The arteries that supply blood to the heart are called the coronary arteries. If the heart's blood vessels narrow, the amount of blood they supply to the heart may be insufficient to provide the oxygen the heart needs. This oxygen deprivation is what causes a type of chest pain known as angina pectoris. A heavy, tight pain in the chest area characterizes angina, usually after some type of exertion. The pain usually recedes with rest.
Angina, also called angina pectoris, refers to pain or heavy pressure in the chest that is caused by reduced blood flow to the heart muscle an insufficient supply of oxygen to the heart tissue. It is typically described as squeezing, pressure, heaviness, tightness or pain in the chest. This chest pain may be severe or mild and is usually associated with physical exertion and relieved by rest. Angina can be a recurring problem or a sudden, acute health concern. It can be a warning sign of impending heart attack.
Angina is relatively common but can be hard to distinguish from other types of chest pain, such as the pain or discomfort of indigestion. If you have unexplained chest pain, seek medical attention right away.
Angina pectoris is known as cardiac "pain of effort". The arteries that supply blood to the heart are called the coronary arteries. If the heart's blood vessels narrow, as in atherosclerotic changes, the amount of blood they supply to the heart may be insufficient to provide the oxygen the heart needs. This oxygen deprivation is what causes a type of chest pain known as angina pectoris.
Symptoms associated with angina include:
- Chest pain or discomfort.
- Pain in your arms, neck, jaw, shoulder or back accompanying chest pain.
- Shortness of breath.
This may develop:
- Gradually over a period of time as atheromas develop.
- Suddenly, as the vessels constrict.
Factors that precipitate (bring on) an attack include:
- Heavy eating.
- Emotional stress.
The chest pain and discomfort common with angina may be described as pressure, squeezing, fullness or pain in the center of your chest. Some people with angina symptoms describe angina as feeling like a vise is squeezing their chest or feeling like a heavy weight has been placed on their chest. For others, it may feel like indigestion. The severity, duration and type of angina can vary. It is important to recognize if you have new or changing chest discomfort. New or different symptoms may signal a more dangerous form of angina (unstable angina) or a heart attack. Stable angina is the most common form of angina, and it typically occurs with exertion and goes away with rest. If chest discomfort is a new symptom for you, it is important to see your health care provider to find out what is causing your chest pain and to get proper treatment. If your stable angina gets worse or changes, seek medical attention immediately.
Characteristics of Stable Angina:
- Develops when your heart works harder, such as when you exercise or climb stairs.
- Can usually be predicted and the pain is usually similar to previous types of chest pain you have had.
- Lasts a short time, perhaps five minutes or less.
- Disappears sooner if you rest or use your angina medication.
Characteristics of Unstable Angina (A Medical Emergency).
- Occurs even at rest.
- Is a change in your usual pattern of angina.
- Is unexpected.
- Is usually more severe and lasts longer than stable angina, maybe as long as 30 minutes.
- May not disappear with rest or use of angina medication.
- Might signal a heart attack.
Angina in Women: A woman's angina symptoms can be different from the classic angina symptoms. For example, women often experience symptoms such as nausea, shortness of breath, abdominal pain or extreme fatigue, with or without chest pain. Or a woman may feel discomfort in her neck, jaw or back or stabbing pain instead of the more typical chest pressure. These differences may lead to delays in seeking treatment.
Signs and symptoms if angina pectoris that you should immediately report:
- Angina is characterized by a heavy or dull, tight pain, discomfort or pressure in the chest area with increasing intensity. It is usually centered under the breast bone (sternum), spreading to the left arm (or either or both arms) and up into the back, jaw, or neck, or any combination of these sites. The person may say something like, "It feels like an elephant is sitting on my chest".
- The pain occurs usually after some type of exertion, exercise or stress.
- Pale or flushed face.
- The person is freely perspiring.
- The person may be frightened or extremely upset.
- The pain usually recedes with rest.
Signs and symptoms may differ with individuals, but the symptoms are usually the same each time a person experiences an attack.
If your chest pain lasts longer than a few minutes and does not go away when you rest or take your angina medications, it may be a sign you are having a heart attack. Call 911 or emergency medical help. Arrange for transportation. Only drive yourself to the hospital as a last resort.
Angina is caused by reduced blood flow to your heart muscle. Your blood carries oxygen, which your heart muscle needs to survive. When your heart muscle is not getting enough oxygen, it causes a condition called ischemia. The most common cause of reduced blood flow to your heart muscle is coronary artery disease (CAD). Your heart (coronary) arteries can become narrowed by deposits called plaques. This is called atherosclerosis. This reduced blood flow is a supply problem in that your heart is not getting enough oxygen-rich blood. You may wonder why you do not always have angina if your heart arteries are narrowed due to fatty buildup. This is because during times of low oxygen demand when you are resting, for example, your heart muscle may be able to get by on the reduced amount of blood flow without triggering angina symptoms. But when you increase the demand for oxygen, such as when you exercise, this can cause angina.
Stable Angina. Stable angina is usually triggered by physical exertion. When you climb stairs, exercise or walk, your heart demands more blood, but it is harder for the muscle to get enough blood when your arteries are narrowed. Besides physical activity, other factors, such as emotional stress, cold temperatures, heavy meals and smoking, also can narrow arteries and trigger angina.
Unstable Angina. If fat-containing deposits (plaques) in a blood vessel rupture and a blood clot forms, it can quickly block or reduce flow through a narrowed artery, suddenly and severely decreasing blood flow to your heart muscle. Unstable angina can also be caused by blood clots that block or partially block your heart's blood vessels. Unstable angina worsens and is not relieved by rest or your usual medications. If the blood flow does not improve, heart muscle deprived of oxygen dies, a heart attack. Unstable angina is dangerous and requires emergency treatment.
Variant Angina. Variant angina, also called Prinzmetal's angina, is caused by a spasm in a coronary artery in which the artery temporarily narrows. This narrowing reduces blood flow to your heart, causing chest pain. Variant angina can occur even when you are at rest, and is often severe. It can be relieved with medications.
The following risk factors increase your risk of coronary artery disease and angina:
- Tobacco use. Chewing tobacco, smoking and long-term exposure to secondhand smoke damage the interior walls of arteries, including arteries to your heart, allowing deposits of cholesterol to collect and block blood flow.
- Diabetes. Diabetes is the inability of your body to produce enough insulin or respond to insulin properly. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, which is a form of sugar from foods. Diabetes increases the risk of coronary artery disease, which leads to angina and heart attacks by speeding up atherosclerosis.
- High blood pressure. Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. Over time, high blood pressure damages arteries.
- High blood cholesterol or triglyceride levels. Cholesterol is a major part of the deposits that can narrow arteries throughout your body, including those that supply your heart. A high level of the wrong kind of cholesterol, known as low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol), increases your risk of angina and heart attacks. A high level of triglycerides, a type of blood fat related to your diet, also is undesirable.
- History of heart disease. If you have coronary artery disease or if you have had a heart attack, you are at a greater risk of developing angina.
- Older age. Men older than 45 and women older than 55 have a greater risk than do younger adults.
- Lack of exercise. An inactive lifestyle contributes to high cholesterol, high blood pressure, type 2 diabetes and obesity. However, it is important to talk with your health care provider before starting an exercise program.
- Obesity. Obesity raises the risk of angina and heart disease because it is associated with high blood cholesterol levels, high blood pressure and diabetes. Also, your heart has to work harder to supply blood to the excess tissue.
- Stress. Stress can increase your risk of angina and heart attacks. Too much stress, as well as anger, can also raise your blood pressure. Surges of hormones produced during stress can narrow your arteries and worsen angina.
The chest pain that can occur with angina can make some normal activities, such as walking, uncomfortable. However, the most dangerous complication to be concerned about with angina is a heart attack. Common signs and symptoms of a heart attack include:
- Pressure, fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes.
- Pain extending beyond your chest to your shoulder, arm, back, or even to your teeth and jaw.
- Increasing episodes of chest pain.
- Prolonged pain in the upper abdomen.
- Shortness of breath.
- Impending sense of doom.
- Nausea and vomiting.
If you are having sudden chest pain (unstable angina), call 911 or your local emergency number right away. If you think you may have recurring angina because your symptoms are brief and only occur during exercise, or you are worried about your angina risk because of a strong family history, make an appointment with your family practitioner. If angina is found early, your treatment may be easier and more effective.
To diagnose angina, your health care provider will start by doing a physical exam and asking about your symptoms. You will also be asked about any risk factors, including whether you have a family history of heart disease. There are several tests your doctor may order to help confirm whether you have angina:
- Electrocardiogram (ECG or EKG). An electrocardiogram traces the electrical signals that cause your heart to beat as they travel through your heart. Your practitioner can look for patterns among these heartbeats to see if the blood flow through your heart has been slowed, interrupted or if you are having a heart attack.
- Stress Test. Sometimes angina is easier to diagnose when your heart is working harder. During a stress test, you exercise by walking on a treadmill or pedaling a stationary bicycle. While exercising, your blood pressure is monitored and your ECG readings are watched. If you are unable to exercise, you may be given drugs that cause your heart to work harder to simulate exercising.
- Echocardiogram. An echocardiogram uses sound waves to produce images of the heart. These images are used to identify whether there are areas of your heart muscle that have been damaged by poor blood flow, a cause of angina. An echocardiogram is sometimes given during a stress test.
- Nuclear Stress Test. A nuclear stress test helps measure blood flow to your heart muscle at rest and during stress. It is similar to a routine stress test, but during a nuclear stress test, a radioactive substance is injected into your bloodstream. This substance mixes with your blood and travels to your heart. A special scanner, which detects the radioactive material in your heart, creates images of your heart muscle. Inadequate blood flow to any part of your heart will show up as a light spot on the images.
- Chest X-ray. This test takes images of your heart and lungs. This is to look for other conditions that might explain your symptoms and to see if you have an enlarged heart.
- Blood Tests. Certain heart enzymes slowly leak out into your blood if your heart has been damaged by a heart attack. Samples of your blood can be tested for the presence of these enzymes.
- Coronary Angiography. Coronary angiography uses X-ray imaging to examine the inside of your heart's blood vessels. It's part of a general group of procedures known as cardiac catheterization. During coronary angiography, a type of dye that is visible by X-ray machine is injected into the blood vessels of your heart. The X-ray machine rapidly takes a series of images (angiograms), offering a detailed look at your blood vessels.
- Cardiac Computerized Tomography (CT) Scan. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest, which can show if any of your heart's arteries are narrowed or if your heart is enlarged.
TREATMENT & MEDICATIONS
Treatment of angina pectoris consists of:
- Diagnosing hidden causes. A treadmill stress test is one method of doing this.
- Teaching the person to avoid stress and sudden exertion.
- Drugs that relax the coronary arteries.
- Coronary artery bypass surgery.
- Angioplasty, a surgical procedure to open the vessels.
There are many options for angina treatment, including lifestyle changes, medications, angioplasty and stenting, or coronary bypass surgery. The goals of treatment are to reduce the frequency and severity of your symptoms and to lower your risk of heart attack and death. However, if you have unstable angina or angina pain that is different from what you usually have, such as occurring when you are at rest, you need immediate treatment in a hospital.
Medications: If lifestyle changes alone do not help your angina, you may need to take medications. These may include:
- Nitrates. Nitrates are often used to treat angina. Nitrates relax and widen your blood vessels, allowing more blood to flow to your heart muscle. You might take a nitrate when you have angina-related chest discomfort, before doing something that normally triggers angina (such as physical exertion), or on a long-term preventive basis. The most common form of nitrate used to treat angina is with nitroglycerin tablets put under your tongue.
- Aspirin. Aspirin reduces the ability of your blood to clot, making it easier for blood to flow through narrowed heart arteries. Preventing blood clots can also reduce your risk of a heart attack. But do not start taking a daily aspirin without talking to your health care provider first.
- Clot-Preventing Drugs. Certain medications, such as clopidogrel (Plavix), prasugrel (Effient) and ticagrelor (Brilinta), can help prevent blood clots from forming by making your blood platelets less likely to stick together.
- Beta Blockers. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. As a result, the heart beats more slowly and with less force, thereby reducing blood pressure. Beta blockers also help blood vessels relax and open up to improve blood flow, thus reducing or preventing angina.
- Statins. Statins are drugs used to lower blood cholesterol. They work by blocking a substance your body needs to make cholesterol. They may also help your body reabsorb cholesterol that has accumulated in plaques in your artery walls, helping prevent further blockage in your blood vessels. Statins also have many other beneficial effects on your heart arteries.
- Calcium Channel Blockers. Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels by affecting the muscle cells in the arterial walls. This increases blood flow in your heart, reducing or preventing angina.
- Ranolazine (Ranexa). Ranexa can be used alone or with other angina medications, such as calcium channel blockers, beta blockers or nitroglycerin. Unlike some other angina medications, Ranexa can be used if you're taking oral erectile dysfunction medications.
Medical Procedures & Surgery: Lifestyle changes and medications are frequently used to treat stable angina. But procedures, such as angioplasty, stenting and coronary artery bypass surgery, also are used to treat angina.
- Angioplasty & Stenting. During an angioplasty, also called a percutaneous coronary intervention (PCI), a tiny balloon is inserted into your narrowed artery. The balloon is inflated to widen the artery, and then a small wire mesh coil (stent) is usually inserted to keep the artery open. This procedure improves blood flow in your heart, reducing or eliminating angina. Angioplasty and stenting is a good treatment option if you have unstable angina or if lifestyle changes and medications do not effectively treat your chronic, stable angina.
- Coronary Artery Bypass Surgery. During coronary artery bypass surgery, a vein or artery from somewhere else in your body is used to bypass a blocked or narrowed heart artery. Bypass surgery increases blood flow to your heart and reduces or eliminates angina. It is a treatment option for both unstable angina and stable angina that has not responded to other treatments.
Lifestyle Changes: If your angina is mild, lifestyle changes may be all you need to do. Even if your angina is severe, making lifestyle changes can still help. Because heart disease is often the cause of most forms of angina, you can reduce or prevent angina by working on reducing your heart disease risk factors. Preventing angina can be achieved by making these same lifestyle changes helping to improve your symptoms. Making lifestyle changes is the most important step you can take. These changes include the following:
- If you smoke, stop smoking. Avoid exposure to secondhand smoke.
- If you are overweight, talk to your practitioner about weight-loss options. Maintain a healthy weight.
- If you have diabetes, make sure that it is well-controlled and that you are following an optimal diet and exercise plan.
- Because angina is often brought on by exertion, it is helpful to pace yourself and take rest breaks.
- Avoid large meals that may you feel overly full.
- Avoiding stress is easier said than done, but try to find ways to relax. Use stress-reduction techniques.
- Eat a healthy diet with lots of whole grains, many fruits and vegetables, and limited amounts of saturated fat.
- Discuss with your health care provider about starting safe exercise plan. Increase your physical activity as recommended by your health care provider.
- If you must take anti-angina medications as prescribed, follow directions carefully.
- Treat diseases or conditions that can increase your risk of angina, such as diabetes, high blood pressure and high blood cholesterol.
CARING FOR A PERSON WITH ANGINA
If you are caring for a person with angina pectoris, you may assist them by first asking if they are on medication for angina. If the patient is being treated for angina and is on medication. If yes, then ask the patient if there is a pill or spray they can take for the angina pain. A patient with a previous bouts of angina usually have medication that can be taken (placed or sprayed under the tongue) to relieve pain. The most common medications of this type is nitroglycerin. The patient may have already taken nitroglycerin prior to your arriving to help them. If the patient has not had a nitroglycerin pill or spray within the last five minutes (it usually relieves pain within 5 minutes), then help the patient to place one of the tiny pills under their tongue or help the patient to administer the spray. If the pain is not relieved after the second dose of medication, assume the patient is having a heart attack and prepare to transport to the nearest medical facility for cardiac care.
You can assist the angina patient by:
Helping the patient to avoid unnecessary emotional or physical stress.
Encouraging the patient not to smoke.
Report any signs or symptoms of an attack to the patient's health care provider at once, especially if medication has not relieved pain within 10 minutes of initially taking it.
Arrhythmias are disturbances in the normal rhythm of a heartbeat. There are different kinds of arrhythmias. Some are quite dangerous - even immediately life-threatening - while others may be merely annoying (or scarcely noticeable), and pose no particular danger.
Cardiac arrhythmias are disruptions in the natural rhythm of the heartbeat that are caused by improper functioning of electrical system cells in the heart. When the electrical impulses that coordinate your heartbeats do not work properly, this causes your heart to beat too fast, too slow or irregularly. Heart arrhythmias may feel like a fluttering or racing heart and may be harmless. However some heart arrhythmias may cause bothersome, sometimes even life-threatening signs and symptoms. There are different kinds of arrhythmias.
