Heart (Cardiovascular) Disease

The heart is like any other muscle in body. It needs an adequate blood supply to provide oxygen so that the muscle can contract and pump blood to the rest of the body. Not only does the heart pump blood to the rest of the body, it also pumps blood to itself via the coronary arteries. These arteries originate from the base of the aorta (the major blood vessel that carries oxygenated blood from the heart) and then branch out along the surface of the heart.

When one or more coronary arteries narrow, it may make it difficult for adequate blood to reach the heart, especially during exercise. This can cause the heart muscle to ache like any other muscle in the body. Should the arteries continue to narrow, it may take less activity to stress the heart and provoke symptoms. The classic symptoms of chest pain or pressure and shortness of breath that often spreads to the shoulders, arms, and/or neck due to atherosclerotic heart disease (ASHD) or coronary artery disease (CAD) are called angina.

Should one of the coronary arteries become completely blocked -- usually due to a plaque that ruptures and causes a blood clot to form -- blood supply to part of the heart may be lost. This causes a piece of heart muscle to die. This is called a heart attack or myocardial infarction (myo=muscle + cardia=heart + infarction= tissue death).

Cardiovascular disease, for this article, will be limited to describing the spectrum of atherosclerosis or hardening of the arteries that ranges from minimal blockage that may produce no symptoms to complete obstruction that presents as a myocardial infarction. Other topics, such as myocarditis, heart valve problems, and congenital heart defects will not be covered.

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Your heart is a pump. It's a muscular organ about the size of your fist, situated slightly left of center in your chest. Your heart is divided into the right and the left side. The division prevents oxygen-rich blood from mixing with oxygen-poor blood. Oxygen-poor blood returns to the heart after circulating through your body.
  • The right side of the heart, comprising the right atrium and ventricle, collects and pumps blood to the lungs through the pulmonary arteries.
  • The lungs refresh the blood with a new supply of oxygen. The lungs also breathe out carbon dioxide, a waste product.
  • Oxygen-rich blood then enters the left side of the heart, comprising the left atrium and ventricle.
  • The left side of the heart pumps blood through the aorta to supply tissues throughout the body with oxygen and nutrients.

Heart valves

Four valves within your heart keep your blood moving the right way by opening only one way and only when they need to. To function properly, the valve must be formed properly, must open all the way and must close tightly so there's no leakage. The four valves are:

  • Tricuspid
  • Mitral
  • Pulmonary
  • Aortic

Heartbeats

A beating heart contracts and relaxes in a continuous cycle.

  • During contraction (systole), your ventricles contract, forcing blood into the vessels to your lungs and body.
  • During relaxation (diastole), the ventricles are filled with blood coming from the upper chambers (left and right atria).

Electrical system

Your heart's electrical wiring keeps it beating, which controls the continuous exchange of oxygen-rich blood with oxygen-poor blood. This exchange keeps you alive.

  • Electrical impulses begin high in the right atrium and travel through specialized pathways to the ventricles, delivering the signal for the heart to pump.
  • The conduction system keeps your heart beating in a coordinated and normal rhythm, which keeps blood circulating.

Various heart disease causes

The causes of heart disease vary by type of heart disease.

Causes of cardiovascular disease

While cardiovascular disease can refer to different heart or blood vessel problems, the term is often used to mean damage to your heart or blood vessels by atherosclerosis (ath-ur-o-skluh-ROE-sis), a buildup of fatty plaques in your arteries. Plaque buildup thickens and stiffens artery walls, which can inhibit blood flow through your arteries to your organs and tissues.

Atherosclerosis is also the most common cause of cardiovascular disease. It can be caused by correctable problems, such as an unhealthy diet, lack of exercise, being overweight and smoking.

