Heart disease, or heart disorders, are conditions that affect the heart muscle or the blood vessels of the heart. There are many different types of heart disease, but the most common is coronary artery disease (CAD). This condition causes the arteries to narrow, and it may lead to stroke or heart attack.
High cholesterol and high blood pressure are often precursors to heart disease. In addition, recent evidence suggests that high levels of homocysteine in the blood increases a patient's risk of developing coronary artery disease (CAD). These factors may damage or irritate the blood vessels, leading to blockages in arteries.
Heart disease is potentially life threatening. In the United States, heart disease is the leading cause of death in adults. According to the U.S. Centers for Disease Control and Prevention (CDC), nearly 700,000 Americans die of heart disease each year. This is because the heart is responsible for pumping blood throughout the body. Blood contains oxygen, which is necessary for the body to function properly.
Patients with heart disease may have heart attacks (myocardial infarctions), which may be fatal. A heart attack occurs when the supply of blood and oxygen to an area of heart muscle is blocked. If treatment is not started quickly, the affected area of heart muscle begins to die. This injury to the heart muscle can lead to serious complications, including death. It is possible to survive a heart attack, but the part of the heart muscle affected may be damaged, causing shortness of breath and chest pain during exertion or rest. Patients who have experienced a heart attack have an increased risk of having another one.
Patients with heart disease also have an increased risk of developing strokes. This occurs when the blood vessels in the brain become blocked. As a result, the brain does not receive enough oxygen.
Although some patients may be genetically predisposed to heart disease, individuals can take steps to reduce their risks. Eating healthfully, exercising regularly, maintaining a healthy weight, and not smoking lower a patient's risk of developing heart disease.
Angioplasty, blood pressure, blood vessels, CAD, cardiovascular disease, cardiovascular health, cholesterol, cor pulmonale, coronary artery disease, EKG, electrocardiograph, endocarditis, heart, heart attack, heart disease, heart failure, high blood pressure, high cholesterol, hyperlipidemia, hypertension, myocardial infarction, pericarditis, stroke.
Cor pulmonale, also called pulmonary heart disease, occurs when the right ventricle of the heart becomes enlarged. If left untreated, the condition may lead to heart failure.
Long-term lung diseases, such as emphysema, chronic bronchitis, or cystic fibrosis, cause cor pulmonale. It may also be caused by serious lung infections. These lung diseases increase the blood pressure in the lungs, causing a condition called pulmonary hypertension (high blood pressure). As a result of this increased pressure, the right ventricle of the heart has to work harder to pump blood and it eventually becomes enlarged causing cor pulmonale. Cor pulmonale may also come on suddenly if the patient's pulmonary artery is blocked with a blood clot, a condition called a pulmonary embolism.
Symptoms of cor pulmonale are usually similar to the underlying cause, which is typically a lung disease such as emphysema or bronchitis. Symptoms often include frequent coughing, wheezing, weakness, fatigue, difficulty breathing, shortness of breath, and irregular heartbeat. Fluid may build up in the body tissue and cause swelling (edema). Patients may feel weak or experience discomfort in the upper chest.
A magnetic resonance imaging (MRI) scan is the standard diagnostic procedure for cor pulmonale. A machine takes pictures of the patient's heart. The pulmonary arteries will be enlarged in patients with cor pulmonale. An electrocardiograph (EKG) may be also performed. During this noninvasive procedure, electrodes are taped to the patient's chest to measure the electrical activity of the heart. Patients with the condition will have frequent premature contractions in the atria or ventricles of the heart because the heart muscle is overworked. A chest X-ray may show an enlarged right pulmonary artery.
Even with treatment, many patients with cor pulmonale develop heart failure. This is because cor pulmonale occurs in the later stages of serious lung diseases. In general, a low-salt diet and restricted fluids are recommended for patients who have cor pulmonale or have an increased risk of developing the condition. Antibiotics may be prescribed if a lung infection is causing the condition. Blood thinners (anticoagulants) may be prescribed if a pulmonary embolism caused the condition. Supplemental oxygen may also be used to increase the amount of oxygen in the blood.
coronary artery disease (cad)
Coronary artery disease (CAD), also called coronary heart disease (CHD), occurs when the blood vessels that supply oxygenated blood to the heart muscle gradually become narrowed or blocked by plaque deposits. Plaque is a combination of fatty material, calcium, scar tissue, and proteins.