- Palpitations is a term that refers to the feeling of a pounding heartbeat, whether regular or irregular.
- Tachycardia is an abnormal increase in the resting heart rate.
- Bradycardia is the opposite, and abnormally slow heart rate.
- Ectopic beats are premature beats (often felt as "skipped" beats).
- Flutter and fibrillation are situations in which the normal steady beating of the heart are converted by electrical error into a rapid twitching of the heart muscle. This ineffective functioning results in an insufficient supply of blood being carried to the body's tissues.
Electrical conduction in the heart originates in the SA node and travels through the AV node to the ventricles, resulting in a heart beat.
Cardiac arrhythmia (also dysrhythmia) is a term for any of a large and heterogenous group of conditions in which there is abnormal electrical activity in the heart. The heart beat may be too fast or too slow, and may be regular or irregular. Some arrhythmias are life-threatening medical emergencies that can result in cardiac arrest and sudden death. Others cause aggravating symptoms such as an abnormal awareness of heart beat, and may be merely annoying. Others may not be associated with any symptoms at all, but pre-dispose toward potentially life threatening stroke or embolus. Some arrhythmias are very minor and can be regarded as variants of normal. In fact, most people will sometimes feel their heart skip a beat, or give an occasional extra strong beat - neither of which are usually a cause for alarm. The term sinus arrhythmia refers to a normal phenomenon of mild acceleration and slowing of the heart rate that occurs with breathing in and out. It is usually quite pronounced in children, and steadily lessens with age.
The term cardiac arrhythmia covers a very large number of very different conditions. The commonest symptom of arrhythmia is an abnormal awareness of heartbeat, termed palpitations. These may be infrequent, frequent, or continuous. Some of these arrhythmias are harmless (though annoying) but many of them predispose to adverse outcomes. Some arrhythmias do not cause symptoms, and are not associated with increased mortality. However, some asymptomatic arrhythmias are associated with adverse events. Examples include increase in risk of blood clotting within the heart, and thus increase the risk of embolization and stroke, or increase in the risk of heart failure, or increase in the risk of sudden cardiac death. If an arrhythmia results in a heart beat that is too fast, too slow or too weak to supply the body's needs, this manifests as a lower blood pressure and may cause lightheadedness or dizziness, or fainting. Some types of arrhythmia result in cardiac arrest, or sudden death.
Heart arrhythmia treatment can often control or eliminate fast or irregular heartbeats. In addition, because troublesome heart arrhythmias are often made worse, or even caused, by a weak or damaged heart, you may be able to reduce your arrhythmia risk by adopting a heart-healthy lifestyle.
Arrhythmias may not cause any signs or symptoms. In fact, your health care provider might find you have an arrhythmia before you do, during a routine examination. Noticeable signs and symptoms do not necessarily mean you have a serious problem, however. Noticeable arrhythmia symptoms may include:
- A fluttering in your chest.
- A racing heartbeat (tachycardia).
- A slow heartbeat (bradycardia).
- Chest pain.
- Shortness of breath.
- Fainting (syncope) or near fainting.
Arrhythmias may cause you to feel premature or extra heartbeats, or you may feel that your heart is racing or beating too slowly. Other signs and symptoms may be related to your heart not pumping effectively due to the fast or slow heartbeat. These include shortness of breath or wheezing, weakness, dizziness, lightheadedness, fainting or near fainting, and chest pain or discomfort. Seek urgent medical care if you suddenly or frequently experience any of these signs and symptoms at a time when you would not expect to feel them.
Tachycardia is an abnormally fast heart rhythm. Common symptoms associated with tachycardia are palpitations, dizziness, chest pain, shortness of breath, and even fainting spells. Sometimes tachycardias are so mild that they are not even noticed; but some tachycardias may be life-threatening. Most cases of tachycardia are due to an abnormal electrical pathway known as a re-entry circuit. When an electrical impulse gets into the pathway, it may start traveling in a loop, causing the heart to contract with each impulse through the pathway. As a result, the heart beats very rapidly. Types of tachycardia that are most common among the general population include AV Nodal Re-entrant Tachycardia, accessory pathway tachycardia, atrial fibrillation, atrial flutter, and ventricular tachycardia.
Ventricular fibrillation is one type of arrhythmia that can be deadly. It occurs when the heart beats with rapid, erratic electrical impulses. This causes pumping chambers in your heart (the ventricles) to quiver uselessly instead of pumping blood. Without an effective heartbeat, blood pressure plummets, cutting off blood supply to your vital organs. A person with ventricular fibrillation will collapse within seconds and soon will not be breathing or have a pulse. If this occurs, follow these steps:
EMERGENCY STEPS: Call 911 or the emergency number in your area. If there is no one nearby trained in cardiopulmonary resuscitation (CPR), provide hands-only CPR. That means uninterrupted chest compressions of about 100 a minute until paramedics arrive. To do chest compressions, push hard and fast in the center of the chest. You do not need to do rescue breathing. If you or someone nearby knows CPR, begin providing it if it is needed. CPR can help maintain blood flow to the organs until an electrical shock (defibrillation) can be given. Find out if an automated external defibrillator (AED) is available nearby. These portable defibrillators, which can deliver an electric shock that may restart heartbeats, are available in an increasing number of places, such as in airplanes, police cars and shopping malls. They can even be purchased for your home. No training is required. The AED will tell you what to do. They are programmed to allow a shock only when appropriate.
Many things can lead to, or cause, an arrhythmia, including:
- A heart attack that is occurring right now.
- Scarring of heart tissue from a prior heart attack.
- Changes to your heart's structure, such as from cardiomyopathy.
- Blocked arteries in your heart (coronary artery disease).
- High blood pressure.
- Overactive thyroid gland (hyperthyroidism).
- Underactive thyroid gland (hypothyroidism).
- Drinking too much alcohol or caffeine.
- Drug abuse>
- Certain prescription medications.
- Certain dietary supplements and herbal treatments.
- Electrical shock.
- Air pollution.
THE NORMAL HEART BEAT & RHYTHM
The normal human heart is made up of four chambers - two upper chambers (atria) and two lower chambers (ventricles). The rhythm of the heart is normally controlled by a natural pacemaker (the sinus node) located in the right atrium. The sinus node produces electrical impulses that normally start each heartbeat. From the sinus node, electrical impulses travel across the atria, causing the atria muscles to contract and pump blood into the ventricles.
The electrical impulses then arrive at a cluster of cells called the atrioventricular node (AV node) - usually the only pathway for signals to travel from the atria to the ventricles. The AV node slows down the electrical signal before sending it to the ventricles. This slight delay allows the ventricles to fill with blood. When electrical impulses reach the muscles of the ventricles, they contract, causing them to pump blood either to the lungs or to the rest of the body.
In a healthy heart, this process usually goes smoothly, resulting in a normal resting heart rate of 60 to 100 beats a minute in the average adult. Conditioned athletes at rest commonly have a heart rate less than 60 beats a minute because their hearts are so efficient.
TYPES OF ARRHTHYMIAS
Health care providers classify arrhythmias not only by where they originate (atria or ventricles) but also by the speed of heart rate they cause:
- Tachycardia: This refers to a fast heartbeat, a resting heart rate greater than 100 beats a minute.
- Bradycardia: This refers to a slow heartbeat, a resting heart rate less than 60 beats a minute.
Not all tachycardias or bradycardias mean you have heart disease. For example, during exercise it is normal to develop a fast heartbeat as the heart speeds up to provide your tissues with more oxygen-rich blood. During sleep or times of deep relaxation, it is not unusual for the heart beat to be slower.
Atrial Tachycardias: Tachycardias originating in the atria include:
- Atrial Fibrillation. Atrial fibrillation is a rapid heart rate caused by chaotic electrical impulses in the atria. These signals result in rapid, uncoordinated, weak contractions of the atria. The chaotic electrical signals bombard the AV node, usually resulting in an irregular, rapid rhythm of the ventricles. Atrial fibrillation may be temporary, but some episodes will not end unless treated. Atrial fibrillation may lead to serious complications such as stroke.
- Atrial Flutter. Atrial flutter is similar to atrial fibrillation. The heartbeats in atrial flutter are more-organized and more-rhythmic electrical impulses than in atrial fibrillation. Atrial flutter may also lead to serious complications such as stroke.
- Supraventricular Tachycardia. Supraventricular tachycardia is a broad term that includes many forms of arrhythmia originating above the ventricles (supraventricular) in the atria or AV node.
- Wolff-Parkinson-White Syndrome. In Wolff-Parkinson-White syndrome, a type of supraventricular tachycardia, there is an extra electrical pathway between the atria and the ventricles, which is present at birth. However, you may not experience symptoms until you're an adult. This pathway may allow electrical signals to pass between the atria and the ventricles without passing through the AV node, leading to short circuits and rapid heartbeats.
Ventricular Tachycardias: Tachycardias occurring in the ventricles include:
- Ventricular Tachycardia. Ventricular tachycardia is a rapid, regular heart rate that originates with abnormal electrical signals in the ventricles. The rapid heart rate does not allow the ventricles to fill and contract efficiently to pump enough blood to the body. Ventricular tachycardia can often be a medical emergency. Without prompt medical treatment, ventricular tachycardia may worsen into ventricular fibrillation.
- Ventricular Fibrillation. Ventricular fibrillation occurs when rapid, chaotic electrical impulses cause the ventricles to quiver ineffectively instead of pumping necessary blood to the body. This serious problem is fatal if the heart is not restored to a normal rhythm within minutes. Most people who experience ventricular fibrillation have an underlying heart disease or have experienced serious trauma, such as being struck by lightning.
- Long QT Syndrome. Long QT syndrome is a heart disorder that carries an increased risk of fast, chaotic heartbeats. The rapid heartbeats, caused by changes in the electrical system of your heart, may lead to fainting, and can be life-threatening. In some cases, your heart's rhythm may be so erratic that it can cause sudden death. A person can be born with a genetic mutation that puts them at risk of long QT syndrome. In addition, several medications may cause long QT syndrome. Some medical conditions, such as congenital heart defects, may also cause long QT syndrome.
Bradycardia: A Slow Heartbeat
Although a heart rate below 60 beats a minute while at rest is considered bradycardia, a low resting heart rate does not always signal a problem. If you are physically fit, you may have an efficient heart capable of pumping an adequate supply of blood with fewer than 60 beats a minute at rest. In addition, certain medications used to treat other conditions, such as high blood pressure, may lower your heart rate. However, if you have a slow heart rate and your heart is not pumping enough blood, you may have one of several bradycardias, including:
- Sick Sinus Syndrome. If the sinus node, which is responsible for setting the pace of the heart, is not sending impulses properly, the heart rate may be too slow (bradycardia), or it may speed up (tachycardia) and slow down intermittently. Sick sinus syndrome can also be caused by scarring near the sinus node that is slowing, disrupting or blocking the travel of impulses.
- Conduction Block. A block of your heart's electrical pathways can occur in or near the AV node, which lies on the pathway between your atria and your ventricles. A block can also occur along other pathways to each ventricle. Depending on the location and type of block, the impulses between the upper and lower halves of the heart may be slowed or blocked. If the signal is completely blocked, certain cells in the AV node or ventricles can make a steady, although usually slower, heartbeat. Some blocks may cause no signs or symptoms, and others may cause skipped beats or bradycardia. Slower heart rates or a conduction block may cause symptoms of fatigue, dizziness or fainting.
Premature Heartbeats: Although it often feels like a skipped heartbeat, a premature heartbeat is actually an extra beat. Even though you may feel an occasional premature beat, it seldom means you have a more serious problem. Still, a premature beat can trigger a longer lasting arrhythmia, especially in people with heart disease. Premature heartbeats are commonly caused by stimulants, such as caffeine from coffee, tea and soft drinks; over-the-counter cold remedies containing pseudoephedrine; and some asthma medications.
Certain factors may increase your risk of developing an arrhythmia. These include:
- Coronary Artery Disease, Other Heart Problems & Previous Heart Surgery. Narrowed heart arteries, a heart attack, abnormal heart valves, prior heart surgery, heart failure, cardiomyopathy and other heart damage are risk factors for almost any kind of arrhythmia.
- High blood pressure. This increases your risk of developing coronary artery disease. It may also cause the walls of your left ventricle to become stiff and thick, which can change how electrical impulses travel through your heart.
- Congenital Heart Disease. Being born with a heart abnormality may affect your heart's rhythm.
- Thyroid Problems. Having an overactive or underactive thyroid gland can raise your risk for arrhythmias.
- Drugs & Supplements. Certain over-the-counter cough and cold medicines and certain prescription drugs may contribute to arrhythmia development.
- Diabetes. Your risk of developing coronary artery disease and high blood pressure greatly increases with uncontrolled diabetes.
- Obstructive Sleep Apnea. This disorder, in which your breathing is interrupted during sleep, can increase your risk of bradycardia, atrial fibrillation and other arrhythmias.
- Electrolyte Imbalance. Substances in your blood called electrolytes, such as Potassium, Sodium, Calcium and Magnesium, help trigger and conduct the electrical impulses in your heart. Electrolyte levels that are too high or too low can affect your heart's electrical impulses and contribute to arrhythmia development.
- Excessive Alcohol. Drinking too much alcohol can affect the electrical impulses in your heart and can increase the chance of developing atrial fibrillation.
- Caffeine or Nicotine Use. Caffeine, nicotine and other stimulants can cause your heart to beat faster and may contribute to the development of more-serious arrhythmias. Illegal drugs, such as amphetamines and cocaine, may profoundly affect the heart and lead to many types of arrhythmias or to sudden death due to ventricular fibrillation.
Certain arrhythmias may increase your risk of developing conditions such as:
- Stroke. When your heart quivers, it is unable to pump blood effectively, which can cause blood to pool. This can cause blood clots to form. If a clot breaks loose, it can travel from your heart to your brain. There it might block blood flow, causing a stroke. Certain medications, such as blood thinners, can greatly lower your risk of stroke or damage to other organs caused by blood clots. Your health care provider will determine if a blood-thinning medication is appropriate for you, depending on your type of arrhythmia and your risk of blood clots.
- Heart Failure. Heart failure can result if your heart is pumping ineffectively for a prolonged period due to a bradycardia or tachycardia, such as atrial fibrillation. Sometimes controlling the rate of an arrhythmia that is causing heart failure can improve your heart's function.
DIAGNOSIS & TESTS
Medical assessment of the abnormality using an electrocardiogram is the best way to diagnose and assess the risk of any given arrhythmia. Cardiac dysrhythmias are often first detected by simple but nonspecific means: auscultation of the heartbeat with a stethoscope, or feeling for peripheral pulses.
These cannot usually diagnose specific dysrhythmias, but can give a general indication of the heart rate and whether it is regular or irregular. Not all the electrical impulses of the heart produce audible or palpable beats; in many cardiac arrhythmias, the premature or abnormal beats do not produce an effective pumping action and are experienced as "skipped" beats. The simplest specific diagnostic test for assessment of heart rhythm is the electrocardiogram (abbreviated ECG or EKG). A Holter monitor is an EKG recorded over a 24-hour period, to detect dysrhythmias that may happen briefly and unpredictably throughout the day.
Because arrhythmias are such a heterogenous group of conditions, treatment needs to be carefully selected by a patient with their physician. Some arrhythmias require no treatment at all. Others require immediate emergency treatment if death is to be avoided. Treatments include physical maneuvers,
antiarrhythmic drugs, other drugs, electricity, and electro or cryo cautery.
To diagnose a heart arrhythmia, your health care provider will review your symptoms and your medical history and conduct a physical examination. Your practitioner may ask about, or test for, conditions that may trigger your arrhythmia, such as heart disease or a problem with your thyroid gland. Heart monitoring tests may be performed that are specific to arrhythmias. These may include:
- Electrocardiogram (ECG). During an ECG, sensors (electrodes) that can detect the electrical activity of your heart are attached to your chest and sometimes to your limbs. An ECG measures the timing and duration of each electrical phase in your heartbeat.
- Holter Monitor. This portable ECG device can be worn for a day or more to record your heart's activity as you go about your routine.
- Event Monitor. For sporadic arrhythmias, you keep this portable ECG device available, attaching it to your body and pressing a button when you have symptoms. This lets your health care provider check your heart rhythm at the time of your symptoms.
- Echocardiogram. In this noninvasive test, a hand-held device (transducer) placed on your chest uses sound waves to produce images of your heart's size, structure and motion.
