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Coronary Artery Disease Risk Assessment
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Heart disease is the number one cause of death in this country. But it’s also one of the most preventable. The choices you make every day - what to eat, how you respond to stress, whether or not to get up off the couch and exercise - affect how much you’re at risk. Click on a condition below to learn more.
Angina pectoris (or simply angina) is recurring chest pain or discomfort that happens when some part of the heart does not receive enough blood and oxygen. Angina is a symptom of coronary artery disease (CAD), which occurs when arteries that carry blood to the heart become narrowed and blocked due to atherosclerosis or a blood clot.
Angina pectoris occurs when the heart muscle (myocardium) does not receive an adequate amount of blood and oxygen needed for a given level of work (insufficient blood supply is called ischemia). The following are the most common symptoms of angina. However, each individual may experience symptoms differently. Symptoms may include:
A pressing, squeezing, or crushing pain, usually in the chest under the breast bone, but may also occur in the upper back, both arms, neck or ear lobes
Pain radiating in the arms, shoulders, jaw, neck, and/or back
Shortness of breath
Weakness and/or fatigue
The chest pain associated with angina usually begins with physical exertion. Other triggers include emotional stress, extreme cold and heat, heavy meals, excessive alcohol consumption, and cigarette smoking. Angina chest pain is usually relieved within a few minutes by resting or by taking prescribed cardiac medications, such as nitroglycerin.
The symptoms of angina pectoris may resemble other medical conditions or problems. Always consult your doctor for more information.
An episode of angina does not indicate that a heart attack is occurring, or that a heart attack is about to occur. Angina does indicate, however, that coronary artery disease is present and that some part of the heart is not receiving an adequate blood supply. Persons with angina have an increased risk of heart attack.
A person who has angina should note the patterns of his or her symptoms--what causes the chest pain, what it feels like, how long episodes usually last, and whether medication relieves the pain. Call for medical assistance if the angina episode symptoms change sharply. This is called unstable angina.
In addition to a complete medical history and medical exam, a doctor can often diagnose angina pectoris by noting the patient's symptoms and how/when they occur. Certain diagnostic procedures may also determine the severity of the coronary artery disease, and may include:
Electrocardiogram (ECG or EKG). A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.
Stress test (usually with ECG; also called treadmill or exercise ECG). A test that is given while a patient walks on a treadmill or pedals a stationary bicycle to monitor the heart during exercise. Breathing and blood pressure rates are also monitored. A stress test may be used to detect coronary artery disease, and/or to determine safe levels of exercise following a heart attack or heart surgery.
Cardiac catheterization. With this procedure, X-rays are taken after a contrast agent is injected into an artery to locate the narrowing, occlusions, and other abnormalities of specific arteries.
Specific treatment for angina pectoris will be determined by the doctor based on:
Your age, overall health, and medical history
Extent of the disease
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
The underlying coronary artery disease that causes angina should be treated by controlling existing risk factors: high blood pressure, cigarette smoking, high blood cholesterol levels, high saturated fat diet, lack of exercise and excess weight.
Medications may be prescribed for people with angina. The most common is nitroglycerin which helps to relieve pain by widening the blood vessels. This allows more blood flow to the heart muscle and decreases the workload of the heart.
There are two other forms of angina pectoris, including:
Variant angina pectoris(or Prinzmetal's angina)
Occurs almost exclusively when a person is at rest
Often does not follow a period of physical exertion or emotional stress
Attacks can be very painful and usually occur between midnight and 8 a.m.
Is related to spasm of the artery
Is more common in women
Can be helped by medications
A recently discovered type of angina
Patients with this condition experience chest pain but have no apparent coronary artery blockages
Doctors have found that the pain results from poor function of tiny blood vessels nourishing the heart as well as the arms and legs
Can be treated with some of the same medications used for angina pectoris
Was once called Syndrome X
Angina is a type of chest discomfort caused by poor blood flow through to the heart muscle.
Atherosclerosis thickening or hardening of the arteries. It is caused by a buildup of plaque in the inner lining of an artery.
Plaque is made up of deposits of fatty substances, cholesterol, cellular waste products, calcium, and fibrin. As it builds up in the arteries, the artery walls become thickened and stiff.
Atherosclerosis is a slow, progressive disease that may start as early as childhood. However, it can progress rapidly.
It's not clear exactly how atherosclerosis starts or what causes it. However, a gradual buildup of plaque or thickening due to inflammation occurs on the inside of the walls of the artery. This reduces blood flow and oxygen supply to the vital body organs and extremities.
Risk factors for atherosclerosis, include:
Signs and symptoms of atherosclerosis may develop gradually, and may be few, as the plaque gradually builds up in the artery. Symptoms may also vary depending on the affected artery. However, when a major artery is blocked, signs and symptoms may be severe, such as those occurring with heart attack, stroke, or blood clot.
The symptoms of atherosclerosis may look like other heart conditions. See your healthcare provider for a diagnosis.
