Heart Disease

The types of heart disease include:

• Atherosclerosis is a buildup of cholesterol, calcium, and blood clotting material on the walls of the arteries. The material that builds up is called plaque.

• Cardiac arrhythmia is an abnormal heart rhythm.

• Cardiomyopathy is a weakened and enlarged heart muscle.

• Congenital heart defect is a problem with the structure of the heart.

• Coronary artery disease (CAD) is a narrowing of the coronary arteries that supply the heart. CAD is primarily due to atherosclerosis. Many people use the term “heart disease” for CAD, which can be confusing. 

• Heart attack (myocardial infarction) is a lack of oxygenated blood to the heart muscle.

• Heart failure is a condition in which the heart has been damaged from a heart attack or other type of heart disease.

• Heart valve disorder is a malfunctioning heart valve that causes abnormal stress on the heart.

• Myocarditis is inflammation of the muscular heart wall, usually from a viral infection.

• Pericarditis is inflammation of the moist lining that surrounds the heart, usually from a viral infection or heart attack or heart surgery.

Symptoms of heart disease can differ depending on the type and severity of heart disease and individual factors. Symptoms can occur as an isolated problem or in combination with other heart conditions. One well-known symptom of heart disease is chest pain, but not all chest pain is caused by heart disease.

In addition, not all people who have heart disease experience chest pain. Some people even have a heart attack without having chest pain. By the time a person experiences chest pain, he or she may have had a form of heart disease, such as atherosclerosis, for many years.

It is common for a person with certain types of heart disease, such as atherosclerosis, not to have noticeable symptoms until complications occur. The only definite way to detect heart disease in its earliest, most treatable stage is through regular medical care that includes comprehensive evaluations from a licensed physician or healthcare professional.

Heart disease symptoms can be vague, mild and subtle and include:

• A feeling of indigestion

• Anxiety and restlessness

• Backache

• Difficulty feeding and poor weight gain in infants

• Erectile dysfunction

• Fatigue

• Mild, transient shortness of breath with exertion

• Mild weakness and feeling lightheaded

• Nausea and vomiting

• Pain, numbness, and mild swelling in the feet and ankles

• Pale skin with or without sweating

• Wet cough

Oftentimes, women with coronary artery disease (CAD)—the most common type of heart disease—experience symptoms differently than men. CAD symptoms in women tend to be milder and vague, so they are often ignored or attributed to other conditions. The symptoms women experience may include:

• Dizziness or lightheadedness

• Fatigue, which may be sudden and not explained by another condition like cold or flu

• Heartburn or sense of fullness

• Irregular heartbeat

• Nausea

• Neck and jaw pain, which may extend into the shoulder or upper back (typically left side)

• Shortness of breath

• Sweating without exertion

• Upper abdominal pain

If you see a healthcare provider for any of these symptoms, ask if heart disease or heart attack is a possible cause and if additional tests can confirm or rule it out.

Some symptoms of heart disease and its complications are severe and may indicate a serious or life-threatening condition that needs immediate treatment. Seek immediate medical care (call 911) for any of these symptoms:

• Bluish discoloration of the lips and fingernails (cyanosis)

• Change in level of consciousness or alertness, such as passing out or unresponsiveness

• Chest pain, tightness, pressure, squeezing, or fullness (angina)

• Extreme sweating and clammy, pale skin

• Loss of pulse

• Nausea and vomiting

• Pain in the shoulders, back, neck, jaw, or arms that radiates from the chest. Chest pain can also occur by itself.

• Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking

• Severe dizziness

• Severe swelling that can affect the arms, legs, and abdomen

The heart is a large, specialized muscle that requires a steady supply of oxygen to pump blood effectively through the body. Oxygen is supplied to the heart by blood that flows through the coronary arteries. Some types of heart disease damage or block the coronary arteries and the flow of oxygen to the heart. Other forms of heart disease damage or impair the functioning of the heart and blood vessels.

Heart disease causes include:

• Abnormal electrical conduction in the heart causing cardiac arrhythmias or abnormal heart rhythms. These include ventricular tachycardia, heart blocks, ventricular fibrillation, asystole, supraventricular tachycardia, and bradycardia.

