What is an abdominal aortic aneurysm (AAA)?
Abdominal aortic aneurysm (AAA) involves an abnormal widening or stretching of the abdominal portion of the aorta, usually due to a weak or damaged area in the wall of the artery. The exact cause is unknown, but risks include atherosclerosis and hypertension. Some causes of an abdominal aortic aneurysm are injury, infection, or congenital weakening of the connective tissue component of the artery wall. Abdominal aortic aneurysm can affect anybody, but it is most often seen in men over 40 years of age. AAA occurs less frequently in white women and African Americans of both sexes. A common complication is “ruptured” aortic aneurysm. This is a medical emergency where the aneurysm breaks open, resulting in profuse bleeding. Ruptured aneurysm occurs in approximately 5 out of 10,000 people. Aortic dissection occurs when the lining of the artery tears and blood leaks into the wall of the artery. An aneurysm that dissects is at even greater risk of rupture.
- Abdomen hernia mass, midline, pulsating, with tenderness to
- Pulsating sensation in the abdomen.
- Pain in the abdomen.
- Severe, sudden, persistent or constant.
- Not colicky or spasmodic.
- May radiate to groin, buttocks, or legs.
- Abdominal rigidity.
- Severe, sudden or persistent pain in the lower back.
- Rapid pulse or heartbeat sensations.
- Dry skin/mouth, excessive thirst.
- Anxiety, nausea & vomiting.
- Lightheadedness and fainting can occur with upright posture.
- Excessive sweating or clammy skin.
- Recently developed fatigue or tiredness.
An aneurysm may develop slowly over many years and often have no symptoms. If the aneurysm expands rapidly, tears open (ruptured aneurysm), or blood leaks along the wall of the vessel the above symptoms may develop suddenly.
Angina is brought on by a brief period of poor blood supply to the heart muscle usually with blockages in the vessels of the heart.
Angina is synonymous with chest pain. It is also described as chest discomfort, heaviness, tightness, pressure, aching, burning, numbness, fullness, or squeezing. It can be mistaken for reflux, indigestion, heartburn, or inflamed ribs and sternum. Angina is usually felt in the chest, but may also be felt in the left shoulder, arms, neck, back or jaw especially in women.
If you have angina discuss with your doctor ASAP or call 911. The symptoms that may indicate a sign of a heart attack and immediate treatment is essential.
- Pain or discomfort in the chest including the arms, left shoulder, back, neck, jaw, or stomach.
- Difficulty breathing or shortness of breath (new).
- Profuse Sweating or “cold sweat”.
- Light-headedness, dizziness, extreme weakness or anxiety.
- Rapid or irregular heartbeat.
In addition, women often report their symptoms before having a heart attack, although the symptoms are not typical “heart” symptoms.
TYPES OF ANGINA:
A type of angina brought on by an imbalance between the heart’s need for oxygen-rich blood and the amount available. It is “stable” which means the same activities bring it on, it feels the same way each time and is relieved by rest and/or oral medications. Stable angina is a warning sign of heart disease and should be evaluated by a doctor. If the pattern of angina changes, it may progress to unstable angina.
This type of angina is considered an acute coronary syndrome. It may be a new symptom or a change from stable angina. Angina may occur more frequently, occur more easily at rest, feel more severe, or last longer. Although this angina can often be relieved with oral medications, it is unstable and may progress to a full-blown heart attack. Usually more intense medical treatment or a procedure is required. Unstable angina is an acute coronary syndrome and should be treated as an emergency.
Variant angina (also called Prinzmetal’s angina or coronary spasm).
A coronary artery can go into spasm disrupting blood flow to the heart muscle (ischemia). It can occur in people without significant coronary artery disease. However, two-thirds of people with variant angina have severe disease in at least one vessel and the spasm occurs at the site of the blockage. This type of angina is not common and almost always occurs when a person is at rest. You are at increased risk for coronary spasm if you have underlying coronary artery disease, smoke, or use stimulants or illicit drugs (such as cocaine). If a coronary artery spasm is severe and occurs for a long period of time a heart attack can occur.
What’s the difference between angina and a heart attack?
Angina is a warning symptom of heart disease but it is not a heart attack. The symptoms of a heart attack (also called myocardial infarction or “MI”) are similar to angina.
If you have coronary artery disease, the arteries in your heart are narrowed or blocked by a sticky material called plaque. Angioplasty is a procedure to restore blood flow through the artery.
You have angioplasty in a hospital. The doctor threads a thin tube through a blood vessel in the arm or groin up to the involved site in the artery. The tube has a tiny balloon on the end. When the tube is in place, the doctor inflates the balloon to push the plaque outward against the wall of the artery. This widens the artery and restores blood flow.
Doctors may use angioplasty to:
- Reduce chest pain caused by reduced blood flow to the heart.
- Minimize damage to the heart muscle from a heart attack.
- Salvage legs from blocked arteries and prevent amputation.
Aortic dissection involves bleeding into and along the wall of the aorta (the major artery from the heart), most often because of a tear or damage to the inner wall of the artery. This most often occurs in the chest portion of the aorta but can also occur in the abdominal portion. The exact cause is unknown, but risks include atherosclerosis and hypertension. Traumatic injury is a major cause of aortic dissection, especially blunt trauma to the chest as with the steering wheel of a car during an accident. It may also be associated with other injuries, infection, congenital weakness of the aorta, collagen disorders such as Marfan’s syndrome, pseudoxanthoma, elastoma, Ehlers-Danlos syndrome, relapsing polychondritis, or abdominal aortic aneurysm. Pregnancy, valve disorders (including aortic insufficiency) may also be associated with aortic dissection.
Aortic dissection occurs in approximately 2 out of 10,000 people. It can affect anybody, but it is most common in men over 40 years of age.
Adequate treatment and control of atherosclerosis and hypertension may reduce risk although many cases are not preventable. Use safety precautions to reduce the risk of injury.
Symptoms (some may begin suddenly):
- Chest pain
- Sudden, severe, sharp, stabbing, tearing or ripping.
- Located below the sternum, under the shoulder blades, or in the back.
- Pain may radiate to shoulders, neck, arm, jaw, abdomen and/or hips.
- The location of the pain may change.
- Difficulty concentrating, feeling confused or disorientated.
- Decreased movement or sensation of any location.
- Feelings of anxiety.
- Rapid pulse (heart rate).
- Excessive sweating.
- Dry skin/mouth and increased thirst
- Nausea or vomiting.
- Dizziness or fainting.
- Shortness of breath.
- Difficulty breathing when lying flat and at night.
- Excessive yawning.
- Clammy skin.
- Weak or absent pulse.
- Excessive cough.
- High blood pressure.
- Chest pain
Signs and Tests.
Listening with a stethoscope to the chest and abdomen may reveal a “blowing” murmur over the aorta, a heart murmur or other abnormality. There may be decreased pulses in the upper extremities. There may be signs of hypovolemia (a decrease in the volume of circulating blood) or signs resembling acute MI. There may also be signs of shock but with normal blood pressure.
Aortic dissection or aortic aneurysm may be revealed on:
- An aortic angiography.
- A chest MRI or CT scan of the chest.
- A chest X-ray (may show mediastinal widening).
- A Doppler ultrasonography (occasionally performed).
- ECG may show signs of cardiac tamponade.
- CBC is performed to evaluate blood loss.
The goal of treatment is the prevention of complications. Hospitalization is usually required. Antihypertensives may be prescribed to reduce blood pressure. These may be given through a vein. Analgesics may be needed for pain. Cardiac medications such as beta-blockers may reduce some of the symptoms. Surgical repair or replacement of the section of the aorta is curative.
Aortic dissection may be life-threatening. The disorder is curable with surgical repair if it is performed before aortic rupture. Less than half of the patients with ruptured aorta survive.
- Bleeding from the aorta.
- Aortic rupture causing rapid blood loss, shock and/or death.
- Clot formation.
- Insufficient circulation past the area of the dissection.
- Irreversible kidney failure.
- Myocardial infarction (tissue death).
- Cardiac tamponade.
It is imperative that you seek medical attention immediately if you develop severe abdominal pain or other symptoms that are suggestive of an abdominal aortic aneurysm aortic dissection.