First, your doctor will do a complete medical history and physical exam. You may also have one or more of these tests:
Your healthcare provider will figure out the best treatment based on:
You can change some risk factors for atherosclerosis such as smoking, high cholesterol levels, high blood sugar (glucose) levels, lack of exercise, poor dietary habits, and high blood pressure.
Medicines that may be used to treat atherosclerosis include:
With this procedure, a long thin tube (catheter) is thread through a blood vessel to the heart. There, a balloon is inflated to create a bigger opening in the vessel to increase blood flow. Although angioplasty is done in other blood vessels elsewhere in the body, percutaneous coronary intervention (PCI) refers to angioplasty in the coronary arteries to permit more blood flow into the heart. There are several types of PCI procedures, including:
Most commonly referred to as bypass surgery, this surgery is often done in people who have angina (chest pain) due to coronary artery disease (where plaque has built up in the arteries). During the surgery, a bypass is created by grafting a piece of a healthy vein from elsewhere in the body and attaching it above and below the blocked area of a coronary artery. This lets blood flow around the blockage. Veins are usually taken from the leg or from the chest wall. Sometimes more than one artery needs to be bypassed during the same surgery.
Plaque buildup inside the arteries reduces the blood flow. A heart attack may occur if the blood supply is reduced to the heart. A stroke may occur if the blood supply is cut off to the brain. Severe pain and tissue death may occur if the blood supply is reduced to the arms and legs.
You can prevent or delay atherosclerosis by reducing risk factors. This includes adopting a healthy lifestyle. A healthy diet, losing weight, being physically active, and not smoking can help reduce your risk of atherosclerosis. A healthy diet includes fruits, vegetables, whole grains, lean meats, skinless chicken, seafood, and fat-free or low-fat dairy products. A healthy diet also limits sodium, refined sugars and grains, and solid fats.
If you are at risk for atherosclerosis because of family history, or high cholesterol, it is important that you take medicines as directed by your healthcare provider.
If your symptoms get worse or you have new symptoms, let your healthcare provider know.
Tips to help you get the most from a visit to your healthcare provider:
Arteriosclerosis occurs when fatty material collects along the walls of arteries, leading to blocked arteries.
A heart attack, or myocardial infarction, occurs when one or more regions of the heart muscle experience a severe or prolonged lack of oxygen caused by blocked blood flow to the heart muscle.
The blockage is often a result of atherosclerosis—a buildup of plaque composed of fat deposits, cholesterol, and other substances. When a plaque ruptures, a blood clot quickly forms. The blood clot is the actual cause of the heart attack.
If the blood and oxygen supply is cut off, muscle cells of the heart begin to suffer damage and start to die. Irreversible damage begins within 30 minutes of blockage. The result is dysfunction of the heart muscle in the area affected by the lack of oxygen or cell death.
There are two types of risk factors for heart attack, including the following:
Inherited (or genetic)
Inherited or genetic risk factors are risk factors you are born with that cannot be changed, but can be improved with medical management and lifestyle changes.
Acquired risk factors are caused by activities that we choose to include in our lives that can be managed through lifestyle changes and clinical care.
People with inherited hypertension (high blood pressure)
People with inherited low levels of HDL (high-density lipoproteins), high levels of LDL (low-density lipoprotein) blood cholesterol or high levels of triglycerides
People with a family history of heart disease (especially with onset before age 55)
Aging men and women
People with type 1 diabetes
Women, after the onset of menopause (generally, men are at risk at an earlier age than women, but after the onset of menopause, women are equally at risk)
People with acquired hypertension (high blood pressure)
People with acquired low levels of HDL (high-density lipoproteins), high levels of LDL (low-density lipoprotein) blood cholesterol, or high levels of triglycerides
People who are under a lot of stress
People who drink too much alcohol
People who lead a sedentary lifestyle
People overweight by 30 percent or more
People who eat a diet high in saturated fat
People with type 2 diabetes
A heart attack can happen to anyone—it is only when we take the time to learn which of the risk factors apply to us, specifically, can we then take steps to eliminate or reduce them.
Managing your risks for a heart attack begins with:
Examining which of the risk factors apply to you, and then taking steps to eliminate or reduce them.
Becoming aware of conditions like hypertension or abnormal cholesterol levels, which may be "silent killers."
Modifying risk factors that are acquired (not inherited) through lifestyle changes. Consult your doctor as the first step in starting right away to make these changes.
Consulting your health care provider soon to determine if you have risk factors that are genetic or inherited and cannot be changed, but can be managed medically and through lifestyle changes.
The following are the most common symptoms of a heart attack. However, each individual may experience symptoms differently. Symptoms may include:
Severe pressure, fullness, squeezing, pain and/or discomfort in the center of the chest that lasts for more than a few minutes
Pain or discomfort that spreads to the shoulders, neck, arms, or jaw
Chest pain that increases in intensity
Chest pain that is not relieved by rest or by taking nitroglycerin
Chest pain that occurs with any/all of the following (additional) symptoms:
Sweating, cool, clammy skin, and/or paleness
Nausea or vomiting
Dizziness or fainting
Unexplained weakness or fatigue
Rapid or irregular pulse
Although chest pain is the key warning sign of a heart attack, it may be confused with indigestion, pleurisy, pneumonia, or other disorders.
