Signs and Symptoms of a Heart Attack

Signs and Symptoms of a Heart Attack By Richard N. Fogoros, MD Medically reviewed by Anisha Shah, MD on December 06, 2019 Print Heart Attack Heart Attack Overview Symptoms Causes Diagnosis Treatment Prevention In This Article Classic Symptoms Other Symptoms Differences in Women Complications When to Go to the Hospital The symptoms of an acute heart attack, also called a myocardial infarction (MI), can range from telltale chest pain to less obvious indications such as sweating, nausea, fatigue, and/or a sense of impending doom. Heart attacks also can occur without causing any symptoms at all, and these are only diagnosed after the fact—what's often referred to as a silent heart attack. What's more, women tend to experience heart attacks differently than men do. Because symptoms can vary dramatically from person to person, it's important to listen to your body and not ignore any symptoms that are unusual or scary for you. This is especially important for anyone who has or is at risk for coronary artery disease (CAD). Man holding arm E+ / Getty Images Classic Symptoms There's no such thing as a typical heart attack but there are a handful of symptoms that most people experience. Chest pain (angina): The majority of both men and women describe chest pain during a heart attack,1 although the terminology that they use varies and might include a sense of fullness, tightness, or burning. Others liken the pain to the sensation of a knot or weight in the chest. Often, it's focused on the center or left side of the chest. Men are more likely than women to describe chest and left arm pain during a heart attack.2 Whatever the nature or location of heart attack pain, it may begin gradually and come and go, come on suddenly, or simply feel like a dull, steady ache. Any change in the pattern of pain is important to note, particularly when it takes less and less activity to bring it on. Shortness of breath: During a heart attack, a feeling of pressure in the chest can make it hard to breathe. Pain, stiffness, or numbness in the upper body: This could be centered in one or both arms, the back, shoulders, neck, jaw, or upper abdomen. A cold sweat: Profuse perspiration is a common response to stress and a facet of the fight-or-flight response that tells the brain the body is being threatened in some way. Nausea and/or vomiting Light-headedness, dizziness, or fainting (syncope): As a heart attack progresses and a portion of the heart becomes damaged, blood pressure drops. This can slow blood flow to the brain, which in turn can result in dizziness or loss of consciousness. Other Symptoms Besides the classic ones, there are other symptoms associated with MI that are less common or may seem unrelated to a heart problem: Fatigue: A decrease in blood flow to the heart can deplete the body of energy and cause extreme tiredness that can set in days or weeks before a heart attack occurs and be an important warning sign. Heartbeat changes: This could be a pounding heart, or an irregular or rapid heart rate. Stomach discomfort: Some people report feeling as if they have heartburn or indigestion. A blue tint to the lips, hands, or feet: This is an indication that blood is not reaching those areas. Differences in Women Women tend to experience, and respond to, heart attacks differently than men do. They're more likely to ignore or downplay what they're feeling (and therefore delay seeking medical treatment) because their symptoms so often are different from or more subtle than the classic ones, according to the Cleveland Clinic. Women are more likely to blame stress or anxiety for their symptoms. However, in one study, more women than men reported seeking medical care for their symptoms prior to hospitalization (29.5%) compared to men (22.1%). Yet 53% of women stated that the provider did not think their symptoms were related to a heart problem, compared to only 37% of men who stated that the medical provider seemed to rule out a cardiac issue.1 In one study, women reported initially believing that their heart attack symptoms were due to sleep problems, arthritis, influenza, osteoporosis, and tooth infection, among other unrelated maladies.2 Women are more likely to experience shortness of breath, nausea or vomiting, and pain in the jaw, neck, arms, or between the shoulder blades during a heart attack.2 Among the heart attack symptoms women report are: "Non-classic" chest discomfort: Although some women do have crushing chest pain during a heart attack, many experience different or less severe chest symptoms, such as the sensation of pressure or tightness. According to the Mayo Clinic, this may be because women tend to have blockages in the smaller arteries that supply blood to the heart as well as the main arteries—what's known as small vessel heart disease or coronary microvascular disease. Pain in both arms: Men usually feel pain only in the left arm. Sleep problems: Women are more likely to experience symptoms of a heart attack while resting or sleeping, including chest pain severe enough to cause them to awaken in the night. Excessive fatigue brought on by seemingly mundane activities: Simply walking from one room to another can be exhausting. Anxiety or a feeling of impending doom In addition, women tend to have worse outcomes with heart attacks than men, according to a 2016 statement by the American Heart Association. For example, those who survive a heart attack and wind up in the hospital are more likely to have shock, bleeding, or heart failure, likely due to delays in seeking treatment. Women and Heart Disease Complications The short-term and long-term consequences of a heart attack are determined by how much of the heart muscle is damaged. For that reason, once an artery that supplies blood to the heart becomes blocked, it's critical to unblock it as quickly as possible to restore blood flow. A matter of minutes can make the difference between a full recovery, permanent disability, or death. Increased risk of another heart attack: Once destroyed, the portion of the heart that's damaged will form scar tissue. This tissue cannot contract as healthy tissue does, which can prevent the heart from pumping normally and increase the possibility of another heart attack. Challenges with everyday activities: Damaged tissue also makes it difficult for someone to exert themselves as they otherwise might have been able to, which can interfere with even simple tasks like climbing the stairs. Death: According to a 2018 report by the American Heart Association, around 14% of people who have a heart attack will die as a result. When to Go to the Hospital It cannot be stressed enough that any type of chest pain or discomfort with or without other possible symptoms of a heart attack should be treated as a medical emergency. The same goes for milder symptoms that don't seem to have another cause or that seem odd or bring on a feeling of panic or anxiety. Always listen to your intuition about any symptoms you may be feeling and head straight to the emergency department of the closest hospital, or call 911. Anyone who has one or more risk factors for CAD needs to pay close attention to any sudden, unusual or unexplained symptoms involving the upper half of the body. A Word From Verywell Most hospitals are geared up to deliver treatment rapidly once a heart attack diagnosis is clear. Most of the delay in beginning treatment is, in fact, in the hands of the person experiencing the event. Take quick action if you recognize possible symptoms of a heart attack and describe them as such to medical staff. Doctors, nurses, and EMTs will not judge you if it turns out there is another explanation for how you're feeling. And if you happen to be right, you will receive the treatment you need to stop the event and preserve as much heart tissue as possible.

What Is a Heart Attack?

