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Heart Disease 

Introduction
Heart disease, also called cardiovascular disease, is a common problem in the United States.  It occurs when the heart and blood vessels do not function properly.  The most common cause is narrowing or blockage of the arteries that supply blood to the heart, but it is also caused by a variety of disorders that can impair heart or vascular functioning.  There are numerous forms of heart disease including arteriosclerosis, angina, congestive heart failure, heart attack, and stroke.  Heart disease can be life threatening.  Certain risk factors for heart disease can be reversed.  Heart disease is treated with lifestyle changes, medications, and surgery.

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Anatomy
The heart is the core of the cardiovascular system.  Your heart is located to the left of the center of your chest.  It is about the size of your fist.  The heart is a muscle that pumps blood throughout your body.  The blood carries oxygen-rich blood that your body cells need for energy.
 
Your heart contains four chambers.  The chambers are separated by the septum, a thick muscle wall.  There are two chambers on each side of your heart.  The top chambers are called atria, and they receive blood.  The bottom chambers are called ventricles, and they send blood.
 
Your heart contains a right and left pumping system.  Your left atrium receives oxygenated blood from the lungs, and your left ventricle sends it out to your body.  Your right atrium receives deoxygenated blood from your body, and your right ventricle sends it to your lungs.
 
Four heart valves prevent the blood from back flowing as the blood moves forward through the heart chambers.  The mitral valve and the tricuspid valve regulate blood flow from the atria to the ventricles.  The aortic valve and the pulmonary valve control blood as it leaves the heart.  The first sound of your heartbeat is from the mitral valve and the tricuspid valve closing.  The second sound in your heartbeat occurs when the aortic valve and the pulmonary valve close after the blood leaves your heart.
 
Arteries are blood vessels that carry oxygenated blood away from your heart.  The aorta is the largest blood vessel in your body.  The aortic valve separates the left ventricle from the aorta.  The coronary arteries branch off of the aorta and supply the heart with oxygen, blood, and nutrients to keep it healthy.  The pulmonary artery carries deoxygenated blood from the right ventricle to the lungs. 
 
Veins are vessels that carry blood from your body and lungs back to your heart.  Your two largest veins are the superior and inferior vena cavae.  They are located above and below your heart.
 
The large arteries and veins surrounding the heart branch out and become smaller throughout your body.  Small capillaries connect the arteries and veins.  Capillaries deliver oxygen and nutrients to all of the cells in your body.  They also remove waste products, such as carbon dioxide.

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Causes
Heart disease occurs when the heart and blood vessels do not function properly.  Heart disease usually develops over time.  Heart disease can result from several disorders that affect the heart or cardiovascular system.  Coronary artery disease is the most common cause of heart disease.  Coronary artery disease causes the coronary arteries to narrow or become blocked and obstruct blood flow to the heart.  Some people are born with heart abnormalities.  Other common causes of heart disease include high blood pressure, heart valve problems, abnormal heart rhythms, and infections or toxins that weaken the heart.
 
There are numerous forms of heart disease.  Common types of heart disease include arteriosclerosis, angina, congestive heart failure, heart attack, and stroke.  Arteriosclerosis is a hardening and narrowing of the arteries caused by cholesterol, fat, and calcium buildup.  Arteriosclerosis impedes blood flow and can lead to blood clots.  Angina is chest pain that occurs when the heart does not receive enough blood because of blockages or coronary artery spasms.  Congestive heart failure develops when the heart cannot pump enough blood for the body.  A heart attack occurs when the heart muscle cells do not receive oxygenated blood and the heart cannot function.  A stroke occurs when the brain does not receive oxygenated blood.  There are many other forms of heart disease that affect the blood vessels and the heart structures.

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Symptoms
Heart disease is termed “a silent threat” because many people do not experience symptoms until a heart attack or stroke occurs.  Cardiovascular symptoms that require immediate emergency medical attention include chest pain, shortness of breath, pain or numbness in your arms or legs, confusion, loss of consciousness, and blurred vision.
 

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Diagnosis
A doctor can perform a physical examination and conduct tests to determine if you have cardiovascular disease.  You should receive routine physical examinations and discuss your heart disease risk factors with your doctor.  Your doctor will check your weight, pulse, and blood pressure.  Your doctor will listen to your heart and lungs for abnormal sounds or heart rhythms.  Your doctor may order blood work, including tests for cholesterol and blood sugar levels. A series of tests may be ordered to evaluate your heart structure and functioning.
 