The symptoms of a heart attack may resemble other medical conditions or problems. Always consult your health care provider for a diagnosis.
If you or someone you know exhibits any of the above warning signs, act immediately. Call 911, or your local emergency number.
The goal of treatment for a heart attack is to relieve pain, preserve the heart muscle function, and prevent death.
Treatment in the emergency department may include:
Intravenous therapy such as nitroglycerin and morphine.
Continuous monitoring of the heart and vital signs.
Oxygen therapy improves oxygenation to the damaged heart muscle.
Pain medication decreases pain, and, in turn, decreases the workload of the heart, thus, the oxygen demand of the heart decreases.
Cardiac medication, such as beta-blockers, promote blood flow to the heart, improve the blood supply, prevent arrhythmias, and decrease heart rate and blood pressure.
Fibrinolytic therapy is the intravenous infusion of a medication which dissolves the blood clot, thus, restoring blood flow.
Antithrombin/antiplatelet therapy is used to prevent further blood clotting.
Antihyperlipidemics are medications used to lower lipids (fats) in the blood, particularly Low Density Lipid (LDL) cholesterol. Statins are a group of antihyperlipidemic medications, and include simvastatin (Zocor), atorvastatin (Lipitor), and pravastatin (Pravachol), among others. Bile acid sequestrants—colesevelam, cholestyramine, and colestipol—and nicotinic acid (niacin) are two other types of medications that may be used to reduce cholesterol levels.
Additional procedures to restore coronary blood flow may be used. Those procedures include:
Coronary angioplasty. With this procedure, a balloon is used to create a bigger opening in the vessel to increase blood flow. This is often followed by the insertion of a stent into the coronary artery to help keep the vessel open. Although angioplasty is performed in other blood vessels elsewhere in the body, percutaneous coronary intervention (PCI) refers to angioplasty in the coronary arteries to permit more blood flow into the heart. PCI is also called percutaneous transluminal coronary angioplasty (PTCA). There are several types of PTCA procedures, including:
Balloon angioplasty. A small balloon is inflated inside the blocked artery to open the blocked area.
Coronary artery stent. A tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open.
Atherectomy. The blocked area inside the artery is cut away by a tiny device on the end of a catheter.
Laser angioplasty. A laser used to "vaporize" the blockage in the artery.
Coronary artery bypass. Most commonly referred to as simply "bypass surgery" or CABG (pronounced "cabbage"), this surgery is often performed in people who have angina (chest pain) and coronary artery disease (where plaque has built up in the arteries). During the surgery, a bypass is created by grafting a piece of a vein above and below the blocked area of a coronary artery, enabling blood to flow around the obstruction. Veins are usually taken from the leg, but arteries from the chest or arm may also be used to create a bypass graft.
Heart attacks are caused by a blockage of blood flow to the heart, usually as a result of plaque build up in the arteries.
Blood pressure is the force of the blood pushing against the artery walls. The force is generated with each heartbeat as blood is pumped from the heart into the blood vessels. The size and elasticity of the artery walls also affect blood pressure. Each time the heart beats (contracts and relaxes), pressure is created inside the arteries.
The pressure is greatest when blood is pumped out of the heart into the arteries. When the heart relaxes between beats (blood is not moving out of the heart), the pressure falls in the arteries.
Two numbers are recorded when measuring blood pressure.
The top number, or systolic pressure, refers to the pressure inside the artery when the heart contracts and pumps blood through the body.
The bottom number, or diastolic pressure, refers to the pressure inside the artery when the heart is at rest and is filling with blood.
Both the systolic and diastolic pressures are recorded as "mm Hg" (millimeters of mercury). This recording represents how high the mercury column in the blood pressure cuff is raised by the pressure of the blood.
Blood pressure is measured with a blood pressure cuff and stethoscope by a nurse or other healthcare provider. You can also take your own blood pressure with an electronic blood pressure monitor. These are available at most pharmacies.
High blood pressure, or hypertension, directly increases the risk of heart attack and stroke. With high blood pressure, the arteries may have an increased resistance against the flow of blood, causing the heart to pump harder to circulate the blood. Usually, high blood pressure has no signs or symptoms. However, you can know if your blood pressure is high by checking it yourself or by having it checked regularly by your healthcare provider.
The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) has determined 2 levels of high blood pressure for adults:
140 mm Hg to 159 mm Hg systolic pressure—higher number
90 mm Hg to 99 mm Hg diastolic pressure—lower number
160 mm Hg or higher systolic pressure
100 mm Hg or higher diastolic pressure
The NHLBI defines prehypertension as:
120 mm Hg to 139 mm Hg systolic pressure
80 mm Hg to 89 mm Hg diastolic pressure
The NHLBI guidelines define normal blood pressure as follows:
Less than 120 mm Hg systolic pressure
Less than 80 mm Hg diastolic pressure
Use these numbers as a guide only. A single elevated blood pressure measurement is not necessarily an indication of a problem. Your healthcare provider will want to see multiple blood pressure measurements over several days or weeks before making a diagnosis of high blood pressure and starting treatment. If you normally run a lower-than-usual blood pressure, you may be diagnosed with high blood pressure with blood pressure measurements lower than 140/90.