Causes of heart arrhythmia

Common causes of abnormal heart rhythms (arrhythmias) or conditions that can lead to arrhythmias include:

  • Heart defects you're born with (congenital heart defects)
  • Coronary artery disease
  • High blood pressure
  • Diabetes
  • Smoking
  • Excessive use of alcohol or caffeine
  • Drug abuse
  • Stress
  • Some over-the-counter medications, prescription medications, dietary supplements and herbal remedies
  • Valvular heart disease

In a healthy person with a normal, healthy heart, it's unlikely for a fatal arrhythmia to develop without some outside trigger, such as an electrical shock or the use of illegal drugs. That's primarily because a healthy person's heart is free from any abnormal conditions that cause an arrhythmia, such as an area of scarred tissue.

However, in a heart that's diseased or deformed, the heart's electrical impulses may not properly start or travel through the heart, making arrhythmias more likely to develop.

Causes of congenital heart defects

Congenital heart defects usually develop while a baby is in the womb. Heart defects can develop as the heart develops, about a month after conception, changing the flow of blood in the heart. Some medical conditions, medications and genes may play a role in causing heart defects.

Heart defects can also develop in adults. As you age, your heart's structure can change, causing a heart defect.

Causes of cardiomyopathy

The cause of cardiomyopathy, a thickening or enlarging of the heart muscle, may depend on the type:

  • Dilated cardiomyopathy. The cause of this most common type of cardiomyopathy often is unknown. It may be caused by reduced blood flow to the heart (ischemic heart disease) resulting from damage after a heart attack, infections, toxins and certain drugs. It may also be inherited from a parent. It usually enlarges (dilates) the left ventricle.
  • Hypertrophic cardiomyopathy. This type, in which the heart muscle becomes abnormally thick, usually is inherited. It can also develop over time because of high blood pressure or aging.
  • Restrictive cardiomyopathy. This least common type of cardiomyopathy, which causes the heart muscle to become rigid and less elastic, can occur for no known reason. Or it may be caused by diseases, such as connective tissue disorders, excessive iron buildup in your body (hemochromatosis), the buildup of abnormal proteins (amyloidosis) or by some cancer treatments.

Causes of heart infection

A heart infection, such as endocarditis, is caused when an irritant, such as a bacterium, virus or chemical, reaches your heart muscle. The most common causes of heart infection include:

  • Bacteria
  • Viruses
  • Parasites

Causes of valvular heart disease

There are many causes of diseases of your heart valves. You may be born with valvular disease, or the valves may be damaged by conditions such as:

  • Rheumatic fever
  • Infections (infectious endocarditis)
  • Connective tissue disorders

Risk factors for developing heart disease include:

  • Age. Aging increases your risk of damaged and narrowed arteries and weakened or thickened heart muscle.
  • Sex. Men are generally at greater risk of heart disease. However, women's risk increases after menopause.
  • Family history. A family history of heart disease increases your risk of coronary artery disease, especially if a parent developed it at an early age (before age 55 for a male relative, such as your brother or father, and 65 for a female relative, such as your mother or sister).
  • Smoking. Nicotine constricts your blood vessels, and carbon monoxide can damage their inner lining, making them more susceptible to atherosclerosis. Heart attacks are more common in smokers than in nonsmokers.
  • Certain chemotherapy drugs and radiation therapy for cancer. Some chemotherapy drugs and radiation therapies may increase the risk of cardiovascular disease.
  • Poor diet. A diet that's high in fat, salt, sugar and cholesterol can contribute to the development of heart disease.
  • High blood pressure. Uncontrolled high blood pressure can result in hardening and thickening of your arteries, narrowing the vessels through which blood flows.
  • High blood cholesterol levels. High levels of cholesterol in your blood can increase the risk of formation of plaques and atherosclerosis.
  • Diabetes. Diabetes increases your risk of heart disease. Both conditions share similar risk factors, such as obesity and high blood pressure.
  • Obesity. Excess weight typically worsens other risk factors.
  • Physical inactivity. Lack of exercise also is associated with many forms of heart disease and some of its other risk factors, as well.
  • Stress. Unrelieved stress may damage your arteries and worsen other risk factors for heart disease.
  • Poor hygiene. Not regularly washing your hands and not establishing other habits that can help prevent viral or bacterial infections can put you at risk of heart infections, especially if you already have an underlying heart condition. Poor dental health also may contribute to heart disease.

