If you believe that you or someone you love is experiencing a heart attack, please call 911 or your local emergency services immediately. A myocardial infarction is a life-threatening emergency.
Heart disease (also called cardiac or cardiovascular disease) is a group of diseases or conditions that affect the heart and adjacent structures (arteries, veins). It is a major cause of disability among Americans and, according to the National Institutes of Health (NIH), ranks as the number one killer in the United States.
Causes/Risk Factors of Heart Disease:
Many of the causes of heart disease can be attributed to lifestyle and biological factors. The National Heart Lung and Blood Institute provides the following risk factors:
- High cholesterol levels – high LDL (bad) cholesterol and low HDL (good) cholesterol can lead to heart disease
- High blood pressure - identified as 140/90 on a long-term basis
- Smoking restricts blood vessels, decreases oxygen intake, and can increase bad cholesterol levels
- Insulin resistance can lead to diabetes
- Diabetes raises blood sugar to dangerous levels
- Obesity - excess weight or fat can constrict the heart
- Metabolic Syndrome increases the risk of diabetes and strokes
- Low physical activity increases the risk of bad cholesterol, high blood pressure, and diabetes
- Unhealthy diet – similar to lack of activity, it also comes with the added risk when trans fats or excessive sodium is consumed
- Old age
- Family history
- Sleep apnea – a condition in which a person stops breathing while sleeping, sleep apnea can lead to high blood pressure, diabetes, heart attack, or stroke
- Stress – research is showing that stress is often a trigger for a heart attack
- Alcohol can damage the heart and worsen other risk factors
- Preeclampsia can increase blood pressure and is correlated with heart disease
If you believe you are having a heart attack, call 9-1-1 immediately. If you have any of the above risk factors it is important to see a doctor right away to help you treat the risk factors, decreasing your overall heart disease risk. This is particularly true for high blood pressure, high cholesterol, diabetes, or obesity.
Early diagnosis of these issues may afford you time to decrease your risk for heart disease and prevent a heart attack or stroke.
Different types of heart disease may also have additional causes. These are described below in Types of Heart Disease.
Symptoms of Heart Disease:
Different types of heart disease have different symptoms. These are described below in Types of Heart Disease; however, if you or someone you love is experiencing any of the following, seek medical help immediately: chest pain (also called angina), shortness of breath, and/or fainting.
Diagnosis of Heart Disease:
A combination of several tests may be used to detect and diagnose heart disease:
- Blood test
- Electrocardiogram (ECG or EKG) records electrical signals that travel through your heart. They are used to reveal previous heart attacks, or one in progress.
- Echocardiograms use sound waves to create an image of the heart and can look for areas of damage or areas that are under-performing.
- PET scan
- Heart CT scan
- Coronary Angiogram or Arteriography
- CT Angiography
- Electron-beam computed tomography (EBCT)
- Magnetic Resonance Angiography
- Exercise stress test
- Nuclear stress test
- Ambulatory cardiac monitor (the patient wears a portable heart monitor for a defined period of time, usually 24 hours to 2 weeks, that records the heart’s responses to daily activities)
Types of Heart Disease:
There are several types of cardiac disease, ranging from problems with the blood vessels that nourish and connect the heart to surrounding organs, to problems with heart rhythm (arrhythmias), structures within the heart (valves and chambers), infections and congenital heart defects. Some of the more commonly known are:
Coronary Artery Disease (CAD) – the narrowing or blockage of the arteries that nourish the heart. When a coronary artery becomes completely blocked, blood can no longer reach the heart muscle, and a heart attack (myocardial infarction or MI) occurs. CAD can also lead to strokes.
Read more about Coronary Artery Disease here.
Read more about Myocardial Infarctions here.
Congenital Heart Defects (also called congenital heart disease, congenital heart malformations or CHD) is a group of more than thirty-five disorders in which the structure of the heart is impaired, restricting normal blood circulation.
Read more about Congenital Heart Defects here.
Arrhythmias – a group of conditions in which there is an irregularity of the heartbeat (rhythm) due to a disruption of the heart’s electrical conduction system that governs when and how forcefully the heart contracts to pump blood through the body.
Read more about Cardiac Arrhythmias here.