What is aortic stenosis?
When aortic valve stenosis occurs, the aortic valve, located between the aorta and left ventricle of the heart, is narrower than normal size. When the degree of narrowing becomes significant enough to impede the flow of blood from the left ventricle to the arteries, heart problems develop. Aortic stenosis is caused by many disorders. One cause is rheumatic fever, which may occur with strep throat and scarlet fever. Other causes include calcification of the valve and congenital abnormalities. There may be a history of other valve diseases, coronary artery disease, or heart murmur. Aortic stenosis is three times more common among men than women. Symptoms usually do not appear until middle age or older.
Aortic stenosis cannot be prevented, but some of the complications can be preventable. Notify your health care provider about any history of heart valve disease before treatment for any condition. Also, any dental work, including cleaning, and any invasive procedure, can introduce bacteria into the bloodstream, which can infect a weakened valve. Follow your provider’s treatment recommended for conditions that may cause valve disease. Treat strep infections promptly to prevent rheumatic fever. Notify the provider if there is a family history of congenital heart diseases.
Symptoms (some may not show until late in the course of the disease).
- Breathlessness, fainting or weakness with activity.
- Sensation of feeling the heartbeat.
- Chest pain, angina-type.
- Under the sternum and may radiate.
- Crushing, squeezing, pressure and/or tightness.
- Increased with exercise and relieved with rest.
- Decreased urine output.
Signs and Tests.
Examination shows a palpable chest thrill or heave (vibration or movement felt by holding the hand over the heart). There is almost always a heart murmur, click or other abnormal sounds on auscultation (examination of the chest with a stethoscope). There may be faint pulses or changes in the quality of the pulse in the neck and blood pressure may be low.
Aortic stenosis and/or enlargement of the left ventricle may be revealed on
- A left coronary angiography.
- An echocardiogram.
- A Doppler ultrasonography.
- A chest X-ray.
An ECG may show left-ventricle enlargement or arrhythmias (unusual pattern of heartbeats) such as ventricular tachycardia or sinus bradycardia. This disease may also alter the results of the following:
- A chest MRI.
- An aortic angiography.
If there are no symptoms or symptoms are mild, only observation may be required. If symptoms are mild to severe, hospitalization may be required. Medications may include diuretics, Digoxin, and other medications to control heart failure. Symptomatic people may be advised to avoid strenuous physical activity. People with symptoms of aortic stenosis may experience difficulty breathing, chest pain, and syncope should have a physical exam every 6 to 12 months, and an ECG performed every 1 to 3 years. Surgical repair or replacement of the valve is the preferred treatment for symptomatic aortic stenosis. Expectations: Aortic stenosis is curable with surgical repair, although there may be a continued risk for arrhythmias. The person may be symptom-free until complications develop. Without surgery, probable outcome is poor if there are signs of angina or heart failure.
- Left ventricular hypertrophy (enlargement) caused by the extra work of pushing blood through the narrowed valve.
- Left-sided heart failure.
- Sudden death from arrhythmias.
Call Your Healthcare Provider.
Call for an appointment with your health care provider if symptoms indicate aortic stenosis may be present or if aortic stenosis has been diagnosed and symptoms worsen or new symptoms develop. Aortic stenosis.
What is an arrhythmia?
An arrhythmia is a change in the regular beat of the heart or abnormal heart rhythm. The heart may seem to skip a beat or beat irregularly or very fast or very slowly. The heart has it’s own natural or built-in pacemaker called the sinoatrial node (also called the SA node or sinus node). In a normal person, the SA node sends out impulses to the right and left upper chambers (atria) of the heart telling them it’s time to beat. The signal then travels through the AV node, then into the ventricles (bottom chambers) via the “His bundle” telling them to beat. This causes the atria to beat first and a split second later, the ventricles beat. This is the most efficient and effective way for your heart to pump blood to the body. In a normal person, the AV node is the only way for heartbeat signals to travel between the top and bottom chambers of the heart.
What happens in the heart during an arrhythmia?
Describing how the heart beats normally helps to explain what happens during an arrhythmia. The heart is a muscular pump divided into four chambers; two atria located on the top and two ventricles located on the bottom. Normally each heartbeat starts in the right atrium. Here, a special group of cells called the sinus node, or natural pacemaker sends an electrical signal. The signal spreads throughout the atria to the area called the atrioventricular (AV) node. The AV node connects to a group of special pathways that conduct the signal to the ventricles below. As the signal travels through the heart, the heart contracts. First the atria contract, pumping blood into the ventricles a fraction of a second later, the ventricles contract, sending blood throughout the body. Usually the whole heart contracts between 60 and 100 times per minute. Each contraction equals one heartbeat.
Many times, there is no recognizable cause of an arrhythmia. Heart disease may cause arrhythmias, but having an arrhythmia does not mean that you have heart disease. An arrhythmia may occur for one of several reasons:
- Instead of beginning in the sinus node, the heartbeat begins in another part of the heart.
- The sinus node develops an abnormal rate or rhythm.
- A patient has a heart block.
- Use of caffeine, tobacco, alcohol, diet pills, and cough & cold medicines.
How common and serious are arrhythmias?
Arrhythmias occur commonly in middle-aged adults. As people get older, they are more likely to experience an arrhythmia. The majority of people with arrhythmias do not need extensive exams or special treatments for their condition. For some, arrhythmias are associated with heart disease, in which case, heart disease, not the arrhythmias, poses the greatest threat to the patient. In a very small number of people with serious symptoms, arrhythmias themselves are dangerous. These arrhythmias require medical treatment to keep the heartbeat regular. Some people have a very slow heartbeat, causing them to feel lightheaded or faint. If left untreated, the heart may stop beating and these people could die. For most people, however, these symptoms are completely harmless.
- Very fast heartbeat or skipped heartbeat.
- Feeling dizzy, faint or lightheaded.
- Shortness of breath.
- Chest pain
- Passing out
What is heart block?
Heart block is a condition in which the electrical signal cannot travel normally down the special pathways to the ventricles. For example, the signal from the atria to the ventricles may be delayed, but each one conducted:
- Delayed with only some getting through.
- Completely interrupted.
- If there is no conduction, the beat generally originates from the ventricles and is very slow .
How are arrhythmias detected?
Sometimes an arrhythmia can be detected by listening to the heart with a stethoscope. However, the electrocardiogram is the most precise method for diagnosing arrhythmia. An arrhythmia may not occur at the time of the exam even though the symptoms are present at other times. In such cases, tests will be done if necessary to find out whether an arrhythmia is causing the symptoms.
How are arrhythmias treated?
Many arrhythmias require no treatment whatsoever. Serious arrhythmias are treated in several ways depending on what is causing the arrhythmia. Sometimes the heart disease is treated to control the arrhythmia. Or, the arrhythmia itself may be treated using one or more of the following treatments:
There are several kinds of drugs used to treat arrhythmias and one or more may be used in combination. Drugs are carefully chosen because they can cause arrhythmias or make arrhythmias worse. For this reason, the benefits of the drug are carefully weighed against any risks associated with taking it.
To quickly restore a heart to its normal rhythm, the doctor may apply an electrical shock to the chest wall. This treatment is called cardioversion and is most often used in emergency situations. After cardioversion, drugs are usually used to prevent the arrhythmia from recurring.
Automatic Implantable Defibrillators.
These devices are used to correct serious ventricular arrhythmias that can lead to sudden death. The defibrillator is surgically placed inside the patient’s chest. There, it monitors the heart’s rhythm and quickly identifies serious arrhythmias. With an electrical shock, it immediately disrupts a life-threatening arrhythmia.
This device can take charge of sending electrical signals to make the heart beat if the heart’s natural pacemaker is not working properly or its electrical pathway is blocked. This electrical device is placed under the skin in a minor operation and a lead is extended from the device to the right side of the heart, where it is permanently attached.
When an arrhythmia cannot be controlled by other treatments, doctors may decide to perform surgery. After locating the heart tissue that is causing the arrhythmia, the tissue is altered or removed so that it will not produce the arrhythmia.
Types of Arrhythmias.