What Is a Heart Attack? By Richard N. Fogoros, MD Medically reviewed by Yasmine S. Ali, MD, MSCI Updated on January 15, 2020 Print Heart Attack Heart Attack Overview Symptoms Causes Diagnosis Treatment Prevention In This Article Heart Attack Symptoms Causes Diagnosis Treatment Prevention A heart attack, or myocardial infarction (MI), occurs when an acute blockage of blood flow causes a portion of the heart to die from lack of oxygen, bringing on symptoms such as chest pain, shortness of breath, and inexplicable anxiety—or none at all. A heart attack is an emergency that requires immediate medical attention followed by treatment ranging from surgery to medication to changes in lifestyle. In the best-case scenario, a heart attack is a wake-up call—an indication of coronary artery disease (CAD), meaning the heart has been severely damaged. In other instances, a heart attack can produce significant disability and premature death. Recognizing the Signs of a Heart Attack Verywell / Brianna Gilmartin Heart Attack Symptoms A heart attack usually produces significant acute symptoms, including: Chest pain that may radiate to the jaw or arm Dyspnea (shortness of breath) Sweating Sudden nausea or vomiting1 However, many people don’t experience these. They may not have chest pain—or any pain—at all. They may describe their symptoms as pressure or nondescript discomfort—“a funny feeling.” In fact, heart attack symptoms may not even be located in the chest but instead show up the back, shoulders, neck, arms, or the pit of the stomach.2 Some people even dismiss what they're feeling as heartburn. Sometimes symptoms of a heart attack are so minor that those who experience them brush them off, figuring they'll go away—and often, they do. When they finally see a doctor, these are the people who likely will be diagnosed as having what's called a silent heart attack. Signs and Symptoms of a Heart Attack Complications Beside immediate symptoms, a heart attack can have dire consequences, some right away, others in the future. Immediate If the amount of heart muscle affected by a blocked coronary artery is extensive, a person having a heart attack may experience acute heart failure in which he or she experiences shortness of breath, low blood pressure, lightheadedness or syncope, and multi-organ failure. Unless blood flow is restored to the heart rapidly, these physiological repercussions can be fatal. In addition, during an acute heart attack, the dying muscle can stop beating normally and begin quivering—a heart rhythm disturbance known as ventricular fibrillation (v-fib). Ventricular fibrillation usually can be treated effectively if it occurs when a person is under medical care; if not treated, v-fib increases the risk of death within the first few hours of a heart attack.3 Long-Term There are three significant long-term consequences of a heart attack: Damage to the heart during a myocardial infarction may leave the organ so weakened that heart failure eventually develops. Depending on the amount of permanent damage done to the heart, the risk of sudden death may be permanently elevated. The very fact that a heart attack has occurred places a person at a very high risk of subsequent heart attacks.4 Causes Most heart attacks occur when an atherosclerotic plaque in a coronary artery suddenly ruptures. The plaque rupture triggers the clotting mechanism within the artery, causing a blood clot to form and block blood flow. If the blockage is severe enough, the heart muscle supplied by that artery begins to die and a heart attack occurs. Researchers aren't certain why plaques rupture. While sometimes they appear to be triggered by, for example, intense physical or emotional stress, more often they occur sporadically, for no apparent reason, and with no identifiable triggers. What's more, it isn't clear that the larger plaques doctors tend to worry about (the kind identified after a heart catheterization as being “significant blockages”) are more prone to rupture than smaller ones. Anyone who has CAD must be regarded as being at risk for a heart attack—whether or not their plaques are labeled as “significant”—and should be treated accordingly. Causes of a Heart Attack Types of Heart Attack A plaque rupture can produce several clinical conditions, which together are categorized as acute coronary syndrome (ACS). In one of these, unstable angina, the blood clot resulting from a plaque rupture is not large enough (or does not last long enough) to produce permanent damage. Although not regarded as a heart attack, per se, unstable angina without aggressive treatment is often followed by an MI in the near future. The other ACS conditions are: ST-elevation myocardial infarction (STEMI): The blood clot is so extensive and severe a large part of the heart muscle will die without rapid treatment. STEMI is the most severe type of ACS and is so named because it shows up as a spike in the ST segment of an electrocardiogram (ECG) tracing. Non-ST segment elevation myocardial infarction (NSTEMI): In terms of potential severity, NSTEMI ranks between unstable angina and STEMI in that the blockage of the coronary artery is only partial, but still large enough to cause damage to the heart muscle. Diagnosis Diagnosing a heart attack usually isn't difficult when a person is having typical symptoms and says so. Often, however, someone in this situation may think they're having symptoms related to their heart but will downplay them out of fear—even in a hospital emergency department. This is understandable but dangerous: The more quickly medical personnel are alerted to the possibility of myocardial infarction, the more quickly they can make (or rule out) that diagnosis. Besides evaluating obvious symptoms, two tests typically are done to diagnose a heart attack: An electrocardiogram (ECG), a non-invasive test that analyzes the patterns of how the heart beats to reveal abnormal rhythms A blood test to measure cardiac enzymes to detect whether damage to heart cells is occurring) How a Heart Attack Is Diagnosed Every Minute Counts If you're even the least concerned you're having symptoms originating from your heart, do not hesitate to say that you think you're having a heart attack. Treatment A heart attack is a medical emergency. Muscle tissue is actively dying, so immediate treatment is critical. Minutes can make the difference between complete recovery and permanent disability or death. After that, long-term treatment will be necessary. Once a person is under medical care and an ongoing myocardial infarction has been diagnosed, doctors typically begin two approaches to treatment simultaneously: stabilization and revascularization. In the majority of cases—especially if treatment is begun quickly—people with acute heart attacks are quite stable within 24 hours. If a person's heart doesn't start again or ​CPR isn't given within four minutes of cardiac arrest, brain damage is, unfortunately, almost guaranteed.5 Stabilization The focus is to treat acute symptoms, relieving stress on the heart muscle, normalizing blood pressure, dealing with the ruptured plaque, and stopping blood clots from forming in the damaged artery. This is done with medication, typically a combination of nitroglycerin, oxygen, morphine, beta-blockers, a statin, aspirin, and another anti-platelet drug such as Plavix (clopidogrel bisulfate). Revascularization The goal is to restore blood flow to the dying heart muscle through the blocked coronary artery as quickly as possible. Most permanent cardiac damage can be avoided if the artery can be re-opened within roughly four hours; at least some permanent damage can be prevented if the artery is opened within eight to 12 hours. In the case of a STEMI, in which the coronary artery is fully blocked, revascularization is done with invasive therapy that typically involves two procedures. The first is angioplasty, in which a small balloon is inflated in the artery to flatten the plaque that's blocking it. This is followed immediately by the insertion of a stent, a metal device that is positioned inside the artery to keep it propped open so that blood can once again flow through easily. If this approach is unfeasible or too risky, thrombolytic therapy—administration of a “clot-busting” drug—is used to dissolve the clot and restore blood flow. Often, an NSTEMI (a partial blockage) can be treated with stabilization measures alone (as can unstable angina). However, most cardiologists believe stenting is more effective for preserving cardiac muscle, and the approach is often the preferred one for both STEMI and NSTEMI. Thrombolytic therapy has been shown to cause more harm than good. How a Heart Attack Is Treated Prevention After surviving a heart attack, your doctor will focus on treatment aimed at preventing three potential long-term consequences: Heart Failure Muscle damaged in a heart attack is converted into scar tissue. This tissue will hold the heart together but will not help the heart do its job. The chance of heart failure after a heart attack depends in large part on the extent of the damage. It also depends on how the remaining heart muscle adjusts. Often it will respond by changing its shape, a process called cardiac remodeling. A certain amount of remodeling may be beneficial at first, but chronic remodeling can lead to heart failure. There are two classes of medications used to prevent this: Beta-blockers: These drugs work by blocking the effect of adrenaline on the heart. Two beta-blocker medications often prescribed after a heart attack are Tenormin (atenolol) and Lopressor (metoprolol). Angiotensin-converting enzyme (ACE) inhibitors: These affect an enzyme that contributes to the regulation of blood pressure and the amount of sodium in blood. Examples of ACE inhibitors include Capoten (captopril), Vasotec (enalapril), Zestril (lisinopril), Altace (ramipril), and Mavik (trandolarpril). Sudden Death The post-heart attack discussion that is often skipped by cardiologists is the one about sudden death. While hard to talk about, sudden death is a substantial risk for many people after a heart attack, especially those whose hearts have sustained a lot of damage. Furthermore, the risk of sudden death can be substantially lowered in people whose risk is very high with an implantable defibrillator.6 Clear guidelines exist regarding which people ought to be considered for an implantable defibrillator after a heart attack. If your doctor doesn't bring up the topic of sudden death or the idea of a defibrillator, ask him or her about both. Future Heart Attacks A person who's survived a heart attack has CAD, and so is at an increased risk for another episode of MI. That risk can be substantially improved with medications and by adopting a healthy lifestyle. In addition to beta-blockers and ACE inhibitors, most people who have had a heart attack need to be on statins (cholesterol-lowering drugs), an anticoagulant (blood-clot) medication such as aspirin, and possibly medication to treat or prevent further angina (such as nitrates or calcium channel blockers). Lifestyle measures that substantially lower future cardiac risk include: Quitting tobacco use Eating a heart-protective diet Maintaining a healthy weight Controlling diabetes and hypertension (if you have either of these) Getting regular exercise, preferably beginning with a formal cardiac rehabilitation program1 It's a lot to be aware of and think about, and this is really just the tip of the iceberg. You may want to develop a post-heart attack checklist with the guidance of your doctor to help you both stay on top of the measures you should be taking to stay healthy after your heart attack. Preventing Another Heart Attack A Word From Verywell A heart attack is a serious medical event. Fortunately, with what experts have learned about heart attacks in the last few decades, and with the newer therapies that have been devised to treat these events, the chances of dying or having permanent disability after a heart attack have been greatly diminished. That, however, hinges on knowing the signs and getting help when you need it.

Coping With Heart Disease

Coping With Heart Disease By Richard N. Fogoros, MD Medically reviewed by Yasmine S. Ali, MD, MSCI on June 15, 2020 More in Heart Disease Living With Causes & Risk Factors Diagnosis Treatment Prevention Atrial Fibrillation Heart Attack Heart Valve Disease VIEW ALL In This Article Know Your Heart Disease Learn About Symptoms Adjust Your Lifestyle Take Charge of Medications Personal Technology Support Groups BACK TO TOP Over the past few decades, modern medicine has made major strides in treating all forms of heart disease, and people who have heart disease today are living much longer, much happier lives than similar people did in previous generations. But enjoying the very best outcomes if you have heart disease depends on more than just what your doctors do for you. To a very large extent, it depends on what you do for yourself. Because living well with heart disease takes some effort. If you have been told you have heart disease, there’s a lot you will need to think about, and a lot you will need to do. You will need to learn as much as you can about your heart disease and about the treatments your doctor has prescribed. You will have to learn what symptoms to watch out for. And, you very likely will have to make some lifestyle changes that might be challenging. It is the people who do all these things—who take personal control over their own wellbeing—who live the longest, healthiest lives with heart disease. Know Your Heart Disease “Heart disease” is a pretty nonspecific term. There are many different kinds of heart disease, and most types will show a tremendous amount of variability from person to person in its symptoms, its severity, its treatment, and its prognosis. So one of the most important things you will need to do is learn as much as you can about your particular disease, about the nature of the problem you have, and about what you can do to slow or even stop its progression. The more knowledge you have, the more you will be able to partner with your doctor in making the decisions about your care that are right for you. The most common types of heart disease are: Coronary artery disease and heart attacks Heart failure1 Heart valve disease Cardiac arrhythmias In addition to learning whatever you can about your disease, you should also learn all you can about any other medical conditions you may have, since these can have a big impact on your outcomes. There are many disorders that particularly impact heart disease, but the two most common are diabetes and hypertension. You should talk with your doctor about this aspect of your medical care. Heart Disease Doctor Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Doctor Discussion Guide Old Man DOWNLOAD PDF Email the GuideSend to yourself or a loved one. Enter your email SIGN UP Learn About Symptoms Symptoms that accompany heart disease are important for two reasons. First, of course, symptoms by their very nature are unpleasant and disturbing, and a chief goal of treating any medical problem is to minimize or eliminate them. But second, noticing symptoms can provide an important clue—to you and your doctor—that your cardiac condition may be changing. They can alert both of you that perhaps something needs to be done to get things back on a stable path. So ignoring a change in your symptoms, hoping they will go away, is a bad idea. It can result in a permanent worsening of your heart problem. For this reason, it is important to know what symptoms you should be watching for with your heart disease and to report them to your doctor if you experience any of them. Different forms of heart disease can cause different kinds of symptoms. But the most common symptoms caused by heart disease include: Chest pain or chest discomfort Dyspnea (shortness of breath) Fatigue or weakness Palpitations Lightheadedness2 Syncope Depression All of these symptoms are potentially very important, and should never be ignored. If you experience any of them, you need to talk to your doctor about it. Adjust Your Lifestyle Many aspects of our lifestyles affect our heart health. There may be some particular lifestyle measures you should take that will be especially important for the heart disease you have. In general, there are several lifestyle adjustments we should all make for the sake of our hearts. These include: Eat a heart-healthy diet Maintain a healthy weight Get plenty of exercise Quit smoking Learn to manage stress About Exercise Cardiologists are learning more every day about the importance of exercise for people who have heart disease. For many people exercise may, in fact, be the best medicine. Be sure to discuss exercise with your doctor, to learn what kinds of exercise might be most advantageous for people with your kind of heart disease, and how to get started with it safely. For many people, beginning with a formal cardiac rehabilitation program is the best way to get started. About Stress It is now pretty clear that certain kinds of emotional stress are potentially damaging to the heart.3 But since stress is a normal part of life, advising people to avoid stress is almost never helpful. Instead, you should learn techniques for coping with the stress you cannot avoid. Take Charge of Medications Medications are involved in many of the remarkable heart disease treatment advances we have seen in recent decades. So, it is extraordinarily likely that your doctor will have prescribed at least a few of these medicines for you. Especially when it comes to heart medicine, it is extremely important that you take them regularly and on time. There are many tips and techniques for taking medicine without missing doses or taking too much. You should find a system for doing so that works for you, and stick to it. Personal Technology Personal electronic technology is being developed by several companies. These promise to be of help to many people with heart disease. A few of these technologies are already widely available and may be helpful to you. These include: Automated home blood pressure monitoring devices Wireless scales that can record and store your weight over time Activity monitors that encourage you to remain active, such as Fitbit or Apple Watch Heart rate monitors that can alert you if your heart rate exceeds some determined threshold, such as the Apple Watch Support Groups It should be clear that, sometimes, living well with heart disease can present a real challenge. To deal with this kind of challenge it can be very helpful to join groups of people who are going through the same thing, who are facing the same difficulties, and who have found different techniques to cope. You should check with your doctor (or look on the website of a local hospital) about local support groups for people with heart disease, and consider joining one. The American Heart Association website can also help you find local support groups, as well as online groups you might find helpful.