• Atherosclerosis, a buildup of plaque on the walls of the coronary arteries. Atherosclerosis narrows the coronary arteries and results in angina. It can also lead to the formation of a blood clot that blocks blood flow to the heart (heart attack). High blood pressure, high cholesterol, obesity, and diabetes can lead to atherosclerosis.

• Birth defects, also called congenital heart or blood vessel defects. These include atrial septal defect, coarctation of the aorta, and atrioventricular septal defect.

• Heart damage, such as heart failure or cardiomyopathy, that weakens the pumping action of the heart

• Heart valve abnormalities, which are also called heart valve disorders. Heart valve disorders include mitral valve insufficiency, mitral valve prolapse, mitral valve stenosis, tricuspid valve insufficiency, and tricuspid valve stenosis.

• High blood pressure (hypertension)

• High cholesterol

• Infection and inflammation of heart muscle and the outer pericardial tissue

Heart disease risk factors include:

• African American, Hispanic American, or Native American ancestry

• Elevated cholesterol levels in the blood

• Excessive alcohol consumption

• Family history of heart disease

• For congenital heart disease, exposure of a baby to certain maternal diseases or toxins during pregnancy

• High blood pressure (hypertension)

• History of atherosclerosis

• History of diabetes

• Long-term stress

• Male biological sex; however, postmenopausal females aged 45 years and older are at higher risk

• Obesity and sedentary lifestyle

• Smoking

Having high levels of certain substances in your body, which can be seen on blood tests, can also increase your risk for heart disease. These include:

• High cholesterol, which can lead to atherosclerosis

• High C-reactive protein (CRP) level, which is linked to atherosclerosis

• High homocysteine level, which is associated with heart disease; however, no causal link has been established

The American Heart Association recommends regular screening for risk factors beginning at age 20. Screening includes measuring blood pressure, body mass index, waist circumference, and pulse every two years, and getting a cholesterol profile and glucose test (a simple blood sugar test) every five years. Your screening frequency depends on your individual risk factors.

Keep in mind that not all people who are at risk for heart disease will develop heart disease, and not all people who develop heart disease have risk factors.

You can reduce your risk of some forms of heart disease by:

• Eating a diet that is low in saturated fat and high in fiber, whole grains, fruits, and vegetables

• Maintaining a healthy weight

• Not drinking alcohol or limiting alcohol consumption to one drink per day for women and two drinks per day for men

• Not smoking or quitting smoking

• Participating in a regular exercise program

• Reducing excessive stress

• Seeking regular medical care and following your treatment plan for such conditions as high cholesterol, hypertension and diabetes

If heart disease was diagnosed in your father or brother before age 55, or if heart disease was diagnosed in your mother or sister before age 65, you'll need to take special precautions to prevent it. For example, you may need to take heart medicine or undergo more frequent screenings for risk factors.

A healthy diet can help prevent heart disease and maintain a healthy lifestyle during and after heart disease treatment. Even if you have a congenital heart defect causing only mild symptoms, it is possible to develop another type of heart disease related to lifestyle factors, such as a sedentary lifestyle. In general, a heart-healthy diet is low in saturated fats and salt and high in fiber; focus on fresh, unprocessed food.

Include these foods in a heart-healthy diet:

• Eggs, which are a good, low-calorie source of protein and unsaturated fats when you cook them without butter (they also contain some saturated fat)

• Fruits and vegetables (fresh or frozen and about nine servings daily)

• Lean protein, such as fish, skinless chicken and turkey, and lean cuts of red meat and pork

• Legumes, such as beans, lentils, peas and chickpeas

• Monounsaturated and polyunsaturated fats, which includes plant-based oils (olive oil, sunflower oil, avocado oil)

• Nuts and seeds

• Spices, which can add flavor without salting your food

• Tea—black or green, which is rich in antioxidants

• Whole grains like whole wheat bread and pasta; brown rice; and barley, millet and oatmeal

Avoid these foods and drinks:

• Alcohol, or limit consumption (one drink per day for female and two drinks per day for males)

• Butter, cream, fatty red meats, and other saturated fats

• Fast food

• Fried and greasy food

• Salt (less than 1,500 grams of sodium per day)

Ask your healthcare provider for guidance before making significant changes to your diet.