Congestive Heart Failure (or simply heart failure) occurs when the heart fails to pump enough blood out to the body. It is typically a chronic condition, but in rare cases, it can develop suddenly. Heart failure can affect either the left side, right side, or both sides of the heart. In most cases, it affects both sides. According to the NIH, approximately 5 million people in the US have heart failure. Approximately 300,000 deaths per year can be attributed to it.
Read more about Congestive Heart Failure here.
Cardiomyopathy – the abnormal growth or enlargement (sometimes referred to as thickening) of the heart muscle that weakens the heart, affecting its ability to pump blood out to the body. If left untreated, it can lead to further complications including blood clots, heart murmurs, heart failure, cardiac arrest and sudden death.
There are three types of cardiomyopathy. Dilated cardiomyopathy affects the left ventricle of the heart, causing it to become dilated (enlarged), which reduces its ability to pump blood effectively. Hypertrophic cardiomyopathy is abnormal growth or thickening of the heart muscle which causes the heart to stiffen and the size of the pumping chamber to shrink,thereby limiting the amount of blood within the chamber, so less blood is pumped out to the body. Restrictive cardiomyopathy is increased rigidity and loss of elasticity in the heart muscle. The heart cannot expand sufficiently to fill with blood between heartbeats, so less blood is available to pump out to the body.
There is no one cause of cardiomyopathy, and it is often unknown why a person develops it. However, contributing factors to the development of cardiomyopathy include medical conditions such as other heart conditions (including cardiac valve disease, chronic tachycardia, or coronary artery disease); chronic high blood pressure; thyroid disease; diabetes; and viral infections. Nutritional deficiencies, hemachromatosis (excessive iron in the heart muscle), pregnancy, and previous myocardial infarction are other medical factors that can contribute to cardiomyopathy. In addition, alcohol abuse, drug abuse, and some types of chemotherapy medication may also contribute to the development of cardiomyopathy.
Symptoms of Cardiomyopathy: During the early stages of the disease, a patient may not notice any symptoms. Symptoms worsen as the disease progresses, and include fatigue; dizziness; fainting; abdominal bloating; breathlessness (either with exertion or rest); swelling in the legs, ankles, and feet; and irregular heartbeats (usually rapid or pounding).
Treatment of Cardiomyopathy: Standard options for treating cardiomyopathy include medications, surgically implanted medical devices, surgery to remove damaged tissue, or in the most severe cases, a heart transplant. Physicians will use a combination of treatments tailored to the individual patient’s needs, depending upon the type and severity of the disease.
Medications include different classes of drugs, such as angiotensin-converting enzyme (ACE), angiotensin receptor blockers (ARBs), beta blockers, digoxin, and diuretics.
Medical devices include implantable pacemakers and implantable cardioverter-defribillator (ICD).
Surgeries other than medical device implantations or heart transplant are usually indicated only for patients with hypertrophic cardiomyopathy. These procedures remove (septal myectomy) or destroy (septal ablation) part of the thickened, overgrown septum – the muscle wall that separates the left and right ventricles.
Cardiac Valve Disease – also known as valvular heart disease, is a general term used to describe a group of conditions in which one or more of the valves within the heart (aortic, mitral, pulmonary, triscuspid) that control the direction of blood flow through the heart and into the body are damaged.
There are three types of cardiac valve damage. Stenosis is the narrowing of the valve opening, which restricts the amount of blood that can flow from one chamber to another. Regurgitation or insufficiency happens when the damaged valve leaks, allowing blood to seep backwards, making less available to be pumped out to the body. This is most often due to a prolapsed valve (a valve that does not close properly during a heartbeat). Atresia is when a valve does not have an opening for the blood to pass through.
Valvular heart diseases include conditions such as aortic regurgitation, aortic stenosis, and aortic sclerosis. Other conditions in this class of valvular diseases can be mitral regurgitation, mitral stenosis, mitral valve prolapse, pulmonic regurgitation, pulmonic stenosis, tricuspid regurgitation, tricuspid stenosis, and congenital heart valve disease.
A patient may be born with cardiac valve disease (congenital heart valve disease) or may acquire it later in life as a result of other conditions. Those conditions include rheumatic fever, infectious endocarditis, connective tissue disorders, and coronary artery disease. Other things that can cause cardiac valve disease are age-related changes, adverse reactions to cancer treatments (both medications and radiation treatments), and previous myocardial infarctions.