How Heart Disease Is Treated

How Heart Disease Is Treated By Richard N. Fogoros, MD Medically reviewed by Yasmine S. Ali, MD, MSCI on November 20, 2019 Heart Disease Overview Symptoms Causes Diagnosis Treatment In This Article Goals by Type Home Remedies and Lifestyle Prescriptions Specialist-Driven Procedures Palliative Care Complementary Medicine (CAM) Since heart disease is a term that encompasses a wide range of heart conditions, treatment depends entirely upon what condition you have. In general, lifestyle changes such as implementing a heart-healthy diet, smoking cessation, exercising, and maintaining a healthy weight are recommended.1 Prescriptions, procedures, or surgeries may also be needed, depending on the type of disease you have and its severity. Some of the major types of heart disease include atherosclerotic disease, cardiac arrhythmias, heart valve disease, heart infections, and heart failure. Types of Heart Disease Verywell / Emily Roberts Heart Disease Doctor Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Doctor Discussion Guide Old Man DOWNLOAD PDF Email the GuideSend to yourself or a loved one. Enter your email SIGN UP Goals by Type Treatment goals depend on the type of heart disease you have, as well as how severe your case is. Atherosclerotic Disease Atherosclerotic diseases include coronary artery disease, carotid artery disease, and peripheral artery disease. The goals of treatment are to prevent symptoms, prevent a heart attack, and slow or stop the worsening of your disease.2 Cardiac Arrhythmias Treatment may not be needed for an arrhythmia unless it's creating problems or if it may lead to a more severe arrhythmia or complications. In these cases, treatment will focus on regulating your heartbeat.3 Heart Valve Disease With heart valve disease, your treatment goals will be to protect your heart from more damage, manage your symptoms, and possibly surgically repair any valve problems.3 Heart Infections When you have a heart infection such as endocarditis, pericarditis, or myocarditis, the main goal of treatment is to get rid of the infection and inflammation in your heart, as well as any symptoms you may be having. Heart Failure Heart failure requires lifelong treatment, but this can help you live a longer, better-quality life. The goal is to reduce your symptoms as much as possible while balancing medications and other treatment options. Home Remedies and Lifestyle No matter what type of heart disease you have, your doctor will likely recommend lifestyle changes to help keep your symptoms at bay and prevent your condition from getting worse.4 Smoking Cessation If you smoke, quitting is one of the best things you can do to help your heart health. Smoking can further damage your heart and your blood vessels, as well as contribute to heart arrhythmias and high blood pressure.5 Talk to your doctor about a program to help you quit. Exercise Enough can't be said about the effectiveness of staying active for heart health. Not only does it help to keep your blood pressure and cholesterol lower, it can help you keep diabetes controlled and prevent you from gaining too much weight—all risk factors for developing or worsening heart disease. If you have a heart arrhythmia or a congenital heart defect, you need to talk to your doctor about any potential exercise restrictions before you begin a program. In general, try to get 30 to 60 minutes of exercise on most days. Heart-Healthy Diet Eating a diet that's rich in fruits, vegetables, and whole grains is good for your heart and your weight. Focus on lean sources of protein and fat-free or low-fat dairy products. Watch your cholesterol, fat, salt, and sugar intake too. Weight Control Getting your weight to a normal level can help prevent your heart disease from worsening. Talk to your doctor about what a good range is for you and your body type. In general, aim for a body mass index (BMI) of 24 or under.6 Stress Management Don't let the stress in your life build up. Make sure you take time for yourself and that you have go-to relaxation methods you can use. Meditation, exercise, yoga, journaling, painting, knitting, muscle relaxation, and deep breathing are all great ways to deal with stress. Good Hygiene If you have heart disease, you need to be especially careful to stay away from people who are sick with contagious illnesses. Wash your hands regularly and thoroughly, brush and floss your teeth at least twice a day, and talk to your doctor about getting vaccinated for the flu and pneumonia to help you stay healthy. Maintain Follow-Up Care Be sure to take all of your medications as directed, keep all of your follow-up appointments, and stick to your treatment plan. If you have questions or concerns, talk to your doctor. Treatment plans often have multiple options, so if something isn't working for you, chances are that your doctor can find a different solution. Staying under the regular care of your doctor also helps him or her tell if there's a change in your condition so steps can be taken to get on top of it before it gets out of control. Diabetes Control If you have diabetes, it's important that you keep it well managed. Uncontrolled diabetes can lead to worsening heart disease, as well as other complications.7 Be honest with your doctor about how well you're complying with your treatment so that he or she can come up with the best plan for you. Prescriptions For any type of heart disease, you may need prescription medication to treat your symptoms and decrease the risk of further damage if lifestyle changes aren't enough or if you have a heart infection or heart failure. There are a large number of different medications that your doctor may prescribe. Aldosterone Antagonists These potassium-sparing diuretics are used for heart failure and can help you live longer while improving your symptoms. One potential side effect is dangerously high potassium levels in your blood, so close monitoring by your doctor will be necessary.8 Aldactone (spironolactone) and Inspra (eplerenone) are the two available brands. Angiotensin-Converting Enzyme (ACE) Inhibitors Used to treat heart failure, high blood pressure, heart valve disease, coronary artery disease, myocarditis, and heart attacks, ACE inhibitors work by relaxing your blood vessels, helping your heart to work more efficiently. Potential side effects include a dry cough, high potassium levels in your blood, dizziness, fatigue, headaches, and losing your sense of taste.9 Examples of ACE inhibitors are Lotensin (benazepril), Vasotec (enalapril), Capoten (captopril), and Monopril (fosinopril). Angiotensin II Receptor Blockers These medications are used to treat heart failure, myocarditis, and high blood pressure. They also work by helping your blood vessels dilate so that your heart can work more efficiently and your blood pressure stays within normal limits. Side effects can include dizziness, high potassium levels in your blood, and swelling in your tissues. Examples of angiotensin II receptor blockers include Atacand (candesartan), Teveten (eprosartan), Avapro (irbesartan), and Cozaar (losartan). Angiotensin Receptor Neprilysin Inhibitors (ARNIs) These new drugs are used to treat heart failure. They contain a combination of angiotensin II receptor blockers and neprilysin inhibitors that helps your blood vessels dilate, improve blood flow to your heart, reduce the amount of salt your body retains, and lessen any strain on your heart. Potential side effects are dizziness, lightheadedness, or a cough. The only ARNI that's currently approved by the U.S. Food and Drug Administration (FDA) is Entresto (sacubitril/valsartan). Antiarrhythmic Medications Antiarrhythmic medications help regulate your heartbeat and are used to treat arrhythmias and heart valve disease. Side effects may include taste changes, appetite loss, sensitivity to sunlight, diarrhea, and constipation. Commonly prescribed antiarrhythmics include Cordarone (amiodarone), Tambocor (flecainide), Rhythmol (propafenone), and quinidine. Antibiotics Antibiotics are used to treat heart infections like endocarditis and bacterial pericarditis. Your doctor will do a blood test to see what kind of microbe is causing your infection and prescribe an antibiotic or a combination of them based on the results. You will likely need to get the antibiotics intravenously, which means you'll probably be in the hospital for at least a week. Once your doctor can see that the infection is clearing, you may be able to come in for intravenous (IV) treatments or even do them at home. Anticoagulants Anticoagulants keep blood clots from forming and prevent any blood clots that you have from getting bigger. They're used to treat a type of arrhythmia called atrial fibrillation, heart valve disease, congenital heart defects, and for people who are at risk of a stroke or heart attack. Side effects may include excessive bleeding, dizziness, weakness, hair loss, and rashes. Examples of anticoagulants are Coumadin (warfarin), heparin, Pradaxa (dabigatran), and Eliquis (apixaban). Antiplatelet Agents Antiplatelet agents stop blood clots from forming by preventing the platelets in your blood from sticking together. These are often used for atherosclerotic disease and for people who have had a heart attack, stroke, transient ischemic attacks (TIAs), unstable angina, or certain heart surgeries. Depending on your condition, you may be prescribed two antiplatelet agents. Potential side effects include headaches, dizziness, nausea, constipation, diarrhea, indigestion, abdominal pain, nosebleeds, and bruising easily. Aspirin is an antiplatelet agent, as are Plavix (clopidogrel), Effient (prasugrel), and Brilinta (ticagrelor). Beta Blockers These medications help reduce your blood pressure by blocking epinephrine, which helps your heart beat slowly and less forcefully and your blood vessels dilate. Beta blockers are usually used for high blood pressure, atherosclerotic disease, heart arrhythmias, myocarditis, heart valve disease, heart failure, and heart attacks. Side effects may include cold hands and feet, fatigue, and weight gain.10 Commonly prescribed beta blockers are Sectral (acebutolol), Tenormin (atenolol), Kerlone (betaxolol), and Zebeta (bisoprolol). Calcium Channel Blockers Calcium channel blockers partially block the effect of calcium on heart muscle cells and blood vessels. They can reduce blood pressure and slow down the heart rate. They're used to treat atherosclerotic disease, high blood pressure, and arrhythmias. Side effects can include constipation, headache, perspiration, drowsiness, rash, dizziness, heart palpitations, nausea, and swelling in your feet or legs.11 Typically prescribed calcium channel blockers include Norvasc (amlodipine), Cardizem and Tiazac (diltiazem), Plendil (felodipine), and Sular (nisoldipine). Digitalis Also known as Lanoxin (digoxin), this drug for heart failure and certain heart arrhythmias slows down your heart, decreases symptoms of heart failure, and helps give you a stronger heartbeat. Common potential side effects are dizziness, fainting, and slow or fast heartbeat. Diuretics You've likely heard diuretics referred to as water pills. That's because they prevent fluid and sodium from building up in your body, which decreases the amount of work your heart has to do. These medications are used to treat heart valve disease, myocarditis, atherosclerotic disease, high blood pressure, and heart failure. While they're generally fairly safe, you will probably notice increased urination, which can lead to mineral loss. Other possible side effects include low sodium levels in your blood, dizziness, dehydration, headaches, muscle cramps, joint problems, and erectile dysfunction. Examples of diuretics include Midamor (amiloride), Bumex (bumetanide), Diuril (chlorothiazide), and Hygroton (chlorthalidone). Statins Statins are used to lower cholesterol. They're typically prescribed when you have an atherosclerotic disease to help keep your cholesterol levels within normal limits