Plaque buildup in the arteries is associated with several risk factors, including high cholesterol, high levels of low-density lipoprotein (LDL or "bad cholesterol") in the blood, low levels of high-density lipoprotein (HDL or "good cholesterol"), high blood pressure, smoking, diabetes mellitus, obesity, age, family history of heart disease, sedentary or inactive lifestyle, stress, and male gender. All of these factors cause the inner lining of the arteries (called the endothelium) to become injured. When the endothelium is injured, the substances that make up plaque cannot flow through the artery. As a result, plaque builds up in the artery.
The plaque deposits decrease the space through which blood can flow. As platelets (disc-shaped particles in the blood that aid clotting) come to the area, blood clots form around the plaque, causing the artery to narrow even more.
Sometimes the blood clot in the artery breaks apart, and blood supply is restored. In other cases, the blood clot may completely block the blood supply to the heart muscle. This lack of blood flow (called ischemia) can "starve" some of the heart muscle of oxygen and lead to chest pain (angina). A heart attack, also known as a myocardial infarction, results when blood flow is completely blocked. Heart attacks usually happen when a blood clot forms over a plaque that has ruptured.
Common symptoms of CAD include chest pain, shortness of breath, irregular or fast heartbeat, weakness or dizziness, nausea, and increased sweating.
The standard diagnostic procedure for CAD is a carotid ultrasonography. This procedure evaluates blood flow using a wand-like device, called a transducer. The transducer sends high-frequency sound waves into the neck to determine if there is any narrowing or clotting in the arteries.
Drugs used that treat CAD include platelet inhibitors such as aspirin or clogidogrel (Plavix®); beta blockers such as metoprolol (Lopressor® or Toprol®); calcium channel blockers such as amlodipine (Norvasc®) or diltiazem (Cardizem®); angiotensin inhibiting drugs or ACE inhibitors such as lisinopril (Prinivil® or Zestril®) or ramipril (Altace®); statins; or HMG-CoA reductase inhibitors such as atorvastatin (Lipitor®) or lovastatin (Mevacor®).
Arteries that are severely blocked may need to be expanded using balloon angioplasty (also called percutaneous transluminal coronary angioplasty or PCTA) and stent placement. This procedure involves using a wire mesh that expands in the blood vessel, allowing more blood to flow normally. A specialized doctor, called a cardiologist, performs these procedures at a hospital. A tube, or catheter, is inserted into a blood vessel. Several types of balloons, stents, and/or catheters are available to treat the plaque inside the vessel. Some of these surgical tools contain anti-clotting medications. The physician chooses the type of procedure based on individual patient needs. Common complications include restinosis (re-narrowing of the artery), bleeding, and infection.
Patients with significant CAD may undergo a procedure called coronary artery bypass graft (CABG) surgery. GABG surgery is when one or more blocked blood vessels is bypassed by a graft (transplant of healthy arteries or veins) to restore normal blood flow to the heart. These grafts usually come from the patient's own arteries and veins located in the chest, leg, or arm. The graft goes around the clogged artery to create new pathways for oxygen-rich blood to flow to the heart. Some problems associated with CABG include heart attack, stroke, blood clots, death, and sternal wound infection. Infection is most often associated with obesity, diabetes, or having had a previous CABG. Some patients may develop swelling in the tissue around the heart (a condition called post-pericardiotomy syndrome) a few days to six months after surgery. Symptoms typically include fever and chest pain. The incision in the chest or the graft site may be itchy, sore, numb, or bruised after surgery. Some patients report memory loss or loss of mental clarity after a CABG.
Endocarditis occurs when the inner lining of the heart is infected. The infection starts in the bloodstream and spreads to the heart.
Bacteria cause most cases of endocarditis, but viruses, fungi, and other microorganisms can also lead to the condition. For instance, dental procedures that have bleeding risks may allow bacteria to enter the bloodstream. Bacteria may also enter the bloodstream during surgical procedures. Other medical conditions, such as skin sores, gum diseases, or intestinal disorders, may also increase a patient's risk of developing a bacterial infection in the blood.
Common symptoms of endocarditis include fever, chills, fatigue, weakness, aching muscles and joints, shortness of breath, night sweats, pale complexion, persistent cough, blood in urine, unexplained weight loss, tenderness in the spleen, new heart murmur (abnormal sound of the heart that can be heard with a stethoscope), and swelling in the legs or abdomen. Some patients may develop tender, red spots under the skin of the fingers (called Osler's nodes). Some may also experience tiny purple or red spots on the skin called petechiae. Similar spots may be present in the whites of the eyes or under the fingernails.