There are many types of arrhythmias. Arrhythmias are identified by the location where they occur in the heart (atria or ventricles) and by what happens to the heart’s rhythm when they occur. Arrhythmias arising in the atria are called atrial or supraventricular (above the ventricles) arrhythmias. Ventricular arrhythmias begin in the ventricles. In general, ventricular arrhythmias caused by heart disease are the most serious.
This is characterized by the heart beating too slow. There may be a problem in your SA node, AV node or His bundle that doesn’t allow the heartbeat to travel through your heart in a normal fashion. Tachycardia is a condition characterized by the heart beating at an abnormally rapid rate and interfering with the pumping of oxygenated blood throughout the body.
When this occurs, there are abnormal fast rhythms from the top chambers of the heart. There are many causes including heart disease, aging, metabolic imbalances and other medical problems. Some people are born with the problem even though it may not be evident until later in life.
This is abnormal fast rhythm from the bottom chambers of the heart and is a serious and potentially life-threatening heart rhythm problem. The heart is beating too fast to effectively pump blood through the body.
This is a rhythm problem during which the heart goes so fast that is essentially not pumping any blood. Defibrillation must be performed within seconds to save the patient’s life. Long-term treatment includes medications or implanted defibrillators. With proper attention and treatment, persons who have suffered from arrhythmia’s can still lead a long and healthy life.
Atherosclerosis also called “hardening” or “clogging” of the arteries, is the buildup of cholesterol, fatty cells and inflammatory deposits (called plaque) on the inner walls of the arteries that restrict blood flow to the heart. Atherosclerosis can affect the arteries in the heart, legs, brain, kidneys and other organs.
The type of atherosclerosis known as peripheral arterial disease (PAD), peripheral vascular disease (PVD) and lower extremity vascular disease occurs in the vessels that carry blood to the arms and legs. In healthy arteries, a smooth lining prevents blood from clotting and promotes steady blood flow. In PAD/PVD, the arteries slowly become narrowed or blocked when plaque gradually forms inside the artery walls. If the arteries become narrowed or blocked, blood cannot get through to nourish the tissues, causing the muscles of the lower extremities to cramp and lose strength. This process of cramping in the legs when walking is called “intermittent claudication.”
Blockage in arteries to the kidneys and intestines can lead to poor blood flow to these organs and ultimately tissue damage. The rate at which atherosclerosis progresses varies with each individual and depends on many factors, including where in the body the plaque has formed and the person’s overall health.
What is Atrial Fibrillation?
Atrial Fibrillation (AF) is an irregular and rapid heartbeat, arising from the heart’s upper chamber (atrium), and conducted downwards to the heart’s main chambers (ventricles). Other symptoms of AF typically include palpitations, discomfort and dizziness. During AF, the regular pumping action of the atria is replaced by irregular and quivering spasms of atrial tissue. These spasms may lead to reduced blood flow, blood clots, stroke and even death. This malfunction results in the failure of the atria to fill the ventricles completely and, consequently, the failure of the heart to pump adequate amounts of blood to the body. Often, the greatest concern is that the reduced cardiac output can lead to blood pooling in the atria and the formation of blood clots. Blood clots in the left atrium can dislodge and travel through the bloodstream to the brain, resulting in stroke and even death.
- Atherosclerosis of coronary arteries, with or without a previous heart attack.
- Congestive heart failure.
- Rheumatic heart disease caused by rheumatic fever.
- Chronic lung disease.
Signs & Symptoms:
- Continuously irregular heartbeat in which no 2 beats are of equal strength or duration.
- Weak, dizziness or faintness.
- Occasionally, no symptoms.
- Recent surgery.
- Pulmonary embolism.
- Electrolyte disturbances – especially low potassium.
- Excessive use of thyroid hormones, caffeine or alcohol.
- Excessive weight.
How is atrial fibrillation treated?
Aspirin and Warfarin are two medications currently used. They interfere with blood clotting thus helping to reduce stroke risk in people with atrial fibrillation. Anticoagulants are also given to people who have atrial fibrillation.
Treating atrial fibrillation is an important way to help prevent stroke. For this reason, aggressive treatment of this heart arrhythmia is recommended.
- A patient who has atrial fibrillation should be treated by his or her physician with some form of preventive medication.
- Aspirin and Warfarin are the medications currently used and can have a major beneficial effect on public health.
- Maintain a low-fat diet.
- Stop smoking.
- Reduce caffeine and alcohol intake.
- Some weight loss symptoms require medication.
- Reduce stress.
- Diagnostic tests include electrocardiogram and blood studies to measure the levels of drugs used in treatments.
- Be sure family and friends are familiar with CPR in case of cardiac arrest.
- Electric shock may restore normal rhythm.
- Learn to check your own pulse for rate & rhythm and avoid non-prescription decongestants.
- As symptoms improve, resume your normal physical activities.
- A regular exercise program is recommended.
- Lose weight if you are overweight.
- Do not use appetite suppressants.
- Maintain a low-fat and low-sodium diet.
- Arterial thrombosis or embolus.
- Acute pulmonary edema.
- Congestive heart failure.
- Other heartbeat irregularities that could trigger cardiac arrest.
Cardiac catheterization (also called cardiac cath or coronary angiogram) is an invasive imaging procedure that allows your doctor to evaluate your heart function. Cardiac catheterization is used to:
- Evaluate or confirm the presence of coronary artery disease, valve disease or disease of the aorta.
- Evaluate heart muscle function.
- Determine the need for further treatment (such as an interventional procedure or coronary artery bypass graft, CABG, or surgery).
During a cardiac catheterization, a long, narrow tube called a catheter is inserted through a plastic introducer sheath (a short, hollow tube that is inserted into a blood vessel in your leg or arm). The catheter is guided through the blood vessel to the coronary arteries with the aid of a special x-ray machine.
Contrast material is injected through the catheter and x-ray movies are created as the contrast material moves through the heart’s chambers, valves and major vessels. This part of the procedure is called a coronary angiogram (or coronary angiography).
Coronary artery disease is the narrowing or blockage of the coronary (heart) arteries. After an interventional procedure, the coronary artery is opened, increasing blood flow to the heart.
The digital photographs of the contrast material are used to identify the site of the narrowing or blockage in the coronary artery.
What is congestive heart failure?
Congestive heart failure (or heart failure) does not mean that the heart suddenly stopped working or that you are about to die. Heart failure is a condition in which the heart can’t pump enough blood to meet the needs of the body’s other organs. It is a common condition that usually develops slowly as the heart muscle weakens and needs to work harder to keep blood flowing through the body. Heart failure develops following an injury to the heart such as the damage caused by a heart attack, long-term high blood pressure or an abnormality of one of the heart valves. The weakened heart must work harder to keep up with the demands of the body.
Heart failure can result from:
- Narrowed arteries that supply blood to the heart muscle – coronary artery disease.
- Previous heart attack, or myocardial infarction with scar tissue that interferes with the heart muscle’s normal work.
- High blood pressure.
- Heart valve disease due to past rheumatic fever or other causes.
- Primary disease of the heart muscle itself, called cardiomyopathy.
- Defects in the heart present at birth (congenital heart disease).
- Infection of the heart valves and/or heart muscle itself – endocarditis and/or myocarditis the “failing” heart keeps working but doesn’t work as efficiently as it should. As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing congestion in the tissues.
Often swelling (edema) results, most commonly in the legs and ankles, but possibly in other parts of the body as well. Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath, especially when a person is lying down. People with heart failure can’t exert themselves.
Heart failure also affects the ability of the kidneys to dispose of sodium and water. The retained water increases the edema.
- Shortness of breath, even during mild activity.
- Difficulty breathing when lying down.
- Weight gain with swelling in the legs and ankles from fluid retention.
- General fatigue, weakness and feeling tired.
Diagnosis & treatment of congestive heart failure.
Your doctor is the best person to diagnose and treat congestive heart failure. Early diagnosis and treatment are very important. Today, so many people with heart failure can live normal lives and be less at risk for being hospitalized. If you are diagnosed with heart failure, there are a number of medications that work together to improve your symptoms. Taking these medicines, in addition to eating right and getting regular exercise, will help improve your health.
Congestive heart failure usually requires a treatment program consisting of:
- Proper diet.
- Modified daily activities.