Nearly one-third of all Americans have high blood pressure, but it is particularly prevalent in:
People who have diabetes, gout, or kidney disease
African Americans (particularly those who live in the southeastern U.S.)
People in their early to middle adult years; men in this age group have higher blood pressure more often than women in this age group
People in their middle to later adult years; women in this age group have higher blood pressure more often than men in this age group (more women have high blood pressure after menopause than men of the same age)
Middle-aged and elderly people; more than half of all Americans age 60 and older have high blood pressure
People with a family history of high blood pressure
People consuming a high salt diet
Heavy drinkers of alcohol
Women who are taking oral contraceptives
People with depression
The following conditions contribute to high blood pressure:
Excessive sodium intake
A lack of exercise and physical activity
These steps can help you control your blood pressure:
Take prescribed medicine exactly as directed by your healthcare provider
Choose foods that are low in sodium (salt)
Choose foods low in calories and fat
Choose foods high in fiber
Maintain a healthy weight, or losing weight if overweight
Limit serving sizes
Increase physical activity
Reduce or omit alcoholic beverages
Sometimes daily medicine is needed to control high blood pressure. If you have high blood pressure, have your blood pressure checked routinely and see your healthcare provider to monitor the condition.
Hypertensive heart disease (high blood pressure) occurs when a person's blood pressure is consistently higher than the normal range.
Pericarditis is inflammation of the pericardium, the thin sac (membrane) that surrounds the heart.
The pericardium holds the heart in place and helps it work properly. There is a small amount of fluid between the inner and outer layers of the pericardium. This fluid keeps the layers from rubbing as the heart moves to pump blood.
Usually, the cause of pericarditis is unknown, but may include any or all of the following:
The following are the most common signs of pericarditis. However, each person may experience symptoms differently. Symptoms may include:
The symptoms of pericarditis may resemble other conditions or medical problems. See a health care provider for a diagnosis.
If your health care provider suspects pericarditis, he or she will listen to your heart very carefully. A common sign of pericarditis is a pericardial rub -- the sound of the pericardium rubbing against the outer layer of your heart. Other chest sounds that are signs of fluid in the pericardium (pericardial effusion) or the lungs (pleural effusion) may be heard, too.
Along with a complete medical history and physical exam, tests used to diagnose pericarditis may include:
Specific treatment for pericarditis will be determined by your health care provider based on the following:
The goal of treatment for pericarditis is to determine and eliminate the cause of the disease. Treatment often involves medications, such as pain medicines, anti-inflammatory drugs, and/or antibiotics.
If serious heart problems develop, treatment may include:
Pericarditis may last from 2 to 6 weeks, and it may come back.
There is a small amount of fluid between the inner and outer layers of the pericardium. Often, when the pericardium becomes inflamed, the amount of fluid between these two layers increases. This is called a pericardial effusion. If the amount of fluid increases quickly, the effusion can keep the heart from working properly. This complication of pericarditis is called cardiac tamponade and is a serious emergency. A thin needle or tube (called a catheter) is put into the chest to remove the fluid in the pericardium and relieve pressure on the heart.
Chronic constrictive pericarditis occurs when scar-like tissue forms throughout the pericardium. It’s a rare disease that can develop over time in people with pericarditis. The scar tissue causes pericardial sac to stiffen and not move properly. In time, the scar tissue squeezes the heart and keeps it from working well. The only way to treat this is to remove the pericardium.
If your symptoms get worse or you have new symptoms, call your health care provider.
Tips to help you get the most from a visit to your health care provider:
Pericarditis means the protective sac around the heart becomes inflamed. Pericarditis is usually a complication stemming from viral, fungal or bacterial infections.
An arrhythmia is an abnormal heart rhythm.
Some arrhythmias can cause problems with contractions of your heart chambers by:
An arrhythmia can occur in the sinus node, the atria, or the atrioventricular node. These are supraventricular arrhythmias. A ventricular arrhythmia is caused by an abnormal electrical focus within your ventricles. This results in abnormal conduction of electrical signals within your ventricles. Arrhythmias can also be classified as slow (bradyarrhythmia) or fast (tachyarrhythmia). "Brady-" means slow, while "tachy-" means fast.
In any of these situations, your body's vital organs may not receive enough blood to meet their needs.
An arrhythmia occurs when there is a problem with the electrical system that is supposed to regulate a steady heartbeat. With an impaired electrical system, your heart may beat too fast, too slow, or irregularly.
Many risk factors can affect the electrical system of your heart and, therefore, cause an arrhythmia. Substances including caffeine, alcohol, tobacco, illegal drugs, diet drugs, some herbs, and even prescription medications can precipitate an arrhythmia. Health conditions including coronary heart disease, high blood pressure, and diabetes contribute to developing arrhythmias.