Symptoms of Cardiac Valve Disease: For patients with congenital cardiac valve disease, symptoms typically appear shortly after birth, and tend to be severe. For patients with acquired cardiac valve disease, symptoms may not appear for a long time, but typically worsen as the disease progresses. These symptoms include irregular heartbeat or murmur; shortness of breath (either with exertion or rest); fatigue; swollen feet or ankles; chest pain; and fainting.
Treatment of Cardiac Valve Disease: If left untreated, cardiac valve disease can lead to heart failure, stroke, blood clots, or sudden cardiac arrest. There are no medications specifically designed to cure cardiac valve disease; rather medications are prescribed to help alleviate the symptoms and prevent further damage.
Those medications include the following classes: vasodilators, diuretics, anti-arrhythmics, anti-hypertensives, cholesterol lowering drugs, and blood thinners.
In severe cases, surgical repair or replacement of the damaged valve may be warranted. Patients with congenital heart valve disease typically have surgery during infancy or early childhood. Physicians will use a combination of medical and surgical treatments tailored to the individual patient’s needs, depending upon the type and severity of the disease.
Heart Infections result when an irritant (viral, bacterial, parasitic, or chemical) reaches the heart muscle and causes it to become inflamed.
There are three categories of heart infections: Pericarditis, inflammation of the tissue surrounding the heart (pericardium); Myocarditis, inflammation of the myocardium, the muscular middle layer of the heart wall; and Endocarditis, inflammation of the inner membrane that divides the chambers and valves within the heart (endocardium).
Heart infections can be caused by a variety of factors. Bacteria can enter the bloodstream through everyday activities (eating, brushing teeth) or by an insect bite (as with Lyme disease). Viruses, including those that cause influenza, mononucleosis, measles, and some sexually transmitted diseases, can cause heart infections. Another possible cause is parasites acquired through food ingestion as well as others transmitted by insect bites. Medications can cause an allergic or toxic reaction, including antibiotics as well as illegal drugs like cocaine. Secondary infections from other diseases, such as vasculitis, lupus, connective tissue disorders, and rare inflammatory disorders, can also cause heart infections.
Symptoms of Heart Infections: Depending upon the type of infection, symptoms may include fever, fatigue, shortness of breath, and dry persistent cough. One may also experience swelling in the legs, abdominal swelling, irregular heartbeat, and/or a rash.
Treatment of Heart Infections: Medications are typically prescribed to treat heart infections. If the infection is caused by bacteria, intravenous antibiotics are given. Depending upon the type and severity of the infection, other medications will be prescribed to help alleviate the symptoms. For example, ACE inhibitors or beta blockers may be prescribed to help regulate heart rhythm. If the infection has caused permanent damage to the heart tissue, surgery may be required to repair it.
Additional Resources For Heart Disease:
The National Heart, Lung and Blood Institute (NHLBI): a division of the National Institutes of Health, this website provides in-depth information on all types of cardiac, pulmonary, and blood disorders.
American Heart Association: a national organization that provides comprehensive information on all heart health-related topics, including stroke.
Womenheart.org: a non-profit organization dedicated to advocating for and improving the health and quality of life of women living with or at risk of heart disease
The Cleveland Clinic has a Heart Attack Risk Assessment Tool and guides for treatment outcomes for all types of heart conditions.
The Congenital Heart Information Network (CHIN): a national organization that provides information, advocacy, support services, financial assistance and resources to people affected by Congenital Heart defects.
Mended Hearts: a national volunteer organization that partners with hospitals and rehabilitation clinics to offer support services, educational forums and visiting programs to heart disease patients and their families.
It’s My Heart: a national, non-profit organization that provides support and education for patients and families affected by congenital heart and pediatric acquired heart defects.
Heart Rhythm Society: the international leader in science, education and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders.
Canadian Heart Disease Resources
Canadian Adult Congenital Heart Network (CACH): a network of healthcare professionals with expertise in the care of patients with congenital heart disease, dedicated to meeting the needs and improving the quality of care for adult congenital heart disease patients.
Heart and Stroke Foundation of Canada: a volunteer-based charity that provides information, education, and research funding for heart-health initiatives. The website has information on cardiac disease, stroke, and contains links to multi-cultural heart-health resources in the provinces.
International Heart Disease Resources
World Heart Federation: a worldwide heart disease resource hub.
Congenital Heart Defect Resources: a website that provides links to international organizations that serve patients with congenital heart disease.