Different types of heart disease may result in a variety of different symptoms.

Arrhythmias

Arrhythmias are abnormal heart rhythms. The symptoms you experience may depend on the type of arrhythmia you have — heartbeats that are too fast or too slow. Symptoms of an arrhythmia include:

  • Light headedness
  • fluttering heart or racing heartbeat
  • slow pulse
  • fainting spells
  • dizziness
  • chest pain

Atherosclerosis

Atherosclerosis reduces blood supply to your extremities. In addition to chest pain and shortness of breath, symptoms of atherosclerosis include:

  • coldness, especially in the limbs
  • numbness, especially in the limbs
  • unusual or unexplained pain
  • weakness in your legs and arms

Congenital heart defects

Congenital heart defects are heart problems that develop when a fetus is growing. Some heart defects are never diagnosed. Others may be found when they cause symptoms, such as:

  • blue-tinged skin
  • swelling of the extremities
  • shortness of breath or difficulty breathing
  • fatigue and low energy
  • irregular heart rhythm

Coronary artery disease (CAD)

CAD is plaque buildup in the arteries that move oxygen-rich blood through the heart and lungs. Symptoms of CAD include:

  • chest pain or discomfort
  • a feeling of pressure or squeezing in the chest
  • shortness of breath
  • nausea
  • feelings of indigestion or gas

Cardiomyopathy

Cardiomyopathy is a disease that causes the muscles of the heart to grow larger and turn rigid, thick, or weak. Symptoms of this condition include:

  • fatigue
  • bloating
  • swollen legs, especially ankles and feet
  • shortness of breath
  • pounding or rapid pulse

Heart infections

The term heart infection may be used to describe conditions such as endocarditis or myocarditis. Symptoms of a heart infection include:

  • chest pain
  • chest congestion or coughing
  • fever
  • chills
  • skin rash

Your doctor may order several types of tests and evaluations to make a heart disease diagnosis. Some of these tests can be performed before you ever show signs of heart disease. Others may be used to look for possible causes of symptoms when they develop.

Physical exams and blood tests

The first thing your doctor will do is perform a physical exam and take an account of the symptoms you’ve been experiencing. Then they’ll want to know your family and personal medical history. Genetics can play a role in some heart diseases. If you have a close family member with heart disease, share this information with your doctor.

Blood tests are frequently ordered. This is because they can help your doctor see your cholesterol levels and look for signs of inflammation.

Noninvasive tests

A variety of noninvasive tests may be used to diagnose heart disease.

  • Electrocardiogram (ECG or EKG). This test can monitor your heart’s electrical activity and help your doctor spot any irregularities.
  • Echocardiogram. This ultrasound test can give your doctor a close picture of your heart’s structure.
  • Stress test. This exam is performed while you complete a strenuous activity, such as walking, running, or riding a stationary bike. During the test, your doctor can monitor your heart’s activity in response to changes in physical exertion.
  • Carotid ultrasound. To get a detailed ultrasound of your carotid arteries, your doctor may order this ultrasound test.
  • Holter monitor. Your doctor may ask you to wear this heart rate monitor for 24 to 48 hours. It allows them to get an extended view of your heart’s activity.
  • Tilt table test. If you’ve recently experienced fainting or lightheadedness when standing up or sitting down, your doctor may order this test. During it, you’re strapped to a table and slowly raised or lowered while they monitor your heart rate, blood pressure, and oxygen levels.
  • CT scan. This imaging test gives your doctor a highly-detailed X-ray image of your heart.
  • Heart MRI. Like a CT scan, a heart MRI can provide a very detailed image of your heart and blood vessels.