in order to prevent heart attack and stroke. The most common side effect is muscle pain. Less common side effects are liver damage, increased blood sugar levels, and neurological effects such as confusion or memory loss.12 Examples of statins are Lipitor (atorvastatin), Lescol (fluvastatin), Altoprev (lovastatin), and Zocor (simvastatin). Vasodilators Also known as nitrates, vasodilators lessen your heart's workload by allowing your blood vessels to relax and dilate, increasing blood and oxygen to your heart. Vasodilators are often used to treat heart valve disease, high blood pressure, heart failure, and atherosclerotic disease. Because they can have a lot of side effects, vasodilators are generally only prescribed if other methods aren't working to control your blood pressure. Side effects can include fast heartbeat, heart palpitations, retaining fluid, nausea, vomiting, skin flushing, headaches, more hair growth than normal, and joint or chest pain.13 Commonly prescribed vasodilators include Isordil (isosorbide dinitrate), Natrecor (nesiritide), nitroglycerin tablets, and Apresoline (hydralazine). Specialist-Driven Procedures If lifestyle changes and prescription medications aren't effectively treating your heart disease, your doctor may recommend other options such as surgery, special procedures, or medical devices. Here's an overview of some of the procedures and devices that may be used. Coronary Artery Bypass Graft (CABG) A coronary artery bypass graft (CABG) is used when your heart is blocked.14 In a CABG, the surgeon uses arteries or veins from your leg, arm, or chest to reroute blood around the blockage to your heart, allowing the blood and oxygen to flow more freely so your heart doesn't have to work so hard. A CABG can also help relieve chest pain (angina). You may have one or up to several grafts done, depending upon how much blockage there is. This surgery is used to treat heart failure, atherosclerotic disease, and arrhythmias. Heart Valve Repair or Replacement If you have a heart valve issue, such as can be found in heart valve disease, heart failure, and endocarditis, your doctor may recommend that you have your valve repaired or replaced. Your original valve may be repaired using one of several different methods or it may be replaced with a prosthetic valve if it's irreparable. There are certain heart valve repairs and replacements that can be done without open heart surgery in minimally invasive procedures. Your doctor will decide what the best choice is for you based on your condition. Implantable Cardioverter-Defibrillator (ICD) If you have a heart arrhythmia, your doctor may recommend that you have an implantable cardioverter-defibrillator (ICD) implanted. It goes right under the skin of your chest and has wires that run through your veins to your heart. The ICD monitors your heart rate and gives your heart a shock if it's going too fast or it stops. It can also function as a pacemaker, keeping your heart from beating too slowly. Sometimes people with heart failure or other heart disease end up with arrhythmias, so an ICD may be an option.15 Ventricular Assist Devices (VADs) If your heart is weak and/or you have heart failure, your doctor may want to implant a ventricular assist device (VAD). This device helps your heart pump blood through your body. It can be placed in either of the two ventricles in your heart or in both, but it's most often placed in the left ventricle, in which case it's called an LVAD. A VAD can be used while you're waiting to have a heart transplant, if you're not a good candidate for a heart transplant, or if your doctor expects your heart to regain normal function but it needs help in the meantime. Implantation does require open-heart surgery, so the risks and benefits need to be weighed. For people with severe heart failure, however, it can be a lifesaver.16 Percutaneous Coronary Interventions [PCI] Also known as angioplasty, percutaneous coronary intervention (PCI) involves threading a tube with a deflated balloon attached through your veins up to your coronary arteries. The balloon is then inflated to widen places in your arteries that are blocked to allow the blood to flow through much more freely. This procedure is often combined with the placement of a stent, a wire mesh tube that helps keep the artery open afterward. PCIs can also help lessen chest pain (angina) and open arteries in your neck and brain if you're at risk of having a stroke. Pacemaker Similar to an ICD, a pacemaker is also implanted just under the skin near your collarbone with a wire that runs to your heart. When your heart rate is abnormal, it sends an electrical impulse to your heart to make it beat regularly. Pacemakers are used for people with arrhythmias. Maze Procedure For some types of arrhythmia, a maze procedure works to regulate heart rhythm. The surgeon creates a series of cuts in the upper part of your heart which then scar over, making it difficult for stray electrical impulses to travel through. Endarterectomy For some people with atherosclerotic disease, surgically removing fatty buildup from the artery walls may be necessary to remove a blockage. When this is done on the arteries in your neck, the carotid arteries, it's called carotid endarterectomy. Catheter Ablation This procedure for certain types of arrhythmias involves threading a catheter with an electrode at the tip through your blood vessels to your heart. The catheter is placed in the area of your heart that's giving off the abnormal electrical signal and the electrode ablates, or destroys, a very small amount of tissue there using radiofrequency energy. This creates a block so the signal can no longer get through. Cardioversion Another procedure for certain arrhythmias, particularly atrial fibrillation, your heart is given a shock by using electrodes or paddles on your chest. This forces it to beat in a normal rhythm. Heart Transplant If your heart is severely and irreversibly damaged and other treatments aren't working, you may need a heart transplant, replacing your diseased heart with a healthy heart from an organ donor. A heart transplant can lengthen your life and improve the quality of your life, but it can take a long time to find a suitable donor. Palliative Care Palliative care involves treating the pain, discomfort, side effects of medications, and symptoms of a serious disease, such as heart failure.17 It may be a good choice for you if you have severe heart disease and you're experiencing distressing symptoms that are difficult to control, such as: Chest pain (angina) even when you're resting Shortness of breath (dyspnea) even when you're resting Persistent symptoms, such as swelling in your feet, despite aggressive treatment Inability to tolerate aggressive treatments because of low blood pressure or kidney disease History of heart attacks and/or resuscitation Keep in mind, palliative care can be implemented at any time during the course of your illness and you may want to consider it as soon as you're diagnosed with any serious illness. It's not just for the end of life, though hospice care does always include palliative care. The purpose of palliative care is to help you deal with symptoms, stress, and to improve your quality of life.17 It's used alongside your regular care so you can keep seeing your current doctors. It can prompt all of your healthcare providers to coordinate their care, which gets everyone on the same page. Palliative care can also give you emotional support, help make sure that your wishes are followed, and educate you about your disease. Your palliative care team is personalized and may be made up of a variety of healthcare providers including doctors, nurses, counselors, nutritionists, social workers, pharmacists, and religious or spiritual advisors. Complementary Medicine (CAM) There are several different foods and supplements you can look into adding to your treatment program that may help your heart disease. It's a good idea to talk to your doctor before increasing or adding these to your diet. Flaxseed A number of studies have shown that supplementing your diet with flaxseed may reduce bad cholesterol if your cholesterol is already high.18 This was seen when whole flaxseed or lignan supplements were used, but not flaxseed oil. Multiple studies have also shown that flaxseed supplements can significantly lower your blood pressure.19 You can mix flaxseed with liquids or solids, but talk to your doctor about how much you should consume because ingesting too much can cause problems like constipation and, rarely, bowel obstruction. Flaxseed also might not be good for people with certain health conditions, so check with your doctor first. Omega-3 Fatty Acids The omega-3 fatty acids in fish may help lower your blood pressure a bit, decrease triglycerides, lower your cholesterol, reduce inflammation, and decrease irregular heartbeats. In fact, if you have heart failure, an atherosclerotic disease, or you've recently had a heart attack, the American Heart Association recommends that you take omega-3 fish oil supplements every day to help treat your disease.20 You can get the same benefits from eating fish that are rich in omega-3 fatty acids at least twice a week. Tuna, salmon, mackerel, lake trout, herring, and sardines have the most, but there are other fish that are beneficial as well. It should be noted that omega-3 fatty acids, whether in supplement or food form, won't prevent heart disease. Garlic In a review of studies of the effects of garlic on heart disease, it was found that garlic supplements have the potential to help prevent heart disease, as well as treat it. Although the studies included in the review used different types of garlic preparations, generally garlic powder, aged garlic extract, or garlic oil, in general, it was found that the aged garlic extract had the most consistent effect. Systolic blood pressure and diastolic blood pressure were reduced by 7 to 16 mmHg and 5 to 9 mmHg respectively, and total cholesterol was reduced by 7.4 to 29.8 mg/dL. Additionally, the studies showed that garlic supplementation had a positive effect on risk factors for atherosclerotic disease such as calcium buildup in the coronary arteries, stiffness of the arteries, and a biomarker of inflammation called C-reactive protein.21 Garlic is very safe and is often used to treat high blood pressure in developing countries. The most common side effects are body odor and bad breath, which can be minimized if you take your garlic in capsule form instead of eating it raw. Garlic may also cause some digestive issues like abdominal pain, bloating, gas, and, rarely, allergic reactions. Vitamin D More and more studies are linking vitamin D deficiency to all sorts of kinds of heart disease like heart attack, heart failure, peripheral arterial disease, strokes, and high blood pressure.22 It would naturally follow then that perhaps adding more vitamin D to your diet may help prevent or treat heart disease. Multiple clinical trials are now being done on just that possibility and, so far, the results are encouraging. One study used a form of vitamin D called 1,25-dihydroxyvitamin D3 (1,25D) in mouse heart cells called cardiac colony-forming unit fibroblasts (cCFU-Fs). cCFU-Fs cells begin to replace the cells in tissue that has been inflamed and damaged from oxygen deprivation after a heart attack. This results in scar tissue in your heart that may stop it from pumping blood effectively and can lead to heart failure. The researchers found that the 1,25D was able to stop the cCFU-Fs from forming, so preliminary studies are positive. Of course, as this is animal research, results may not be the same in humans.23 That said, having your doctor check your vitamin D level may be a good idea to make sure you're on track, especially since it has been proven to be good for your bones and there may be an extra cardiovascular benefit. Getting around 10 minutes of a medium amount of summer sun exposure is the best way to boost your levels.