The effects on the body are often the same, however, whether the heartbeat is too fast, too slow, or too irregular. Some symptoms of arrhythmias include, but are not limited to:
The symptoms of arrhythmias may resemble other conditions. Consult your doctor for a diagnosis.
There are several different types of procedures that may be used to diagnose arrhythmias. Some of these procedures include the following:
There are several variations of the ECG test:
Some arrhythmias may cause few, if any, problems. In this case, you may not need treatment. When the arrhythmia causes symptoms, you have several different choices for treatment. Your healthcare provider will choose an arrhythmia treatment based on the type of arrhythmia you have, how severe your symptoms are, and whether you have other conditions such as diabetes, kidney failure, or heart failure. These can affect the course of the treatment.
Some treatments for arrhythmias include:
Some arrhythmias have no complications. However, arrhythmias that are more serious can result in heart failure, stroke, or even cardiac arrest.
Living with an arrhythmia includes making lifestyle changes (avoiding caffeine, alcohol, or other triggers) and taking medicines as directed. It may also include having a pacemaker or implantable cardioverter defibrillator inserted. If you have a pacemaker or implantable cardioverter defibrillator, make sure that you ask your healthcare providers about any restrictions or lifestyle changes you may need to make. Working with your provider can promote your health and well-being.
Tell your healthcare provider if:
Arrhythmias occur when there is a disruption in the normal pace of the heartbeat.
When the heart or blood vessels near the heart do not develop normally before birth, a condition called congenital heart defect occurs (congenital means "existing at birth").
Congenital heart defects occur in close to 1 percent of infants. Most young people with congenital heart defects are living into adulthood now.
In most cases, the cause is unknown. Sometimes a viral infection in the mother causes the condition. The condition can be genetic (hereditary). Some congenital heart defects are the result of alcohol or drug use during pregnancy.
Most heart defects either cause an abnormal blood flow through the heart, or obstruct blood flow in the heart or vessels (obstructions are called stenoses and can occur in heart valves, arteries, or veins). A hole between two chambers of the heart is an example of a very common type of congenital heart defect.
More rare defects include those in which:
The right or left side of the heart is incompletely formed (hypoplastic)
Only one ventricle is present.
Both the pulmonary artery and aorta arise from the same ventricle.
The pulmonary artery and aorta arise from the "wrong" ventricles.
There are many disorders of the heart that require clinical care by a doctor or other health care professional. Listed below are some of the conditions, for which we have provided a brief overview.
Aortic stenosis (AS). In this condition, the aortic valve between the left ventricle and the aorta did not form properly and is narrowed, making it difficult for the heart to pump blood to the body. A normal valve has three leaflets or cusps, but a stenotic valve may have only one cusp (unicuspid) or two cusps (bicuspid).
In some children, chest pain, unusual tiring, dizziness, or fainting may occur. Otherwise, most children with aortic stenosis have no symptoms. But, even mild stenosis may worsen over time, and a catheter-based procedure or surgery may be needed to correct the blockage or the valve may need to be replaced with an artificial one.
Pulmonary stenosis (PS). The pulmonary, or pulmonic, valve, located between the right ventricle and the pulmonary artery, opens to allow blood to flow from the right ventricle to the lungs. When a defective pulmonary valve does not open properly, it causes the heart to pump harder than normal to overcome the obstruction. Usually, the obstruction can be corrected by a catheter-based procedure known as balloon valvuloplasty, although in some patients, open heart surgery may be needed.
Bicuspid aortic valve. In this condition, an infant is born with a bicuspid valve which has only two flaps. (A normal aortic valve has three flaps that open and close). If the valve becomes narrowed, it is more difficult for the blood to flow through, and often the blood leaks backward. Symptoms usually do not develop during childhood, but are often detected during the adult years.
Subaortic stenosis. This condition refers to a narrowing of the left ventricle just below the aortic valve. Normally, blood passes through it to go into the aorta. However, subaortic stenosis limits the blood flow out of the left ventricle, often resulting in an increased workload for the left ventricle. Subaortic stenosis may be congenital or caused by a form of cardiomyopathy.
Coarctation of the aorta (coarct). In this condition, the aorta is narrowed or constricted, obstructing blood flow to the lower part of the body and increasing blood pressure above the constriction. Usually there are no symptoms at birth, but they can develop as early as the first week after birth. If severe symptoms of high blood pressure and congestive heart failure develop, surgery is necessary. Less severe cases may not be detected until a child is older but can result in long-term health problems if not corrected.
Some congenital heart defects allow blood to flow between the right and left chambers of the heart because an infant is born with an opening in the wall (or septum) that separates the right and left sides of the heart.
Atrial septal defect (ASD). In this condition, there is an opening between the two upper chambers of the heart--the right and left atria--causing an abnormal blood flow through the heart. Children with ASD have few symptoms. The ASD may be closed by catheter-based techniques or open-heart surgery. Closing the atrial defect by open heart surgery in childhood can often prevent serious problems later in life.
Ventricular septal defect (VSD). In this condition, a hole is present between the two lower chambers of the heart. Because of this hole, blood from the left ventricle flows back into the right ventricle, due to higher pressure in the left ventricle. This causes extra blood to be pumped into the lungs by the right ventricle, which can create congestion in the lungs. while some VSDs close on their own, others require surgery to repair the hole.