- Drugs such as
- A.C.E. inhibitors
- Beta blockers
The various drugs used to treat congestive heart failure perform different functions. ACE inhibitors and vasodilators expand blood vessels and decrease resistance, allowing blood to flow more easily and making the heart’s work easier or more efficient. Beta-blockers can improve the function of the left ventricle. Digitalis increases the pumping action of the heart, while diuretics help the body eliminate excess salt and water. When a specific cause of congestive heart failure is discovered, it should be treated or, if possible, corrected. For example, in some cases, congestive heart failure can be treated by treating high blood pressure. Some are treated with surgery to replace abnormal heart valves. However, when the heart becomes so damaged that it can’t be repaired, a more drastic approach, such as a heart transplant, should be considered.
Living with congestive heart failure.
About two-thirds of all patients die within five years of diagnosis. People with heart failure are also at risk for sudden death. However, most cases of mild and moderate congestive heart failure are treatable and some patients live for many years. The outlook for an individual patient depends on the patient’s age, severity of heart failure, overall health, and a number of other factors including the desire and ability to make lifestyle changes and take prescribed medications. To improve the chances of surviving with heart failure and to enhance quality of life, patients must make lifestyle changes and take care of themselves.
As heart failure progresses, the effects can become quite severe, and patients can lose the ability to perform even modest physical activity. Eventually, the heart’s reduced pumping capacity may interfere with routine functions, and patients may become unable to care for themselves. The loss in functional ability can occur quickly if the heart is further weakened by heart attacks other conditions that affect heart failures, such as diabetes and coronary heart disease. Heart failure patients also have an increased risk of cardiac arrest caused by an irregular heartbeat.
The best defense against heart failure is the prevention of heart disease. Almost all major coronary risk factors can either be controlled or eliminated: smoking, high cholesterol, high blood pressure, diabetes and obesity.
Tips for living with heart failure:
- Research your condition. Having knowledge about this condition is the first step to managing it and taking control of your health.
- See your physician regularly and closely follow his or her instructions.
- Don’t smoke.
- Monitor your blood pressure, pulse and weight. Know your ideal weight and notify your doctor whenever body weight changes by more than 5 lbs. between visits.
- Never stop taking prescribed medication without talking to your doctor. It is important for patients with heart failure to understand that their blood pressure needs to be lower than that of a person without heart failure.
- Keep a current medication list in your wallet or purse for emergency situations. Include information about any blood thinners you may be taking and any artificial implants, valves, pacemakers or defibrillators that you have. Also, note your diagnosis and your doctor’s telephone number.
- Know what you need to do to travel and go on vacation. With careful planning, many patients with heart failure can enjoy traveling.
- Ask your physician about how much alcohol you are allowed to drink. Some patients can have a small amount and others can have none.
- Ask your doctor about getting the flu or pneumonia shot. These can be important in preventing or lessening the effects of the disease.
Coronary artery disease (CAD) is the narrowing or blockage of the coronary arteries which supply blood to the heart. This limits the amount of blood that the heart muscle receives (ischemia) and causes chest pain (angina) at rest or during exertion. This, in turn, causes several important heart problems such as:
- Myocardial infarction (heart attack).
- Heart failure (poor heart pump function).
- Cardiac arrhythmias (life-threatening abnormal heartbeat).
- Limited exercise tolerance due to angina (chest pain) or dyspnea (shortness of breath).
Specialists in the Coronary Artery Disease Center help patients who:
- Have significant disease and/or symptoms and need treatment (such as medications, angioplasty, stents or coronary artery bypass surgery).
- Have been diagnosed with CAD and are looking for ways to control the condition and prevent future blockage.
- Want an expert opinion about the best way to treat their CAD and trying to choose between coronary artery bypass surgery or a catheter–based procedure.
- Have significant blockage or ischemic heart disease and have been told they are not eligible for further traditional treatment options.
What is coronary artery bypass surgery?
Coronary artery bypass surgery is often the best solution for patients suffering from severe coronary artery disease, Atherosclerosis. Atherosclerosis is a disease that is the result of fatty build-up on the inner walls of the arteries that nourish the heart and allows less room for blood to flow. These build-ups can narrow the arteries and thus restrict the normal flow of oxygen-rich blood, or can actually block the flow of blood altogether. If your doctor has recommended coronary bypass surgery to “detour” your blocked artery, the following information can help answer your questions about this procedure.
In its early stages, CAD has no obvious symptoms. As Atherosclerosis worsens, it may cause one or more of the following:
- Dull, crampy pain in your buttock, thigh and calf muscles during exertion.
- Sudden onset of localized paralysis, tingling or numbness in a limb; partial vision or speech loss. These symptoms may indicate cerebral atherosclerosis, which can lead to stroke.
- A feeling of tightness or heavy pressure in the chest.
How is coronary bypass done?
During bypass surgery, surgeons take a blood vessel from another part of the body and construct a detour around the blocked part of the coronary artery. The breastbone is broken and opened to gain access to the heart; however, the heart itself is not opened. There are two common procedures:
- An artery may be detached from the chest wall and the open end attached to the coronary artery below the blocked area.
- A piece from a long vein in your leg may be removed and one end is sewn onto the large artery leaving your heart. The other end of the vein is grafted to the coronary artery below the blocked area.
Either way, blood can then use this new path to once again flow freely to the heart.
What is minimally invasive bypass surgery?
This is a new technique that is being evaluated as an alternative to traditional coronary artery bypass surgery. It involves the use of special tools to perform a coronary artery bypass procedure without breaking the breastbone and without the use of a heart-lung machine. The benefits of this procedure are less pain and shorter hospitalization. This is a new technique and many medical centers do not yet perform. Your doctor will help you decide which treatment is best for you.
What to expect.
Prior to your surgery, you will have a full medical and cardiac evaluation that usually includes cardiac catheterization (an examination of the inside of your heart), a coronary angiogram ventriculogram (an x-ray picture of the pumping action of the lower left part of your heart). The procedure is performed under general anesthesia. You will recover in the intensive care unit of the hospital and monitored closely for 2 – 3 days. You will have several tubes to help you breathe, empty your bladder and provide medications. Once your condition is stable and the tubes are removed, you will be moved to a regular hospital room where you will spend 7 – 10 days. You will then receive physical, respiratory and occupational therapy. Bypass surgery is a major surgical procedure, so it is important that you speak with your doctor in advance about possible complications, as it does carry some risks.
After surgery care.
Your recovery time at home will be approximately one to two months. You will have follow-up visits during that time to monitor your progress and the success of the surgery and your doctor will place you on a specialized post-operative rehabilitation and prevention program. It is imperative that you follow your physician’s instructions about reducing your risk of the progress of further Atherosclerosis by stopping smoking (if you smoke), reduce your consumption of high fat and cholesterol foods, follow your doctor’s recommended exercise program and learn how to control your blood pressure. Sexual activities may be resumed 3-4 weeks after surgery. You should be somewhat careful in protecting the area around the leg from which the vein was removed; this may take a few months to return to normal. Most people who have sedentary office jobs can return to work in four to six weeks. Those who have physically demanding jobs will need to wait longer. In some cases, they may need to find other employment with less physical activity.
Hope for the future.
Without coronary artery bypass surgery, for many people there would be no hope for tomorrow. By providing your heart with life-giving oxygen, coronary artery bypass surgery can help ensure a longer healthier life.
What is deep venous thrombosis?
Deep venous thrombosis (DVT) affects mainly the veins in the lower leg and the thigh. It involves the formation of a clot (thrombus) in the larger veins of the area. This thrombus may interfere with circulation of the area, and it may break off and travel through the blood stream (embolize). The embolus thus created can lodge in the brain, lungs, heart, or other area, causing severe damage to that organ.
Risks include prolonged sitting, bed rest, or immobilization; recent surgery or trauma, especially hip surgery, gynecological surgery, heart surgery, or fractures; childbirth within the last 6 months; obesity; and the use of medications such as estrogen and birth control pills. Risks also include a history of polycythemia vera, malignant tumor, changes in the levels of blood clotting factors making the blood more likely to clot, disseminated intravascular coagulation (DIC), and dysfibrinogenia.