Several tests, including blood tests, echocardiograms, and a chest X-ray, may be necessary to confirm a diagnosis. Blood tests may reveal low levels of iron in the blood, called anemia. This is because chronic infections often interfere with the production of red blood cells and lead to anemia. Because endocarditis may make it harder for the heart to pump blood, an X-ray may reveal blood and fluid backed up in the lungs. An echocardiogram uses sound waves to produce images of the heart. Patients with endocarditis may have abnormally thick and/or leaky heart valves. Others may have abnormal growths in the heart that contain collections of the disease-causing bacteria.
Left untreated, endocarditis can damage the heart valves and permanently damage the lining of the heart. If the heart suffers from permanent damage, it may lead to heart failure, which is fatal, unless the patient undergoes a heart transplant. However, most patients who are diagnosed and treated promptly experience a full recovery.
Patients with endocarditis receive intravenous (IV) antibiotics to treat the infection. The type of antibiotic and duration of treatment depends on the type and severity of the infection, as well as the patient's overall health.
high blood pressure
Blood pressure is the force of blood pushing against the walls of arteries (blood vessels). Each time the heart beats, it pumps blood through blood vessels, supplying the body's muscles, organs, and tissues with the oxygen and nutrients that they need to function. Throughout the day, an individual's blood pressure rises and falls many times in response to various stimuli. For instance, stress typically increases blood pressure, and patients generally have lower blood pressure during sleep. Elevated blood pressure over a sustained period of time is a condition called hypertension (HTN) or high blood pressure.
The cause of 90-95% of the cases of high blood pressure is unknown. Patients who are obese, sensitive to salt, consume excessive amounts of alcohol, do not exercise regularly, smoke, eat poor diets, or experience frequent stress have an increased risk of developing high blood pressure. In addition, individuals may be genetically predisposed to developing high blood pressure. Also, blood pressure tends to increase with age.
Hypertension is called the silent killer because an individual can have it for years without knowing it. High blood pressure rarely causes symptoms at first, but it is a risk factor for many other conditions, including kidney disease and CAD, which may lead to heart attack and/or stroke. Although it rarely happens, high blood pressure that has persisted for many months to years occasionally causes symptoms, such as dizziness, ringing in the ears, impaired vision, fatigue, irregular heartbeat, inability of males to achieve or maintain erection (erectile dysfunction), and fainting. Extremely high blood pressure can cause a headache upon awakening or, even more rarely, nosebleed, nausea, or vomiting.
Blood pressure is measured with a stethoscope and an inflatable arm cuff with a pressure-measuring gauge called a sphygmomanometer. A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first number measures the pressure in the arteries when the heart beats (systolic pressure). The second number measures the pressure in the arteries between beats when the chambers of the heart are filling with blood (diastolic pressure). To get an accurate blood pressure reading, a healthcare professional should evaluate the readings based on the average of two or more blood pressure readings.
The latest blood pressure (BP) guidelines, issued in 2003 by the National Heart, Lung, and Blood Institute, divide blood pressure measurements into four general categories. Normal blood pressure is below 120/80 mmHg. Patients have pre-hypertension if their systolic pressure is 120-139 and their diastolic pressure is 80-89. Patients have stage 1 hypertension when their systolic pressure is140-159 and their diastolic pressure is 90-99. Patients have stage 2 hypertension when their systolic pressure is 160 or higher and their diastolic pressure is 100 or higher.
Treating high blood pressure can help prevent serious and life-threatening complications. Experts recommend using the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains and low-fat dairy foods. Experts also recommend: getting plenty of potassium (e.g. bananas and green leafy vegetables such as spinach), which can help prevent and control high blood pressure; eating less saturated fat (animal fat) and total fat; and limiting the amount of sodium (salt) in the diet. Although 2,400 milligrams of sodium a day is the current limit for otherwise healthy adults, limiting sodium intake to 1,500 milligrams a day will have a more dramatic effect on blood pressure. Consumers should look at the food labels to determine sodium content. If cooking at home, individuals should use less salt or a salt substitute that contains potassium iodide, which does not increase blood pressure.
Other lifestyle changes, including bodyweight management, regular exercise, smoking cessation, and stress management, may also help treat high blood pressure.