How Heart Disease Is Diagnosed

How Heart Disease Is Diagnosed By Richard N. Fogoros, MD Medically reviewed by Jeffrey S. Lander, MD Updated on June 25, 2020 Heart Disease Overview Symptoms Causes Diagnosis Treatment In This Article Medical History Physical Examination Specialized Testing The ways doctors diagnose heart disease can vary quite a bit, depending on which kind of heart disease we’re talking about. However, it is possible to outline the general method which most doctors use to make a diagnosis when they suspect you may have heart disease. It looks like this: First, take a careful medical history. Second, perform a focused physical examination. Finally, decide which medical tests are likely to help complete the diagnosis. heart disease diagnosis © Verywell, 2018 Medical History “Taking a medical history” simply means that your doctor will interview you to learn what kinds of symptoms or medical complaints you may have (if any) and tease out any features associated with those symptoms that might point toward their causes. Depending on the symptoms you describe, your doctor may ask you a lot of questions detailing those symptoms—what seems to bring them on, what makes them stop, how long they last, when they have occurred, and any other associated circumstances. For certain potentially important cardiac symptoms—chest pain and syncope being two good examples—taking a careful medical history is often the most important step in making the diagnosis. Physical Examination The cardiac examination may also give some important clues as to the presence, absence, or type of cardiovascular problem a person may have. Cardiac arrhythmias, heart valve disease, congestive heart failure, aortic aneurysm, and postural orthostatic tachycardia syndrome (POTS), are only a few of the kinds of cardiovascular problems for which the physical examination often gives very important clues, or indeed, actually confirms the diagnosis. Heart Disease Doctor Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Doctor Discussion Guide Old Man DOWNLOAD PDF Email the GuideSend to yourself or a loved one. Enter your email SIGN UP Specialized Testing A wide variety of sophisticated tests have been developed for diagnosing heart problems. While specialized cardiovascular tests are often the “gold standard” for making or confirming a cardiac diagnosis, in general they are the most useful when your doctor already has a very good idea—from performing a history and physical exam—of what the correct diagnosis is.1 Cardiovascular tests can be expensive, difficult to perform, time-consuming, and in some cases invasive. So, diagnostic tests should be used, whenever possible, in a targeted fashion to confirm the suspected diagnosis rather than just doing several tests, in shotgun fashion, to see what turns up. In other words, doctors should rely on the information they obtain during their initial clinical evaluation to decide what in particular to look for, which test or tests are best suited to look for it, and if more than one test is needed, which order they ought to be performed in. This way, if you have a heart problem your doctor can get to the right answer as expeditiously as possible, without exposing you to unnecessary expense or risk. The Electrocardiogram (ECG) The ECG records the electrical activity of the heart and can reveal information about the heart rhythm and important clues about structural heart disease that may be present (such as a prior heart attack, or ventricular hypertrophy.2 The ECG is performed so commonly that many doctors consider it to be a routine part of an annual wellness examination. Ambulatory Monitoring Several systems are available that allow the recording of an electrocardiogram for days or weeks at a time, in order to record the heart rhythm over a prolonged period. These systems allow doctors to diagnose cardiac arrhythmias that occur only infrequently and sporadically.3 Echocardiogram or Cardiac Ultrasound The echocardiogram study is a noninvasive test that uses sound waves to construct an image of the beating heart. The echo study is very useful for detecting the enlargement of cardiac chambers, heart valve disease, and heart muscle problems such as dilated cardiomyopathy or restrictive cardiomyopathy.2 It is a relatively quick study to perform, is noninvasive, and does not require radiation. This makes the echocardiogram a nearly ideal screening tool if structural abnormalities of the heart are suspected or if you're at high risk for heart disease but don't have any symptoms. It is also a test that can be performed repeatedly, over time, to monitor the status of a cardiac problem. Cardiac CT Scan A cardiac CT scan, like any CT scan, uses computerized X-ray equipment to make an image of the heart. This technique can also be used to look for calcium deposits in the coronary arteries, which is an indication that atherosclerosis is present.4 CT scans used to use a substantial amount of radiation, but the amount of radiation used now is significantly reduced, and may be less than the amount used for a nuclear stress test. Cardiac MRI Study The cardiac MRI study uses magnetic fields to construct an image of the heart and surrounding structures. This test can show impressive anatomic details, and in certain circumstances can be very useful in diagnosing and characterizing structural heart disease.5 Stress Testing Cardiac stress testing has several potential uses, but it is used chiefly to help assess whether coronary artery disease is producing cardiac ischemia that may be responsible for angina, and if so, to help assess the severity of the problem. A stress test is often combined with a thallium scan, which uses a small dose of a radioactive material to produce an image of the heart that reflects whether the heart muscle is getting the blood flow it needs. Stress testing can also be very useful in monitoring the effectiveness of anti-anginal therapy.6 Cardiac Catheterization With this invasive test, small catheters are inserted into the blood vessels and passed into the heart and/or coronary arteries. Pressures can be measured inside the heart, and dye can be injected into blood vessels and cardiac chambers to make a moving x-ray image of blood flow. The catheterization study has many potential applications but is used most commonly to visualize the coronary arteries in people with known or suspected coronary artery disease. Cardiac catheterization is also used to deliver therapy, most commonly, by performing angioplasty and placing stents in people with arterial blockages.7 Electrophysiology Study This is another form of cardiac catheterization, but in this case the catheters are insulated wires instead of hollow tubes. This test is used to study the cardiac electrical system to determine the presence or absence, and the mechanism, of various kinds of cardiac arrhythmias. This technique is also used to deliver ablation therapy in order to treat several kinds of arrhythmias.8 Tilt Table Study A tilt table study is performed by strapping a person to a table that has a footboard on it, then raising the table to an upright position. With certain cardiovascular conditions an upright tilt for 20 minutes or more can reproduce certain kinds of cardiovascular instability, particularly in people who are suspected of having vasovagal syncope. The tilt study can help to confirm the diagnosis.9 

Causes and Risk Factors of Heart Disease

Causes and Risk Factors of Heart Disease By Richard N. Fogoros, MD Medically reviewed by Jeffrey S. Lander, MD Updated on June 20, 2020 Heart Disease Overview Symptoms Causes Diagnosis Treatment In This Article Common Causes Genetics Lifestyle Risk Factors Other Risk Factors Determining Your Risk Because heart disease is a general term for a number of different conditions, the cause of your case depends on the type you have. The bad news about heart disease is that it remains extremely prevalent in our society—it's the leading cause of death for both men and women in the United States.1 The good news is that many of the factors that determine your risk of developing heart disease are, to a large extent, under your control. heart disease causes and risk factors © Verywell, 2018 Common Causes The causes of heart disease depend on the general type you have. Atherosclerotic Disease Atherosclerosis, a condition in which plaque builds up and hardens in your arteries, blocking and narrowing the passages, can lead to atherosclerotic diseases such as coronary artery disease, peripheral artery disease, and carotid artery disease. Though the exact cause of atherosclerosis isn't known, there are factors that can lead to artery damage, which can then lead to plaque building up where the damage occurs. These damaging factors include: Smoking High blood pressure High levels of fats and cholesterol in your blood High levels of sugar in your blood due to diabetes or insulin resistance Plaque is made up of fat, cholesterol, calcium, and other substances. If plaque build-ups rupture, this can lead to blood clots, which make the arteries even more narrow and can lead to problems like angina (chest pain), heart attack, stroke, and transient ischemic attacks (TIAs). Cardiac Arrhythmias Cardiac arrhythmias are abnormal heart rhythms, whether too fast, too slow, or irregular. Common causes of arrhythmias include: Heart defects that you're born with (congenital) Coronary artery disease (a type of atherosclerotic disease) High blood pressure Diabetes Heart valve disease Certain medications, including over-the-counter medicines, herbal remedies, and prescription medications Smoking Drinking alcohol or caffeine in excessive amounts Drug use Stress Heart Valve Disease Heart valve disease has many causes. While it can result from infectious endocarditis or rheumatic heart disease, valvular heart disease is more commonly caused by heart dilation (or cardiac remodeling), calcium deposits on the valves that may occur with aging, and congenital cardiac problems. Any of the four heart valves can develop either stenosis or regurgitation. A bicuspid aortic valve is the most common congenital heart valve problem. Among adults, the most common types of significant heart valve disease are aortic stenosis, aortic regurgitation, mitral stenosis and mitral regurgitation. The most commonly diagnosed heart valve problem in adults is mitral valve prolapse (MVP), but the large majority of people who are diagnosed with MVP have a very mild form that will never cause significant heart problems.2 Heart Infections A heart infection is caused by a bacterium, virus, parasite, or chemical getting into your heart muscle. This can occur when microbes from your mouth or elsewhere in your body get into your bloodstream and attach to the damaged areas of your heart. It can also happen when a microbe gets into your body through a break in your skin from surgery or drug use.3 The resulting infection is usually fairly mild, but it sometimes becomes serious. Areas of your heart that can become infected and inflamed include the chamber and valves (endocarditis), the protective sac around your heart (pericarditis), and the muscular layer of your heart (myocarditis). Heart Failure The most common cause of heart failure is cardiomyopathy, a condition in which there is an abnormality in the heart muscle. Dilated cardiomyopathy, which is characterized by a prominent enlargement, thinning, and stretching of the left ventricle, is the most common type of cardiomyopathy. The exact cause of dilated cardiomyopathy is unknown, but it may be due to damage to the heart that results in less blood flow. You can either be born with this heart defect or it can result from things that cause thinning and stretching of the left ventricle, including drug use, a heart infection, an alcohol use disorder, a heart attack, or