Deep venous thrombosis occurs in approximately 2 out of 1,000 people. The condition is most commonly seen in adults over age 60.
Anticoagulants may be prescribed as a preventive measure for high-risk people. Minimize mobility of the legs.
- Leg pain in only one leg.
- Leg tenderness in only one leg.
- Swelling of only one leg.
- Increased warmth of one leg.
- Changes in skin color of one leg, redness or bluish.
- Joint pain.
Signs and Tests.
An examination may reveal a red, swollen, tender area of the leg. The Homans sign is positive, there is sharp pain when the foot is flexed upward.
The presence of deep venous thrombosis may be seen on:
- Venography of the legs.
- Extremity arteriography.
- Blood flow studies.
- Doppler ultrasound exam of an extremity.
- Plethysmography of the legs.
The clot itself usually will resolve through the natural healing processes. Treatment is also aimed at relieving symptoms and preventing the clot from traveling to the lungs, heart, brain, or other areas. Treatment usually requires hospitalization, at least initially.
Anticoagulants or antiplatelet medications are prescribed to prevent further clotting. Analgesics may be needed to control pain. Thrombolytics (clot-dissolving medications) are rarely needed.
Bed rest may be recommended until the symptoms are relieved. The leg may be elevated to reduce swelling. Avoid prolonged sitting. Warm, moist heat to the area may help relieve pain.
After returning home, the patient may continue oral anticoagulants or antiplatelet medications for a prolonged period of time. Warm compresses may also be continued. Continue to avoid prolonged sitting or standing in one position.
Most DVT’s disappear without difficulty. Complications may be life-threatening.
- Pulmonary embolus.
- Stroke (rare)
- Embolus in other organs (rare).
It is recommended that you call your health care provider if symptoms suggestive of DVT occur. With proper attention and care, a person with DVT can still live a long and productive life.
ECG is a device used to record on graph paper the electrical activity of the heart. The picture is drawn by a computer from the information supplied by the electrodes.
Your doctor uses the EKG to:
- Assess your heart rhythm.
- Diagnose poor blood flow to the heart muscle (ischemia).
- Diagnose a heart attack.
- Diagnose abnormalities of your heart, such as heart chamber enlargement and abnormal electrical conduction.
A heart attack, or myocardial infarction (MI), is permanent damage to the heart muscle. “Myo” means muscle, “cardial” refers to the heart, and “infarction” means death of tissue due to lack of blood supply.
A closer look inside your coronary arteries.
Your heart muscle needs to receive a good supply of blood at all times to function properly. Your heart muscle gets the blood it needs to do its job from the coronary arteries.
What is coronary artery disease?
Coronary artery disease is the narrowing or blockage of the coronary arteries caused by atherosclerosis. Atherosclerosis (sometimes called “hardening” or “clogging” of the arteries) is the buildup of cholesterol and fatty deposits (called plaque) on the inner walls of the arteries that restricts blood flow to the heart.
Without adequate blood, the heart becomes starved of oxygen and the vital nutrients it needs to work properly. This can cause chest pain called angina. When one or more of the coronary arteries are completely blocked, a heart attack (injury to the heart muscle) may occur.
What happens during a heart attack?
A network of blood vessels known as coronary arteries surround the heart muscle and supply it with blood that is rich with oxygen and nutrients. The heart muscle needs this continuous supply of oxygen and nutrients to function.
A heart attack occurs when a coronary artery becomes suddenly blocked, stopping the flow of blood to the heart muscle and damaging it.
Types of Heart Attacks.
When fat builds up inside your arteries it causes slight injury to your blood vessel walls. In an attempt to heal the blood vessel walls, the cells release chemicals that make the blood vessel walls stickier. Other substances traveling through your bloodstream such as inflammatory cells, cellular waste products, proteins and calcium begin to stick to the vessel walls. The fat and other substances combine to form a material called plaque.
Over time, the inside of the arteries develop plaques of different sizes. Many of the plaque deposits are soft on the inside with a hard fibrous “cap” covering the outside. If the hard surface cracks or tears, the soft, fatty inside is exposed. Platelets (disc-shaped particles in the blood that aid clotting) come to the area, and blood clots form around the plaque.
If a blood clot totally blocks the blood supply to the heart muscle, called a coronary thrombus or coronary occlusion, the heart muscle becomes “starved” for oxygen and nutrients (called ischemia) in the region below the blockage. Within a short time, an acute coronary syndrome can occur.
The term “heart failure” can be frightening. It does not mean the heart has “failed” or stopped working. It means the heart does not pump as well as it should.
Heart failure is a major health problem in the United States, affecting about 5.7 million Americans. About 550,000 new cases of heart failure occur each year. It is the leading cause of hospitalization in people older than 65.
If you have heart failure, taking care of yourself and keep yourself in balance will allow you to enjoy better health and quality of life. It is important to learn about heart failure, how to keep in good balance and when to call the doctor.
How common is heart failure?
Almost 6 million Americans have heart failure and more than 870,000 people are diagnosed with heart failure each year. The condition is the leading cause of hospitalization in people over age 65.
Heart failure and aging.
Although the risk of heart failure does not change as you get older, you are more likely to have heart failure when you are older.
Women and heart failure.
Women are just as likely as men to develop heart failure, but there are some differences:
- Women tend to develop heart failure later in life compared with men.
- Women tend to have heart failure caused by high blood pressure and have a normal EF.
- Women may have more shortness of breath than men do. There are no differences in treatment for men and women with heart failure.
What are the types of heart failure?
There are many causes of heart failure, but the condition is generally broken down into two types:
Heart failure with reduced left ventricular function (HF-rEF).
The lower left chamber of the heart (left ventricle) gets bigger (enlarges) and cannot squeeze (contract) hard enough to pump the right amount of oxygen-rich blood to the rest of the body.
Heart failure with preserved left ventricular function (HF-pEF).
The heart contracts and pumps normally, but the bottom chambers of the heart (ventricles) are thicker and stiffer than normal. Because of this, the ventricles can’t relax properly and cannot fill up all the way. Because there is less blood in the ventricles, less blood is pumped out to the rest of the body when the heart contracts.
What is ejection fraction?
Ejection Fraction: refers to how well your left ventricle (or right ventricle) pumps blood with each heartbeat. Most times, EF refers to the amount of blood being pumped out of the left ventricle each time it contracts. The left ventricle is the heart’s main pumping chamber.
Your EF is expressed as a percentage. An EF that is below normal can be a sign of heart failure. If you have heart failure and a lower-than-normal (reduced) EF (HF-rEF), your EF helps your doctor know how severe your condition is.
How is EF measured?
Ejection fraction can be measured using:
- Echocardiogram (echo) – this is the most common way to check your EF
- Magnetic resonance imaging (MRI) scan of the heart
- Nuclear medicine scan (multiple gated acquisition MUGA) of the heart; also called a nuclear stress test
Why it’s important to know your EF.
If you have a heart condition, it is important for you and your doctor to know your EF. Your EF can help your doctor determine the best course of treatment for you. Measuring your EF also helps your healthcare team check how well our treatment is working.
Ask your doctor how often you should have your EF checked. In general, you should have your EF measured when you are first diagnosed with a heart condition, and as needed when your condition changes.
What do the numbers mean?
Ejection Fraction (EF) 55% to 70%
- Pumping Ability of the Heart: Normal
- Level of Heart Failure/Effect on Pumping: Heart function may be normal or you may have heart failure with preserved EF (HF-pEF)
Ejection Fraction (EF) 40% to 54%
- Pumping Ability of the Heart: Slightly below normal.
- Level of Heart Failure/Effect on Pumping: Less blood is available so less blood is ejected from the ventricles. There is a lower-than-normal amount of oxygen-rich blood available to the rest of the body. You may not have symptoms.
Ejection Fraction (EF) 35% to 39%
- Pumping Ability of the Heart: Moderately below normal.
- Level of Heart Failure/Effect on Pumping: Mild heart failure with reduced EF (HF-rEF).
Ejection Fraction (EF) Less than 35%
- Pumping Ability of the Heart: Severely below normal.
- Level of Heart Failure/Effect on Pumping: Moderate-to-severe HF-rEF. Severe HF-rEF increases the risk of life-threatening heartbeats and cardiac dyssynchrony/desynchronization (right and left ventricles do not pump in unison).