Medications may also be prescribed to reduce blood pressure. Beta-blockers, such as propranolol (Inderal®), metoprolol (Lopressor® or Toprol®), or atenolol (Tenormin®), may reduce the workload on the heart, causing the heart to beat slower and with less force. Angiotensin converting enzyme inhibitors (ACE inhibitors) may be taken to dilate blood vessels and increase oxygen to the heart. Calcium channel blockers (CCBs), such as amlodipine (Norvasc®), felodipine (Plendil®), nicardipine (Cardene® or Carden SR®), and nifedipine (Procardia® or Adalat®), may also be used. These medications affect the transport of calcium into the cells of the heart and blood vessels, causing blood vessels to relax. Alpha blockers, such as doxazosin (Cardura®), prazosin (Minipress®), and terazosin (Hytrin®), may be taken to help dilate the blood vessels. Alpha-beta blockers, such as carvedilol (Coreg®) and labetolol (Normodyne® or Trandate®), may be taken to reduce nerve impulses to blood vessels and slow the heartbeat. This helps reduce the amount of blood that must be pumped through the vessels. Vasodilators, such as hydralazine (Apresoline®), may also be taken. These medications work directly on the muscles in the walls of the arteries, preventing the muscles from tightening and the arteries from narrowing. Medications should be taken exactly as prescribed. Taking more or less than recommended may have serious effects on the heart.
High cholesterol, or hypercholesterolemia, is a condition in which there are unhealthy high levels of cholesterol in the blood. It is less commonly called dyslipidemia, hyperlipidemia, and lipid disorder.
Cholesterol is a soft, waxy, fat-like substance found within the bloodstream and cells of the body. Cholesterol is naturally produced in the body and consumed in the diet. Cholesterol is needed to make membranes for all cells in the body, including those in the brain, nerves, muscles, skin, liver, intestines, and heart. Cholesterol is also converted into steroid hormones, such as the male and female sex hormones (androgens and estrogens) and the adrenal hormones (cortisol, corticosterone, and aldosterone). In the liver, cholesterol is the precursor to bile acids that aid in the digestion of food, especially fats. Cholesterol is also used to make vitamin D.
Too much cholesterol in the blood increases a patient's risk of developing heart disease, which may lead to a heart attack, heart failure, stroke, and death. Although eating an unhealthy diet may increase cholesterol, some patients are genetically predisposed to developing high cholesterol.
High cholesterol can cause plaque deposits to form in the arteries. Plaque is composed of cholesterol, other fatty substances, fibrous tissue, and calcium. When plaque builds up in the arteries, it causes atherosclerosis (hardening of the arteries) or coronary heart disease (CHD). Atherosclerosis can lead to plaque ruptures and blockages in the arteries. If the blood supply to the heart is blocked, a heart attack may occur. If blood supply to the brain is blocked, a stroke may occur.
High cholesterol does not lead to specific symptoms unless it is a long-term condition. If patients have high cholesterol for many months to years, they may develop thickening of tendons due to accumulation of cholesterol (xanthoma), yellowish patches around the eyelids (xanthelasma), and white discoloration of the outer edges of the cornea due to cholesterol deposits (arcus senilis). A high level of blood cholesterol causes the arteries to narrow (atherosclerosis) and can slow, or even block, blood flow to the heart. This reduced blood supply prevents the heart from receiving enough oxygen. Left untreated, persistent high blood pressure may cause chest pain (angina), heart attack, transient ischemic attacks (TIAs, or temporary lack of blood flow and oxygen to the brain), lack of oxygen to the brain (called cerebrovascular accidents or stroke), and blocked peripheral arteries (called peripheral artery disease or PAD).
Healthcare providers typically take a sample of the patient's blood to measure the patient's total cholesterol levels, lipoprotein levels, and triglyceride levels and diagnose high cholesterol.
Healthy total cholesterol levels are less than 200 milligrams per deciliter of blood. If the total cholesterol is less than 200 milligrams per deciliter of blood, the risk of heart attack risk is relatively low, unless there are other risk factors, such as smoking, a previous heart attack, or high blood pressure. Borderline high cholesterol is diagnosed in patients who have 200-239 milligrams of cholesterol per deciliter of blood. High cholesterol is diagnosed when patients have 240 milligrams of cholesterol per deciliter of blood. These patients are twice as likely to develop coronary artery disease as patients who have cholesterol levels lower than 200 milligrams per deciliter of blood.