If your practitioner does not find an arrhythmia during those tests, he or she may try to trigger your arrhythmia with other tests, which may include:
- Stress Test. Some arrhythmias are triggered or worsened by exercise. During a stress test, you will be asked to exercise on a treadmill or stationary bicycle while your heart activity is monitored. If health care providers are evaluating you to determine if coronary artery disease may be causing the arrhythmia, and you have difficulty exercising, then your practitioner may use a drug to stimulate your heart in a way that is similar to exercise.
- Tilt Table Test. This test may be recommended if you have had fainting spells. Your heart rate and blood pressure are monitored as you lie flat on a table. The table is then tilted as if you were standing up. Your practitioner observes how your heart and the nervous system that controls it respond to the change in angle.
- Electrophysiological Testing & Mapping. In this test, practitioners thread thin, flexible tubes (catheters) tipped with electrodes through your blood vessels to a variety of spots within your heart. Once in place, the electrodes can map the spread of electrical impulses through your heart. In addition, your cardiologist can use the electrodes to stimulate your heart to beat at rates that may trigger or halt an arrhythmia. This allows your health care provider to see the location of the arrhythmia and what may be causing it.
TREATMENTS & MEDICATIONS
If you have an arrhythmia, treatment may or may not be necessary. Usually it is required only if the arrhythmia is causing significant symptoms or if it is putting you at risk of a more serious arrhythmia or arrhythmia complication.
Treating Slow Heartbeats: If slow heartbeats (bradycardias) do not have a cause that can be corrected, practitioners often treat them with a pacemaker because there are not any medications that can reliably speed up your heart. A pacemaker is a small device that is usually implanted near your collarbone. One or more electrode-tipped wires run from the pacemaker through your blood vessels to your inner heart. If your heart rate is too slow or if it stops, the pacemaker sends out electrical impulses that stimulate your heart to beat at a steady rate.
Treating Fast Heartbeats: For fast heartbeats (tachycardias), treatments may include one or more of the following:
- Vagal Maneuvers. You may be able to stop an arrhythmia that begins above the lower half of your heart (supraventricular tachycardia) by using particular maneuvers that include holding your breath and straining, dunking your face in ice water, or coughing. These maneuvers affect the nervous system that controls your heartbeat (vagus nerves), often causing your heart rate to slow. However, vagal maneuvers do not work for all types of arrhythmias.
- Medications. For many types of tachycardia, you may be prescribed medication to control your heart rate or restore a normal heart rhythm. It is very important to take any anti-arrhythmic medication exactly as directed by your practitioner in order to minimize complications. If you have atrial fibrillation, you may be prescribed blood-thinning medications to help keep dangerous blood clots from forming.
- Cardioversion. If you have a certain type of arrhythmia, such as atrial fibrillation, your practitioner may use cardioversion, which can be conducted as a procedure or using medications. In the procedure, a shock is delivered to your heart through paddles or patches on your chest. The current affects the electrical impulses in your heart and can restore a normal rhythm.
- Catheter Ablation. In this procedure, your practitioner threads one or more catheters through your blood vessels to your heart. Electrodes at the catheter tips can use heat, extreme cold or radiofrequency energy to damage (ablate) a small spot of heart tissue and create an electrical block along the pathway that is causing your arrhythmia.
Implantable Devices: Treatment for heart arrhythmias also may involve use of an implantable device:
- Pacemaker. A pacemaker is an implantable device that helps control abnormal heart rhythms. A small device is placed under the skin near the collarbone in a minor surgical procedure. An insulated wire extends from the device to the heart, where it is permanently anchored. If a pacemaker detects a heart rate that is abnormal, it emits electrical impulses that stimulate your heart to beat at a normal rate.
- Implantable Cardioverter Defibrillator (ICD). This device may be recommended if you are at high risk of developing a dangerously fast or irregular heartbeat in the lower half of your heart (ventricular tachycardia or ventricular fibrillation). If you have had sudden cardiac arrest or have certain heart conditions that increase your risk of sudden cardiac arrest, your practitioner may also recommend an ICD. An ICD is a battery-powered unit that is implanted under the skin near the collarbone similar to a pacemaker. One or more electrode-tipped wires from the ICD run through veins to the heart. The ICD continuously monitors your heart rhythm. If it detects an abnormal heart rhythm, it sends out low- or high-energy shocks to reset the heart to a normal rhythm. An ICD does not prevent an abnormal heart rhythm from occurring, but it treats it if it occurs.
Surgical Treatments: In some cases, surgery may be the recommended treatment for heart arrhythmias:
- Maze Procedure. In the maze procedure, a surgeon makes a series of surgical incisions in the heart tissue in the upper half of your heart (atria) to create a pattern or maze of scar tissue. Because scar tissue does not conduct electricity, it interferes with stray electrical impulses that cause some types of arrhythmia. The procedure is effective, but because it requires surgery, it is usually reserved for people who do not respond to other treatments or for those who are having heart surgery for other reasons. The surgeon may use radiofrequency energy or extreme cold (cryotherapy) to create the scars.
- Coronary Bypass Surgery. If you have severe coronary artery disease in addition to arrhythmias, your practitioner may perform coronary bypass surgery. This procedure may improve the blood flow to your heart.
Your health care provider may suggest that, in addition to other treatments, you make lifestyle changes that will keep your heart as healthy as possible. These same recommendations also are helpful in preventing arrhythmia and reduce your risk of heart disease.These healthy lifestyle changes may include:
- Eat heart-healthy foods. Eat a healthy diet that is low in salt and solid fats and rich in fruits, vegetables and whole grains.
- Exercise regularly. Exercise daily and increase your physical activity.
- Quit and avoid smoking. If you smoke and cannot quit on your own, discuss strategies or programs to help you break a smoking habit.
- Maintain a healthy weight. Being overweight increases your risk of developing heart disease.
- Keep blood pressure and cholesterol levels under control. Make lifestyle changes and take medications as prescribed to correct high blood pressure (hypertension) or high cholesterol.
- Drink alcohol in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger. Limiting or avoiding caffeine and alcohol is recommended.
- Reducing stress, as intense stress and anger can cause4 heart rhythm problems.
- Using over the counter medication with caution, as some cold and cough medications contain stimulants that may trigger a rapid heartbeat.
- Maintain follow-up care. Take your medications as prescribed and have regular follow-up appointments with your health care provider. Tell your practitioner if your symptoms worsen.
Research is ongoing regarding the effectiveness of several forms of complementary and alternative medical therapies for arrhythmia. Some types of complementary and alternative therapies may be helpful to reduce stress, such as:
Atherosclerosis is a common form of vascular disease.
- Roughened areas known as atheromas, which are growths developed over deposits of fatty materials, form on the inner walls of the arteries and narrow the vessels.
- The vessels of the heart and brain, and those leading to the legs from the body, are often affected.
- The atheromas gradually grow larger until they eventually block blood flow to the parts and organs served by the affected vessels.
|Coronary Artery Cross-Section Undergoing Progressive Atherosclerosis|
Normal artery with open lumen
Elevated cholesterol and blood fats forming a small atheroma.
Enlarging atheroma from plaque deposits.
Moderate atherosclerotic narrowing of lumen.
Moderate mycardial ischemia leads to angina pectoris.
Complete or almost complete occlusion, with hardening due to calcium deposition.
Severe acute myocardial ischemia and infarction.
- Sometimes clots that have formed over the irregular areas in the vessel walls break off and travel as emboli to block distant vessels.
- The narrowing of vessels can lead to serious complications, such as:
- Formation of blood clots.
- Angina pectoris.
- Myocardial infarction (MI).
- Strokes (CVA) (also known as brain attacks).
The exact cause of this vascular disease is unknown, but several factors seem to increase the risk that a person will develop it. These factors include:
- Diabetes mellitus.
- Lack of exercise.
- Diets high in cholesterol and fats.
- Proper diet.
- Reduction of stress.
- Control of smoking and obesity.
Aortic Atherosclerosis is a systemic disease involving the heart, brain, aorta, and peripheral arteries. Blood tests have not traditionally been used to diagnose or to assess risk. Trans-esophageal echocardiography, a type of ultrasound test, and MRI (magnetic resonance imaging) have been used to identify plaque buildup. A resent blood test for the presence of C-reactive protein may be helpful. The C-reactive protein is a systemic biomarker for inflammation.
Arteriosclerosis occurs when the blood vessels that carry oxygen and nutrients from your heart to the rest of your body (arteries) become thick and stiff, sometimes restricting blood flow to your organs and tissues. Healthy arteries are flexible and elastic, but over time, the walls in your arteries can harden, a condition commonly called hardening of the arteries. Atherosclerosis is a specific type of arteriosclerosis, but the terms are sometimes used interchangeably. Atherosclerosis refers to the buildup of fats, cholesterol and other substances in and on your artery walls (plaques), which can restrict blood flow. These plaques can burst, triggering a blood clot. Although atherosclerosis is often considered a heart problem, it can affect arteries anywhere in your body. Atherosclerosis usually is preventable and is treatable.
Atherosclerosis develops gradually. Mild atherosclerosis usually does not have any symptoms. You usually will not have atherosclerosis symptoms until an artery is so narrowed or clogged that it cannot supply adequate blood to your organs and tissues. Sometimes a blood clot completely blocks blood flow, or even breaks apart and can trigger a heart attack or stroke. Symptoms of moderate to severe atherosclerosis depend on which arteries are affected. For example:
If you have atherosclerosis in your heart arteries, you may have symptoms, such as chest pain or pressure (angina).
If you have atherosclerosis in the arteries leading to your brain, you may have signs and symptoms such as sudden numbness or weakness in your arms or legs, difficulty speaking or slurred speech, or drooping muscles in your face. These signal a transient ischemic attack (TIA), which, if left untreated, may progress to a stroke.
If you have atherosclerosis in the arteries in your arms and legs, you may have symptoms of peripheral artery disease, such as leg pain when walking (intermittent claudication).
If you have atherosclerosis in the arteries leading to your kidneys, you develop high blood pressure or kidney failure.
If you have atherosclerosis in the arteries leading to your genitals, you may have difficulties having sex. Sometimes, atherosclerosis can cause erectile dysfunction in men. In women, high blood pressure can reduce blood flow to the vagina, making sex less pleasurable.
If you think you have atherosclerosis, talk to your health care provider. Also pay attention to early symptoms of inadequate blood flow, such as chest pain (angina), leg pain or numbness. Early diagnosis and treatment can stop atherosclerosis from worsening and prevent a heart attack, stroke or another medical emergency.
Atherosclerosis is a slow, progressive disease that may begin as early as childhood. Although the exact cause is unknown, atherosclerosis may start with damage or injury to the inner layer of an artery. The damage may be caused by:
- High blood pressure.
- High cholesterol, often from getting too much cholesterol or saturated fats in your diet.
- High triglycerides, a type of fat (lipid) in your blood.
- Smoking and other sources of tobacco.
- Inflammation from diseases, such as arthritis, lupus or infections, or inflammation of unknown cause.
Once the inner wall of an artery is damaged, blood cells and other substances often clump at the injury site and build up in the inner lining of the artery. Over time, fatty deposits (plaques) made of cholesterol and other cellular products also build up at the injury site and harden, narrowing your arteries. The organs and tissues connected to the blocked arteries then do not receive enough blood to function properly. Eventually pieces of the fatty deposits may break off and enter your bloodstream. In addition, the smooth lining of a plaque may rupture, spilling cholesterol and other substances into your bloodstream. This may cause a blood clot, which can block the blood flow to a specific part of your body, such as occurs when blocked blood flow to your heart causes a heart attack. A blood clot can also travel to other parts of your body, blocking flow to another organ.
Hardening of the arteries occurs over time. Besides aging, factors that increase the risk of atherosclerosis include:
- High blood pressure.
- High cholesterol.
- Smoking and other tobacco use.
- A family history of early heart disease.
- Lack of exercise.
The complications of atherosclerosis depend on which arteries are blocked. For example:
- Coronary Artery Disease. When atherosclerosis narrows the arteries close to your heart, you may develop coronary artery disease, which can cause chest pain (angina), a heart attack or heart failure.
- Carotid Artery Disease. When atherosclerosis narrows the arteries close to your brain, you may develop carotid artery disease, which can cause a transient ischemic attack (TIA) or stroke.
- Peripheral Artery Disease. When atherosclerosis narrows the arteries in your arms or legs, you may develop circulation problems in your arms and legs called peripheral artery disease. This can make you less sensitive to heat and cold, increasing your risk of burns or frostbite. In rare cases, poor circulation in your arms or legs can cause tissue death (gangrene).
- Aneurysms. Atherosclerosis can also cause aneurysms, a serious complication that can occur anywhere in your body. An aneurysm is a bulge in the wall of your artery. Most people with aneurysms have no symptoms. Pain and throbbing in the area of an aneurysm may occur and is a medical emergency. If an aneurysm bursts, you may face life-threatening internal bleeding. Although this is usually a sudden, catastrophic event, a slow leak is possible. If a blood clot within an aneurysm dislodges, it may block an artery at some distant point.
During a physical exam, your health care provider may find signs of narrowed, enlarged or hardened arteries, including:
- A weak or absent pulse below the narrowed area of your artery.
- Decreased blood pressure in an affected limb.
- Whooshing sounds (bruits) over your arteries, heard using a stethoscope.
- Signs of a pulsating bulge (aneurysm) in your abdomen or behind your knee.
- Evidence of poor wound healing in the area where your blood flow is restricted.
Depending on the results of the physical exam, your health care provider may suggest one or more diagnostic tests, including:
- Blood Tests. Lab tests can detect increased levels of cholesterol and blood sugar that may increase the risk of atherosclerosis. You will need to go without eating or drinking anything but water for nine to 12 hours before your blood test. Your health care provider should tell you ahead of time if this test will be performed during your visit.
- Doppler Ultrasound. Your health care provider may use a special ultrasound device (Doppler ultrasound) to measure your blood pressure at various points along your arm or leg. These measurements can help your health care provider gauge the degree of any blockages, as well as the speed of blood flow in your arteries.
- Ankle-Brachial Index. This test can tell if you have atherosclerosis in the arteries in your legs and feet. Your health care provider may compare the blood pressure in your ankle with the blood pressure in your arm. This is known as the ankle-brachial index. An abnormal difference may indicate peripheral vascular disease, which is usually caused by atherosclerosis.
- Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack. If your signs and symptoms occur most often during exercise, your health care provider may ask you to walk on a treadmill or ride a stationary bike during an ECG.
- Stress Test. A stress test, also called an exercise stress test, is used to gather information about how well your heart works during physical activity. Because exercise makes your heart pump harder and faster than it does during most daily activities, an exercise stress test can reveal problems within your heart that might not be noticeable otherwise. An exercise stress test usually involves walking on a treadmill or riding a stationary bike while your heart rhythm and blood pressure and breathing are monitored. In some types of stress tests, pictures will be taken of your heart, such as during a stress echocardiogram (ultrasound) or nuclear stress test. If you are unable to exercise, you may receive a medication that mimics the effect of exercise on your heart.
- Cardiac Catheterization & Angiogram. This test can show if your coronary arteries are narrowed or blocked. A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that is fed through an artery, usually in your leg, to the arteries in your heart. As the dye fills your arteries, the arteries become visible on X-ray, revealing areas of blockage.
Other imaging tests may include the use of ultrasound, a computerized tomography (CT) scan or magnetic resonance angiography (MRA) to study your arteries. These tests can often show hardening and narrowing of large arteries, as well as aneurysms and calcium deposits in the artery walls.
ifestyle changes, such as eating a healthy diet and exercising, are often the best treatment for atherosclerosis. Sometimes, medication or surgical procedures may be recommended as well. Various drugs can slow or even reverse the effects of atherosclerosis. Here are some common choices:
- Cholesterol medications. Aggressively lowering your low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol, can slow, stop or even reverse the buildup of fatty deposits in your arteries. Boosting your high-density lipoprotein (HDL) cholesterol, the "good" cholesterol, may help, too. Your health care provider can choose from a range of cholesterol medications, including drugs known as statins and fibrates. In addition to lowering cholesterol, statins have additional effects that help stabilize the lining of your heart arteries and prevent atherosclerosis.
- Anti-platelet medications. Your health care provider may prescribe anti-platelet medications, such as aspirin, to reduce the likelihood that platelets will clump in narrowed arteries, form a blood clot and cause further blockage.
- Beta blocker medications. These medications are commonly used for coronary artery disease. They lower your heart rate and blood pressure, reducing the demand on your heart and often relieve symptoms of chest pain. Beta blockers reduce the risk of heart attacks and some heart rhythm problems.
