers the risk of heart attack and stroke.

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 healthcare provider may recommend dietary and lifestyle changes, These include such things 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 healthcare provider must prescribe medication to help control your blood pressure.

Many older people with high blood pressure also have a condition called sleep apnea. With sleep apnea, people stop breathing for short periods of time during sleep. This condition is more common in people who are overweight or obese. Sleep apnea can contribute to high blood pressure or make the blood pressure more difficult to control. Losing weight and wearing a breathing mask at night can help control both sleep apnea and high blood pressure.  

Q:  What is coronary artery disease?

A: CAD is the narrowing of the blood vessels (arteries) that supply blood to the heart muscle. This is most often caused by a buildup of plaque (deposits of fat-like substances and calcium) in the arteries. This condition reduces the blood supply to the heart and can cause a heart attack (also known as a myocardial infarction, or MI). In most cases, a heart attack causes permanent damage to the heart muscle.

A number of simple tools are now available to help you determine your own risk of CAD and heart attack - the two biggest killers. You can check your risk on the American Heart Association's website in just a couple of minutes or in your healthcare provider's office. The risk calculator takes into account your age, sex, and race, and your specific risk factors including diabetes, blood pressure, cholesterol, smoking history, and certain medications.  Since some of these risk factors are within your control, it will give you a good idea of what you can do to lower your risk.

Q:  What are the symptoms of a heart attack? 

A:  Common warning signs of a heart attack include:

  • An uncomfortable feeling of pressure, fullness, squeezing or pain in the center of the chest that lasts more than a few minutes, or goes away and comes back
  • Chest discomfort that spreads to the shoulders, neck or arms
  • Chest discomfort with shortness of breath, sweating, nausea, lightheadedness, or fainting
If you experience any of these symptoms, call 911 right away.

Chest pain associated with the heart is often called angina or angina pectoris.  There are less-common warning symptoms of a heart attack as well. These include:

  • back or shoulder pain
  • indigestion
  • stomach or abdominal pain
  • nausea or dizziness (without chest pain)
  • shortness of breath and difficulty breathing (without chest pain)
  • unexplained anxiety
  • weakness or fatigue
  • palpitations
  • a cold sweat
  • 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 reduces the clotting action of blood platelets, which in turn protects arteries that are already narrowed by a buildup of plaque. However, recent studies have shown that any benefits from aspirin are balanced by an increased risk of serious bleeding.  For this reason, taking an aspirin a day is no longer recommended for older people who do not have a history of heart disease. Nonetheless, the decision to take aspirin to prevent a heart attack should be made with your healthcare provider. Your provider can weigh your risk of heart disease against the likelihood of negative reactions to prolonged aspirin use.  

Q:  What is heart failure?

A:  Heart failure is a condition in which the heart doesn’t 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 condition, such as high blood pressure or a diseased heart valve. People with heart failure often become short of breath and tired when exerting themselves. Other common signs of heart failure are swollen legs or ankles and weight gain due to a buildup of fluid in the body.  Heart failure is common in older people but it most cases it can be kept under control with medications or other treatments. 

Q:  What does it mean if I get lightheaded when I stand up in the morning?

A:  When you stand up, your blood pressure normally decreases slightly due to gravity. This can cause a feeling of dizziness or lightheadedness. As we age, the body takes longer to adjust to changes in position, so the dizziness may seem worse. To help lessen this feeling and to avoid a possible fall, take your time when getting up. This way your system can adjust to an upright position. Certain medications can also cause a lightheaded feeling. Talk to your healthcare provider if you are feeling lightheaded or dizzy when standing, especially if you have experienced falls or near falls.

Q:  Why does my heart occasionally skip a beat and sometimes beat really fast?

A: Occasional skipping or fluttering of the heartbeat is common, even in young people.  In most cases, it does not mean there is a serious heart problem and it does not require treatment.  However, when the heart has an ongoing fast heartbeat or 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 prompt medical attention. 


Last Updated August 2019

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