Common tests include an electrocardiogram (ECG), echocardiogram, exercise stress test, carotid artery scan, coronary angiography, and nuclear ventriculography (MUGA or RNV).  An ECG records the heart’s electrical activity.  An ECG may be repeated over several hours.  An echocardiogram uses sound waves to produce an image of the heart on a monitor.  An exercise stress test checks the heart's ability to respond to exercise.  You will walk on a treadmill or pedal a stationary bike while an ECG records your heart’s activity.  A carotid artery scan uses sound waves to check for blockages in the carotid artery, a main blood vessel in the neck that supplies the brain.  Coronary angiography involves inserting a long narrow tube through a blood vessel and injecting dye into the heart to see how the heart and coronary arteries are working.  A nuclear ventriculography involves using a safe radioisotope injection to produce an image of the heart with special scanners.  The heart structures may also be viewed with imaging scans including computed tomography (CT) scans and magnetic resonance imaging (MRI) scans.

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Treatment
If you or someone else experiences the symptoms of a stroke or heart attack you should call the emergency medical services in your area, usually 911, for an ambulance.  Strokes and heart attacks are life-threatening events that require immediate emergency medical attention.  Minutes count, so do not delay your call.  Emergency medical treatment is vital to sustain life and prevent complications.
 
If your doctor finds that you have heart disease, but it is not an emergency, your condition may be treated with lifestyle changes, medications, or surgery.  Treatment for heart disease is focused on relieving symptoms and preventing progression of the disease.  You should make lifestyle changes to keep your heart and cardiovascular system healthy.  This may include maintaining a healthy weight, not smoking, not drinking alcohol, not using illegal drugs, eating healthy foods, and regular aerobic exercise.  Your doctor may advise you to restrict your salt and fluid intake.
 
You should keep your blood pressure, cholesterol, and blood sugar levels within healthy ranges.  There are several types of medications that your doctor may prescribe depending on the type of heart disease that you have.  You should take all of your medications as instructed.  Follow up care is necessary to monitor your condition and to avoid associated medical complications.
 
Depending on the severity and type of heart disease, there are several types of surgery for the heart and cardiovascular system.  Common surgeries include coronary angioplasty, bypass surgery, atherectomy, carotid endarterectomy, pacemakers, and valve replacement.  A coronary angioplasty is used to open blocked coronary arteries.  A stent may be inserted to ensure that the coronary artery remains open after this procedure. 

Coronary artery bypass surgery (CABG) involves taking a blood vessel from another part of the body to create a detour around the clogged artery to restore blood flow to the heart.  Blood vessels are commonly taken from the leg and surgically attached to the coronary artery.  It may be necessary to have bypass surgery on one or more coronary arteries.

An atherectomy is a procedure that removes plaque from an artery to improve blood flow.  A carotid endarterectomy removes plaque from the carotid arteries to prevent a stroke.  Heart valve replacement and implanted pumps, pacemakers, and defibrillators may be necessary to help the heart function.  Select people may be candidates for a heart transplant surgery.

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Prevention
You can reverse the risk factors for heart disease that are treatable.  It is helpful to monitor and maintain your correct blood sugar, cholesterol, and blood pressure levels.  Exercise regularly and maintain a healthy weight.  Do not smoke, consume alcohol, or use illegal drugs.  Ask your doctor for dietary recommendations.  Your doctor can refer you to a nutritionist that can help you plan meals and recipes.
 
If you have been diagnosed with heart disease, follow your doctor’s instructions carefully.  Make and keep all of your appointments.  Be sure to take all of your medications as directed.

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Am I at Risk
The risk for heart disease increases with age.  Aging causes changes in the heart and blood vessels.  You have an increased risk for heart disease if other members of your family have the condition.  Smoking, high blood pressure, high cholesterol, being overweight, alcohol abuse, illegal drug abuse, diabetes, and lack of exercise are factors that can increase your risk of developing heart disease.

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Complications
Heart disease can cause death, reduce life expectancy, and result in complications that reduce the quality of life.

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Advancements
Researchers are continually developing and perfecting implanted heart pacemakers, pumps, defibrillators, and transplant methods.  They are trying to design artificial hearts.  Researchers are evaluating trends among individuals that experience heart disease to help identify prevention strategies.  Further, public service campaigns are promoting healthy heart habits, CPR training, and the placement of defibrillators in public places.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.