- Angiotensin-converting enzyme (ACE) inhibitors. These medications may help slow the progression of atherosclerosis by lowering blood pressure and producing other beneficial effects on the heart arteries. ACE inhibitors can also reduce the risk of recurrent heart attacks.
- Calcium channel blockers. These medications lower blood pressure and are sometimes used to treat angina.
- Water pills (diuretics). High blood pressure is a major risk factor for atherosclerosis. Diuretics lower blood pressure.
Your health care provider may suggest certain medications to control specific risk factors for atherosclerosis, such as diabetes. Sometimes specific medications to treat symptoms of atherosclerosis, such as leg pain during exercise, are prescribed. Sometimes more aggressive treatment is needed. If you have severe symptoms or a blockage that threatens muscle or skin tissue survival, you may be a candidate for one of the following surgical procedures:
- Angioplasty and stent placement. In this procedure, your health care provider inserts a long, thin tube (catheter) into the blocked or narrowed part of your artery. A second catheter with a deflated balloon on its tip is then passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls. A mesh tube (stent) is usually left in the artery to help keep the artery open.
- Endarterectomy. In some cases, fatty deposits must be surgically removed from the walls of a narrowed artery. When the procedure is done on arteries in the neck (the carotid arteries), it is called a carotid endarterectomy.
- Thrombolytic therapy. If you have an artery that is blocked by a blood clot, your health care provider may use a clot-dissolving drug to break it apart.
- Bypass surgery. Your health care provider may create a graft bypass using a vessel from another part of your body or a tube made of synthetic fabric. This allows blood to flow around the blocked or narrowed artery.
Lifestyle changes can help you prevent or slow the progression of atherosclerosis (coronary artery disease).
- Stop Smoking. Smoking is a major risk factor for coronary artery disease. Smoking damages your arteries. If you smoke or use tobacco in any form, quitting is the best way to halt the progression of atherosclerosis and reduce your risk of complications. Nicotine constricts blood vessels and forces your heart to work harder, and carbon monoxide reduces oxygen in your blood and damages the lining of your blood vessels. If you smoke, quitting is one of the best ways to reduce your risk of a heart attack.
- Control Your Blood Pressure. Ask your health care provider for a blood pressure measurement at least every two years. He or she may recommend more frequent measurements if your blood pressure is higher than normal or you have a history of heart disease. The ideal blood pressure is below 120 systolic and 80 diastolic, as measured in millimeters of mercury (mm Hg).
- Check Your Cholesterol. Ask your health care provider for a baseline cholesterol test when you are in your 20s and at least every five years after. If your test results are not within desirable ranges, your practitioner may recommend more-frequent measurements. Most people should aim for an LDL level below 130 milligrams per deciliter (mg/dL), or 3.4 millimoles per liter (mmol/L). If you have other risk factors for heart disease, your target LDL may be below 100 mg/dL (2.6 mmol/L).
- Keep Diabetes Under Control. If you have diabetes, tight blood sugar control can help reduce the risk of heart disease.
- Get Moving. Exercise helps you achieve and maintain a healthy weight and control diabetes, elevated cholesterol and high blood pressure. All risk factors for coronary artery disease. Ideally, you should exercise 30 to 60 minutes most days of the week. If you cannot fit it all into one session, try breaking it up into 10-minute intervals. You can take the stairs instead of the elevator, walk around the block during your lunch hour, or do some situps or pushups while watching television. Regular exercise can condition your muscles to use oxygen more efficiently. Physical activity can also improve circulation and promote development of new blood vessels that form a natural bypass around obstructions (collateral vessels). Exercise helps lower blood pressure and reduces your risk of diabetes.
- Eat Healthy Foods. A heart-healthy diet, such as the Mediterranean diet, that emphasizes plant-based foods, such as fruits, vegetables, whole grains, legumes and nuts, and is low in saturated fat, cholesterol and sodium. It can help you control your weight, blood pressure, cholesterol and blood sugar. Eating one or two servings of fish a week also is beneficial. Try substituting whole-grain bread in place of white bread; grabbing an apple, a banana or carrot sticks as a snack; and reading nutrition labels as a guide to controlling the amount of salt and fat you eat.
- Maintain Healthy Weight. Being overweight increases your risk of coronary artery disease. Losing even just a few pounds can help lower your blood pressure and reduce your risk of coronary artery disease. Lose extra pounds and maintain a healthy weight. If you are overweight, losing as few as 5 to 10 pounds (about 2.3 to 4.5 kilograms) can help reduce your risk of high blood pressure and high cholesterol, two of the major risk factors for developing atherosclerosis. Losing weight helps reduce your risk of diabetes or control your condition if you already have diabetes.
- Manage Stress. Reduce stress as much as possible. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing.
In addition to healthy lifestyle changes, remember the importance of regular medical checkups. Some of the main risk factors for coronary artery disease, such as high cholesterol, high blood pressure and diabetes, have no symptoms in the early stages. Early detection and treatment can set the stage for a lifetime of better heart health. Some individuals may consider asking their practitioner about a yearly flu vaccine. Coronary artery disease and other cardiovascular disorders increase the risk of complications from the flu.
Nutritional changes are important. In addition to a heart healthy diet, these nutrients are important for heart health and are available in our foods and as supplements.
- Omega-3 Fatty Acids are a type of unsaturated fatty acid that's thought to reduce inflammation throughout the body, a contributing factor to coronary artery disease. Fish and Fish Oil are the most effective sources of omega-3 fatty acids. Fatty fish, such as salmon, herring and, to a lesser extent, tuna, contain the most omega-3 fatty acids and, therefore, the most benefit. Fish oil supplements may offer benefit, but the evidence is strongest for eating fish. Flaxseed & Flaxseed Oil also contain beneficial omega-3 fatty acids, though studies have not found these sources to be as effective as fish. The shell on raw flaxseeds also contains soluble fiber, which can help lower blood cholesterol. Other dietary sources of omega-3 fatty acids include walnuts, canola oil, Soybeans & Soybean Oil. These foods contain smaller amounts of omega-3 fatty acids than do fish and fish oil, and evidence for their benefit to heart health is not as strong.
Other supplements may help reduce your blood pressure or cholesterol level, two contributing factors to coronary artery disease. Nuts and seeds are good dietary sources of essential nutrients used to control cholesterol and contribute to heart health. These nutrients include:
- Alpha-Linolenic Acid (ALA) (Flaxseed, Wheat Germ)
- Beta-Sitosterol (Nigella sativa (Black Cumin/Black Caraway), Seabuckthorn, Goji (Wolfberry), Avocado, Pumpkin Seed, also found in oral supplements and some margarines)
- Blond Psyllium
- Coenzyme Q10
- Oat bran (found in oatmeal and whole oats)
- Sitostanol (Almonds, Hazelnuts, Pumpkin Seeds, Sunflower Seeds, Flaxseed, found in oral supplements and some margarines)
FOR DETAILED INFORMATION
MoonDragon's Health & Wellness: Atherosclerosis & Arteriosclerosis
Blood abnormalities are often called blood dyscrasias. Dyscrasia is a general term which is used to describe any abnormality in the blood or bone marrow's cellular components, such as low white blood cell count, low red blood cell count or low platelet count.
Anemia is a condition that results from a decrease in the quantity or quality of red blood cells. There are several causes, such as:
- Poor diet.
- Low production of new red blood cells.
- Blood loss, as in hemorrhage.
TYPES OF ANEMIA
Pernicious: Inability to absorb Vitamin B-12 (most often seen in the elderly). Vitamin B-12 is required by the body to produce red blood cells.
MoonDragon's Womens Health Disorders: Pernicious Anemia
Sickle Cell: Inability to form normal hemoglobin. Sickle cell anemia is transmitted genetically. It is seen more often in African Americans.
MoonDragon's Womens Health Disorders: Sickle Cell Anemia
MoonDragon's Womens Health Disorders: Sickle Cell Neonatal Screening
MoonDragon's Womens Health Disorders: Sickle Cell Pregnancy Contraception
MoonDragon's Womens Health Disorders: Cell Prenatal Diagnosis
Thalassemia: A group of genetic blood disorders. The oxygen-carrying component of red blood cells, hemoglobin, consists of two different proteins, an alpha and a beta protein. If the body does not produce enough of either of these two proteins, the red blood cells do not form properly and cannot carry sufficient oxygen. The result is anemia that begins early in childhood and is life long. It is common to people of Mediterranean heritage, including Italians, Greeks, and Turks, and other regions, including Arabian Peninsula, Africa, the Indian subcontinent, China and Southeast Asia.
MoonDragon's Womens Health Disorders: Thalassemia Anemia
Nutrient Deficiency: Inadequate intake of nutrients, such as
Folic Acid (Vitamin B-9), or
Vitamin B-12 in the diet. Inability to properly absorb or utilize nutrients, or excessive loss of nutrients.
MoonDragon's Womens Health Disorders: Iron Deficiency Anemia
ANEMIA SIGNS & SYMPTOMS
The person with anemia may have little energy.
May be pale or jaundiced.
Have dyspnea (difficulty breathing).
Experience digestive disorders.
May have a rapid pulse.
May complain of light-headedness.
Experience dizziness and/or fainting.
Have an increased respiratory rate.
ANEMIA TREATMENT GOALS
Improve the quality and quantity of the blood by giving nutritional supplements.
Eliminating the basic cause of the disease.
Giving blood transfusions as needed.
ADDITIONAL ANEMIA LINKS
MoonDragon's Womens Health Disorders: Anemia Index
MoonDragon's Womens Health Disorders: Anemia During Pregnancy
MoonDragon's Womens Health Disorders: Holistic Recommendations For Anemia Treatment
MoonDragon's Womens Health Disorders: Folic Acid Deficiency
MoonDragon's Womens Health Disorders: G6PD Deficiency Anemia
MoonDragon's Womens Health Disorders: Iron Deficiency Anemia
MoonDragon's Womens Health Disorders: Sickle Cell Anemia
Leukemia is sometimes called cancer of the blood. The causes of the many forms of leukemia are not known. This disease may strike young or old. The number of white blood cells increases, but the white blood cells may be of poor quality. The number of erythrocytes (red blood cells) and platelets decreases. Patients with leukemia are highly susceptible to infection. During the course of the disease, even minor trauma causes bleeding.
Treatment is aimed at:
- Easing symptoms and keeping the patient comfortable.
- Maintaining normal blood levels. Transfusions may be needed to combat the anemia that accompanies the condition.
- Combating infection by using antibiotics.
- Slowing the production of abnormal white cells through chemotherapy and/or radiation therapy.
Patients who have cancer or anemia require special care.
- Check vital signs.
- Encourage rest and a good diet.
- Handle the patient very gently.
- Give special mouth care, because the mouth and tongue become sensitive.
- Be sure to report any signs of bleeding, such as bruises or discolorations, because further blood loss makes the condition worse.
- Keep patient warm.
- Protect patient from falls that may result from dizziness or weakness.
- Change the patient's position often, at least every two hours.
- Provide emotional support.
MoonDragon's Health Care: Cardiovascular Patient Care
HEART ATTACK (MYOCARDIAL INFARCTION)
If the coronary arteries that carry oxygen and nutrients to the heart muscle become obstructed, the flow of the blood is cut off completely, and a heart attack, or myocardial infarction (MI), can occur, resulting in damage to the heart muscle. Arteriosclerosis, or hardening of the arteries, and the presence of a thrombus, or clot, in a blood vessel are the most common causes of obstruction. Arteriosclerosis is responsible for most of the deaths resulting from heart attacks. Spasms of the coronary arteries can also result in a heart attack. A heart attack may feel as if someone is applying intense pressure to the chest. This pain may last for several minutes, often extending to the shoulder, arm, neck, or jaw. Other signs of heart attack include sweating, nausea, vomiting,
shortness of breath, dizziness, fainting, feelings of anxiety, difficulty swallowing, sudden ringing in the ears, and loss of speech. The amount and type of chest pain vary from one individual to another. Some people have intense pain, while others feel only mild indigestion. Some have no symptoms at all. a situation referred to as a "silent" heart attack.
The medical term for a heart attack is myocardial infarction (MI). This refers to the formation of infarcts (areas of local tissue death or decay) in the myocardium (heart muscle). Infarction occurs when the blood supply to an area of the heart is cut off, usually as a result of a blood clot that blocks a narrowed coronary artery. Depending on the size and location of the areas affected, a heart attack may be described as mild or severe, but it always involves some irreparable damage to the heart muscle.
The term myocardial infarction (MI), or heart attack, refers to a period in which the heart suddenly cannot function properly. There are different kinds of heart attacks. They differ in their severity and prognosis (expected outcome). The heart is muscle tissue and may become tired just as any muscle my tire. The cells of the heart require nourishment and oxygen like all other cells.
An acute myocardial infarction occurs when the coronary arteries that carry oxygen and nutrients to the heart muscle become obstructed (blocked). Part of the heart muscle where the flow of blood is cut off completely becomes ischemic (loses its blood supply). Unless circulation is restored quickly, the cells die (infarction), and a heart attack, or myocardial infarction, can occur, resulting in damage to the heart muscle. If too much tissue dies, the person cannot survive. Coronary heart attack is also called:
- Coronary occlusion: blockage of coronary arteries.
- Coronary thrombosis: when a thrombus (stationary blood clot) forms at the site, blocking the blood flow.
- Coronary embolism: when a moving clot or insoluble particle (embolus), which originated elsewhere and has moved, becomes lodged in the artery.
Arteriosclerosis, or hardening of the arteries, and the presence of a thrombus, or clot, in a blood vessel are the most common causes of obstruction. Arteriosclerosis is responsible for most of the deaths resulting from heart attacks. Spasms of the coronary arteries can also result in a heart attack.
The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Often it is in the center or left side of the chest and lasts for more than a few minutes. The discomfort may occasionally feel like heartburn. Other symptoms may include shortness of breath, nausea, feeling faint, a cold sweat, or feeling tired. About 30 percent of people have atypical symptoms, with women more likely than men to present atypically. Among those over 75 years old, about 5 percent have had an MI with little or not history of symptoms. An MI may cause heart failure, an irregular heartbeat, or cardiac arrest.
- A heart attack may feel as if someone is applying intense pressure to the chest. The pain may resemble severe indigestion. It is often described as "crushing" chest pain.
- This pain may last for several minutes.
- The pain may radiate into the shoulder, left arm, neck, or jaw.
- Sweating (perspiration, diaphoresis).
- Shortness of breath.
- Fainting (syncope).
- Feelings of anxiety and weakness.
- Indications of shock, which include drop in blood pressure and pallor.
- Difficulty swallowing.
- Sudden ringing in the ears.
- Loss of speech.
- The amount and type of chest pain vary from one person to another. Some people have intense pain, while others feel only mild discomfort. Many mistake the signs of a heart attack for indigestion. Some have no symptoms at all, a situation referred as a "silent" heart attack.
Immediate treatment has saved many people. The treatment is directed toward:
- Relieving the pain.
- Reducing heart activity.
- Altering the clotting ability of the blood.
- Administering drugs to dissolve the clot.
CAUSES & RISK FACTORS
Most MIs occur due to coronary artery disease. Risk factors include high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, and excessive alcohol, among others. The mechanism of an MI often involves the rupture of an atherosclerotic plaque leading to complete blockage of a coronary artery. MIs are less commonly caused by coronary artery spasms which may be due to cocaine, significant emotional stress, and extreme cold, among others.
A number of tests are useful to help with diagnosis including electrocardiograms (ECGs), blood tests, and coronary angiography. An ECG may confirm an ST elevation MI if ST elevation is present. Commonly used blood tests include troponin and less often creatine kinase MB.
Aspirin is an appropriate immediate treatment for a suspected MI.
Nitroglycerin or opioids may be used to help with chest pain; however, they do not improve overall outcomes.
Supplemental oxygen should be used in those with low oxygen levels or shortness of breath.
In ST elevation MIs treatments which attempt to restore blood flow to the heart are typically recommended and include angioplasty, where the arteries are pushed open, or thrombolysis, where the blockage is removed using medications.
People who have a non-ST elevation myocardial infarction (NSTEMI) are often managed with the blood thinner heparin, with the additional use angioplasty in those at high risk.
In people with blockages of multiple coronary arteries and diabetes, bypass surgery (CABG) may be recommended rather than angioplasty.
After an MI lifestyle modifications along with long term treatment with aspirin, beta blockers, and statins is typically recommended.
During the acute stage, heart attack patients require professional care. Many hospitals provide intensive cardiac care units for these patients. Nursing care supports the therapy ordered. Special attention must be given to:
- Noting signs of a recurrence and reporting immediately to the nurse.
