More than chest pain
Stacey Solt/Special to the Times News Dr. Christopher Cutitta uses a model of the heart to explain types of heart disease.
Symptoms of cardiovascular disease, commonly known as heart disease, go far beyond chest pain.
This was the message that Dr. Christopher Cutitta, a specialist at St. Luke's Heart and Vascular Center, shared during a recent talk at the Pyramid Sports Performance Center in Lehighton. The heart center has a branch at St. Luke's Miners Campus.
"Myocardial infarction (heart attacks) and stenting get a lot of publicity. But people don't know a lot about the other types of heart disease. They can kind of sneak up on you," he said.
Coronary artery disease, the most common type of heart disease, affected nearly 80 million Americans in 2007, said Cutitta. Approximately 700,000 Americans will have a first heart attack this year. He noted that it costs more than $150 billion to treat heart disease each year.
"It's important to recognize the symptoms of cardiovascular disease so that you get to the root of problems, before you wind up in an emergency situation," said Cutitta.
He noted that he has treated patients who are short of breath or experiencing other common symptoms of heart disease for years, but don't realize the extent of their health problems until they are in the emergency room after a heart attack or stroke.
"That's not the time that you want to find this out," he said. "We see a lot of people whose diagnosis of cardiovascular disease is made in the emergency room. I want to find these problems in my office, so we can start treating them."
Cutitta noted that it is easier to treat earlier symptoms of heart disease, rather than deal with it in later stages.
The symptoms of heart disease vary by the different types of disease. The most common type of heart disease, coronary heart disease, is hallmarked by sharp pressure or pain radiating down the right arm, chest, back, or into the neck and jaw. If you experience these symptoms, especially while being physically active, seek medical help immediately.
"If you're climbing a flight of stairs and you feel a lot of pain, that's probably your heart," he said. "If you're watching TV and you get a stabbing pain, it's likely musculoskeletal."
Another common type of heart disease is atrial fibrillation, in which the heart does not pump properly but tends to flutter. Symptoms include heart palpitations, lightheadedness, fatigue, reduced exercise tolerance and shortness of breath.
"Often, people sense that they can't do as much as they used to," said Cutitta. "People sometimes assume that it's just aging. If you're 85 and can't do as much, it's probably aging. But if you're 50 you shouldn't assume that you're just getting older."
Syncope, or passing out, can also be linked to heart disease although there are various other reasons for passing out, such as dehydration or overheating. After ruling out other reasons for the problem, doctors diagnose syncope by determining if there is a structural heart problem and monitoring the heart's rhythm. Because it is difficult to capture the occasional heart rhythms leading to syncope in a medical setting, patients are often sent home with an external or small internal heart monitor.
Congestive heart failure is another growing problem in the United States. There are two types of heart failure: Systolic heart failure, in which the heart is weakened by a heart attack, viral illness, or other cause; and diastolic heart failure, in which the heart muscle is stiff and cannot relax to allow proper blood flow. Diastolic heart failure is often caused by high blood pressure.
Symptoms of congestive heart failure include shortness of breath, swelling in the lower body, weight gain and a nighttime cough. It can be treated with a strict diet, typically low sodium, which is typically maintained for life.
Cutitta noted that patients needing extra pillows to prop themselves up in bed is a red flag for congestive heart failure, because it can become difficult to sleep lying flat due to reduced blood flow and water retention. He has seen patients in emergency settings with up to 20-50 pounds of water weight.
"It's good to recognize the symptoms before it gets that far," he said, noting that rapid water weight gain is often noticeable if you weigh yourself regularly.
Valvular heart disease, in which blood regurgitates (flows backward) or the blood valves narrow, has similar symptoms to other forms of heart disease. Symptoms include heart palpitations, shortness of breath, swelling in the lower body and reduced exercise tolerance.
The last link to heart disease discussed by Cutitta, high blood pressure, has very few symptoms but may be the easiest to detect.
"When you go to the pharmacy, use those little cuffs to test your blood pressure," he said. "They're not as good as a doctor's cuff, but they are a good screening tool."
Normal blood pressure, for a healthy individual, is 120/80. Doctors may aim for a lower "normal" number if the patient has other risk factors for heart disease such as diabetes.
Symptoms of high blood pressure don't typically appear until it has reached a dangerously high level, but may include headache, blurred vision, chest pain, shortness of breath or dizziness.
"If you know that your blood pressure is high and you get any of these symptoms, you should call 911," said Cutitta.
He noted that even mildly elevated blood pressure can damage small blood vessels in the eyes, kidney and brain over time.