A normal left ventricular ejection fraction (LVEF) ranges from 55% to 70%. For example, an LVEF of 65% means that 65% of the total amount of blood in the left ventricle is pumped out with each heartbeat. Your EF can go up and down based on your heart condition and how well your treatment works.
What are the symptoms of heart failure?
There may be times that your symptoms are mild or you may not have any symptoms at all. This does not mean you no longer have heart failure. Symptoms of heart failure can range from mild to severe and they may come and go.
In general, heart failure gets worse over time. As it worsens, you may have more or different signs or symptoms. It is important to let your doctor know if you have new symptoms or if your symptoms get worse.
Common signs and symptoms of heart failure:
- Shortness of breath or trouble breathing. You may have trouble breathing when you exercise, when you are resting or when lying flat in bed. Shortness of breath happens when fluid backs up into the lungs (congestion) or when your body isn’t getting enough oxygen-rich blood. If you wake up suddenly at night to sit up and catch your breath, the problem is severe and you need medical treatment.
- Feeling tired (fatigue) and leg weakness when you are active. When your heart does not pump enough oxygen-rich blood to major organs and muscles, you become tired and your legs may feel weak.
- Swelling in your ankles, legs and abdomen; weight gain. When your kidneys do not filter enough blood, your body holds onto extra fluid and water. Extra fluid in your body causes swelling edema and weight gain.
- Need to urinate while resting at night. Gravity causes more blood flow to the kidneys when you are lying down. So, your kidneys make more urine and you have the need to urinate.
- Dizziness, confusion, difficulty concentrating, fainting. You may have these symptoms because your heart is not pumping enough oxygen-rich blood to the brain.
- Rapid or irregular heartbeats. When your heart muscle does not pump with enough force, your heart may beat faster to try to get enough oxygen-rich blood to major organs and muscles. You may also have an irregular heartbeat if your heart is larger than normal (after a heart attack or due to abnormal levels of potassium in your blood).
- A dry hacking cough. A cough caused by heart failure is more likely to happen when you are lying flat and you have extra fluid in your lungs.
What causes heart failure?
Heart failure can be caused by many medical conditions that damage the heart muscle. Common conditions are:
- Coronary artery disease (also called coronary atherosclerosis or “hardening of the arteries”) affects the arteries that carry blood and oxygen to the heart (coronary arteries). The normal lining inside the arteries breaks down, the walls of the arteries become thick, and deposits of fat and plaque partially block the flow of blood. Over time, the arteries become very narrow or completely blocked, which causes a heart attack. The blockage keeps the heart from being able to pump enough blood to keep your organs and tissues (including your heart) healthy. When arteries are blocked, you may have chest pain (angina) and other symptoms of heart disease.
- Heart attack. A heart attack happens when a coronary artery suddenly becomes blocked and blood cannot flow to all areas of the heart muscle. The heart muscle becomes permanently damaged and muscle cells may die. Normal heart muscle cells may work harder. The heart may get bigger (HF-rEF) or stiff (HF-pEF).
- Cardiomyopathy is a term that describes damage to and enlargement of the heart muscle not caused by problems with the coronary arteries or blood flow. Cardiomyopathy can occur due to many causes including viruses, alcohol or drug abuse, smoking, genetics and pregnancy (peripartum cardiomyopathy).
- High blood pressure (hypertension). Blood pressure is the force of blood pushing against the walls of your blood vessels (arteries). If you have high blood pressure, it means the pressure in your arteries is higher than normal. When blood pressure is high, your heart has to pump harder to move blood to the body.
- Abnormal heart rhythms including atrial fibrillation.
- Being overweight.
- Tobacco and illicit drug use.
Medications. Some drugs used to fight cancer can lead to heart failure.
A heart murmur is a swishing sound heard when there is turbulent or abnormal blood flow across the heart valve.
Murmurs can be present without any medical or heart conditions. Two common examples include:
- Childhood murmurs
Causes of heart murmurs.
Valvular heart disease is the most common cause of a heart murmur.
- Valve stenosis– a narrow, tight, stiff valve, limiting forward flow of blood.
- Valve regurgitation– a valve that does not close completely, allowing backward flow (a “leaky” valve).
The abnormal changes to the valve cause the abnormal heart sound (murmur).
Other causes of heart murmurs include:
- Hypertrophic cardiomyopathy
- Septal defect
Functional causes for heart murmurs.
Murmurs can be caused by increased blood flow across the valve-related to other medical conditions without valvular heart disease, such as:
Your kidneys play a role in keeping your blood pressure at the right level. This is important because blood pressure is closely related to the health of the kidneys. High blood pressure, also called hypertension, can damage the kidneys.
As blood flows through your veins, it presses against the walls of your blood vessels. Extra fluid in your body increases the volume of fluid in your blood and makes your blood pressure higher. Narrow or clogged blood vessels also raise blood pressure.
High blood pressure makes the heart work harder and, over time, can damage blood vessels throughout the body. If the blood vessels in the kidneys are damaged, they may stop doing their job of removing wastes and extra fluid from the blood. The extra fluid may then raise blood pressure even more.
After diabetes, high blood pressure is the leading cause of kidney failure, commonly called end-stage renal disease (ESRD). Patients with ESRD must either go on dialysis or receive a new kidney through transplant. Every year, high blood pressure causes more than 15,000 new cases of ESRD in the United States.
Most people with high blood pressure do not have any symptoms. The only way to know if your blood pressure is high is to have it measured by a health professional. The measurement consists of two numbers that represent the pressure when your heart is beating and when it is resting between beats. A person’s blood pressure is considered high if it goes over 140/90.
African Americans are more likely than whites to have high blood pressure and to develop kidney problems from it even when blood pressure is only mildly elevated. In fact, African Americans ages 25 to 44 are 20 times more likely than their white counterparts to develop hypertension-related kidney failure.
There are four steps that can help control blood pressure:
- Control your weight.
- Limit your sodium intake.
- Get plenty of exercise.
- Avoid excessive consumption of alcohol.
Many people need medication to control high blood pressure. A group of medications called ACE inhibitors lower blood pressure and have an added protective effect on the kidney in diabetic patients. If you have high blood pressure, see your doctor regularly.
Need to Lower Your Cholesterol? We Can Help.
Cholesterol really matters. How much you ask? For every one percent decrease in your cholesterol, your risk of developing heart disease decreases by two percent.
That’s why it’s important for you to lower high cholesterol whether you are looking to prevent heart disease or are trying to prevent any further damage following a heart attack.
Lower cholesterol is possible.
While lowering your cholesterol may seem like a daunting task, it is possible.
If you have high cholesterol or other risk factors for developing heart disease. We evaluate our patients’ health with very special attention to modifiable risk factors, especially hyperlipidemias, such as high LDL cholesterol, increased triglycerides, low HDL cholesterol, high blood pressure, homocysteine, as well as sedentary lifestyle, obesity and diabetes.
Our team is familiar with the latest and most effective drugs for lowering cholesterol as well as for hypertension and diabetes. Besides prescribing medications to manage your cardiac risk, we can also prescribe highly individualized lifestyle adjustments that can enhance your efforts to stay well and symptom-free. Although many people know the importance of a heart-healthy lifestyle, few are sure of how to implement healthier ways of living in their own day-to-day lives.
How to start.
If you haven’t had a recent cholesterol screening, be sure to schedule yours today. Experts recommend getting a cholesterol panel at 20 years of age, and then every five years. If you have high risk factors for heart disease, your doctor may recommend a yearly check.
It is best to have a test called a “lipoprotein profile.” This blood test is done after fasting for nine to 12 hours and provides a snapshot of your total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides (a type of fat in your blood).
Your goal should be:
- Total cholesterol (a measure of HDL, LDL and other lipoproteins):
- Less than 200 mg/dL
- Less than 150 mg/dL
- LDL (Low-density lipoprotein):
- Less than 130 mg/dL
- Less than 100 mg/dL for those with heart or blood vessel disease and for those with diabetes or high total cholesterol.
HDL (High-density lipoprotein).
- Greater than 55 mg/dL (females)
- Greater than 45 mg/dL (males)
Making your numbers shrink.