- Watching for bleeding and reporting immediately.
- Assisting with activities of daily living.
- Monitoring vital signs.
Immediate treatment has saved many people. The treatment is directed toward:
- Relieving the pain.
- Reducing heart activity.
- Altering the clotting ability of the blood.
- Administering drugs to dissolve the clot.
During the acute stage, heart attack patients require professional care. Many hospitals provide intensive cardiac care units for these patients. Nursing care supports the therapy ordered. Special attention must be given to:
- Noting signs of a recurrence and reporting immediately to the nurse.
- Watching for bleeding and reporting immediately.
- Assisting with activities of daily living.
- Monitoring vital signs.
MoonDragon's Health & Wellness Disorders: Heart Attack
Heart block is a condition that develops due to interference in the electrical current through the heart. (The flow of electrical current through the heart muscle makes the normal cardiac cycle possible.)
An electronic device called a pacemaker is implanted under the chest muscles or in the abdomen. An electrode carries electrical current from the pacemaker directly into the heart muscle to replace the lost control. The electrical current signals the heart to contract. Some pacemakers send messages only if normal messages carried by the conduction system are delayed. This type of pacemaker is called a demand pacemaker. Other pacemakers send regular signals to keep the heart contracting at a preset rate.
When caring for a patient with a pacemaker:
- Count and record the pulse rate.
- Report any irregularities or changes below the present rate.
- Report any discoloration over the implant site.
- Report hiccuping, because this may indicate problems.
- Keep the patient away from microwave ovens and cellular phones, because they may disrupt the function of the pacemaker.
Patients usually function very well with pacemakers so long as they are adequately monitored.
While a heart attack occurs because of an interruption in blood flow to the heart, heart failure is characterized by inadequate blood flow from the heart - the heart fails to pump enough blood to meet the body's needs. Symptoms include fatigue, poor color, shortness of breath, and edema (swelling due to the accumulation of fluid in the body's tissues), especially around the ankles.
Heart failure is another type of cardiovascular disease. While a heart attack occurs because of an interruption in blood flow to the heart, heart failure is characterized by inadequate blood flow from the heart - the heart fails to pump enough blood to meet the body's needs.
Common symptoms of heart failure include:
Heart failure (HF) is often referred to as chronic heart failure (CHF) and the terms congestive heart failure (CHF) or congestive cardiac failure (CCF) are often used interchangeably with chronic heart failure. Heart failure is a disorder that occurs when a damaged heart becomes unable to pump effectively, unable to sufficiently maintain blood flow to meet the body's needs, depriving the body's tissues of adequate oxygen and nutrients to function properly. Heart failure can be either acute (short-term) or chronic, and has a variety of different causes.
- Poor color.
- Shortness of breath.
- Edema (swelling due to the accumulation of fluid in the body's tissues), especially around the ankles.
CONGESTIVE HEART FAILURE
The heart, like any other muscle will enlarge and tire if it has to work against increasing pressure. When blood vessels narrowed by atherosclerosis increase the resistance to blood flow, and when there is severe damage to major organs like the liver and spleen, it is more difficult to maintain the circulation. The heart muscle may also have been damaged and weakened by myocardial infarction. The heart must pump harder to maintain the internal flow of blood.
At first, the heart enlarges (hypertrophy) and makes up (compensates) for the additional workload.
Eventually, however, it reaches a point when it can no longer compensate. Heart failure follows.
This form of heart disease is known as congestive heart failure (CHF) or cardiac decompensation.
Symptoms commonly include shortness of breath, excessive tiredness, and leg swelling. The shortness of breath is usually worse with exercise, while lying down, and may wake the person at night. A limited ability to exercise is also a common feature.
The signs and symptoms are the result of the heart being unable to pump the blood with sufficient force.
- Hemoptysis (spitting up blood).
- Dyspnea (difficulty breathing).
- Orthopnea (difficulty breathing unless sitting upright).
- Ascites (fluid collecting in the abdomen).
- Neck vein swelling.
- Fatiguing easily.
- Hypoxia (inadequate oxygen levels).
- Edema (swelling), which develops in dependent tissues and slows blood flow, congesting the vessels and allowing more fluid to enter the body spaces and tissues.
- Fluid accumulation in the lungs.
- Cyanosis, which occurs because fluid in the lungs makes gas exchange less efficient.
- Irregular and rapid pulse.
Common causes of heart failure include coronary artery disease including a previous myocardial infarction (heart attack), high blood pressure, atrial fibrillation, valvular heart disease, excess alcohol use, infection, and cardiomyopathy of an unknown cause. These cause heart failure by changing either the structure or the functioning of the heart. There are two main types of heart failure: heart failure due to left ventricular dysfunction and heart failure with normal ejection fraction depending on if the ability of the left ventricle to contract is affected, or the heart's ability to relax. The severity of disease is usually graded by the degree of problems with exercise. Heart failure is not the same as myocardial infarction (in which part of the heart muscle dies) or cardiac arrest (in which blood flow stops altogether). Other diseases that may have symptoms similar to heart failure include obesity, kidney failure, liver problems, anemia and thyroid disease.
The condition is diagnosed based on the history of the symptoms and a physical examination with confirmation by echocardiography. Blood tests, electrocardiography, and chest radiography may be useful to determine the underlying cause.
Treatment depends on the severity and cause of the disease. In people with chronic stable mild heart failure, treatment commonly consists of lifestyle modifications such as stopping smoking, physical exercise, and dietary changes, as well as medications. In those with heart failure due to left ventricular dysfunction, angiotensin converting enzyme inhibitors or angiotensin receptor blockers along with beta blockers are recommended. For those with severe disease, aldosterone antagonists, or hydralazine plus a nitrate may be used. Diuretics are useful for preventing fluid retention. Sometimes, depending on the cause, an implanted device such as a pacemaker or an implantable cardiac defibrillator may be recommended. In some moderate or severe cases cardiac resynchronization therapy (CRT) may be suggested or cardiac contractility modulation may be of benefit. A ventricular assist device or occasionally a heart transplant may be recommended in those with severe disease despite all other measures. Heart failure is a common, costly, and potentially fatal condition.
Drugs to help the heart beat more strongly and regularly and to increase the output of fluids (diuresis) by the kidneys.
Restriction of fluids, if ordered.
Weighing patient daily to monitor level of fluid retention.
Monitoring apical pulse and observing for pulse deficit.
MoonDragon's Nutrition Information: Diet Index
Positioning patient in orthopedic position or high Fowler's supported by pillows, or supported in a chair. The position must be changed frequently, but changes in position should be made slowly. Padded footboards help keep the weight of the bedding off the toes.
Applying elasticized stockings or TED hose. TED hose are elastic anti-embolism stockings. TED hose and Ace bandages help channel blood to the deeper vessels. They must be checked often and reapplied every 6 to 8 hours. Check the extremities carefully for adequate circulation. The skin should be normal color and warm.
Assisting with activities of daily living as needed.
Attending to general hygiene. Complete bathing is tiring, but partial baths can stimulate circulation and provide comfort. Special attention must be given to the skin because the combination of position, edema, and poor circulation contributes to tissue breakdown.
Assisting with oxygen therapy. Oxygen therapy may be provided either by face mask or nasal cannula. Because cardiac patients often breathe through the mouth, the mouth tends to be very dry. Special mouth care may be needed.
Providing for elimination. A bedside commode is convenient. The use of a commode is less tiring for the patient than using a bedpan for elimination.
Encouraging adequate nutrition. Small, easily digested meals should be provided. You may need to assist in feeding the patient to prevent fatigue.
Monitoring and recording fluid intake. Patients with acute heart failure may be given drugs that increase the output of urine and alter the heart rate. Measuring the intake and output and taking daily weights are ways of determining if fluid is being retained.
Regularly checking vital signs. Sometimes the force of heart contraction, which propels the blood forward into the blood vessels, does not have enough strength to make the vessels expand.
MoonDragon's Health & Wellness Disorders: Atherosclerosis & Arteriosclerosis
MoonDragon's Health & Wellness Disorders: Heart Attack
HYPERTENSION (HIGH BLOOD PRESSURE)
Hypertension, also known as high blood pressure, is often a precursor to heart problems. Hypertension is an extremely common form of cardiovascular disease. It usually results from a decrease in the elasticity or a reduction in the interior diameters of the arteries or both, which may be caused by arteriosclerosis, defects in sodium metabolism, stress, nutritional deficiencies, and enzyme imbalances. Kidney disease, hyperthyroidism, disorders of the pituitary or adrenal glands, and heredity may be contributing factors. People considered to be at high risk are those with diabetes, those who smoke, or those who already have had a heart attack or stroke. Because it is essentially painless, especially in the early stages, many people don't even know they have it - hence the term "silent killer". By the time hypertension causes complications that result in symptoms (such as rapid pulse, shortness of breath, dizziness, headaches, sweating), the disorder is more difficult to treat. Untreated hypertension is the leading cause of stroke and also greatly increases the risk of heart attack, heart failure, and kidney failure. Treatment seeks to lower blood pressure to less than 140 mm Hg (millimeters of Mercury) systolic and less than 90 mm Hg diastolic for most people. Treatment for those with diabetes and chronic kidney disease aims to lower blood pressure to less than 130 mm Hg systolic and less than 80 mm Hg diastolic. For people aged 50 and older, systolic blood pressure may be a more important cardiovascular risk factor than diastolic pressure.
Hypertension is also known as high blood pressure. High blood pressure is a common condition in which the force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease. Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.
You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.High blood pressure generally develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.
Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels. Although a few people with early-stage high blood pressure may have dull headaches, dizzy spells or a few more nosebleeds than normal, these signs and symptoms usually do not occur until high blood pressure has reached a severe or life-threatening stage.
You will likely have your blood pressure taken as part of a routine health care provider's appointment. Ask your health care providerr for a blood pressure reading at least every two years starting at age 18. Blood pressure should be checked in both arms to determine if there is a difference. Your health care provider will likely recommend more frequent readings if you have already been diagnosed with high blood pressure or other risk factors for cardiovascular disease. Children age 3 and older will usually have their blood pressure measured as a part of their yearly checkups. If you do not regularly see your health care provider, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. You can also find machines in some stores that will measure your blood pressure for free, but these machines can give you inaccurate results.
There are two types of high blood pressure.
Primary (Essential) Hypertension: For most adults, there are no identifiable causes of high blood pressure. This type of high blood pressure, called essential hypertension or primary hypertension, tends to develop gradually over many years.
Secondary Hypertension: Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:
- Kidney problems.
- Adrenal gland tumors.
- Thyroid problems.
- Certain defects in blood vessels you are born with (congenital).
- Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs.
- Illegal drugs, such as cocaine and amphetamines.
- Alcohol abuse or chronic alcohol use.
- Obstructive sleep apnea.
High blood pressure has many risk factors, including:
Age. The risk of high blood pressure increases as you age. Through early middle age, or about age 45, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.
Race. High blood pressure is particularly common among blacks, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack, and kidney failure, also are more common in blacks.
Family history. High blood pressure tends to run in families.
Being overweight or obese. The more you weigh the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow, increasing your blood pressure. Secondhand smoke also can increase your blood pressure.
Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. If you do not get enough potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood.
Too little vitamin D in your diet. It is uncertain if having too little vitamin D in your diet can lead to high blood pressure. Vitamin D may affect an enzyme produced by your kidneys that affects your blood pressure.
Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than two drinks a day for men and more than one drink a day for women may affect your blood pressure. If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.
Stress. High levels of stress can lead to a temporary increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure.
Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, such as kidney disease and sleep apnea. Sometimes pregnancy contributes to high blood pressure, as well.
Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits, such as an unhealthy diet, obesity and lack of exercise, contribute to high blood pressure.
Hypertension can cause serious complications. The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.Uncontrolled high blood pressure can lead to:
It is never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and becoming more physically active. These are primary lines of defense against high blood pressure and its complications, including heart attack and stroke.
- Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
- Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
- Heart failure. To pump blood against the higher pressure in your vessels, your heart muscle thickens. Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body's needs, which can lead to heart failure.
- Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.
- Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
- Metabolic syndrome. This syndrome is a cluster of disorders of your body's metabolism, including increased waist circumference; high triglycerides; low high-density lipoprotein (HDL); or "good," cholesterol; high blood pressure; and high insulin levels. If you have high blood pressure, you are more likely to have other components of metabolic syndrome. The more components you have, the greater your risk of developing diabetes, heart disease or stroke.
- Trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people with high blood pressure.
To measure your blood pressure, your health care provider will usually place an inflatable arm cuff around your arm and measure your blood pressure using a pressure-measuring gauge. A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first, or upper, number measures the pressure in your arteries when your heart beats (systolic pressure). The second, or lower, number measures the pressure in your arteries between beats (diastolic pressure). Blood pressure measurements fall into four general categories:
Normal Blood Pressure. Your blood pressure is normal if it's below 120/80 mm Hg. However, some health practitioners recommend 115/75 mm Hg as a better goal. Once blood pressure rises above 115/75 mm Hg, the risk of cardiovascular disease begins to increase.
Prehypertension. Prehypertension is a systolic pressure ranging from 120 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg. Prehypertension tends to get worse over time.
Stage 1 Hypertension. Stage 1 hypertension is a systolic pressure ranging from 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg.
Stage 2 Hypertension. More severe hypertension, stage 2 hypertension is a systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher.
Both numbers in a blood pressure reading are important. But after age 60, the systolic reading is even more significant. Isolated systolic hypertension is when diastolic pressure is normal but systolic pressure is high, which is a common type of high blood pressure among people older than 60. Your health care provider will likely take two to three blood pressure readings each at three or more separate appointments before diagnosing you with high blood pressure. This is because blood pressure normally varies throughout the day, and sometimes specifically during visits to the health care provider, a condition called white-coat hypertension. Your blood pressure should be measured in both arms to determine if there is a difference. Your health care provider may ask you to record your blood pressure at home and at work to provide additional information.
If you have any type of high blood pressure, your health care provider will review your medical history and conduct a physical examination. Your health care provider may also recommend routine tests, such as a urine test (urinalysis), blood tests and an electrocardiogram, a test that measures your heart's electrical activity. Your health care provider may also recommend additional tests, such as a cholesterol test, to check for more signs of heart disease.
Taking your blood pressure at home: An important way to check if your blood pressure treatment is working, or to diagnose worsening high blood pressure, is to monitor your blood pressure at home. Home blood pressure monitors are widely available and can be purchased at most pharmaceutical stores. You do not need a prescription to buy one.
Changing your lifestyle can go a long way toward controlling high blood pressure. Eating a healthy diet with less salt, exercising regularly, quit smoking and maintain a healthy weight is a good start to a healthy lifestyle. But sometimes lifestyle changes are not enough. In addition to lifestyle changes, your health care provider may recommend medication to lower your blood pressure. Your blood pressure treatment goal depends on how healthy you are.
Blood Pressure Treatment Goals: Although 120/80 mm Hg or lower is the ideal blood pressure goal, health care providers are unsure if you need treatment (medications) to reach that level.
Less than150/90 mm Hg
If you are a healthy adult age 60 or older.
Less than140/90 mm Hg
If you are a healthy adult younger than age 60.
Less than140/90 mm Hg
If you have chronic kidney disease, diabetes, or coronary artery disease or at high risk of coronary artery disease.
If you are age 60 or older, and use of medications results in lower systolic blood pressure (such as less than 140 mm Hg), your medications will not need to be changed unless they cause negative effects to your health or quality of life. Also, people older than 60 commonly have isolated systolic hypertension, when diastolic pressure is normal but systolic pressure is high. The category of medication your health care provider prescribes depends on your blood pressure measurements and whether you also have other medical problems.
Medications to treat high blood pressure include:
Additional medications to treat high blood pressure - If you are having trouble reaching your blood pressure goal with combinations of the above medications, your health care provider may prescribe:
- Thiazide diuretics. Diuretics, sometimes called water pills, are medications that act on your kidneys to help your body eliminate sodium and water, reducing blood volume. Thiazide diuretics are often the first, but not the only, choice in high blood pressure medications. If you are not taking a diuretic and your blood pressure remains high, talk to your health care provider about adding one or replacing a drug you currently take with a diuretic. Diuretics or calcium channel blockers may work better for blacks than do angiotensin-converting enzyme (ACE) inhibitors alone.
- Beta blockers. These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force. When prescribed alone, beta blockers do not work as well, especially in older adults, but may be effective when combined with other blood pressure medications.
- Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels. People with chronic kidney disease may benefit from ACE inhibitors as one of their medications. Angiotensin II receptor blockers (ARBs). These medications help relax blood vessels by blocking the action, not the formation, of a natural chemical that narrows blood vessels. People with chronic kidney disease may benefit from ARBs as one of their medications.
- Calcium channel blockers. These medications help relax the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for older people and blacks than do ACE inhibitors alone. Grapefruit juice interacts with some calcium channel blockers, increasing blood levels of the medication and putting you at higher risk of side effects. Talk to your health care provider if you are concerned about interactions.
- Renin inhibitors. Aliskiren (Tekturna) slows down the production of renin, an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure. Tekturna works by reducing the ability of renin to begin this process. Due to a risk of serious complications, including stroke, you should not take aliskiren with ACE inhibitors or ARBs.
Once your blood pressure is under control, your health care provider may have you take a daily aspirin to reduce your risk of cardiovascular disorders. To reduce the number of daily medication doses you need, your health care provider may prescribe a combination of low-dose medications rather than larger doses of one single drug. In fact, two or more blood pressure drugs may be more effective than one. Sometimes finding the most effective medication or combination of drugs is a matter of trial and error.
- Alpha blockers. These medications reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels.
Alpha-beta blockers. In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels.
- Central-acting agents. These medications prevent your brain from signaling your nervous system to increase your heart rate and narrow your blood vessels.
- Vasodilators. These medications work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.
- Aldosterone antagonists. Examples are spironolactone (Aldactone) and eplerenone (Inspra). These drugs block the effect of a natural chemical that can lead to salt and fluid retention, which can contribute to high blood pressure.
No matter what medications your health care provider prescribes to treat your high blood pressure, you will need to make lifestyle changes to lower your blood pressure. These may include eating a healthier diet with less salt (the Dietary Approaches to Stop Hypertension, or DASH, diet), exercising regularly, quitting smoking, and losing weight,
Eat healthy foods. Try the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains and low-fat dairy foods. Get plenty of potassium, which can help prevent and control high blood pressure. Eat less saturated fat and total fat. Although diet and exercise are the most appropriate tactics to lower your blood pressure, some supplements also may help lower it. These include:
While it is best to include these supplements in your diet as foods, you can also take supplement pills or capsules. Discuss with your health care provider before adding any of these supplements to your blood pressure treatment. Some supplements can interact with medications, causing harmful side effects, such as an increased bleeding risk that could be fatal.
- Fiber, such as blond Psyllium and Wheat Bran.
- Minerals, such as Calcium and Potassium.
- Supplements that increase nitric oxide or widen blood vessels (vasodilators), such as Cocoa, Coenzyme Q10 or Garlic, Omega-3 Fatty Acids, found in fatty fish, Fish Oil supplements or Flaxseed, Probiotics, found in fermented dairy products such as cultured yogurt, buttermilk, acidophilus milk, cultured sour cream and cheese.
Decrease the salt in your diet. A lower sodium level to 1,500 milligrams (mg) a day. This is appropriate for people 51 years of age or older, and individuals of any age who are African-American or who have hypertension, diabetes or chronic kidney disease. Otherwise healthy people can aim for 2,300 mg a day or less. While you can reduce the amount of salt you eat by putting down the saltshaker, you should also pay attention to the amount of salt that is in the processed foods you eat, such as canned soups or frozen dinners.
Maintain a healthy weight. If you are overweight, losing even 5 pounds (2.3 kilograms) can lower your blood pressure.
Increase physical activity. Regular physical activity can help lower your blood pressure and keep your weight under control. Strive for at least 30 minutes of physical activity a day.
Limit alcohol. Even if you are healthy, alcohol can raise your blood pressure. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.
Do not smoke. Tobacco and nicotine injures blood vessel walls and speeds up the process of hardening of the arteries. If you smoke, ask your health care provider to help you quit.
Manage stress. Reduce stress as much as possible. Practice healthy coping techniques, such as muscle relaxation and deep breathing. Getting plenty of sleep can help, too. You can also practice relaxation techniques, such as yoga or deep breathing, to help you relax and reduce your stress level. These practices may temporarily reduce your blood pressure. Practice relaxation or slow, deep breathing. Practice taking deep, slow breaths to help relax. There are some devices available that can help guide your breathing for relaxation.
Monitor your blood pressure at home. Home blood pressure monitoring can help you keep closer tabs on your blood pressure, show if medication is working, and even alert you and your health care provider to potential complications. If your blood pressure is under control, you may be able to make fewer visits to your health care provider if you monitor your blood pressure at home.
When your high blood pressure is difficult to control and if your blood pressure remains stubbornly high despite taking at least three different types of high blood pressure drugs, one of which should be a diuretic, you may have resistant hypertension. Resistant hypertension is blood pressure that is resistant to treatment. People who have controlled high blood pressure but are taking four different types of medications at the same time to achieve that control also are considered to have resistant hypertension. Having resistant hypertension does not mean your blood pressure will never get lower. In fact, if you and your health care provider can identify what is behind your persistently high blood pressure, there is a good chance you can meet your goal with the help of treatment that is more effective.
Your health care provider can evaluate whether the medications and doses you are taking for your high blood pressure are appropriate. You may have to fine-tune your medications to come up with the most effective combination and doses. In addition, you and your health care provider can review medications you are taking for other conditions. Some medications, foods or supplements can worsen high blood pressure or prevent your high blood pressure medications from working effectively. Be open and honest with your health care provider about all the medications or supplements you take. If you do not take your high blood pressure medications exactly as directed, your blood pressure can pay the price. If you skip doses because you cannot afford the medication, because you have side effects or because you simply forget to take your medications, talk to your health care provider about solutions. Do not change your treatment without your health care provider's guidance.
FOR DETAILED INFORMATION
MoonDragon's Health & Wellness: Hypertension (High Blood Pressure)
PERIPHERAL VASCULAR DISEASE
The blood vessels that serve the outer parts of the body, particularly those of the hands and feet, are referred to as peripheral (toward the outer part) blood vessels. Diseases of these vessels affect the parts of the body through which they pass. The health of these vessels also influences heart function.
Peripheral vascular diseases that affect the arteries diminish the flow of the blood to the extremities. Tissues through which the narrowed arteries pass may not get the nourishment they need. Areas affected are the extremities: the arms, legs, and brain. The signs and symptoms associated with decreased peripheral circulation are:
- Burning pain during exercise.
- Hair loss over feet and toes.
- Thick and rigid toenails.
- Dusky red skin or cyanotic, brownish skin.
- Dry and scaly or shiny skin.
- Chronic edema of the feet and legs.
- Cool skin temperature of feet and legs.
- Difficulty with ambulation.
When the arteries are affected, the blood flow may be seriously interrupted. This condition requires immediate medical treatment. Vascular ulcers may occur. These are sores that start because of the poor circulation of the blood in the legs. These ulcers are difficult to treat and may take months to heal.
Treatment is aimed at:
Increasing local circulation.
Positioning and specific prescribed exercise can promote arterial flow and venous return.
Sometimes an oscillating (rocking bed) is employed to improve the circulatory flow. The oscillating bed rocks up and down in cycles, raising the patient's feet 6 inches above his head and then lowering them 12 to 15 inches. The steady rhythm provides both passive exercise for the patient and some circulatory stimulation.
Nothing that would hamper the patient's circulation is permitted.
Preventing injuries that heal poorly.
SYNDROME X METABOLIC DISORDER
Syndrome X, also known as the metabolic syndrome, is a syndrome characterized by a number of signs of overall poor health.
People with syndrome X are more likely to suffer strokes than other people. About a quarter of all American adults are estimated to have syndrome X. That means they have at least 3 of the 5 common conditions associated with the syndrome:
- Abdominal obesity.
- High blood sugar.
- High blood pressure.
- High triglyceride levels.
- Low HDL (good) cholesterol levels.
While diabetes significantly increases the risk for stroke, it has been found that for people who have not been diagnosed with diabetes, having a metabolic syndrome can be as powerful a risk factor. Based on a recent study, it is estimated that 20 percent of all strokes could be prevented by getting out of the
syndrome X category. The role of nutrition in achieving this is crucial.
Unfortunately, despite remarkable new technology for both diagnosis and treatment of heart-related conditions, the first sign of cardiovascular disease may be a life-threatening calamity. Disorders of the cardiovascular system are often far advanced before they become symptomatic. An estimated 25 percent of people who have had heart attacks have no previous symptoms of heart trouble. Every minute, someone in the United States dies of a heart attack. According to a recent study, the blockages in arteries that can lead to a heart attack or sudden death appear to start forming early in life, in young adults and adolescents as young as age 15.
Cardiovascular disease is not an inevitable result of aging. Many preventive measures can be taken to avoid heart disease. Controllable factors that can contribute to heart disease include smoking,
high blood pressure,
excessive alcohol consumption,
elevated serum cholesterol, a type-A personality,
obesity, a sedentary lifestyle, and
You can alter your lifestyle to keep your heart healthy.
TRANSIENT ISCHEMIC ATTACK
Transient ischemic attack (TIA) is a temporary interruption of the blood flow to part of the brain. The symptoms may be:
- Weakness or paralysis of any extremity or the face.
- Vision problems.
- Difficulty with speech.
- Difficulty with swallowing.
These symptoms come on quickly and may last from just a few minutes to 24 hours. There are no permanent effects. However, a TIA is usually a warning that a brain attack will occur at some time. If you have any of these symptoms listed, report them to your health care provider immediately.
MoonDragon's Health & Wellness: Stroke
ISCHEMIC HEART DISEASE
Ischemic heart disease (IHD) is a condition in which the blood flow (and thus the oxygen) is restricted or reduced in a part of the body. Cardiac ischemia is the name for decreased blood flow and oxygen to the heart muscle. It is caused by obstruction of the blood flow to the heart, usually (most often) as a result of atherosclerosis, usually present even when the artery lumens appear normal by angiography. Ischemia (lack of sufficient oxygen) can lead to angina, cardiac arrhythmias, congestive heart failure, or a heart attack.
ISCHEMIC HEART DISEASE
It is the term given to heart problems caused by partial or complete narrowing of heart arteries, also known as coronary arteries. The coronary arteries supply blood to the heart muscle and no alternative blood supply exists, so a blockage in the coronary arteries or when arteries are narrowed, less blood and oxygen reaches the heart muscle. This is also called myocardial ischemia, cardiac ischemia, coronary artery disease and coronary heart disease. This can ultimately lead to heart attack. Ischemia often causes chest pain or discomfort known as angina pectoris.
Initially there is sudden severe narrowing or closure of either the large coronary arteries and/or of coronary artery end branches by debris showering downstream in the flowing blood. It is usually felt as angina, especially if a large area is affected.
The narrowing or closure is predominantly caused by the covering of atheromatous plaques within the wall of the artery rupturing, in turn leading to a heart attack. A sudden, severe blockage of a coronary artery may lead to a heart attack. Heart attacks cause by just artery narrowing are rare. A heart attack causes damage to heart muscle by cutting off its blood supply.
Cardiac ischemia can lead to a number of serious complications. It can damage your heart muscle, reducing it ability to pump blood efficiently. If a coronary artery becomes completely blocked, the lack of blood and oxygen can lead to heart attack that destroys part of the heart muscle, causing serious and in some cases fatal heart damage. It may also cause serious abnormal, irregular heart rhythms (arrhythmia). Your heart muscle needs sufficient oxygen to beat properly. It it does not receive enough oxygen, the electrical impulses in your heart that coordinate your heartbeats may malfunction, causing your heart to beat too fast, too slow, or irregularly. In some cases, arrhythmias can be life threatening. Cardiac ischemia can damage the heart muscle itself, leading to a reduction in its ability to effectively pump blood to the rest of your body. Over time, this damay may lead to heart failure.
Many Americans may have ischemic episodes without knowing it as they do not experience any signs or symptoms. These people have ischemia without pain, known as silent ischemia. They may have a heart attack with no prior warning. People with angina also may have undiagnosed episodes of silent ischemia. In addition, people who have had previous heart attacks or those with diabetes are especially at risk for developing silent ischemia.
Conditions that may cause myocardial ischemia include:
Things that may trigger chest pain associated with myocardial ischemia include:
- Coronary Artery Disease (Atherosclerosis). Atherosclerosis occurs when plaques made of cholesterol and waste products build up on your artery walls and restrict blood flow. Atherosclerosis of the heart arteries is called coronary artery disease and is the most common cause of myocardial ischemia.
- Blood Clot. The plaques that develop in atherosclerosis can rupture, causing a blood clot, which may lead to sudden, severe myocardial ischemia, resulting in a heart attack.
- Coronary Artery Spasm. A coronary artery spasm is a brief, temporary tightening (contraction) of the muscles in the artery wall. This can narrow and briefly decrease or even prevent blood flow to part of the heart muscle.
- Physical exertion.
- Emotional stress.
- Cold temperatures.
- Lying down.
- Cocaine use.
Chest pressure or pain, typically on the left side of the body (angina pectoris).
Neck or jaw pain.
Shoulder or arm pain.
A fast heartbeat.
Shortness of breath.
Nausea and vomiting.
If you have chest discomfort, especially if it i accompanied by one or more of the other signs and symptoms listed above, seek medical care immediately. Call 911 or your local emergency number. If you do not have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only as a last resort, if there are absolutely no other options. Driving yourself puts you and others at risk if your condition suddenly worsens.
Diagnosis may include an electrocardiogram (ECG) test. You may need to wear a Holter monitor (a battery-operated portable tape recording that measures and records your electrocardiogram (ECG) continuously, usually for 24 to 48 hours). A stress test involving a treaedmill or stationary bike while being monitored can reveal problems otherwise not noticeable. These are two tests often used to diagnose this problem. Other tests also may be used and may include an echocardiogram using sound waves to produce images of the heart. nuclear scan using radioactive material injected into your bloodstream and detected by special cameras to identify blood flow problems, coronary angiography using x-ray imaging with a special type of dye to examine the inside of the heart's blood vessels, and Cardiac CT scan for a detailed look at the inside of blood vessels to determine coronary artery calcification, a sign of coronary atherosclerosis, and .
Factors that may increase your risk of developing myocardial ischemia include:
- Tobacco. Both smoking and long-term exposure to secondhand smoke can damage the interior walls of arteries, including arteries in your heart, allowing deposits of cholesterol and other substances to collect and slow blood flow. Smoking also increases the risk of blood clots forming in the arteries that can cause myocardial ischemia.
- Diabetes. Diabetes is the inability of your body to adequately produce or respond to insulin properly. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, which is a form of sugar from foods. Both type 1 and type 2 diabetes are linked to an increased risk of myocardial ischemia, heart attack and other heart problems.
- High Blood Pressure (Hypertension). Over time, high blood pressure can damage arteries that feed your heart by accelerating atherosclerosis. High blood pressure is more common in those who are obese. Eating a diet high in salt also may increase your risk of high blood pressure.
- High Blood Cholesterol or Triglyceride Levels. Cholesterol is a major part of the deposits that can narrow arteries throughout your body, including those that supply your heart. A high level of "bad" (low-density lipoprotein, or LDL) cholesterol in your blood is linked to an increased risk of atherosclerosis and myocardial ischemia. A high LDL level may be due to an inherited condition or a diet high in saturated fats and cholesterol. A high level of triglycerides, another type of blood fat, may also contribute to atherosclerosis. However, a high level of high-density lipoprotein (HDL) cholesterol (the "good" cholesterol), which helps the body clean up excess cholesterol, is desirable and lowers your risk of heart attack.
- Lack of Physical Activity. An inactive lifestyle contributes to obesity and is associated with higher cholesterol and triglycerides and an increased risk of atherosclerosis. People who get regular aerobic exercise have better cardiovascular fitness, which is associated with a decreased risk of myocardial ischemia and heart attack. Exercise also lowers high blood pressure.
- Obesity. Obese people have a high proportion of body fat, often with a body mass index of 30 or higher. Obesity raises the risk of myocardial ischemia because it is associated with high blood cholesterol levels, high blood pressure and diabetes.
- Waist Circumference. A waist circumference of more than 35 inches (88 centimeters) for women and 40 inches (102 cm) or more in men increases the risk of heart disease.
- Family History. If you have a family history of heart attack or coronary artery disease, you may be at increased risk of myocardial ischemia.
Treatment is directed at improving blood flow to the heart muscle and may include medications, a procedure to open blocked arteries , or coronary artery bypass surgery. Making heart-healthy lifestyle choices and following a health diet is important in preventing and treating Cardiac Ischemia.