other types of heart disease like high blood pressure and arrhythmias.4 Hypertrophic cardiomyopathy is usually due to a genetic disorder of the heart that produces a thickening (hypertrophy) of the heart muscle. It can produce several kinds of cardiac problems, including heart failure. The severity of hypertrophic cardiomyopathy varies tremendously from person to person and is related to the specific genetic variant (of which there are many) that is producing it. This type of cardiomyopathy can also occur over time from high blood pressure or aging. Restrictive cardiomyopathy, which causes the heart to become stiff and rigid, is the least common type. It can happen for no reason or it can be caused by conditions such as connective tissue disorders, a buildup of iron or protein in your body, and by certain treatments for cancer. Other conditions that can weaken and damage your heart, leading to heart failure, include: Coronary artery disease Heart attack High blood pressure Damaged heart valves Myocarditis, a heart infection Congenital heart defects Heart arrhythmias Chronic diseases like diabetes, thyroid disease, and HIV Too much iron or protein in your body Acute (sudden) heart failure can be caused by: Viruses that attack the heart Allergic reaction Blood clots in your lungs Severe infections Certain medications Illnesses that affect your entire body Genetics There are many inherited heart diseases or conditions that affect your heart, including: Arrhythmogenic right ventricular cardiomyopathy: This inherited disorder causes the muscle tissue in your heart to die and be replaced by fatty, scar tissue. ARVD is rare, but it can cause arrhythmias, heart failure, and sudden cardiac death in young people.5 Brugada syndrome: This is a family of inherited cardia arrhythmias. In people who have one of the forms of Brugada syndrome, dangerous arrhythmias can be triggered by various drugs and electrolyte imbalances. In this syndrome, there's a defect in the channels where your heart's electrical activity takes place, leading to potentially life-threatening heart arrhythmias. Cardiac amyloidosis: This is a type of restrictive cardiomyopathy in which the heart becomes stiff and rigid because of protein clumps replacing normal heart tissue. It can be inherited, but it can also be caused by other diseases. Cardiac myxoma: This non-cancerous heart tumor is inherited in around 1 in 10 cases. It can cause heart arrhythmias, block blood flow, and lead to an embolism, in which tumor cells break off and travel through the bloodstream. Familial dilated cardiomyopathy: While many causes of dilated cardiomyopathy are unknown, up to one-third of people who develop this condition inherit it from their parents, known as familial dilated cardiomyopathy. Familial valvular heart disease: Valve disorders and defects can be congenital, meaning you're born with them, due to gene mutations.6 The most common congenital valve abnormalities are the bicuspid aortic valve, mitral valve prolapse, pulmonary valve stenosis, and Ebstein anomaly of the tricuspid valve. Hypertrophic cardiomyopathy: This type of cardiomyopathy is usually inherited due to a change in the genes of the proteins in your heart muscle that causes it to thicken. Long QT syndrome: This abnormality in the heart's electrical system is usually inherited, but can also be caused by drug use, and can produce a severe arrhythmia that causes fainting or sudden death. Loeyz-Dietz syndrome: This genetic disorder causes the aorta, the blood vessel through which blood flows from the heart to the rest of the body, to become enlarged. This can stretch and weaken it, resulting in an aneurysm, a bulge in the aortic wall, as well as tears in the wall. People with this syndrome are often born with heart defects like an atrial septal defect, patent ductus arteriosus, or bicuspid aortic valve. Marfan syndrome: This genetic disorder affects the aorta in the same way as Loeyz-Dietz syndrome. The two syndromes can be distinguished by the different gene mutations they each have. Familial hypercholesterolemia: This inherited disorder, which is caused by a chromosomal defect, begins at birth and results in extremely high LDL cholesterol (the "bad" type), putting you at high risk of developing atherosclerosis. Heart attacks at a young age can occur as a result. Lifestyle Risk Factors Most of the risk factors for heart disease involve your lifestyle choices. This means that you can lower your chances of developing heart disease by pinpointing the areas that put you at risk and taking steps to change them. Smoking: Smokers are more likely to develop atherosclerosis and have heart attacks.7 This is because carbon monoxide can damage the lining of your blood vessels and nicotine raises your blood pressure. Being around other people's smoke can also increase your risk of developing heart disease. Unhealthy diet: A diet that's high in fat, sugar, and cholesterol can contribute to developing heart diseases like atherosclerosis.8 Consuming too much salt can lead to high blood pressure. Eating a diet that's rich in fruits, vegetables, and whole grains can help reduce your risk. Obesity: Being obese increases your risk of heart disease because it leads to other risk factors such as high cholesterol, diabetes, and high blood pressure.9 Sedentary lifestyle: Regular exercise lowers your risk for heart disease in part by helping to keep your cholesterol lower, your diabetes controlled, your weight down, and, for some people, blood pressure lower. Excessive alcohol consumption: Drinking too much alcohol can result in raised blood pressure and it increases your cholesterol level, which can lead to atherosclerosis.10 It can also cause heart arrhythmias, stroke, and cardiomyopathy. Limit your alcohol consumption to two drinks a day for men and one drink a day for women. Stress: The exact relationship between stress and heart disease is still being studied, but excessive and prolonged stress definitely contributes to long-term illnesses like high blood pressure. Stress may also influence your behavior and the lifestyle risks you take that contribute to heart disease. For instance, you may drink more alcohol and/or smoke when you're under stress, both known contributors to developing heart disease. Poor hygiene: When you don't regularly wash your hands, you're more at risk for picking up bacteria and viruses that can lead to a heart infection, particularly if you already have a heart condition. Poor dental hygiene can also lead to heart disease, especially heart infections.11 Other Risk Factors There are some risk factors that you have no control over, including: Age: As you get older, your heart muscle may get weaker and/or thicker and your arteries may become damaged. Most people who die from heart disease are age 65 or older.12 Sex: Men have a higher risk of having a heart attack than women do and they're more at risk to develop heart disease. Women's risk increases after menopause but is still lower than men's. Heredity: If you have a family history of heart disease, your risk is greater, especially if it involves one or both of your parents and diagnosis was made before the age 55 in a man or before age 65 in a woman.13 Race: African Americans, Mexican Americans, Native Americans, Native Hawaiians, and some Asian Americans have higher rates of heart disease. Certain treatable medical conditions can also increase your risk of heart disease, including: High blood pressure: When the pressure in your arteries and blood vessels is too high, it causes high blood pressure, which, if uncontrolled, can lead to your arteries thickening and hardening. There are often no symptoms, so it's important to get your blood pressure checked periodically since it can be controlled with medication and/or lifestyle changes. High cholesterol: When you consume more cholesterol than your body can use, it builds up in your artery walls, including the arteries in your heart. This can cause your arteries to narrow and atherosclerosis to occur, decreasing blood flow to your heart and other organs. Cholesterol can also be elevated due to the body producing too much cholesterol or the body not adequately getting rid of cholesterol. Like high blood pressure, high cholesterol can also be treated with lifestyle modifications and/or medication. Diabetes: Even when your blood sugar levels are under control, your risk of heart disease and stroke is higher than that of the general population, especially if your diabetes is poorly controlled. The risk of death from heart disease is also much higher in people who have diabetes.14 It's important to make sure that your blood sugar level is well-controlled and that your doctor is monitoring your heart health closely as well, especially as you get older. Keep in mind that your chance of developing heart disease increases with each additional risk factor that applies to you, so work with your doctor to keep these medical conditions treated and under control. Heart Disease Doctor Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Doctor Discussion Guide Old Man DOWNLOAD PDF Email the GuideSend to yourself or a loved one. Enter your email SIGN UP Determining Your Risk If your doctor has not performed a formal cardiac risk assessment, you should estimate your risk yourself. If your risk appears to be intermediate or high, you need to talk to your doctor about taking aggressive measures to prevent heart disease. To assess your own risk of heart disease, you need to consider the following information: Smoking history Your total and HDL cholesterol levels Your blood pressure Whether you have evidence of diabetes or metabolic syndrome Whether you are overweight for your age and height Whether close relatives have had premature heart disease With this information, you can place yourself into one of three categories: low, intermediate, or high. Of course, if you believe you are at risk and have trouble performing this assessment yourself, speak with your doctor about your concern and ask that he or she assist you. Low-Risk Category All of the following must be present: Nonsmoker Total cholesterol less than 200 mg/dL, HDL cholesterol greater than 40 mg/dL Systolic blood pressure less than 120, diastolic blood pressure less than 80 No evidence of diabetes Not overweight No family history of premature cardiovascular disease If you are at low risk, you don't need any special medical interventions to reduce your risk, except perhaps for routine coaching on maintaining a healthy lifestyle. About 35 percent of American adults fall into this category. High-Risk Category You're at high risk if any of the following apply to you: Known coronary artery disease or another vascular disease Type 2 diabetes Over age 65 with more than one risk factor If you're in the high-risk group, this means one of two things: Either your risk of developing heart disease within the next few years is quite high, or you already have heart disease and are unaware. Unfortunately, a substantial proportion of people who learn they're in the high-risk category turn out to already have significant coronary artery disease (CAD). They just don't know about it because, so far, they aren't having symptoms. Having a high risk for heart disease is very serious and requires a very serious response. About 25 percent of American adults are in the high-risk category. Intermediate Risk Category You're in this group if you don't fit into either the low- or high-risk groups. If you're in this group, you should take aggressive steps to modify the risk factors keeping you out of the low-risk category. Also, you should discuss with your doctor whether further testing should be done to characterize your risk more accurately. Such testing might include having your C-reactive protein (CRP) level measured and getting a calcium scan.