Heart disease is itself a type of cardiovascular disease, but not all cardiovascular diseases are heart diseases. Nearly 50% of U.S. adults ages 20 or older have some form of cardiovascular disease.

Cardiovascular diseases include:

• Carotid artery disease, narrowing within the arteries that carry blood away from the heart to the brain and head

• Deep vein thrombosis, a blood clot in a deep vein of the leg 

• Hypertension (high blood pressure), which is defined (since 2017) as a recurring blood pressure measurement of 130/80 or higher 

• Peripheral artery disease, narrowing within arteries that carry blood away from the heart

• Stroke, loss of fresh oxygen to the brain caused by a blood clot or ruptured blood vessel in the brain

• Transient ischemic attack, or mini-stroke

To diagnose heart disease, your doctor will perform a physical exam, ask about your symptoms and medical history, and order a series of tests.

Questions your doctor may ask include:

• How long have you experienced heart symptoms (may include chest pain, fatigue, unexplained nausea or indigestion, shortness of breath)?

• Do you experience symptoms when you are resting?

• Do you experience symptoms when you are moving around or exercising?

• Do you have a family history of heart disease?

• Have you been under more stress lately?

Diagnostic heart tests include:

• Blood tests, such as complete blood count, cholesterol (lipid profile), organ function tests, and cardiac enzyme levels

• Blood glucose tests to diagnose diabetes or prediabetes

• Electrocardiogram (EKG or ECG) to evaluate heart rhythm. (An EKG as you exercise is called a stress test.)

• Echocardiogram (ultrasound) to observe heart structure and function

• CT scan (computed tomography) or MRI (magnetic resonance imaging) to capture high-resolution images of the heart and guide treatment decisions

• Cardiac catheterization to measure pressure inside the heart, blood flow through the heart, and check for heart defects  

• Coronary angiography to observe the coronary arteries and locate any blockages (angiography requires catheterization).

Some heart diseases that are diagnosed early can be successfully treated before the development of permanent heart damage and complications, such as heart failure and cardiac arrest. Heart disease treatment plans are individualized to the type and severity of your heart disease, risk factors, lifestyle, medical history, and other diseases and conditions you have.

Advanced or critical stages of heart disease generally require hospitalization and some combination of:

• Intensive monitoring and stabilization of heart rhythm and vital signs. This may require cardiopulmonary resuscitation (CPR) and advanced life support measures, such as intubation and mechanical ventilation to support breathing.

• Monitoring your heart rate and rhythm with an electrocardiogram (EKG) and lab tests, such as cardiac enzymes, to determine the extent of heart damage

• Supplemental oxygen to increase the amount of oxygen that is delivered to the heart tissue and the rest of the body

• Treatment of abnormal heart rhythms (cardiac arrhythmias) with medications and possibly cardioversion or electrical defibrillation

The following medications may be prescribed for a variety of types of heart disease during and after hospitalization:

• ACE inhibitors (ramipril, lisinopril, enalapril, or captopril), which lower high blood pressure and help prevent heart failure

• Aspirin, which helps prevent new blood clots

• Beta blockers (metoprolol, atenolol, and propranolol), which lower high blood pressure and reduce strain on the heart

• Heparin, which helps prevent new blood clots

• Medications to lower high cholesterol, including statins, niacin, and selective cholesterol absorption inhibitors  

• Medications to raise low blood pressure, which may be used in certain situations, such as in cardiogenic shock

• Medications to treat cardiac arrhythmias, which include digitalis, beta blockers, verapamil, adenosine, lidocaine, or calcium channel blockers

• Morphine, which reduces pain and anxiety and lowers the amount of oxygen the heart needs

• Nitroglycerine, which helps widen narrowed coronary arteries and improves blood flow to the heart

• Thrombolytic (clot-dissolving) drugs, which break up and dissolve the clot that is causing a heart attack. Thrombolytic drugs are most effective if given within three hours of the onset of chest pain.

Surgical treatments vary depending on the specific type of heart disease and other factors. Surgical treatments may include:

• Angioplasty and stent placement to widen the artery using a balloon device. In most cases, a small stent (hollow tube) is placed in the artery to keep it open.

• Coronary artery bypass to graft new arteries that bypass the blocked coronary artery or arteries. Blood flow is then redirected through healthy new grafted arteries to the affected heart tissues.