FOR DETAILED INFORMATION
MoonDragon's Health & Wellness: Atherosclerosis & Arteriosclerosis
MoonDragon's Health & Wellness: Heart Attack
Mayo Clinic: Myocardial Ischemia
Wikipedia: Coronary Artery Disease (CAD) & Ischemic Heart Disease (IHD)
The veins can also cause problems. Varicose veins form when the valves in the veins in the legs become weakened. This means:
- The blood does not flow through the veins as it should.
- The veins become distended and visible through the skin.
- The veins become inflamed (phlebitis).
- A blood clot may form in the vein.
Veins contain valves to prevent the backward flow of blood.
A. External view of the vein shows wider area of valve.
B. Internal view with the valve open as blood flows through.
C. Internal view with the valve closed.
D. Vein with weakened valve causing a varicose vein.
Report the following signs:
- Pain or aching in the legs.
- Signs of inflammation (warmth and redness).
Remember to never rub or massage the area of a varicose vein.
MoonDragon's Health & Wellness: Varicose Veins
Valvular disease is a term for disorders that impair the functioning of one or more of the heart's valves. It may be caused by congenital defect, or it may be the consequence of illness such as rheumatic fever or endocarditis (infection of the heart muscle). Mitral valve prolapse (MVP) is a condition in which the mitral valve, which controls blood flow from the left atrium to the left ventricle (the heart's main pumping chamber), protrudes too far into the left atrium while it is pumping. In many cases, this causes no symptoms at all, although some people experience occasional fatigue, dizziness, palpitations, and/or vague chest pain. Mitral valve prolapse also causes a distinctive sound that a skilled health care provider can identify by means of a stethoscope. This
condition is now known to be rarer than once thought. And for most of those who do have MVP, it is not thought to lead to severe complications.
Valvular disease is a term for disorders that impair the functioning of one or more of the heart's valves. It may be caused by a congenital defect, or it may be the consequence of illness such as rheumatic fever or endocarditis (infection of the heart muscle).
While there are many causes of valvular heart disease (including rheumatic fever, congenital heart disease, cardiac dilation, and age-related calcification of the valves), whatever the cause, heart valve problems are generally manifested in one of two ways. Either the valve openings become too narrow and blood has a difficult time crossing the valves (i.e., stenosis), or the valves become incompetent, allowing blood to leak across the valves when they are supposed to be closed (i.e., regurgitation). Valvular stenosis causes the blocking of the blood behind the valve. This blocking or damming up of blood leads to increased pressure in the cardiac chambers behind the valve.
Valvular regurgitation allows blood to wash backwards across the valve when the valve should be closed. This extra volume of blood produced by this backwash causes dilation of the cardiac chambers receiving the extra blood. Both increased pressures and increased blood volume in any of the cardiac
chambers can eventually produce permanent weakening of the cardiac muscle, and can ultimately lead to heart failure. Either stenosis or regurgitation in a cardiac valve causes turbulence of blood flow, and that turbulence is detected as a "heart murmur" when the health care provider listens to the heart with a stethoscope. Generally, heart valve problems can be readily diagnosed by performing an echocardiogram.
The Tricuspid Valve: The tricuspid valve separates the right atrium from the right ventricle. When the tricuspid valve develops stenosis, increased pressure in the right atrium leads to high pressure in the veins throughout the body, causing edema (swelling) of the liver, abdomen and legs. When tricuspid regurgitation occurs, both the right atrium and right ventricle tend to dilate, reducing the efficiency of both these cardiac chambers.
The Pulmonic Valve: The pulmonic valve separates the right ventricle from the pulmonary artery. With pulmonic stenosis there is increased pressure in the right ventricle. With pulmonic regurgitation there is volume overload of the right ventricle. Either way, the right ventricle can ultimately fail.
The Mitral Valve: The mitral valve separates the left atrium from the left ventricle. Mitral stenosis causes damming up of blood in the left atrium, and ultimately in the lungs. Mitral regurgitation causes dilation of both the left atrium and left ventricle, and can lead to failure of both cardiac chambers. Mitral valve prolapse (MVP) is a common condition that results in one of the leaflets of the mitral valve flopping backwards into the atrium during the contraction of the left ventricle. MVP often involves at least mild regurgitation.
The Aortic Valve: The aortic valve separates the left ventricle from the aorta. Aortic stenosis causes increased pressure in the left ventricle. Aortic regurgitation causes dilation of the left ventricle. Both of these aortic valve problems can lead to heart failure.
AORTIC STENOSIS (AS)
Aortic Stenosis (AS) is a condition in which there is a narrowing of the exit of the left ventricle of the heart. It may occur at the aortic valve as well as above or below this level. When this is narrowed, problems from the restriction of blood flow from the heart into the aorta. It can be a result from congenital malformations of the valve or from damage, such as from rheumatic fever. It typically gets worse over time. Symptoms, which may come on gradually with a decreased ability to exercise often occurring first. It may begin in early childhood, include fainting, chest pain, and shortness of breath, especially with exertion. If heart failure, loss of consciousness, or heart related chest pain occurs due to AS the outcomes are worse. Loss of consciousness typically occurs with standing or exercise. Signs of heart failure include shortness of breath especially with lying down, at night, and with exercise as well as swelling of the legs. Thickening of the valve without narrowing is known as aortic sclerosis.
AORTIC VALVE STENOSIS SYMPTOMS
Aortic valve stenosis, also known as aortic stenosis, occurs when the heart's aortic valve narrows. This narrowing prevents the valve from opening fully, which obstructs blood flow from your heart into your aorta and onward to the rest of your body. When the aortic valve is obstructed, your heart needs to work harder to pump blood to your body. Eventually, this extra work limits the amount of blood it can pump and may weaken your heart muscle. If you have severe aortic valve stenosis, you will usually need surgery to replace the valve. Left untreated, aortic valve stenosis can lead to serious heart problems.
Aortic valve stenosis ranges from mild to severe. Aortic valve stenosis signs and symptoms generally develop when narrowing of the valve is severe and can include:
- Chest pain (angina) or tightness.
- Feeling faint or fainting with exertion.
- Shortness of breath, especially with exertion.
- Fatigue, especially during times of increased activity.
- Heart palpitations, sensations of a rapid, fluttering heartbeat.
- Heart murmur.
The heart-weakening effects of aortic valve stenosis may lead to heart failure. Heart failure signs and symptoms include fatigue, shortness of breath, and swollen ankles and feet. Aortic valve stenosis often does not produce warning signs or symptoms right away, making it difficult to detect at first. You also may not recognize that you are experiencing symptoms. The condition is often discovered during a routine physical when your health care provider hears an abnormal heart sound (heart murmur). This murmur may occur long before other signs and symptoms develop. Depending on the amount of narrowing, an infant or child with aortic valve stenosis may have no symptoms, may tire easily or may have chest pain with vigorous physical activity.
Aortic valve stenosis usually affects adults but can occur in children. Infants and children with the condition may experience symptoms similar to those of adults. If you or your child experiences such signs or symptoms, see a health practitioner, especially if you or your child has a known heart problem.
Aortic valve stenosis is narrowing of the aortic valve. Many things can narrow this passageway between your heart and aorta. Causes of aortic valve stenosis include:
- Congenital Heart Defect. The aortic valve consists of three tightly fitting, triangular-shaped flaps of tissue called leaflets. Some children are born with an aortic valve that has only one (unicuspid), two (bicuspid) or four (quadricuspid) leaflets, not three. This deformity may not cause any problems until adulthood, at which time the valve may begin to narrow or leak and may need to be repaired or replaced. Having a congenitally abnormal aortic valve requires regular evaluation by a practitioner to watch for signs of valve problems. In most cases, practitioners do not know why a heart valve fails to develop properly, so it is not something you could have prevented.
- Calcium Buildup on the Valve. With age, heart valves may accumulate deposits of calcium (aortic valve calcification). Calcium is a mineral found in your blood. As blood repeatedly flows over the aortic valve, deposits of calcium can accumulate on the valve's leaflets. These deposits may never cause any problems. These calcium deposits are not linked to taking calcium tablets or drinking calcium-fortified drinks. However, in some people, particularly those with a congenitally abnormal aortic valve, such as a bicuspid aortic valve, calcium deposits result in stiffening of the leaflets of the valve. This stiffening narrows the aortic valve and can occur at a younger age. However, aortic valve stenosis that is related to increasing age and the buildup of calcium deposits on the aortic valve is most common in men older than 65 and women older than 75.
- Rheumatic Fever. A complication of strep throat infection or scarlet fever, rheumatic fever may result in scar tissue forming on the aortic valve. Scar tissue alone can narrow the aortic valve and lead to aortic valve stenosis. Scar tissue can also create a rough surface on which calcium deposits can collect, contributing to aortic valve stenosis later in life. Rheumatic fever may damage more than one heart valve, and in more than one way. The mitral valve is another common valve damaged by rheumatic fever bacteria. A damaged heart valve may not open fully or close fully, or both. While rheumatic fever and scarlet is rare in the United States today, some older adults had rheumatic fever and scarlet fever as children.
HEART FUNCTION: Your heart, the center of your circulatory system, consists of four chambers. The two upper chambers (atria) receive blood. The two lower chambers (ventricles) pump blood. Blood returning to your heart enters the right upper chamber (right atrium). From there, blood empties into the right ventricle underneath. The right ventricle pumps blood into your lungs, where blood is oxygenated. Blood from your lungs then returns to your heart but this time to the left side, to the left upper chamber (left atrium). Blood then flows into the left ventricle, your heart's main pump. With each heartbeat, the left ventricle forces blood through the aortic valve into the aorta, your body's largest artery. Blood flows through your heart's chambers, aided by four heart valves. These valves open and close to let blood flow in only one direction through your heart:
- Tricuspid valve.
- Pulmonary valve.
- Mitral valve.
- Aortic valve.
The aortic valve, your heart's gateway to the aorta, consists of three tightly fitting, triangular-shaped flaps of tissue called leaflets. These leaflets connect to the aorta via a ring called the annulus. Heart valves open like a one-way gate. The leaflets of the aortic valve are forced open as the left ventricle contracts and blood flows into the aorta. When all of the left ventricular blood has gone through the valve and the left ventricle has relaxed, the leaflets swing closed to prevent the blood that has just passed into the aorta from flowing back into the left ventricle.
A defective heart valve is one that fails to either open or close fully. When a valve does not close tightly, blood can leak backward. This backward flow through a valve is called regurgitation. When a valve narrows, the condition is called stenosis.
Aortic valve stenosis is not considered preventable, and presently it is not known why some people develop this condition. Some risk factors include:
- A deformed aortic valve. Some people are born with an already narrowed aortic valve or develop aortic valve stenosis later in life because they were born with a bicuspid aortic valve, one with two flaps (leaflets) instead of three. People may also develop aortic valve stenosis if they were born with one leaflet (unicuspid aortic valve) or four leaflets (quadricuspid aortic valve), but these are much more rare conditions. A bicuspid aortic valve is a major risk factor for aortic valve stenosis. A bicuspid aortic valve can run in families, so knowing your family history is important. If you have a first-degree relative, such as a parent, sibling or child, with a bicuspid aortic valve, it is reasonable to check to see if you have this abnormality.
- Age. Aortic valve stenosis may be related to increasing age and the buildup of calcium deposits on heart valves.
- Previous rheumatic fever. Rheumatic fever can cause the flaps (leaflets) of your aortic valve to stiffen and fuse, eventually resulting in aortic valve stenosis.
- Chronic kidney disease. Aortic valve stenosis is associated with chronic kidney disease.
Risk factors for aortic valve stenosis and atherosclerotic heart disease are similar, such as high blood pressure, high cholesterol, type 2 diabetes and smoking, which may indicate a link between the two.
Aortic valve stenosis, of any cause, can be a serious condition. If the aortic valve is narrowed, the left ventricle has to work harder to pump a sufficient amount of blood into the aorta and onward to the rest of your body. In response, the left ventricle may thicken and enlarge. At first, these adaptations help the left ventricle pump blood with more force. But eventually it is harder for the heart to maintain the blood flow to the body through the narrowed valve. Then you will start to experience symptoms. Eventually, the extra work of the heart can weaken the left ventricle and your heart overall. Left unchecked, aortic valve stenosis can lead to life-threatening heart problems, including:
- Chest pain (angina).
- Fainting (syncope).
- Heart failure.
- Irregular heart rhythms (arrhythmias).
- Cardiac arrest.
Some possible ways to prevent aortic valve stenosis include:
- Taking steps to prevent rheumatic fever. You can do this by making sure you see your health care provider when you have a sore throat. Untreated strep throat or scarlet fever can develop into rheumatic fever. Fortunately, strep throat and scarlet fever can usually be easily treated with antibiotics. Rheumatic fever is more common in children and young adults.
- Addressing risk factors for coronary artery disease. These include high blood pressure, obesity and high cholesterol levels. These factors may be linked to aortic valve stenosis, so it is a good idea to keep your weight, blood pressure and cholesterol levels under control if you have aortic valve stenosis.
Taking care of your teeth and gums. There may be a link between infected gums (gingivitis) and infected heart tissue (endocarditis). Inflammation of heart tissue caused by infection can narrow arteries and aggravate aortic valve stenosis. Once you know that you have aortic valve stenosis, your health care provider may recommend that you limit strenuous activity to avoid overworking your heart.
- If you are a woman of childbearing age with aortic valve stenosis, discuss pregnancy and family planning with your health care provider before you become pregnant. Your heart works harder during pregnancy. How a heart with aortic valve stenosis tolerates this extra work depends on the degree of stenosis and how well your heart pumps. Should you become pregnant, you will need evaluation by your cardiologist and obstetrician throughout your pregnancy, labor and delivery, and after delivery.
To diagnose your condition, your health care provider will review your medical history and symptoms and conduct a physical examination. As part of a routine physical exam, a stethoscope is used to listen to your heart for, among other things, an abnormal heart sound (heart murmur). If your practitioner discovers a heart murmur, he or she will discuss it with you. Many heart conditions, including aortic valve stenosis, can produce a heart murmur. In the case of aortic valve stenosis, the heart murmur results from turbulent blood flow through the narrowed valve.
If your health care provider suspects that you or your child may have a deformed or narrowed aortic valve, you may need to undergo several tests to confirm the diagnosis and gauge the severity of the problem. You may be referred to a practitioner trained in heart conditions (cardiologist) for tests such as:
- Echocardiogram. This test uses sound waves to produce an image of your heart. This is the primary test that may used to diagnose your condition if a heart valve condition is suspected. In an echocardiogram, sound waves are directed at your heart from a wandlike device (transducer) held on your chest. The sound waves bounce off your heart and are reflected back through your chest wall and processed electronically to provide video images of your heart. An echocardiogram helps to closely examine the heart and heart valves to check for any problems or abnormalities. This test helps to diagnose aortic valve stenosis, evaluate the severity of your condition and determine the most appropriate treatment for your condition. An echocardiogram will also be used to monitor your condition over time. In some cases, a tube with a transducer attached to it may be inserted and guided down your throat into your esophagus (transesophageal echocardiogram) while you are sedated. This type of echocardiogram may offer more detailed images of your heart.
- Electrocardiogram (ECG). In this test, patches with wires (electrodes) are attached to your skin to measure the electrical impulses given off by your heart. Impulses are recorded as waves displayed on a monitor or printed on paper. An ECG can provide clues about whether the left ventricle is thickened or enlarged, a problem which can occur with aortic valve stenosis.
- Chest X-ray. An X-ray image of your chest allows your health care provider to check the size and shape of your heart to determine whether the left ventricle is enlarged, a possible indicator of aortic valve stenosis. A chest X-ray can also reveal calcium deposits on the aortic valve. In addition, a chest X-ray helps check the condition of your lungs. Aortic valve stenosis may lead to blood and fluid backing up in your lungs, which causes congestion that may be visible on an X-ray.
- Cardiac Catheterization. This procedure may be ordered if noninvasive tests have not provided enough information to firmly diagnose the type or severity of your heart condition. In this procedure, a thin tube (catheter) is threaded through an artery in your arm or groin and guided to an artery in your heart. A dye is injected through the catheter, which helps your arteries become visible on an X-ray (coronary angiogram). This test helps show any blockages in arteries to your heart that can coexist with aortic valve stenosis that may need surgical treatment along with aortic valve stenosis.
- Exercise Tests. In exercise tests, you exercise to increase your heart rate and make your heart work harder. If you have severe aortic valve stenosis but are not experiencing symptoms, your practitioner may order exercise tests to evaluate how your heart responds to exertion (exercise) and to measure your tolerance for activity.