Cyanotic defects are defects in which blood pumped to the body contains less-than-normal amounts of oxygen. It causes a blue discoloration of the skin. Infants with cyanosis are often called "blue babies."
Tetralogy of Fallot. This condition is characterized by four defects, including the following:
An abnormal opening, or ventricular septal defect, that allows blood to pass from the right ventricle to the left ventricle without going through the lungs
A narrowing (stenosis) at or just beneath the pulmonary valve that partially blocks the flow of blood from the right side of the heart to the lungs
The right ventricle is more muscular than normal
The aorta lies directly over the ventricular septal defect
Tetralogy of Fallot is the most common defect causing cyanosis in people beyond 2 years of age. Most children with tetralogy of Fallot have open-heart surgery before school age (frequently in infancy) to close the ventricular septal defect and remove the obstructing muscle. Lifelong medical follow-up is needed.
Tricuspid atresia. In this condition, there is no tricuspid valve, therefore, no blood flows from the right atrium to the right ventricle. Tricuspid atresia is characterized by the following:
A small right ventricle
A large left ventricle
Diminished pulmonary circulation
A surgical shunting procedure is often necessary to increase the blood flow to the lungs.
Transposition of the great arteries. In this embryologic defect, the positions of the pulmonary artery and the aorta are reversed, thus:
The aorta originates from the right ventricle, so most of the blood returning to the heart from the body is pumped back out without first going to the lungs.
The pulmonary artery originates from the left ventricle, so that most of the blood returning from the lungs goes back to the lungs again.
Immediate medical intervention is necessary to correct this condition.
Hypoplastic left heart syndrome (HLHS). In this condition, the left side of the heart, including the aorta, aortic valve, left ventricle, and mitral valve, is underdeveloped. Blood reaches the aorta through a patent ductus arteriosus, and if this ductus closes, as is normal, the baby will die. The baby often seems normal at birth, but the condition will become noticeable within a few days of birth, as the ductus closes. Babies with this syndrome become ashen (gray), have diminished or absent pulses in the legs, have difficulty breathing, and are unable to feed. Treatment is surgical and typically requires three operations.
Patent ductus arteriosus (PDA). This condition results from failure of the PDA to close normally after birth, allowing blood to mix between the pulmonary artery and the aorta. When it does not close, extra blood may flood the lungs and cause pulmonary congestion. Patent ductus arteriosus is often seen in premature infants.
Ebstein's anomaly. In this defect, there is a downward displacement of the tricuspid valve (located between the upper and lower chambers on the right side of the heart) into the right bottom chamber of the heart (or right ventricle). This means the atrium is larger than normal and the ventricle is smaller than normal, which can lead to rhythm abnormalities and heart failure. It is usually associated with an atrial septal defect.
Babies with congenital heart problems are followed by specialists called pediatric cardiologists. These doctors diagnose heart defects and help manage the health of children before and after surgical repair of the heart problem. Specialists who correct heart problems in the operating room are known as pediatric cardiovascular or cardiothoracic surgeons.
A new subspecialty within cardiology is emerging as the number of adults with congenital heart disease (CHD) is now greater than the number of babies born with CHD, as a result of the advances in diagnostic procedures and treatment interventions that have been made since 1945. These doctors care for adults with heart problems that began in infancy or childhood, as opposed to the types of heart conditions that develop in adults as they age.
In order to achieve and maintain the highest possible level of wellness, it is imperative that those individuals born with CHD who have reached adulthood transition to the appropriate type of cardiac care. The type of care required is based on the type of CHD a person has. Those people with simple CHD can often be cared for by a community adult cardiologist. Those with more complex types of CHD will need to be cared for at a center that specializes in adult CHD.
For adults with CHD, guidance is necessary for planning key life issues such as college, career, employment, insurance, activity, lifestyle, inheritance, family planning, pregnancy, chronic care, disability, and end of life. Knowledge about specific congenital heart conditions and expectations for long-term outcomes and potential complications, and risks must be reviewed as part of the successful transition from pediatric care to adult care. Parents should help pass on the responsibility for this knowledge and accountability for ongoing care to their young adult children to help ensure the transition to adult specialty care and optimize the health status of the young adult with CHD.
Congenital refers to a problem with the heart's structure and function due to abnormal heart development before birth.
Heart failure occurs when the heart cannot pump sufficient blood to the rest of body's organs.
Peripheral vascular disease (PVD) is a slow and progressive circulation disorder caused by narrowing, blockage, or spasms in a blood vessel.
PVD may involve disease in any of the blood vessels outside of the heart including the arteries, veins, or lymphatic vessels. Organs supplied by these vessels, such as the brain, and legs, may not get enough blood flow for proper function. However, the legs and feet are most commonly affected, thus the name peripheral vascular disease.
The terms "peripheral vascular disease" and "peripheral arterial disease" are often used interchangeably.