The first line of attack for lowering your cholesterol is a combination of changes in lifestyle including diet, exercise and weight loss.
A heart-healthy diet from the National Cholesterol Education Program called the TLC (therapeutic lifestyle changes) diet can help lower your cholesterol. This is a low-saturated-fat and low-cholesterol eating plan that calls for less than 7 percent of calories from saturated fat and less than 200 mg of dietary cholesterol per day. The TLC diet recommends only enough calories to maintain a desirable weight and avoid weight gain. If your LDL is not lowered enough by reducing your saturated fat and cholesterol intakes, you can increase the amount of soluble fiber (think: oats, oranges, beans) in your diet. You can also add certain food products that contain plant stanols or plant sterols (such as cholesterol-lowering margarine) to boost your diet’s LDL-lowering power.
Aim for 30 minutes of physical activity on most, if not all days. It can help raise HDL and lower LDL and is especially important for those with high triglycerides and/or low HDL levels who are overweight with a large waist measurement (more than 40 inches for men and more than 35 inches for women). Your activity should be of moderate intensity, which means you are able to carry on two to three-word sentences. Try running, walking briskly, swimming or dancing.
Losing weight if you are overweight can help lower LDL and is especially important for those with a cluster of risk factors that includes high triglycerides and/or low HDL levels and being overweight with a large waist measurement. Research shows that women whose waist measures more than 35 inches and men more than 40 inches are at a greater risk for developing heart disease. What’s more, the ratio of this waist measurement relative to your hip measurement appears to be one of the strongest predictors of the chances of having a heart attack.
If it’s not low enough.
If you aren’t able to lower your cholesterol enough through lifestyle changes, your doctor may recommend you begin drug treatment. (You will still need to continue your lifestyle changes to keep the dose of medicine as low as possible, and lower your risk in other ways!). There are several types of drugs available for cholesterol-lowering including statins, bile acid sequestrants, nicotinic acid, fibric acids and cholesterol absorption inhibitors. Your doctor can help decide which type of drug is best for you.
Lipids: What you should know.
Cholesterol and triglycerides are the two main types of fat molecules — or lipids — in the body. Without them, the body could not function. For instance, cholesterol is an essential component of cell membranes and is used by the body to produce vitamin D and hormones such as estrogen. It also is used to produce substances that aid digestion. Triglycerides are a major source of energy.
The body has two main sources of cholesterol and triglycerides, the liver and your diet. Cholesterol is found only in animal products (meat, milk, cheese, butter and cream). For some people, eating excesses of cholesterol-rich foods will raise blood cholesterol levels. In normal healthy humans, the liver produces all the cholesterol the body needs so you really don’t need supplemental cholesterol from your diet.
Triglyceride levels can be elevated for a number of reasons: excess sugar, alcohol, fat or calories or uncontrolled diabetes. In addition, some medical conditions and medications or your genetic makeup can cause elevated triglyceride levels.
Cholesterol and triglycerides travel throughout the body via the bloodstream but only with the help of lipoproteins — LDL and HDL — which ferry these fat molecules to various destinations. LDL, or low-density lipoprotein, is known as the bad cholesterol because it sneaks through artery walls and unloads cholesterol there. This is how coronary artery disease, the most common type of atherosclerosis, begins and progresses. HDL (high-density lipoprotein) clears cholesterol from the bloodstream and ferries it back to the liver for removal from the body. HDL can also help clear the cholesterol that LDL leaves embedded behind artery walls. That’s why it’s called “good cholesterol”.
In general, optimal lipid levels are characterized by low levels of LDL and high levels of HDL.
What is blood pressure?
Your blood pressure is a measurement of the pressure/force inside your arteries with each heartbeat. Each time your heart beats, blood is pumped out of the heart into arteries that carry the blood throughout your body.
How is blood pressure measured?
A special cuff is used to measure your blood pressure. The cuff inflates and deflates, and during the process, your pressures are measured. Many times, a stethoscope is also used.
Blood pressure readings.
Blood pressure is recorded as two measurements: systolic and diastolic blood pressure. Systolic blood pressure is the top/first number, and diastolic blood pressure is the bottom/second number. The numbers are expressed as a millimeter of mercury (mmHg).
Systolic blood pressure.
The pressure in the arteries when the heart is beating and the arteries are filled with blood.
Diastolic blood pressure.
The pressure in the arteries when the heart is resting between beats.
What do the numbers mean?
- Your blood pressure can be normal, elevated, or you may have Stage 1 or 2 hypertension (high blood pressure).
- Normal blood pressure is <120/<80 mmHg.
- Elevated blood pressure is 120-129/<80 mmHg.
- Stage 1 hypertension is 130-139 (top number) OR 80-89 (bottom number).
- Stage 2 hypertension is 140 or higher (top number) OR 90 or higher (bottom number).
Two or more readings are needed to determine if you have high blood pressure.
GET IMMEDIATE MEDICAL ATTENTION!
IF YOUR TOP NUMBER IS EVER 180 OR HIGHER AND/OR YOUR BOTTOM NUMBER IS EVER 110 OR HIGHER, GET EMERGENCY MEDICAL TREATMENT OR HAVE SOMEONE TAKE YOU TO THE HOSPITAL RIGHT AWAY!
Your blood pressure does not stay the same at all times. When you are exercising or excited, your blood pressure goes up. When you are resting, your blood pressure is lower. Your blood pressure can also change due to age, medications you take, and changes in position.
Tips for measuring your blood pressure.
- Sit for at least 5 minutes before your blood pressure is measured.
- Do not smoke or drink caffeine 30 minutes before you measure your blood pressure.
- If you are nervous when you go to the doctor, you could have a false high blood pressure reading. This is called “white coat syndrome.” If this happens, your doctor may ask you to use a blood pressure monitor to check your blood pressure throughout the day. You can bring a record of your readings to your appointments.
Some people are asked to wear a blood pressure monitor for 24 hours. The monitor is usually set to take blood pressure every 15 to 30 minutes as you go about your normal activities.
What are the symptoms of high blood pressure?
High blood pressure usually has no symptoms. It is often called the “silent killer” because it can damage your heart, kidneys and brain without you even knowing anything is wrong.
Who is at risk of getting high blood pressure?
Your risk of high blood pressure is higher if:
- You have a family history of high blood pressure, cardiovascular disease or diabetes.
- You are African American.
- You are age 60 or older.
- You take oral contraceptives.
- You are overweight.
What treatments are available for patients with high blood pressure?
High blood pressure is a major risk factor for cardiovascular disease. Without treatment, you can have a transient ischemic attack (TIA) or stroke, heart attack, enlarged heart, heart failure, peripheral vascular disease (such as poor circulation and pain in your legs), aneurysms, kidney disease and broken blood vessels in your eyes. Treatment includes making changes recommended by your healthcare provider.
Diet and lifestyle changes:
- Reach and stay at your ideal body weight.
- Get regular exercise.
- Eat a well-balanced, heart-healthy diet that is low in salt, fat and cholesterol, and contains lots of fresh fruits and vegetables*.
- *Your diet is an important part of blood pressure control. The Dietary Approaches to Stop Hypertension (DASH) eating plan and limiting sodium (salt) help control blood pressure. Ask your doctor to refer you to a dietitian for a more personalized eating plan. More information is available from the National Heart, Lung and Blood Institute at www.nhlbi.nih.gov or the American Heart Association at www.americanheart.org*.
- Having no more than two alcoholic drinks per day (for most men) and no more than one drink per day for women and lighter-weight men. One drink is considered to be 12 ounces of beer or wine cooler, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
- Control stress and anger.
- Avoid all tobacco and nicotine products.
- Other lifestyle changes such as controlling lipid levels (LDL, cholesterol, triglycerides) and managing other health conditions such as diabetes.
Medications and follow-up care:
- Take all medications as prescribed. Do not stop or start taking any medication without talking to your doctor. Blood pressure medication does not keep working after you stop taking it.
- Some over-the-counter medications such as decongestants can change the way your blood pressure medication works.
- Keep all follow-up appointments so your doctor can monitor your blood pressure, make any needed changes to your medications and help control your risk of cardiovascular disease.
