Q: I read your column faithfully and respect your knowledge of medical problems. Would you explain to me the difference between heart disease and hypertension? Are they the same thing? We are asking these questions for my husband so he can see another doctor and are not sure if his high blood pressure is heart disease or not. Thank you for your help.
A: I will explain the two separate conditions that can be related but without knowing your husband’s symptoms and history, I cannot determine his diagnosis. Heart disease covers a wide range of disorders that affect the heart and may include congenital defects, arrhythmias, infection, and coronary artery disease also known as cardiovascular disease. High blood pressure is a common disorder marked by abnormally high readings. When no specific cause can be found, the condition is referred to as essential hypertension. When a specific cause is determined, the condition is referred to as secondary hypertension. Hypertension against arterial walls refers to the arteries that may surround and serve the heart, as well as those that serve the brain, kidney and extremities. I’ll begin by briefly covering heart disease.
Risk factors for heart disease include hypertension that is uncontrolled with medication, a smoking habit that constricts blood vessels, age, family history, diabetes, obesity, and poor diet. Diagnosis can be made through an EKG, Holter monitor, echocardiogram, X-ray,CT, MRI, laboratory testing and numerous other methods.
Congenital heart defects are commonly detected shortly after birth and may include shortness of breath, cyanosis (a pale gray or blue skin tone), and edema of the abdomen and legs. Those defects not diagnosed early on include symptoms of fatigue with activity, edema of the extremities, shortness of breath and a build-up of fluid in the lungs or heart.
An arrhythmia indicates an abnormal heartbeat that can be detected by a physician, physician assistant, nurse, nurse practitioner or other health care provider using a stethoscope. Signs and symptoms include heart flutter, chest pain, fainting, bradycardia (slow beat), tachycardia (rapid beat), chest pain and more. Causes may include high blood pressure, coronary artery disease, diabetes, drug abuse, excessive alcohol consumption, caffeine, and the use of some prescription/over-the-counter/herbals/ dietary supplements.
Infections of the heart that may represent the cause include endocarditis, (inflammation of the inside of the heart), pericarditis (inflammation of the membrane that covers the heart), and myocarditis that affects the middle layer of the walls of the heart. Symptoms include fever, edema of the legs or abdomen, fatigue, shortness of breath, chest pain and more. Causes for infection include viruses or bacteria that enter the bloodstream. Causes unrelated to infection include rare side effects to antibiotics such as penicillin and sulfonamides, having a connective tissue disorder such as lupus, and more.
Coronary artery disease occurs when coronary arteries become damaged or diseased. Plaque on the arteries is commonly to blame for the condition that prevents the heart and all parts of the body from receiving a sufficient supply of blood. Symptoms include angina (chest pain), shortness of breath and more. Causes include hypertension, high cholesterol levels and diabetes.
On to hypertension. There are numerous reasons for a person to have high readings, such as obesity, stress, consuming too much salt, smoking, drinking to excess, family history and diabetes. Many individuals have hypertension without symptoms. In fact the condition is known as the silent killer because with a lack of symptoms, such conditions as heart disease can develop.
If your husband is found to have essential hypertension, medication and lifestyle changes might be sufficient to bring his levels to an acceptable level. If he has secondary hypertension, the cause should be investigated, properly diagnosed, and treated appropriately.
He should see his primary care physician or a cardiologist who can order testing and determine if his hypertension is linked with a heart condition. Some lifestyle changes may be in order initially, such as losing weight, exercising, eating a healthful diet, and taking prescription medication.
Readers who would like related information can order Dr. Gott’s Health Reports “Hypertension” and “Coronary Artery Disease” by sending a self-addressed, stamped number 10 envelope and a $2 (for each report) US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.