HEART DISEASE

Symptoms

Heart disease symptoms depend on what type of heart disease you have.

Symptoms of heart disease in your blood vessels (atherosclerotic disease)

Cardiovascular disease is caused by narrowed, blocked or stiffened blood vessels that prevent your heart, brain or other parts of your body from receiving enough blood. Cardiovascular disease symptoms may be different for men and women. For instance, men are more likely to have chest pain; women are more likely to have symptoms such as shortness of breath, nausea and extreme fatigue.

Symptoms can include:

• Chest pain (angina)
• Shortness of breath
• Pain, numbness, weakness or coldness in your legs or arms if the blood vessels in those parts of your body are narrowed
• Pain in the neck, jaw, throat, upper abdomen or back

You might not be diagnosed with cardiovascular disease until you have a heart attack, angina, stroke or heart failure. It's important to watch for cardiovascular symptoms and discuss concerns with your doctor. Cardiovascular disease can sometimes be found early with regular exams.

Heart disease symptoms caused by abnormal heartbeats (heart arrhythmias)

A heart arrhythmia is an abnormal heartbeat. Your heart may beat too quickly, too slowly or irregularly. Heart arrhythmia symptoms can include:

• Fluttering in your chest
• Racing heartbeat (tachycardia)
• Slow heartbeat (bradycardia)
• Chest pain or discomfort
• Shortness of breath
• Lightheadedness
• Dizziness
• Fainting (syncope) or near fainting

Heart disease symptoms caused by heart defects

Serious congenital heart defects — defects you're born with — usually become evident soon after birth. Heart defect symptoms in children could include:

• Pale gray or blue skin color (cyanosis)
• Swelling in the legs, abdomen or areas around the eyes
• In an infant, shortness of breath during feedings, leading to poor weight gain

Less serious congenital heart defects are often not diagnosed until later in childhood or during adulthood. Signs and symptoms of congenital heart defects that usually aren't immediately life-threatening include:

• Easily getting short of breath during exercise or activity
• Easily tiring during exercise or activity
• Swelling in the hands, ankles or feet

Heart disease symptoms caused by weak heart muscle (dilated cardiomyopathy)

Cardiomyopathy is the thickening and stiffening of heart muscle. In early stages of cardiomyopathy, you may have no symptoms. As the condition worsens, symptoms may include:

• Breathlessness with exertion or at rest
• Swelling of the legs, ankles and feet
• Fatigue
• Irregular heartbeats that feel rapid, pounding or fluttering
• Dizziness, lightheadedness and fainting

Heart disease symptoms caused by heart infections

There are three types of heart infections:

• Pericarditis, which affects the tissue surrounding the heart (pericardium)
• Myocarditis, which affects the muscular middle layer of the walls of the heart (myocardium)
• Endocarditis, which affects the inner membrane that separates the chambers and valves of the heart (endocardium)

Varying slightly with each type of infection, heart infection symptoms can include:

• Fever
• Shortness of breath
• Weakness or fatigue
• Swelling in your legs or abdomen
• Changes in your heart rhythm
• Dry or persistent cough
• Skin rashes or unusual spots

Heart disease symptoms caused by valvular heart disease

The heart has four valves — the aortic, mitral, pulmonary and tricuspid valves — that open and close to direct blood flow through your heart. Valves may be damaged by a variety of conditions leading to narrowing (stenosis), leaking (regurgitation or insufficiency) or improper closing (prolapse).

Depending on which valve isn't working properly, valvular heart disease symptoms generally include:

• Fatigue
• Shortness of breath
• Irregular heartbeat
• Swollen feet or ankles
• Chest pain
• Fainting (syncope)

Causes

How the heart works

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 protects 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 most 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

Causes of congenital heart defects

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), infections, toxins and certain drugs. It also may 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 or excessive iron buildup in your body (hemochromatosis), or by some cancer treatments, such as chemotherapy and radiation.

