Living with coronary disease

258 Pages·2007·4.12 MB·English

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Living with Coronary Disease
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Clive Handler
Gerry Coghlan
Living with
Coronary Disease
Foreword by Professor Dame Carol Black
DBE, FRCP, FMedSci
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Clive Handler, BSc, MD, MRCP, Gerry Coghlan, MD, FRCP
FACC, FESC Consultant Cardiologist
Consultant Cardiologist Department of Cardiology
The National Pulmonary The Royal Free Hospital
Hypertension Unit London, UK
The Royal Free Hospital
London, UK
and
Honorary Senior Lecturer
Department of Medicine
Royal Free and University
College Medical School
London, UK
and
Consultant Cardiologist
Highgate Hospital
London, UK
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Control Number: 2006928328
ISBN-10: 1-84628-550-X e-ISBN-10: 1-84628-551-8
ISBN-13: 978-1-84628-550-9 e-ISBN-13: 978-1-84628-551-6
© Springer-Verlag London Limited 2007
Apart from any fair dealing for the purposes of research or private study, or
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Dr. Clive Handler dedicates this book to Caroline, Charlotte,
Sophie, and Julius.
Dr. Coghlan dedicates this book to Eveleen, Niall, Cathal,
and Eoin.
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Foreword
Patients are increasingly and rightly demanding accessible and
readily understandable information which enables them to be
full partners in management decisions about their conditions.
Organisations such as the British Heart Foundation and the
American Heart Association have produced many helpful book-
lets explaining heart disease, and for many patients this is suffi-
cient. However, for those who want self-help advice and a more
comprehensive explanation of coronary artery disease, its cause,
risk factors, how it is investigated, and its medical management,
this book is an excellent companion.
“Living with Coronary Disease” uses terminology in every
day use and each chapter can be read in isolation, giving the
reader a thorough understanding of one particular aspect of the
subject. The relationships between exercise, smoking, diet, and
heart disease, are fully explained, and the reasons why not ev-
ery smoker gets heart disease elucidated. “Living with Coronary
Disease” helps you communicate with your doctor more effec-
tively; it helps you understand why certain tests are necessary,
what the results mean, when to rush to hospital and when not
to worry too much.
This book meets the needs of anyone interested in under-
standing and avoiding coronary disease, and also helps those
who have or know someone with heart problems, to live as nor-
mal a life as possible, avoiding future problems.
Professor Dame Carol Black DBE, FRCP, FMedSci
Chairman, Academy of Medical Royal Colleges, London
Emeritus Professor of Rheumatology
Royal Free Hospital, London
Foreword vii
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Preface
We are all more likely to die from a heart attack or a stroke than
from any other condition including cancer or infections. Angina
and heart attacks are due to narrowings and blockages in the
heart arteries causing a lack of blood and oxygen to the heart. A
stroke is due to lack of blood and oxygen to the brain. These heart
and brain problems are due to stiffened and narrowed arteries
due to deposits of fat called atheroma. This is more likely to
occur if a person has certain risk factors. Fat in the heart arteries
is called coronary heart disease and it is the commonest cause of
death in the world.
Coronary heart disease affects men and women equally and
starts in childhood. People of all ages, particularly the young,
should understand what coronary heart disease is and what
can be done to prevent it, or at least, delay it for as long as
possible.
Although we do not fully understand how and why fat gets
deposited in the arteries, we know that it is more likely to happen
as we get older, in those who smoke, in those who have a high
level of a fat called cholesterol or sugar (diabetes) in their blood,
in those with high blood pressure (hypertension), and in those
who are overweight and do little exercise. Stress is also bad for
health and the heart but is more difficult to measure. These are
called risk factors. Although many have been proposed, only a
few account for the majority of problems. Coronary heart disease
also runs in families although there is no single gene that accounts
for this.
People without these risk factors are less likely to get angina,
heart attacks, or strokes. People who have angina or have had
a heart attack or a heart operation, improve their chances of
a longer, more enjoyable life without further heart problems
if they control and correct risk factors. This slows down the
progression of fat deposition. The measures that really work
are having a low blood level of cholesterol which is helped by
eating very little fat – some people may need to take a tablet
Preface ix
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to lower the cholesterol – not smoking, making sure that the
blood pressure is within the normal range, being slim and fit,
and exercising frequently, preferably every day. These things are
also very effective in reducing stress and make us feel better,
stronger, more alert, and in better spirits.
A diagnosis of angina is made only if a person has symp-
toms of angina. The diagnosis is not made from a test. A diag-
nosis of a heart attack is made if a person has symptoms and
an abnormal electrical recording of the heart (electrocardio-
gram, or ECG) and an abnormal blood test result. The treatment
of angina and heart attacks has changed a lot in the last few
years.
There is no doubt that if patients, their families, their doc-
tors, and other clinicians involved in their care do their best and
work together as a team, the outcome for patients will improve.
The more people understand about this common condition, the
more likely it is that they will be able to help themselves and re-
duce their risk of getting it in the first place. If they already have
it, they will be able to improve their chances of living a longer,
trouble-free life. Some things that have been proposed help a lot
and others very little or not at all.
Both of us spend much of our working lives looking after
patients with coronary heart disease. In order for patients and
their families to receive the best care, they should understand
their condition, what the tests and treatments involve – both
the risks and the benefits – and which tests and treatments are
the most appropriate for them. Although there are principles
of treatment we can apply to all patients with angina and heart
attacks, we try to tailor the tests and treatments to the patient
because each case is different.
We have written this book for people who have coronary
heart disease as well as for those who want to prevent it, including
young people. We have tried to avoid medical jargon and have
used simple, direct language in order to clarify a highly technical
and complex subject.
We hope that you will enjoy this book and that it will dis-
pel the natural fears of the condition and allow you to be more
in control of your health and your future. It is important to
remember that most people with coronary heart disease can
and should lead a full, normal, and active life. If you look
x Preface
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after your arteries and your heart, your heart will look after
you.
Clive Handler
Gerry Coghlan
The Royal Free Hospital
London, UK
Preface xi
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Acknowledgements
We would like to thank our patients and their families. Without
them, we could not and would not have written this book. We
would also like to thank our hospital colleagues and particularly
the nurses, physiological technicians, and radiographers in our
departments, who are very important members of the team. We
are also grateful to our many colleagues in primary care, who
help us care for our patients.
Dr. Clive Handler would like to thank his wife, Caroline, and
his three children, Charlotte, Sophie, and Julius, for their support
during the writing of this book. He would also like to thank
Professor Lawrence Cohen MD, special adviser to the Dean, Yale
University Medical School, who has emphasized the importance
of clear communication with patients and their families.
The authors are also grateful to Charlotte Handler, Depart-
ment of English, Bristol University, UK, and to Katie Wake, De-
partment of History, University of Bristol, UK, for their help with
editing the text, and to Dee Maclean for doing the illustrations.
Dr. Gerry Coghlan would like to thank his wife, Eveleen, and
his three sons, Niall, Cathal, and Eoin, for their support during
the writing of this book.
Acknowledgements xiii