- Computerized Tomography (CT) Scan. A CT scan uses a series of X-rays to create detailed images of your heart and heart valves. This test may used to measure the size of your aorta and look at your aortic valve more closely. Sometimes practitioners may inject a dye into your blood vessels to show the blood flow (CT angiography).
- Magnetic Resonance Imaging (MRI). An MRI uses powerful magnets and radio waves to create detailed images of your heart and heart valves. Practitioners may inject a dye into your blood vessels to highlight the heart and blood vessels in images (magnetic resonance angiography). Doctors may use this test to measure the size of your aorta.
These tests and others help your health care provider determine how narrow or tight your aortic valve may be and how well your heart is pumping. Once aortic valve stenosis is discovered, your health care provider will either recommend treatment or suggest careful monitoring.
TREATMENT & MEDICATIONS
No medications can reverse aortic valve stenosis. However, you may be prescribed certain medications to help your symptoms, such as ones to reduce fluid accumulation, to slow your heart rate or to control heart rhythm disturbances associated with aortic valve stenosis. Lowering blood pressure may prevent or slow the development of aortic stenosis. Ask if you need to lower your blood pressure with medications.
Medications sometimes can ease symptoms of aortic valve stenosis. However, the only way to eliminate aortic valve stenosis is surgery to repair or replace the valve and open up the passageway. Surgery is not always needed right away. If tests reveal that you have mild to moderate aortic valve stenosis and you have no symptoms, your practitioner will schedule checkups to carefully monitor the valve so that surgery can be done at the appropriate time. In follow-up appointments, your health care provider will review your medical history and conduct a physical examination. Your practitioner may also discuss symptoms and what to expect as your condition progresses. An echocardiogram may be ordered to view your aortic valve and monitor your condition every three to five years if you have mild aortic valve stenosis, and every year if you have moderate aortic valve stenosis.
If you have severe aortic valve stenosis, you may be scheduled for checkups every three to six months. An echocardiogram may be ordered every six to 12 months to view your heart valve and monitor your condition. In some cases, additional tests may be ordered.
In general, surgery is necessary when narrowing becomes severe and symptoms develop. In some cases, surgery may recommended if you have severe aortic valve stenosis even if you are not experiencing symptoms. If you have moderate or severe aortic valve stenosis and other conditions that require heart surgery, surgery may be recommended to treat your conditions.
You may need valve repair or replacement to treat aortic valve stenosis. Although less invasive approaches are possible in some cases, surgery is the primary treatment for this condition. Therapies to repair or replace the aortic valve include:
- Balloon Valvuloplasty. Occasionally, balloon valvuloplasty is an option. Balloon valvuloplasty uses a soft, thin tube (catheter) tipped with a balloon. A catheter is guided through a blood vessel in your groin to your heart and into your narrowed aortic valve. Once in position, a balloon at the tip of the catheter is inflated. The balloon pushes open the aortic valve and stretches the valve opening, improving blood flow. The balloon is then deflated, and the catheter with the balloon is guided back out of your body. Balloon valvuloplasty may relieve aortic valve stenosis and its symptoms, especially in infants and children. However, in adults, the valve tends to narrow again even after initial success. For these reasons, balloon valvuloplasty is rarely used today to treat aortic valve stenosis in adults, except in people who are too sick to undergo surgery or are waiting for a transcatheter aortic valve replacement.
- Aortic Valve Replacement. This is the primary surgical treatment for severe aortic valve stenosis. Your surgeon removes the narrowed aortic valve and replaces it with a mechanical valve or a tissue valve. This procedure is generally performed during open-heart surgery. Mechanical valves, made from metal, are durable, but they carry the risk of blood clots forming on or near the valve. If you receive a mechanical valve, you will need to take an anticoagulant medication, such as warfarin (Coumadin), for life to prevent blood clots. Tissue valves, which may come from a pig, cow or human deceased donor, often eventually narrow over the years and need to be replaced. Another type of tissue valve replacement that uses your own pulmonary valve (autograft) is sometimes possible but less likely in an older person. Your health care provider can discuss the risks and benefits of each type of heart valve with you. Aortic valve replacement can relieve aortic valve stenosis and its symptoms.
- Transcatheter Aortic Valve Replacement (TAVR). Aortic valve replacement, the most common treatment for aortic valve stenosis, has traditionally been performed with open-heart surgery. This is a less invasive approach that involves replacing the aortic valve with a prosthetic valve via the femoral artery in your leg (transfemoral) or the left ventricular apex of your heart (transapical). In TAVR, a catheter is inserted with a balloon at the tip in an artery in your leg or in a small incision in your chest and guided to your heart and into your aortic valve. A balloon at the tip of the catheter, which has a folded valve around it, is then inflated. This pushes open the aortic valve and stretches the valve opening and expands the folded valve into the aortic valve. The balloon is then deflated and the catheter with the balloon is guided back out of your body. Alternatively, a self-expanding valve may be inserted into the aortic valve, and a balloon then is not used. In some cases, a valve can be inserted via a catheter into a tissue replacement valve that needs to be replaced (valve-in-valve procedure). TAVR is usually reserved for individuals with severe aortic valve stenosis who are at increased risk of complications from aortic valve surgery. This procedure can relieve severe aortic valve stenosis and its symptoms in those who are at increased risk of complications from aortic valve surgery. TAVR has a higher risk of stroke and vascular complications than aortic valve replacement surgery. The technique is relatively new and is evolving quickly, and there are newer valves and indications occurring frequently. TAVR is sometimes referred to as transcatheter aortic valve implantation (TAVI).
- Surgical Valvuloplasty. In rare cases, surgical repair may be a more effective option than balloon valvuloplasty, such as in infants born with an aortic valve in which the leaflets of the valve are fused together. Using traditional surgical tools, a cardiac surgeon operates on the valve and separates these leaflets to reduce stenosis and improve blood flow. Aortic valve stenosis can be treated effectively with surgery. However, you will need regular follow-up appointments with your practitioner to check for any changes in your condition. You may still be at risk of irregular heart rhythms even after you have been treated for aortic valve stenosis. You may need to take medications to lower that risk. If your heart has become weakened from aortic valve stenosis, you may need medications to treat heart failure. If you have had aortic valve replacement surgery, you need to take antibiotics before certain dental or medical procedures due to the risk of infection in your heart tissue (endocarditis).
A heart murmur is a sound made by the heart that may or may not point to the existence of a heart condition. A diastolic murmur occurs between beats. A systolic murmur occurs during heart contractions.
Heart murmurs are very common, especially in children, and are usually harmless. These normal murmurs are called "innocent" heart murmurs. There is nothing wrong with your heart when you have an innocent murmur. Up to half of all children have innocent murmurs. They usually go away as children grow.
Adults can have innocent murmurs too. They can happen when your blood flows harder and faster than usual-during pregnancy, for example, or a temporary illness, such as a fever. They usually go away on their own.
Sometimes, though, a heart murmur is a sign of a serious heart problem. This is called an abnormal heart murmur. Abnormal murmurs are signs of a heart problem. In children, abnormal heart murmurs are usually caused by problems they are born with, such as a heart valve that does not work right or a hole in the wall between two heart chambers. In adults, abnormal murmurs are most often caused by damaged heart valves. Heart valves operate like one-way gates, helping blood flow in one direction between heart chambers as well as into and out of the heart. When disease or an infection damages a heart valve, it can cause scarring and affect how well the valve works. The valve may not be able to close properly, allowing blood to leak through. Or the valve may become too narrow or stiff to let enough blood through. When a damaged heart valve cannot close properly, the problem is called regurgitation. When the valve cannot let enough blood through, the problem is called stenosis.
Heart valves can be damaged by heart disease or by infections like rheumatic fever or endocarditis. The normal wear and tear that comes with aging can also cause some damage. Some heart murmurs are caused by an enlarged heart. When the heart muscle grows too large, it can get in the way of normal blood flow and cause a murmur.
MITRIAL VALVE PROLAPSE (MVP)
Mitrial valve prolapse (MVP) is a valvular heart disease condition characterized by the displacement of an abnormally thickened mitral valve leaflet, which controls blood flow from the left atrium and left ventricle, protrudes too far into the left atrium between beats (during systole). This means the valve does not close properly leading to blood leaking backward into the left atrium. In most people, mitral valve prolapse is not life-threatening and does not require treatment or changes in lifestyle. Some people with mitral valve prolapse, however, require treatment.
MVP is the primary form of myxomatous degeneration of the valve. Myxomatous degeneration refers to a pathological weakening of connective tissue. There are various types of MVP, broadly classified as classic and nonclassic. In its nonclassic form, MVP carries a low risk of complications and often can be kept minimal by dietary attention. In severe cases of classic MVP, complications include mitral regurgitation, infective endocarditis, congestive heart failure, and, in rare circumstances, cardiac arrest.
MVP may or may not cause symptoms, such as dizziness or palpitations. Although mitral valve prolapse is usually a lifelong disorder, many people with this condition never have symptoms. When diagnosed, people may be surprised to learn that they have a heart condition. When signs and symptoms do occur, it may be because blood is leaking backward through the valve (regurgitation). Mitral valve prolapse symptoms can vary widely from one person to another. They tend to be mild and develop gradually. Symptoms may include:
- A racing or irregular heartbeat (arrhythmia).
- Dizziness or lightheadedness.
- Difficulty breathing or shortness of breath, often when lying flat or during physical activity.
- Chest pain that is not caused by a heart attack or coronary artery disease.
Mitral valve prolapse is frequently associated with mild mitral regurgitation, a disorder of the heart in which the mitral valve does not close properly when the heart pumps out blood. It is the abnormal leaking of blood backwards from the left ventricle, through the mitral valve, into the left atrium, when the left ventricle contracts, i.e. there is regurgitation of blood back into the left atrium. Mitral valve regurgitation is the most common complication. Being male or having high blood pressure increases the risk of mitral valve regurgitation. Other complications include heart rhythm problems (arrhythmias, irregular heart rhythms), heart valve infection (endocarditis, an infection of the thin membrane lining inside the heart) from bacteria, leading to further damage to the mitral valve.
MVP can develop in any person of at any age. Serious symptoms of MVP tend to occur most often in men older than 50. It can also run in familes and be linked to several other conditions. MVP may occur with greater frequency in individuals with Ehlers-Danlos Syndrome, Ebstein's anomaly, Marfan Sydrome, Muscular dystrophy, Scoliosis, or polycystic kidney disease. Other risk factors include Graves disease and chest wall deformities such as pectus excavatum. Rheumatic fever is a common worldwide cause for many cases of damaged heart valves. In the older generation and in much of the less-developed world, valvular disease (including mitral valve prolapse and mitral valve stenosis, reinfection in the form of valvular endocarditis, and valve rupture) from undertreated rheumatic fever continues to be a problem.
Echocardiography is the most useful method of diagnosing a prolapsed mitral valve. 2D and 3D echocardiography are particularly valuable as they allow visualization of the mitral leaflets relative tot he mitral annulus. This allows measurement of the leaflet thickness and their displacement relative tot he annulus. Thickening of the mitral leaflets greater than 5mm and leaflet displacement greater than 2mm indicates classice mitral valve prolapse.
Individuals with mitral valve prolapse, particularly those without symptoms, often require no treatment. Those with MVP and symtpoms of palpitations and chest pain may benefit from beta-blockers. Patients with prior stroke and/or atrial fibrillation may require blood thinners, such as aspirin or warfarin. In rare cases when MVP is associated with severe mitral regurgitation, mitral valve repair or surgical replacement may be necesseary. Repair if preferable to replacement.
PULMONARY (VALVE) STENOSIS (PS)
Pulmonary stenosis (PS) is a condition in which the pulmonic artery is narrowed or the pulmonary heart valve is narrowed, thickened or fused and does not fully open thus restricting the flow of blood, allowing less blood flow from the heart to the pulmonary artery. The pulmonary artery carries blood from the heart to the lungs. This is the valve separating the right ventricle (one of the heart chambers) and the pulmonary artery. The pulmonary artery carries oxygen-poor blood to the lungs to become oxygenated. Narrowing that occurs in the valve itself is called pulmonary valve stenosis. There may also be a narrowing just before or after the valve. Valvular pulmonic stenosis accounts for about 80 percent of right ventricular outflow tract obstruction.
This is most often a congenital defect. It causes a distinctive murmur and may or may not cause symptoms. The defect may occur alone or with other heart defects that are present at birth. The condition can be mild to severe. Pulmonary valve stenosis is a rare disorder, but in some cases the problem runs in families. The cause is unknown, but genes may play a role. Pulmonary valve stenosis may also be due to rheumatic heart disease or a malignant carcinoid tumor. Both stenosis of the pulmonary artery and pulmonary valve stenosis are causes of pulmonic stenosis.
When the valve narrowing (stenosis) is moderate to severe, the symptoms includ abdominal distention, bluish color to the skin (cyanosis), chest pain, fainting, fatigue, poor weight gain or failure to thrive in infants with a severe blockage, shortness of breath, sudden death. Symptoms may get worse with exercise of activity.
Pulmonary stenosis is usually first diagnosed in childhood. A heart murmur may be heard when listening to the heart using a stethoscope. Murmurs are blowing, whoosing or rasping sounds heard during a heartbeat. Tests used ot diagnose pulmonary stenosis may include cardiac catheterization, ECG, Echocardiogram, Chest x-ray, or MRI of the heart. The severity of the valve stenosis will be graded to plan treatment.
If the condition is mild, treatment may not be needed. When there are also other heart defects, medications may be used to help blood flow through the heart (prostaglandins), help the heart beat stronger, prevent clotting (anticoagulants), remove excess fluid (diuretics), and to treat abnormal heartbeats and rhythms.
Percutaneous balloon pulmonary dilation (valvuloplasty) may be performed when no other defects are present. This procedure is done through an artery in the groin. A flexible tube (catheter) is sent with a balloon attached to the heart. Diagnostic imaging is used to help guide the catheter. The balloon stretches the opening of the valve.
Surgery may be indicated for some individuals to repair or replace the pulmonary valve. The new valve can be made from different materials. If the valve cannot be repaired or replaced, other procedures may be needed.
People with mild disease rarely get worse. However, those with moderate to severe disease will get worse. The outcome is often very good when surgery or balloon dilation is successful. Other congenital heart defects may be a factor in the final outlook. Most ofetn the new valves can last for decades. However, some will wear out and need replacement. Complications include abnormal heartbeats (arrhythmias), heart failure and enlargement of the right side of the heart, lealking of blood back into the right ventricle (pulmonary regurgitation) after repair. and death. If you have been treated or have untreated pulmonary valve stenosis and have developed swelling of the ankles, legs, or abdomen, difficulty breathing, or other symptoms, contact your health care provider.
RHEUMATIC HEART DISEASE
Rheumatic heart disease is damage to the heart caused by rheumatic fever, a complication of infection with group A streptococcus bacteria, the bacteria that causes strep throat and scarlet fever, both of which can progress into rheumatic fever. It causes scarring and contracture of heart valves (e.g., mitral valve stenosis), and can lead to arrhythmias and heart failure.
Rheumatic fever is an inflammatory disease that can involve heart, joints, skin, and brain. The disease typically develops 2 to 4 weeks after a throat infection. Signs and symptoms include fever, multiple painful joints, involuntary muscle movements, and a characteristic but uncommon non-itchy rash known as erythema marginatum. The heart is involved in about half of cases. Permanent damage to the hear valves, known as rheumatic heart disease (RHD), usually only occurs after multiple attacks but may occasionally occur after a single case of acute rheumatic fever. The damaged valves may result in heart failure. The abnormal valves also increase the risk of the person developing atrial fibrillation and infection of the valves. Acute rheumatic fever may occur following the infection of the throat by the bacteria Streptococcus pyogenes (group A streptococcus).
Scarlet fever is an infectious disease which most commonly affects children. Signs and symptoms include sore throat,fever, and a characteristic red rash. Scarlet fever is usually spread by inhalation. There is no vaccine, but the disease is effectively treated with antibiotics. Most of the clinical features associated with scarlet fever are caused by erythrogenic toxin, a substance produced by the bacterium Streptococcus pyrogenes (group A streptococcus) when it is infected by a certain bacteriophage. Before the availability of antibiotics, scarlet fever was a major cause of death. It also sometimes caused late complications, such as kidney problems (glomerulonephritis) and endocarditis leading to heart valve disease, all of which were protracted and often fatal afflictions at the time. Strains of group A streptococcus that produce the erythrogenic toxin are not inherently more dangerous than other strains that do not, they are merely more easily diagnosed because of the characteristic rash.
MoonDragon's Health & Wellness Disorders: Rheumatic Fever