• Heart transplantation in selected patients

• Surgery to correct congenital heart defects

• Ablation procedure to reduce or eliminate abnormal nerve impulses that cause irregular heart rhythm

• Surgery to replace or repair abnormal heart valves

• Surgical implantation of a cardioverter-defibrillator or pacemaker to deliver electrical stimulation to the heart using a small device and electrical wires placed in the body. The electrical stimulation corrects abnormal heart rhythms (cardiac arrhythmias).

Other treatments and therapies that may be recommended as part of a complete treatment program for heart disease include:

• Cardiac rehabilitation and physical therapy to help strengthen your body, reduce complications, increase alertness, reduce fatigue, and improve overall health and functional ability

• Complementary or alternative treatments, such as acupuncture, massage therapy, and yoga to reduce stress, increase flexibility, and improve well-being. Complementary treatments are not a substitute for full medical care. Be sure to notify your doctor if you are taking nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

• Palliative care to improve the overall quality of life for families and patients with serious diseases

• Regular follow-up care is very important to help monitor your treatment and progress and to address any problems or complications promptly.

The impact heart disease has on your life depends on the specific condition, its severity, how well it is treated, and your outlook on life. In many cases, there are no symptoms of disease until complications occur, such as heart attack. Regardless of complications, getting a heart disease diagnosis can be life-changing. For many, it can be a call to start eating right and moving more.

While there are many types of successful treatments, certain heart diseases and symptoms are more difficult to manage than others. Oftentimes, heart disease requires lifelong medication and follow-up care. Taken together, heart disease is a significant burden, and some people report a reduced quality of life because of it.

To help you combat the physical and mental effects of heart disease and its treatment, check in with your care team about how you feel. Learning about your condition and how to recover from any emergency or elective procedure is vital. When you understand what is going on in your body, the prescribed treatment makes more sense and is easier to follow.

Part of your heart disease diagnosis and treatment may involve cardiac rehabilitation. This program is geared for people who have experienced a heart attack or who have undergone a serious heart procedure, such as open-heart surgery, but your doctor can also prescribe it to help you reduce your risk of heart disease complications. Cardiac rehab can help you get “back on your feet,” which can boost quality of life. Cardiac rehab typically involves:

• Education about your condition and follow-up care

• Physical therapy

• Strategies for living heart-healthy

• Strength training, which is important after surgery

A supportive family and friend group can also improve quality of life. You may also consider joining an online or in-person support group. Ask your care team or hospital for recommendations. Your doctor can also recommend a professional counselor, who can help you process what you are going through.

Complications of heart disease are serious and can be life-threatening. You can best help minimize the risk of serious complications of heart disease by following the treatment plan you and your healthcare professional design specifically for you.

Serious complications of heart disease include:

• Aneurysm, a life-threatening bulging and weakening of the wall of an artery that can burst and cause severe hemorrhage

• Blood clots that cause heart attack, stroke and pulmonary embolism (blood clots in the lungs)

• Cardiac arrest

• Cardiogenic shock

• Disability

• Heart failure

• Heart valve damage

• Lethal cardiac arrhythmias

• Stroke

Life expectancy and prognosis vary greatly by the type and severity of heart disease, treatment, your age, biological sex, other health conditions you may have, and other factors. Keep in mind that heart disease includes many different conditions affecting the heart or its blood vessels (the coronary arteries), from atherosclerosis to heart failure. Overall, from the time of heart disease diagnosis, women have a longer life expectancy (7.9 years) than men (6.7 years).

Heart disease prognosis depends on following the treatment plan, such as taking prescribed medications, and adopting a healthy lifestyle. Your cardiologist is the best resource for help understanding your own prognosis and the factors that can improve it.

Heart Disease Awareness Day is February 22, bringing awareness to heart disease symptoms, prevention, diagnosis and treatment. The Centers for Disease Control and Prevention’s Division for Heart Disease and Stroke Prevention supports and provides funding to state, local and tribal programs to educate and reduce risk factors for heart disease. Million Hearts 2022 is a government initiative to prevent one million heart attacks and strokes within five years (2027), focusing on the message, “Start Small. Live Big,” or the small things you can do every day to stay heart-healthy.