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Understanding heart disease

My family physician asked me if I had a history of heart disease. My grandmother had a heart defect, but I'm not sure if that's the same thing. What exactly constitutes heart disease?

Knowledge is one of the most important tools for ensuring good health. When you understand your own health, it's easier to take steps to maintain it. Where heart disease is concerned, learning about your family health history is important because studies have indicated that heart disease may run in families.

Distinct and important differences exist between types of heart disease, according to Michael Klein, M.D., professor of medicine at Boston University School of Medicine and director of the Electrocardiography Lab at Boston Medical Center. Klein says there are several types of heart disease. The most common type is ischemic, which involves blockages of arteries or damage to the heart muscle due to inadequate blood supply. Other forms of heart disease include congenital defects, valvular heart disease (problems with the valves inside the heart), and arrhythmias (abnormal heart rhythms).

Frequently referred to as coronary artery disease, ischemic heart disease is caused by a process known as arteriosclerosis. "Arteriosclerosis is an umbrella term, which used to be known as hardening of the arteries," says Klein. The form we hear most about is known as atherosclerosis, which occurs when fatty deposits build up inside artery walls, blocking the normal flow of blood. A heart attack results when blood can't reach the heart muscle, and the affected parts of the heart muscle weaken and die.

Weakening of the heart muscle can also lead to congestive heart failure (CHF). "CHF occurs when the heart is no longer strong enough to pump blood to other parts of the body," says Klein. "While it may sound more serious than some other conditions, heart failure simply means that the heart muscle isn't working the way it should."

The inefficient pumping can lead to pulmonary congestion -- a dangerous buildup of fluid in the lungs -- or to swelling in the legs and ankles. "Pulmonary congestion happens because the weakened heart cannot pump enough oxygen-rich blood out of the lungs and to the rest of the body," says Klein. "The blood has to go somewhere, and it begins to leak out of the capillaries and into the spaces between the tissues in the lungs."

Treating CHF involves treating the underlying causes, which can include high blood pressure. "Keeping your blood pressure under control is very important," says Klein. "High blood pressure causes small tears in the walls of blood vessels, which when healed form scars called plaques. These plaques build up along the artery walls and facilitate the process of atherosclerosis and lead eventually to coronary artery disease."

High cholesterol, obesity, and lack of exercise can also be risk factors for developing heart disease. "While we have a range of medications that form part of the treatment approach for heart disease, a physician cannot emphasize enough the value of a healthy diet and regular exercise in helping heart patients stay healthy," says Klein.

"Health Matters" is written in cooperation with staff members of Boston Medical Center. For more information on cataracts or other health matters, call 617-638-6767.

8 February 2001
Boston University
Office of University Relations