Lipoprotein levels are also measured. A high level of low density lipoprotein (LDL), also called "bad" cholesterol, is a major risk factor for atherosclerosis and coronary artery disease. LDL levels are reported in several categories. An LDL level below 100 milligrams per deciliter of blood is best for people at risk for heart disease. If an individual is at very high risk for heart disease, such as having a previous heart attack, an LDL level less than 70 milligrams per deciliter of blood is optimal. LDL levels can also be near optimal (100-129 milligrams per deciliter of blood), borderline high (130-159 milligrams per deciliter of blood), high (160-189 milligrams per deciliter of blood), and very high (190 or more milligrams per deciliter of blood). When LDL levels are high, the condition is sometimes called hyperlipoproteinemia.
HDL ("good") cholesterol protects against heart disease, so for HDL, higher numbers are better. A level less than 40 milligrams per deciliter of blood is low and is considered a major risk factor for developing heart disease. HDL levels of 60 milligrams per deciliter of blood or more help to lower the risk for developing heart disease.
High levels of triglycerides also indicate an increased risk of heart disease risk. Patients that have levels that are borderline high (150-199 milligrams per deciliter of blood) or high (200 milligrams or more per deciliter of blood) may need treatment.
The main goal of cholesterol-lowering treatment is to lower LDL levels enough to reduce the risk of developing heart disease or having a heart attack. There are two main ways to lower cholesterol: therapeutic lifestyle changes (TLC) and drug therapy. TLC includes a cholesterol-lowering diet (called the TLC diet), physical activity, and weight management. TLC is for anyone whose LDL is more than their target number and goal. Drug treatment with cholesterol-lowering drugs can be used together with TLC treatment to help lower LDL. Prevention of elevated cholesterol with TLC and possibly drug therapy is started if the individual is at risk for high cholesterol level or heart disease, or if the patient has suffered from a heart attack or stroke in the past.
Hyperhomocysteinemia is a medical condition that is characterized by high levels of an amino acid, called homocysteine, in the blood. Patients with hyperhomocysteinemia have an increased risk of developing coronary artery disease (CAD). This is because high levels of homocysteine may irritate blood vessels, leading to blockages in arteries.
Deficiencies in folic acid (folate), vitamin B6, or vitamin B12 may lead to hyperhomocysteinemia. Patients with kidney failure who are undergoing dialysis also have an increased risk of developing hyperhomocysteinemia. However, researchers have not discovered exactly why this condition may develop in dialysis patients.
Hyperhomocysteinemia does not cause any symptoms. Therefore, the American Heart Association recommends regular homocysteine testing in patients who have high risks of developing heart disease.
Hyperhomocysteinemia is diagnosed after a blood test, called a homocysteine test. Patients who have 14 or more micromoles of homocysteine per liter of blood are diagnosed with the condition.
Patients with hyperhomocysteinemia receive folate, vitamin B6, or vitamin b12 supplements until homocysteine levels are normal.
Pericarditis occurs when the sac-like membrane that surrounds the heart (called the pericardium) becomes inflamed.
Pericarditis is usually caused by an infection, such as staphylococcus, tuberculosis, or herpes simplex, which spreads to the heart through the blood. It may also occur after a traumatic injury to the heart or after heart surgery. Some patients may develop pericarditis after a severe heart attack. Pericarditis may occur as a result of inflammatory conditions, such as systemic lupus erythematosus or rheumatoid arthritis.
Symptoms of pericarditis may include chest pain, shortness of breath, fever, fatigue, dry cough, and swollen legs and/or abdomen.
Patients with pericarditis may also have pleural effusions, which occur when the membrane that surrounds the heart fills with fluid.
During a physical examination, a healthcare provider listens to the patient's heart. When the sac around the heart is inflamed, it will make a distinct noise when it rubs against the outer layer of the heart. If abnormal sounds are present, a chest X-ray is warranted. Pericarditis is diagnosed after a chest X-ray reveals inflammation around the heart.
Treatment of pericarditis depends on the underlying cause. If an infection is causing the inflammation, patients will receive antibiotics. The specific medication and duration of treatment depends on the type and severity of the infection, as well as the patient's overall health.
In addition to antibiotics, patients with pleural effusions will also need to have the fluid drained at a hospital. During the procedure, called pericardiocentesis, a healthcare provider administers a local anesthetic to numb the patient's chest. Then, a thin needle is inserted into the pericardium and fluid is removed. This treatment may last several days during the course of the patient's hospitalization.