PVD is often characterized by a narrowing of the vessels that carry blood to the leg and arm muscles. The most common cause is atherosclerosis, the buildup of plaque inside the artery wall. Plaque reduces the amount of blood flow to the limbs and decreases the oxygen and nutrients available to the tissue. Clots may form on the artery walls, further decreasing the inner size of the vessel and potentially blocking off major arteries.
Other causes of peripheral vascular disease may include:
People with coronary artery disease often also have peripheral vascular disease.
A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, diet, family history, or many other things. Risk factors for peripheral vascular disease include factors which can be changed or treated and factors that cannot be changed.
Risk factors that you can’t change:
Risk factors that may be changed or treated include:
Those who smoke or have diabetes mellitus have the highest risk of complications from peripheral vascular disease because these risk factors also cause impaired blood flow.
Approximately half the people diagnosed with peripheral vascular disease are symptom free. For those experiencing symptoms, the most common first symptom is intermittent claudication in the calf (leg discomfort described as painful cramping that occurs with exercise and is relieved by rest). During rest, the muscles need less blood flow, so the pain disappears. It may occur in one or both legs depending on the location of the clogged or narrowed artery.
Other symptoms of peripheral vascular disease may include:
The symptoms of peripheral vascular disease may resemble other conditions. Consult your physician for a diagnosis.
In addition to a complete medical history and physical exam, other tests may include:
The main goals for treatment of peripheral vascular disease are to control the symptoms and halt the progression of the disease to lower the risk for heart attack, stroke, and other complications.
Specific treatment will be determined by your health care provider based on:
Treatment may include:
With both angioplasty and vascular surgery, an angiogram is often done before the procedure.
Complications of peripheral vascular disease most often occur because of decreased or absent blood flow. Such complications may include:
By following an aggressive treatment plan for peripheral vascular disease, complications such as these may be prevented.
Steps to prevent PVD are primarily aimed at management of the risk factors for PVD. A prevention program for PVD may include:
A prevention plan for PVD may also be used to prevent or lessen the progress of PVD once it has been diagnosed. Consult your doctor for diagnosis and treatment.
It’s important to follow your health care provider’s recommendation for managing PVD to manage the symptoms and stop the disease from progressing.
If your symptoms get worse or you get new symptoms, let your health care provider know.
Peripheral vascular disease(PVD) is a slow and progressive circulation disorder that involves disease in any of the blood vessels outside of the heart.
The heart consists of four chambers--two atria (upper chambers) and two ventricles (lower chambers). There is a valve through which blood passes before leaving each chamber of the heart. The valves prevent the backward flow of blood. They act as one-way inlets of blood on one side of a ventricle and one-way outlets of blood on the other side of a ventricle. The four heart valves include the following:
Tricuspid valve. Located between the right atrium and the right ventricle.
Pulmonary valve. Located between the right ventricle and the pulmonary artery.
Mitral valve. Located between the left atrium and the left ventricle.
Aortic valve. Located between the left ventricle and the aorta.
As the heart muscle contracts and relaxes, the valves open and close, letting blood flow into the ventricles and out to the body at alternate times. The following is a step-by-step illustration of how the valves function normally in the left ventricle:
After the left ventricle contracts, the aortic valve closes and the mitral valve opens to allow blood to flow from the left atrium into the left ventricle.
The left atrium contracts and more blood flows into the left ventricle.
When the left ventricle contracts, the mitral valve closes and the aortic valve opens so blood flows into the aorta and out into the systemic circulation to the rest of the body.
Heart valve disorders can arise from two main types of malfunctions:
Regurgitation (or leakage of the valve). The valve(s) does not close completely, causing the blood to flow backward through the valve. The heart is forced to pump more blood on the next beat, making it work harder.
Stenosis (or narrowing of the valve). The valve(s) opening becomes narrowed, limiting the flow of blood out of the ventricles or atria. The heart is forced to pump blood with increased force in order to move blood through the narrowed or stiff (stenotic) valve(s).
Heart valves can develop both malfunctions at the same time (regurgitation and stenosis). Also, more than one heart valve can be affected at the same time. When heart valves fail to open and close properly, the implications for the heart can be serious, possibly hampering the heart's ability to pump blood adequately through the body. Heart valve problems are one cause of heart failure.
Mild heart valve disease may not cause any symptoms. The following are the most common symptoms of heart valve disease. However, each individual may experience symptoms differently. Symptoms may vary depending on the type of heart valve disease present and may include:
Palpitations caused by irregular heartbeats
Low or high blood pressure, depending on which valve disease is present
Abdominal pain due to an enlarged liver (if there is tricuspid valve malfunction)
Symptoms of heart valve disease may resemble other medical conditions and problems. Always consult your doctor for a diagnosis.
The causes of heart valve damage vary depending on the type of disease present, and may include the following:
A history of rheumatic fever, a condition characterized by painful fever, inflammation, and swelling of the joints. Rheumatic fever is now rare in North America due to effective antibiotic treatment.