Invasive tests

If a physical exam, blood tests, and noninvasive tests aren’t conclusive, your doctor may want to look inside your body to determine what’s causing any unusual symptoms. Invasive tests may include:

  • Cardiac catheterization and coronary angiography. Your doctor may insert a catheterinto your heart through the groin and arteries. The catheter will help them perform tests involving the heart and blood vessels. Once this catheter is in your heart, your doctor can perform a coronary angiography. During a coronary angiography, a dye is injected into the delicate arteries and capillaries surrounding the heart. The dye helps produce a highly detailed X-ray image.
  • Electrophysiology study. During this test, your doctor may attach electrodes to your heart through a catheter. When the electrodes are in place, your doctor can send electric pulses through and record how the heart responds.

Treatment for heart disease largely depends on the type of heart disease you have as well as how far it has advanced. For example, if you have a heart infection, your doctor is likely to prescribe an antibiotic.

If you have plaque buildup, they may take a two-pronged approach: prescribe a medication that can help lower your risk for additional plaque buildup and look to help you adopt healthy lifestyle changes.

Treatment for heart disease falls into three main categories:

Lifestyle changes

Healthy lifestyle choices can help you prevent heart disease. They can also help you treat the condition and prevent it from getting worse. Your diet is one of the first areas you may seek to change.

A low-sodium, low-fat diet that’s rich in fruits and vegetables may help you lower your risk for heart disease complications. One example is the Dietary Approaches to Stop Hypertension (DASH) diet.

Likewise, getting regular exercise and quitting tobacco can help treat heart disease. Also look to reduce your alcohol consumption.

Medications

A medication may be necessary to treat certain types of heart disease. Your doctor can prescribe a medication that can either cure or control your heart disease. Medications may also be prescribed to slow or stop the risk for complications. The exact drug you’re prescribed depends on the type of heart disease you have. Read more about the drugs that may be prescribed to treat heart disease.

Surgery or invasive procedures

In some cases of heart disease, surgery or a medical procedure is necessary to treat the condition and prevent worsening symptoms.

For example, if you have arteries that are blocked entirely or almost completely by plaque buildup, your doctor may insert a stent in your artery to return regular blood flow. The procedure your doctor will perform depends on the type of heart disease you have and the extent of damage to your heart.

Some risk factors for heart disease can’t be controlled, like your family history, for example. But it’s still important to lower your chance of developing heart disease by decreasing the risk factors that you can control.

Aim for healthy blood pressure and cholesterol numbers

Having healthy blood pressure and cholesterol ranges are some of the first steps you can take for a healthy heart. Blood pressure is measured in millimeters of mercury (mm Hg). A healthy blood pressure is considered less than 120 systolic and 80 diastolic, which is often expressed as “120 over 80” or “120/80 mm Hg.” Systolic is the measurement of pressure while the heart is contracting. Diastolic is the measurement when the heart is resting. Higher numbers indicate that the heart is working too hard to pump blood.

Your ideal cholesterol level will depend on your risk factors and heart health history. If you’re at a high risk of heart disease, have diabetes, or have already had a heart attack, your target levels will be below those of people with low or average risk.

Find ways to manage stress

As simple as it sounds, managing stress can also lower your risk for heart disease. Don’t underestimate chronic stress as a contributor to heart disease. Speak with your doctor if you’re frequently overwhelmed, anxious, or are coping with stressful life events, such as moving, changing jobs, or going through a divorce.

Embrace a healthier lifestyle

Eating healthy foods and exercising regularly are also important. Make sure to avoid foods high in saturated fat and salt. Doctors recommend 30 to 60 minutes of exercise on most days for a total of 2 hours and 30 minutes each week. Check with your doctor to make sure you can safely meet these guidelines, especially if you already have a heart condition.

If you smoke, stop. The nicotine in cigarettes causes blood vessels to constrict, making it harder for oxygenated blood to circulate. This can lead to atherosclerosis.

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