Symptoms of Heart Disease

Symptoms of Heart Disease By Richard N. Fogoros, MD Medically reviewed by Yasmine S. Ali, MD, MSCI Updated on April 05, 2020 Print Heart Disease Heart Disease Overview Symptoms Causes Diagnosis Treatment In This Article Frequent Symptoms By Condition Complications When to See a Doctor When to Go to the Hospital There are many different kinds of heart disease, and while each can produce its own set of symptoms, there are some key ones that many types share. These frequent symptoms include chest pain or discomfort, palpitations, lightheadedness or dizziness, fainting, fatigue, and shortness of breath. However, sometimes heart disease has no symptoms at all, especially if it's in the early stages. heart disease symptoms © Verywell, 2018 Frequent Symptoms Here are some of the symptoms most frequently found in many types of heart disease: Chest Pain or Discomfort Few symptoms are more alarming than chest pain, and while many other conditions can cause chest pain, cardiac disease is so common—and so dangerous—that this symptom should never be dismissed or considered insignificant. Chest pain is an imprecise term. It's often used to describe any pain, pressure, squeezing, choking, numbness, or other discomforts in the chest, neck, or upper abdomen, and it's often also associated with pain in the jaw, head, or arms. Depending on its cause, chest pain may last from less than a second to days or weeks; might occur frequently or rarely; and might occur completely randomly or under predictable circumstances. Sorting through these variations can help your doctor determine the actual cause of your chest discomfort, in particular, whether it represents angina or some other serious problem.1 Palpitations Noticeable differences in your heartbeat, whether that means it's rapid, unusually strong, or irregular, are classified as palpitations. They are an extremely common symptom of heart disease. Many people who complain of palpitations describe them either as "skips" in the heartbeat (that is, a pause, often followed by a particularly strong beat) or as periods of rapid and/or irregular heartbeats. Most people with palpitations have some type of cardiac arrhythmia, an abnormal heart rhythm. There are many types of arrhythmias, and almost all can cause palpitations. The most common causes of palpitations are premature atrial complexes (PACs), premature ventricular complexes (PVCs), episodes of atrial fibrillation, and episodes of supraventricular tachycardia (SVT).2 Unfortunately, on occasion, palpitations can signal a more dangerous heart arrhythmia, such as ventricular tachycardia.3 Palpitations are more likely to signal a serious cause if they're accompanied by episodes of lightheadedness or dizziness. Lightheadedness or Dizziness Episodes of lightheadedness or dizziness can have many causes including anemia (low blood count) and other blood disorders; dehydration; viral illnesses; prolonged bed rest; diabetes; thyroid disease; gastrointestinal disturbances; liver disease; kidney disease; vascular disease; neurological disorders; dysautonomias; vasovagal episodes; heart failure; and cardiac arrhythmias. Because so many different conditions can produce these symptoms, if you experience episodes of lightheadedness or dizziness, you ought to have a thorough and complete examination by your physician. Fatigue, Lethargy, or Daytime Sleepiness Fatigue, lethargy, and somnolence (daytime sleepiness) are very common symptoms. Fatigue or lethargy can be thought of as tiredness, exhaustion, or loss of enthusiasm that makes it difficult to function at your normal level. Somnolence implies that you either crave sleep or, worse, that you find yourself suddenly asleep during the daytime, a condition known as narcolepsy. While fatigue and lethargy can be symptoms of heart disease (particularly heart failure), these common and non-specific symptoms can also be due to disorders of virtually any other organ system in the body. If you suffer from fatigue or lethargy, you need a general medical evaluation in order to begin pinning down a specific cause. Somnolence is often caused by nocturnal sleep disorders such as sleep apnea, restless leg syndrome, or insomnia. All these sleep disturbances, however, are more common if you have heart disease. Dyspnea (Shortness of Breath) Dyspnea, the medical term for shortness of breath, is most often a symptom of cardiac or pulmonary (lung) disorders. Heart failure and coronary artery disease frequently produce shortness of breath among other symptoms. If you have heart failure, you may commonly experience dyspnea with exertion, or orthopnea, which is dyspnea when lying flat. You may also suddenly wake up at night gasping for breath, a condition known as paroxysmal nocturnal dyspnea. Other cardiac conditions such as heart valve disease or pericardial disease can produce dyspnea, as can cardiac arrhythmias.4 Syncope (Fainting/Loss of Consciousness) Syncope is a sudden and temporary loss of consciousness or fainting. It's a common symptom (most people pass out at least once in their lives) and often does not indicate a serious medical problem. However, sometimes syncope indicates a dangerous or even life-threatening condition, so it's important to figure out the cause. The causes of syncope can be grouped into four major categories: neurologic, metabolic, vasomotor, and cardiac. Of these, only cardiac syncope carries a serious threat of causing sudden death.5 Vasomotor syncope, commonly called vasovagal syncope, is by far the most common cause. It happens when your body reacts to certain triggers such as severe emotional stress or seeing blood or needles. Neurologic and metabolic syncope are relatively rare. Any loss of consciousness should be evaluated by a doctor. By Condition These are the symptoms that are common to some of the major types of heart disease, including atherosclerotic disease, cardiac arrhythmias, heart valve disease, heart infections, and heart failure. Atherosclerotic Disease Atherosclerosis is caused by a buildup of plaque within blood vessels. Symptoms occur when the atherosclerotic plaques restrict blood flow to one or more of the body's vital organs, particularly the heart or the brain.6 Symptoms of atherosclerosis often include: Pain or discomfort in your chest, including tightness or pressure (angina) Shortness of breath (dyspnea) Numbness, weakness, coldness, or pain in your legs or arms Pain in your neck, jaw, back, upper abdomen, or throat Nausea Fatigue Cardiac Arrhythmias While many people with cardiac arrhythmias (abnormal heartbeats) have no symptoms whatsoever, any type of arrhythmia has the potential to produce palpitations, weakness, or lightheadedness. Other symptoms can include:7 Slow heartbeat (bradycardia) Fast heartbeat (tachycardia) Pain in your chest Shortness of breath Feeling dizzy Fainting (syncope) Heart Valve Disease Symptoms of heart valve disease depend on which of the four valves isn't working right, but they can include:8 Shortness of breath Fatigue Irregular heartbeat Swollen feet or ankles Pain in your chest Fainting Heart Infections If you have an infection in your heart, symptoms may include:9 Fever Chills Night sweats Shortness of breath Fatigue Weakness Swelling in your legs, feet, or abdomen Abnormal heartbeat Pain in the center or left side of your chest that often gets worse when you lie down or take a deep breath A dry cough that may be persistent Rash or strange spots Weight gain Heart Failure Heart failure, which is due to a weak heart muscle and is also a potential complication of heart disease, may not cause noticeable symptoms in its early stages. As it gets worse, the most prominent symptoms are shortness of breath (dyspnea) when exerting yourself and/or when you're resting, becoming easily fatigued, and an irregular heartbeat that may feel fast or like it's pounding.10 Other symptoms can include: Swelling in your legs, ankles, and feet Feeling dizzy or lightheaded Fainting Complications Potential complications of heart disease illustrate the importance of getting treatment and living a healthy lifestyle. They include:11 Heart failure: One of the most common complications of heart disease, heart failure occurs when your heart becomes damaged and weak, leaving it unable to pump your blood the way it should. Heart failure can be the result of many different types of heart disease such as heart attack, coronary artery disease, high blood pressure, congenital heart defects, valve disorders, and heart infections. Heart attack: A blockage in one or more of your coronary arteries can cause a heart attack. Atherosclerotic disease is usually the culprit of this complication. Stroke: Also usually caused by atherosclerotic disease, a stroke occurs when the arteries to your brain are blocked and don't allow enough blood flow. This is an emergency because your brain tissue starts to die within minutes of this occurring. Aneurysm: A bulge in the wall of an artery is called an aneurysm. This can occur anywhere in your body and, if it ruptures, it can be a life-threatening situation. One of the causes of aneurysms is atherosclerosis, hardening of the arteries.12 Peripheral artery disease: This type of atherosclerotic disease is technically a complication of atherosclerosis. When you have peripheral artery disease, the blood flow to your extremities, especially your legs, is poor, potentially causing pain, numbness, and infections.13 Sudden cardiac arrest: Often caused by a cardiac arrhythmia (abnormal heartbeat), sudden cardiac arrest happens when your heart stops working, causing you to lose consciousness and stop breathing. If you don't get emergency treatment, it will result in death. When to See a Doctor The symptoms most commonly caused by heart disease can also be produced by other medical conditions, from very serious to entirely benign. If you experience any of the above symptoms, you need an evaluation by your doctor to identify the cause. These are symptoms that should never be ignored. Additionally, if you're having any difficulty getting an erection, especially if the problem has been gradual, this is nearly always one of the first signs of either heart disease or diabetes in men. Be sure to see your doctor as soon as you notice any problem with erectile dysfunction.14 If you have a family history of heart disease or you're worried about your risk for developing it, be sure to talk to your doctor. Staying proactive where your heart health is concerned can help you detect any problems early, giving you a better potential outcome. Heart Disease Doctor Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Doctor Discussion Guide Old Man DOWNLOAD PDF Email the GuideSend to yourself or a loved one. Enter your email SIGN UP When to Go to the Hospital You need to seek emergency treatment if you have any of these symptoms: Chest Pain Chest pain should always be considered a serious symptom because it can indicate an emergency situation. If you're experiencing chest pain and any of these factors apply to you, you should seek emergency care: You have a strong family history of early heart disease. You're 45 years old or older and you have any of the risk factors for coronary artery disease, including obesity, smoking, family history, diabetes, high cholesterol, or a sedentary lifestyle. The pain is worse than any other chest pain you've had. The pain feels like it's spreading to your neck, shoulders, arms, back, or jaws. The pain is crushing, tight, heavy, or feels like squeezing. You also feel nauseous, weak, short of breath, dizzy, sweaty, or you've fainted. You feel like something is very wrong. The pain keeps getting worse as the minutes pass. The pain is unlike anything you've experienced before. Heart Attack Symptoms If you have symptoms of a heart attack, be sure to seek emergency medical care. These symptoms include:15 Chest or arm pain, pressure, or discomfort that may spread to your neck, back, or jaw Shortness of breath Heartburn, indigestion, nausea, or pain in your abdomen Breaking out in a cold sweat Fatigue Feeling lightheaded or dizzy Stroke Symptoms If you have symptoms of a stroke, you need to seek emergency medical care. These include:13 Difficulty speaking or difficulty understanding someone else when they're speaking Confusion Weakness Numbness or paralysis of your arms, face, or legs, usually on one side of your body Visual disturbances such as blurry, black, or double vision in one or both eyes Severe headache Dizziness and loss of coordination Fainting Difficulty breathing If you're with a loved one and suspect he or she is having a stroke, use these measures to help you determine if there's a problem:16 Ask your loved one to smile. If one side of his or her face droops, this can indicate a stroke. Ask your loved one to raise both arms. If one arm starts to fall down or he or she can't raise one arm, this is a sign of stroke. Have your loved one repeat a sentence back to you. Slurred or unusual speech is another symptom. Call 911 immediately if any of the above symptoms occur. With a stroke, every minute counts. The longer your loved one goes without blood to his or her brain, the more damage there can be. Sudden Cardiac Arrest A sudden cardiac arrest is dramatic, happens fast, and can result in death if it's not treated immediately. If a loved one has these symptoms, call 911 right away: Collapsing suddenly No pulse Not breathing Unconscious

What Is Heart Disease?