Damage resulting from a heart attack
Damage resulting from an infection
Changes in the heart valve structure due to the aging process
Congenital birth defect
Syphilis, a disease characterized by progressive symptoms if not treated. Syphilis is a sexually-transmitted infection. Symptoms may include small, painless sores that disappear, followed by a skin rash, enlarged lymph nodes, headache, aching bones, loss of appetite, fever, and fatigue.
Myxomatous degeneration, an inherited connective tissue disorder that weakens the heart valve tissue.
The mitral and aortic valves are most often affected by heart valve disease. Some of the more common heart valve diseases include:
Heart valve disease
Symptoms and causes
Bicuspid aortic valve
This congenital birth defect is characterized by an aortic valve that has only two flaps (a normal aortic valve has three flaps). If the valve becomes narrowed, it is more difficult for the blood to flow through, and often the blood leaks backward. Symptoms usually do not develop during childhood, but are often detected during the adult years.
Mitral valve prolapse (also known as click-murmur syndrome, Barlow's syndrome, balloon mitral valve, or floppy valve syndrome)
This disease is characterized by the bulging of one or both of the mitral valve flaps during the contraction of the heart. One or both of the flaps may not close properly, allowing the blood to leak backward. This may result in a mitral regurgitation murmur.
Mitral valve stenosis
Often caused by a past history of rheumatic fever, this condition is characterized by a narrowing of the mitral valve opening, increasing resistance to blood flow from the left atrium to the left ventricle.
Aortic valve stenosis
This type of valve disease occurs primarily in the elderly and is characterized by a narrowing of the aortic valve opening, increasing resistance to blood flow from the left ventricle to the aorta.
This condition is characterized by a pulmonary valve that does not open sufficiently, causing the right ventricle to pump harder and enlarge.
Heart valve disease may be suspected if the heart sounds heard through a stethoscope are abnormal. This is usually the first step in diagnosing a heart valve disease. A characteristic heart murmur (abnormal sounds in the heart due to turbulent blood flow across the valve) can often indicate valve regurgitation or stenosis. To further define the type of valve disease and extent of the valve damage, doctors may use any of the following diagnostic procedures:
Electrocardiogram (ECG or EKG). A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and can sometimes detect heart muscle damage.
Echocardiogram (echo). A noninvasive test that uses sound waves to evaluate the heart's chambers and valves. The echo sound waves create an image on a monitor as an ultrasound transducer is passed over the heart.
Transesophageal echocardiogram (TEE). A diagnostic procedure that involves passing a small ultrasound transducer down into the esophagus. The sound waves create an image of the valves and chambers of the heart on a computer monitor without the ribs or lungs getting in the way.
Chest X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. An X-ray can show enlargement in any area of the heart.
Cardiac catheterization. This diagnostic procedure involves the insertion of a tiny, hollow tube (catheter) through a large artery in the leg or arm leading to the heart in order to provide images of the heart and blood vessels. This procedure is helpful in determining the type and extent of certain valve disorders.
Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
In some cases, the only treatment for heart valve disease may be careful medical supervision. However, other treatment options may include medication, surgery to repair the valve, or surgery to replace the valve. Specific treatment will be determined by your doctor based on:
The location of the valve
Your signs and symptoms
Treatment varies, depending on the type of heart valve disease, and may include one, or a combination of, the following:
Medication. Medications are not a cure for heart valve disease, but in many cases are successful in the treatment of symptoms caused by heart valve disease. These medications may include:
Medications such as beta-blockers, digoxin, and calcium channel blockers to reduce symptoms of heart valve disease by controlling the heart rate and helping to prevent abnormal heart rhythms.
Medications to control blood pressure, such as diuretics (medications that remove excess water from the body by increasing urine output) or vasodilators (medications that relax the blood vessels, decreasing the force against which the heart must pump) to ease the work of the heart.
Surgery. Surgery may be necessary to repair or replace the malfunctioning valve(s). Surgery may include:
Heart valve repair. In some cases, surgery on the malfunctioning valve can help alleviate symptoms. Examples of heart valve repair surgery include remodeling abnormal valve tissue so that the valve functions properly, or inserting prosthetic rings to help narrow a dilated valve. In many cases, heart valve repair is preferable, because a person's own tissues are used.
Heart valve replacement. When heart valves are severely malformed or destroyed, they may need to be replaced with an entirely new replacement valve. Replacement valve mechanisms fall into two categories: tissue (biologic) valves, which include animal valves and donated human aortic valves, and mechanical valves, which can consist of metal, plastic, or another artificial material.
Another treatment option that is less invasive than valve repair or replacement surgery is balloon valvuloplasty, a nonsurgical procedure in which a special catheter (hollow tube) is threaded into a blood vessel in the groin and guided into the heart. The catheter, which contains a deflated balloon, is inserted into the narrowed heart valve. Once in place, the balloon is inflated to stretch the valve open, and then removed. This procedure is sometimes used to treat pulmonary stenosis and, in some cases, aortic stenosis. There are also some special cases where a new valve can be inserted through the groin into the heart and opened up with a balloon like a stent. This is called total aortic valve replacement.
A condition where one or more of the heart's valves do not work properly due to disease or structural defect.
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