Causes of heart infection

Heart infections, such as pericarditis, endocarditis and myocarditis, are caused when an irritant, such as a bacterium, virus or chemical, reaches your heart muscle. The most common causes of heart infections 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

Diagnosis

The tests you'll need to diagnose your heart disease depend on what condition your doctor thinks you might have. No matter what type of heart disease you have, your doctor will likely perform a physical exam and ask about your personal and family medical history before doing any tests. Besides blood tests and a chest X-ray, tests to diagnose heart disease can include:

• Electrocardiogram (ECG). An ECG records these electrical signals and can help your doctor detect irregularities in your heart's rhythm and structure. You may have an ECG while you're at rest or while exercising (stress electrocardiogram).
• Holter monitoring. A Holter monitor is a portable device you wear to record a continuous ECG, usually for 24 to 72 hours. Holter monitoring is used to detect heart rhythm irregularities that aren't found during a regular ECG exam.
• Echocardiogram. This noninvasive exam, which includes an ultrasound of your chest, shows detailed images of your heart's structure and function.
• Cardiac catheterization. In this test, a short tube (sheath) is inserted into a vein or artery in your leg (groin) or arm. A hollow, flexible and longer tube (guide catheter) is then inserted into the sheath. Aided by X-ray images on a monitor, your doctor threads the guide catheter through that artery until it reaches your heart. The pressures in your heart chambers can be measured, and dye can be injected. The dye can be seen on an X-ray, which helps your doctor see the blood flow through your heart, blood vessels and valves to check for abnormalities.
• Cardiac computerized tomography (CT) scan. This test is often used to check for heart problems. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest.
• Cardiac magnetic resonance imaging (MRI). For this test, you lie on a table inside a long tube-like machine that produces a magnetic field. The magnetic field produces pictures to help your doctor evaluate your heart.

Preventions

Certain types of heart disease, such as heart defects, can't be prevented. However, you can help prevent many other types of heart disease by making the same lifestyle changes that can improve your heart disease, such as:

• Quit smoking
• Control other health conditions, such as high blood pressure, high cholesterol and diabetes
• Exercise at least 30 minutes a day on most days of the week
• Eat a diet that's low in salt and saturated fat
• Maintain a healthy weight
• Reduce and manage stress
• Practice good hygiene

Risk Factors

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.
• 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.

Complications

Complications of heart disease include:

• Heart failure. One of the most common complications of heart disease, heart failure occurs when your heart can't pump enough blood to meet your body's needs. Heart failure can result from many forms of heart disease, including heart defects, cardiovascular disease, valvular heart disease, heart infections or cardiomyopathy.
• Heart attack. A blood clot blocking the blood flow through a blood vessel that feeds the heart causes a heart attack, possibly damaging or destroying a part of the heart muscle. Atherosclerosis can cause a heart attack.
• Stroke. The risk factors that lead to cardiovascular disease also can lead to an ischemic stroke, which happens when the arteries to your brain are narrowed or blocked so that too little blood reaches your brain. A stroke is a medical emergency — brain tissue begins to die within just a few minutes of a stroke.
• Aneurysm. A serious complication that can occur anywhere in your body, an aneurysm is a bulge in the wall of your artery. If an aneurysm bursts, you may face life-threatening internal bleeding.
• Peripheral artery disease. Atherosclerosis also can lead to peripheral artery disease. When you develop peripheral artery disease, your extremities — usually your legs — don't receive enough blood flow. This causes symptoms, most notably leg pain when walking (claudication).
• Sudden cardiac arrest. Sudden cardiac arrest is the sudden, unexpected loss of heart function, breathing and consciousness, often caused by an arrhythmia. Sudden cardiac arrest is a medical emergency. If not treated immediately, it is fatal, resulting in sudden cardiac death.

Treatment

Heart disease treatments vary by condition. For instance, if you have a heart infection, you'll likely be given antibiotics. In general, treatment for heart disease usually includes:

• Lifestyle changes. These include eating a low-fat and low-sodium diet, getting at least 30 minutes of moderate exercise on most days of the week, quitting smoking, and limiting alcohol intake.
• Medications. If lifestyle changes alone aren't enough, your doctor may prescribe medications to control your heart disease. The type of medication will depend on the type of heart disease.
• Medical procedures or surgery. If medications aren't enough, it's possible your doctor will recommend specific procedures or surgery. The type of procedure will depend on the type of heart disease and the extent of the damage to your heart.