What Is Heart Disease? By Richard N. Fogoros, MD Medically reviewed by Jeffrey S. Lander, MD Updated on June 18, 2020 Heart Disease Overview Symptoms Causes Diagnosis Treatment In This Article Types Symptoms Causes Diagnosis Treatment Coping Prevention Heart disease is the generic term used for a wide variety of heart conditions that can affect the heart muscle, valves, vessels, structure, electrical system, or coronary arteries. Heart disease includes conditions such as cardiac arrhythmias, high blood pressure, heart failure, coronary artery disease, valve disorders, and congenital heart defects. Though each disease affects the heart differently, the ultimate problem with all varieties of heart disease is that, in one way or another, they can disrupt the vital pumping action of the heart. Heart disease is the leading cause of death in the United States for both men and women. Types of Heart Disease Verywell / Emily Roberts The Cardiac System The heart is fundamentally a powerful and tireless pump. It consists of muscular chambers that contract to push the blood through the vascular system and a series of valves that keep the blood moving efficiently and in the right direction. There's a self-regulating electrical system that determines your heart rate and coordinates the sequential beating of the various cardiac chambers. To do all this muscular work around the clock, your heart needs a large and continuous supply of oxygen-rich blood. The coronary arteries are the vessels that supply this blood to the heart muscle, so they are critically important to the heart and to life. Types of Heart Disease The normal function of the heart and the vascular system can be disrupted by a large variety of conditions. Several umbrella categories are often used to bucket them. Atherosclerotic Disease While many, many disease processes can affect the blood vessels, the term “cardiovascular disease” commonly encompasses the blood vessel (vascular) disorders that are related either to atherosclerosis, hypertension, or heart disease.1 Atherosclerosis is a disease in which plaque, made up of fat, calcium, cholesterol, and other substances builds up and hardens in your arteries, intruding on blood flow. There are different types of atherosclerotic diseases, including coronary artery disease, carotid artery disease, and peripheral artery disease. Coronary artery disease (CAD) is prevalent in Western societies, can lead to heart attacks, and is the most common type of heart disease.2 In CAD, atherosclerotic plaques form in the lining of the coronary arteries, hardening and narrowing the arteries. Atherosclerosis and high blood pressure (hypertension) can not only lead to coronary artery disease, but also carotid artery disease, which affects the carotid arteries on both sides of your neck, and peripheral artery disease, which can affect almost any other artery in the body.3 Strokes and transient ischemic attacks (TIAs) are also often due to atherosclerotic disease. Cardiac Arrhythmias Cardiac arrhythmias are disorders of the heart’s electrical system. The electrical system of the heart is responsible for setting the heart rate (how fast the heart beats) and coordinating the organized, sequential contraction of the heart muscle in the atria and the ventricles. Disorders of the heart’s electrical system generally tend to produce either heart rates that are too slow (bradycardia), or heart rates that are too fast (tachycardia).1 With either slow or fast cardiac arrhythmias, the normal sequence of heart muscle contraction may also be disrupted. Heart Valve Disease The four heart valves (tricuspid, pulmonary, mitral, and aortic) play a critical role in cardiac function. They assure that when the heart beats, the blood moves freely through the cardiac chambers and flows in the right direction. In general, heart valve disease produces two general types of problems. Either the valve becomes partially obstructed, which impedes blood flow (called stenosis), or the valve becomes leaky, allowing blood to flow in the wrong direction when the heart muscle contracts (called regurgitation).1 In either case, if the valvular disease becomes severe enough, heart failure can result. In addition, a valvular disease sometimes produces cardiac arrhythmias, especially atrial fibrillation. Heart Infections Though our hearts can usually fight off infections, they can still occur. These infections are more common in adults who are 60 years or older, especially those with an underlying heart condition. Types of infections include endocarditis (inflammation in your heart's chamber and valves), pericarditis (inflammation in the protective sac around your heart), and myocarditis (inflammation in the muscular area of the heart).4 Heart Failure Heart failure is an all too common end result of many different types of heart disease. In heart failure, heart damage of one form or another leaves the heart unable to perform all the work it must to fulfill the body’s needs. Blood is no longer pumped effectively throughout the body and stays in the heart.1 It can be chronic or sudden. Numerous symptoms may result; some degree of disability is common, as is an early death. Treatment of heart failure has advanced significantly in recent decades, and many people with heart failure are now able to live quite well for many years. Heart Disease Symptoms The symptoms of heart disease depend on what condition you have. However, the most common ones that are found in many of the different types of heart disease include chest pain or discomfort, palpitations, lightheadedness or dizziness, fainting, fatigue, and shortness of breath.5 Heart Disease Signs and Symptoms Causes Because there are many types of heart disease, there are many different causes. Some causes are unclear and some are obvious, such as a genetic abnormality, a birth defect, or as the result of certain underlying conditions or medication or drug use. Many of the risk factors for heart disease are based on lifestyle choices, such as diet, activity level, weight, smoking, and making sure chronic conditions are treated and controlled. Heart Disease Causes and Risk Factors Diagnosis To diagnose heart disease, your doctor will do a thorough medical history, perform a detailed physical exam, and choose from a variety of tests. Depending on what your doctor is looking for, these tests may include an electrocardiogram, an echocardiogram, ambulatory monitoring, a cardiac computerized tomography (CT) scan, a cardiac magnetic resonance imaging (MRI) study, stress testing, an electrophysiology study, or a tilt table study.6 How Heart Disease Is Diagnosed Treatment The treatments for heart disease are variable and depend on what type you have. For pretty much all kinds of heart disease, lifestyle changes such as a heart-healthy diet, daily exercise, weight loss, smoking cessation, and stress management are key. In the event that these changes don't help, your doctor may prescribe medications. There are many options that may be considered, from ACE inhibitors to anticoagulants, beta blockers to calcium channel blockers, and more.7 There are also surgeries, special procedures, and medical devices that can be used for severe or special cases. How Heart Disease Is Treated Coping If you're diagnosed with heart disease, rest assured that treatments have come a long way and people with it are living longer than ever. Coping with heart disease means making some lifestyle changes, learning about the symptoms to watch for, and perhaps taking medications. Lifestyle modifications that you may need to implement include smoking cessation, eating a healthy diet, getting regular exercise, losing weight, and learning to cope with stress. Coping With Heart Disease Prevention The most common forms of heart disease are largely preventable if you pay attention to your cardiac risk factors and take reasonable steps to reduce them. Ideally, you should work with your doctor to perform a formal risk assessment, but you can do a reasonably accurate risk assessment yourself as well. If your risk is low, that's great. Just keep in mind the things you ought to be doing (and not doing) to keep it that way. On the other hand, if your cardiac disease risk is substantially elevated, use that as motivation to influence the risk factors you have some control over. Reducing or eliminating risk factors as soon as possible is ideal. And often, the high-risk people who are most successful in doing this are the ones who do adopt a "change it all now" attitude. For example, they'll stop smoking, adopt an exercise program, and change their diet all at once. Improving their heart health becomes a driving force by which all choices are made. Tackling each risk factor one by one with a more gradual approach to lifestyle changes, in this case, may not be as effective. While you are working to quit smoking, for example, a poor diet and lack of exercise may be continuing to pose risks that can have a serious effect on your heart health. Likewise, a sole focus on changing one habit may push the addressing of others to the bottom of the list—or off the priority list entirely, with time. Given the consequences of heart disease, making as many of the changes you need to make as soon as you can make them is worth your time and effort. That said, everyone is different, and whatever works for you is, in the end, the best approach. The success that comes with time is better than change that never happens at all. Share your approach, your achievements, and your struggles with your doctor, who can help guide you along the way. A Word From Verywell People who educate themselves and take an active role in making clinical decisions tend to have the best medical outcomes. There are many different kinds of heart disease, and they all have different causes, severities, and treatments. If you have heart disease, you are likely to live a much longer and healthier life if you learn all you can about your particular cardiac problem. With that knowledge, you will be able to work more closely with your doctor and adopt the kinds of treatments that are best suited to you.

TMAO and Gut Bacteria's Role in Cardiovascular Health

TMAO and Gut Bacteria's Role in Cardiovascular Health By Cleveland Clinic Medically reviewed by Richard N. Fogoros, MD on December 03, 2019 Heart Disease Heart Disease Overview Symptoms Causes Diagnosis Treatment Gut bacteria and heart health TLFurrer/iStockphoto Most doctors used to advise watching how often you eat meat, eggs, and high-fat dairy products due to the elevated levels of saturated fat and cholesterol they contain. Consuming saturated fat can raise levels of low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol and the type implicated in increasing one's risk of cardiovascular disease and its outcomes, like heart attack and stroke. But the degree of the connection between dietary fats and cholesterol and heart disease has recently been questioned. Today, we know that most cholesterol is produced by the liver and only 15 to 20 percent comes from your diet. This finding is not a license to feast on bacon, eggs, and buttered toast, however. Experts still recommend you eat these foods in moderation. Although these foods may not raise your cholesterol as much as previously thought, they wreak havoc on your cardiovascular health in a different way. Studies have found a direct link between the chemical products created in the gut when these foods—which are common in a Western diet—are eaten and the occurrence of heart attack, stroke, heart failure, and death, the major adverse outcomes of cardiovascular disease. Digestion Is Key Our gut is swarming with bacteria that serve as a filter for our largest environmental exposure—the food we eat. “What we feed these bacteria over time influences what happens throughout our bodies,” says Stanley Hazen, MD, Ph.D., Section Head of Preventive Cardiology at Cleveland Clinic, who has led the institution’s research in this area. Dr. Hazen’s laboratory conducted key studies discovering a mechanistic link between gut microbes and heart disease via a substance called trimethylamine-N-oxide (TMAO). TMAO is formed from nutrients commonly found in animal products. These studies and subsequent key findings showed how certain bacteria in the intestines turn choline—a byproduct of lecithin found in meat, egg yolks, and high-fat dairy products—into trimethylamine (TMA), which is absorbed into the bloodstream and metabolized by the liver. There, TMA is transformed into TMAO, which appears to be a key player in a number of disease processes linked to the heart and blood vessel walls. Moreover, these studies revealed a clear link between higher TMAO levels and higher rates of heart attack, stroke, and death within three years in humans, as well as accelerated heart disease in animal models. Dr. Hazen’s lab also showed that the same gut microbe-based process plays a role in accelerated heart disease following ingestion of L-carnitine, a compound that is found naturally in most red meats but is also a frequent additive to energy drinks. The study found that the gut also turns L-carnitine into TMA (and then TMAO) and that TMAO contributes to heart disease in part by changing how the body uses cholesterol. TMAO also was shown to trigger inflammation in blood vessels and to create unstable plaques in artery walls, thereby raising the risk of heart attack. Heart Failure Further studies by Dr. Hazen’s team have shown a link between the TMAO pathway and heart failure. When they examined the role of TMAO in patients with stable heart failure, they found that the higher the TMAO level, the greater the risk of cardiovascular death. “This risk held true regardless of other traditional risk factors and regardless of kidney function or blood markers indicating heart strain,” notes Dr. Hazen. In this study, higher TMAO levels more than tripled the risk of death. Kidney Disease Traditional risk factors don’t account for the increased cardiovascular risk in patients with impaired kidney function (conditions called chronic kidney disease and end-stage kidney disease). Dr. Hazen’s team found a connection between the TMAO pathway, kidney disease, and the heightened cardiovascular risks observed in people with diminished kidney function. In addition to showing a link between TMAO and elevated cardiovascular risk in subjects with impaired kidney function, they found (in animal models) that consuming increased levels of choline via diet and exposure to high levels of TMAO over time triggers scar tissue formation (fibrosis) in the kidneys. This can cause kidney function to deteriorate. In one study, Dr. Hazen observed people with and without kidney disease for five years. He found that those with high TMAO levels when the study began were more likely to have an accelerated decline in kidney function, a heart attack, a stroke, or die—compared to those with lower TMAO levels. Furthermore, as kidney function declines, TMAO levels rise because TMAO is excreted by the kidneys. “The higher TMAO levels observed may explain why people with serious kidney disease tend to have increased risk of dying from heart disease,” Dr. Hazen reports. More Research and Findings Dr. Hazen’s lab continues to investigate TMAO’s role in other disease processes. Studies to date confirm that gut microbes, through a generation of TMAO, are a major player in cardiovascular health. Most recently, studies from the Hazen lab point to TMAO's role in peripheral arterial disease—a disease of the leg arteries—and in the formation of blood clots that can lead to heart attack and stroke. The discovery that gut microbes and the TMAO pathway are linked to cardiovascular health opens the door for many potential advances. Improvements in dietary recommendations and nutrition are one obvious action. Another is that the recognition of this pathway is leading to new diagnostic tests and potential treatments targeting microbe processes that contribute to cardiovascular disease. The pioneering studies by Dr. Hazen’s team showed that targeting the first step in the creation of TMAO—production of TMA, which gets converted into TMAO by microbes—can help prevent atherosclerosis (hardening of the arteries) in animal models. This new approach holds promise for its eventual use as a preventive treatment for heart attack, stroke, and other manifestations of atherosclerosis. For example, when mice were fed diets rich in choline or carnitine (similar to a Western diet), they experienced accelerated atherosclerosis. When half the mice on the high-choline diet were given a naturally occurring substance that blocks the microbial pathway leading to TMAO formation, less atherosclerosis occurred. The natural substance used on the mice, found in cold-pressed, extra-virgin olive oil and grape seed oil, was also shown to be very safe, even in high doses. What This Means for You New evidence links gut microbes to metabolism and heart health. And diet is the single largest factor that impacts gut microbe composition and function. “The studies, to date, suggest that adopting a diet where one eats less meat and animal products, like a vegetarian or vegan diet as well as a Mediterranean diet, might be particularly beneficial, especially if you have high cardiovascular risk, heart failure, or chronic kidney disease,” says Dr. Hazen. As for the rest of us, he adds that it’s hard to say whether or not cutting down or cutting out red meat, dairy, and eggs might help us live longer, healthier lives. However, a blood test for TMAO is now available and Dr. Hazen notes that it can help individual patients determine whether his or her TMAO level is too high. “Knowing your TMAO level can give a clearer picture of your cardiovascular risk,” he says. Was this page helpful? Related Articles Mediterranean diet Understanding the Relationship Between Gut Bacteria and Heart Disease Medically reviewed by Richard N. 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