Heart Disease

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Introduction

What is heart disease?

Heart disease, or cardiovascular disease, is a general name for a wide variety of diseases, disorders and conditions that affect the heart and blood vessels. Heart disease is the number one cause of death in the United States, according to the Centers for Disease Control and Prevention (Source: CDC).

The heart is composed of muscle tissue that requires a steady supply of oxygen in order to pump blood effectively throughout the rest the body. Heart diseases can damage the coronary arteries, which provide oxygen-rich blood to the heart muscle. Heart diseases can also impair the functioning or structure of the heart and blood vessels. Coronary artery disease causes most heart attacks and is the most common form of 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 is a narrowing of the coronary arteries that supply the heart.

  • 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 an infection of the middle layer of the heart wall.

  • Pericarditis is an infection of the lining that surrounds the heart.

Left untreated, heart disease can result in serious complications, such as lethal cardiac arrhythmias, severe heart failure, cardiac arrest, and death. Some complications can occur suddenly and require immediate treatment. Immediate emergency treatment best minimizes the risk of complications.

Seek immediate medical care (call 911) if you, or someone you are with, have chest pain, difficulty breathing, or palpitations, which may be combined with dizziness, sweating, fainting, and anxiety.

Symptoms

What are the symptoms of heart disease?

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 health care professional.

Symptoms of heart disease

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

Serious symptoms that might indicate a life-threatening condition

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) if you, or someone you are with, have 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

Causes

What causes heart disease?

The heart is a muscle that requires a steady supply of oxygen in order 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. These disorders 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).

  • 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.

  • Infection and inflammation caused by myocarditis or pericarditis

What are the risk factors for heart disease?

A number of factors are thought to increase your chances of having heart disease. These risk factors include:

  • African American, Hispanic American, or Native American ancestry

  • Elevated cholesterol levels in the blood

  • Excessive alcohol consumption

  • Exposure of a baby to certain maternal diseases during pregnancy

  • Exposure of a baby to certain toxins during pregnancy

  • Family history of heart disease

  • High blood pressure (hypertension)

  • History of atherosclerosis

  • History of diabetes

  • Long-term stress

  • Male gender and postmenopausal females aged 45 years and older

  • Obesity and sedentary lifestyle

  • Smoking

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

  • High cholesterol, which can lead to atherosclerosis

  • High C-reactive protein (CRP) level, which increases atherosclerosis

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

    Reducing your risk of heart disease

    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

    Treatments

    How is heart disease treated?

    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 use a multifaceted approach and are individualized to the type and severity of your heart disease, risk factors, lifestyle, medical history, and other diseases and conditions you have.

    Treatment for advanced or critical stages of heart disease

    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

    Medications used to treat heart disease

    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 for heart disease

    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 stent (hollow tube) is placed in the artery to keep it open.

    • Coronary artery bypass to graft new arteries to 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

    • 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 for heart disease

    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.

    What are the possible complications of heart disease?

    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 health care 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

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    Medical Reviewer: William C. Lloyd III, MD, FACS
    Last Review Date: 2018 Oct 31
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    3. What Is a Heart Attack? National Heart Lung and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/HeartAttack/HeartAttack_WhatIs.html
    4. Pediatric Cardiomyopathies. American Heart Association. http://www.heart.org/HEARTORG/Conditions/More/ChildrensHealth/Pediatric-Cardiomyopathies_UCM_312219_...
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    6. Collins RD. Differential Diagnosis in Primary Care, 5th ed. Philadelphia: Lippincott, Williams & Williams, 2012.
    7. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy. Philadelphia: Saunders, 2013.
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