Your doctor may ask you to record your blood pressure at home. Follow your doctor’s instructions for recording your blood pressure.
The most common heart valve abnormality is called mitral valve prolapse (MVP), which affects mostly women between the ages of 20 and 40. It can go undetected for years, as symptoms usually do not occur until adolescence or even adulthood. It is a condition of the mitral valve, a two-flapped heart valve between the left atrium and left ventricle. In MVP, one or both of the valve flaps are too large, and the mitral valve does not close evenly with each heartbeat. Because of this imperfect closing, the valve itself slightly balloons back into the left atrium, sometimes causing what is known as a “click”. With the flap there may sometimes be a slight backward leaking of blood (regurgitation) as well, resulting in a heart murmur.
It seems that MVP is an inherited disorder, although the exact genes are not known. If proper precautions are taken it will not affect life expectancy, and generally has no impact on normal activities.
What are the symptoms?
Generally, a stressful situation (childbirth, change in job situation or marital status, viral illness) brings on symptoms that ordinarily would not be present. Some 60% of those with MVP never show symptoms. Some symptoms include:
- Irregular heartbeat or palpitations, particularly when lying on the left side.
- Non-specific sharp or dull chest pain lasting from a few seconds to several hours, occurring at rest rather than during exertion.
- Panic attack, a sudden feeling of anxiety or doom for no apparent reason.
- Fatigue and weakness, even after slight exertion; sometimes misdiagnosed as Chronic Fatigue Syndrome or depression.
- Tachycardia, increased heartbeats often after exertion.
- Migraine headaches resulting from abnormal nervous system control of blood flow.
The condition can be detected during a routine check-up with a simple stethoscope. After the ventricle begins to contract, a clicking sound can be heard, the sound of the abnormal valve fighting the pressure of the left ventricle. The diagnosis can be confirmed with a cardiac echo or echocardiogram, which can also determine the level of severity of the prolapse and the degree of regurgitation. Most patients can be monitored simply, with a follow-up checkup every few years.
Common risks and problems associated with MVP.
Many MVP patients never experience any symptoms. However, rare complications include chest pain and irregular heartbeat, both of which can be treated with medication, usually a beta-blocker. Another rare complication involves formation of blood clots on the valve, making an MVP patient vulnerable to strokes; this problem requires treatment with medication.
The most common and serious MVP-related problem, endocarditis, involves bacterial infection of the mitral valve. Although it can be fatal if left untreated, endocarditis can be easily prevented. MVP patients are most commonly vulnerable to the introduction of bacteria into the bloodstream when they are undergoing certain medical procedures, particularly dental work or minor surgery. To avoid this, patients should inform their doctor or dentist that they have MVP, and be given preventative treatment before the procedure.
When is surgery recommended?
Although most MVP patients do very well with treatments and preventive measures, there is sometimes a need for heart surgery to either repair or replace the mitral valve. This occurs only among patients who experience severe mitral regurgitation which can result in progressive heart enlargement and ultimately heart failure. Surgeons are more likely to perform corrective surgery rather than replace the valve with an artificial one mainly because the introduction of an artificial valve requires lifelong use of blood thinners to prevent clotting.
Mitral Stenosis is a heart valve disorder characterized by narrowing or obstruction of the mitral valve, which prevents the valve from opening properly. Also known as mitral valve obstruction affects about 2 out of 10,000 people. Symptoms usually develop between the ages of 20 and 50.
Causes & Risk Factors.
Mitral Stenosis most commonly occurs in people who have had rheumatic fever but can be caused by any disorder that causes the narrowing of the mitral valve. Congenital mitral stenosis alone is rare. It more commonly occurs with complex groups of cardiac abnormalities.
Narrowing of the mitral valve obstructs blood flow from the left atrium to the left ventricle. This can reduce the amount of blood that flows forward to the body. The atrium enlarges as pressure builds up in it, and blood may backflow into the lungs resulting in fluid in the lung tissue.
Symptoms may begin with an episode of atrial fibrillation or may be triggered by pregnancy or other stress on the body such as respiratory infection, stroke, endocarditis and other cardiac disorders.
Mitral stenosis cannot be prevented but complications can be. As with mitral valve prolapse, advise your physician or dentist of any history of heart valve disease before receiving treatment to prevent a bacterial infection.
There are often no symptoms, or symptoms may appear or worsen with exercise or an increase in heart rate. Symptoms include:
- Difficulty breathing after exercise or when lying flat, also awakening at night with difficulty breathing
- Cough (may have blood in the sputum).
- Fatigue, tired easily.
- Frequent respiratory infections such as bronchitis.
- .Chest discomfort
- Tight, crushing, pressure, squeezing and/or constricting.
- Radiates to the arm, neck, jaw or other areas.
- Increases with activity and decreases with rest.
- The Sensation of feeling the heartbeat.
- Swelling of feet or ankles
Signs and Tests.
A stethoscope examination reveals a distinctive murmur, snap, or other abnormal sounds. This means a rumbling sound is heard over the point of the heart during the resting phase of the heartbeat, and it gets more pronounced just before the heart contraction begins. Examination may also reveal irregular heartbeat or lung congestion. Blood pressure is usually normal. There may be vibration or tapping on palpation over the heart making it difficult to distinguish from a heart tumor.
Narrowing or obstruction of the valve, or enlargement of the atrium may show on an echocardiogram, Doppler ultrasound, chest X-ray, ECG or coronary angiography.
No treatment may be necessary if symptoms are absent or mild. Hospitalization may be required for diagnosis and for treatment of more severe symptoms. Medications include diuretics, dioxin, or antiarrhythmics. Anticoagulants may be used to prevent blood clots. Heart valve surgery or replacement of the valve may be necessary. Balloon valvuloplasty may be considered instead of surgery.
The disorder may be mild or without symptoms. It may be more severe and eventually disabling. Complications may be severe or life-threatening. Mitral stenosis is usually controllable with treatment, and improved with surgery.
- Enlargement of the atrium.
- Incomplete atrial emptying.
- Heart failure.
- Pulmonary edema.
- Atrial fibrillation.
- Emboli to the intestines, lungs, or other areas.
Mitral Regurgitation is a disorder in which the mitral heart valve does not close properly, causing blood to leak into the left atrium when the left ventricle contracts. Mitral regurgitation affects approximately 5 out of 10,000 people.
Causes and Risk Factors.
Regurgitation is caused by disorders that weaken or damages the valve. Inadequate closure of the mitral valve causes blood to backflow to the left atrium decreasing the blood flow to the rest of the body causing the heart to pump harder to try to compensate for the decreased blood flow. It may also be the result of dysfunction or injury to the valve following MI or infective endocarditis, which may result in rupture of the valve, papillary muscle, or chordae tendineae (the structures that anchor the valve cusps). Such a rupture results in the valve leaflet protruding into the atrium, leaving an opening for the backflow of blood.
Risk factors include an individual or family history of the above disorders.
Prompt treatment of causative disorders reduces the risk of mitral regurgitation. As with mitral stenosis and mitral valve prolapse, you should advise your physician or dentist of any history of heart valve disease before receiving treatment to prevent a bacterial infection.
There may be an abrupt onset of symptoms.
- Shortness of breath.
- Rapid respiration.
- A sensation of feeling the heartbeat.
- Chest pain unrelated to coronary artery disease or myocardial infarction.
Signs and Tests.
Palpation may show a vibration over the heart. A stethoscope may reveal a distinctive murmur in the heart. If fluid backs up into the lungs, there may be signs of congestion of the pulmonary (lung) veins. Blood pressure is usually normal. Billowing of the mitral valve and/or regurgitation of blood may show on an echocardiogram or coronary angiography.
A chest X-ray may also show fluid in the lungs or prominent pulmonary veins. Swan-Ganz left heart catheterization pressure readings will record a marked elevation of left atrial pressure. An ECG usually shows a normal sinus rhythm, but may show arrhythmias such as atrial fibrillation. Other tests may include a chest MRI scan, radionucleotide scans, or a CT scan of the chest.
Hospitalization may be required for diagnosis and treatment of severe symptoms. Emergency surgery is often necessary if acute regurgitation is a result of endocarditis, MI, or ruptured chordae.
Antibiotics may be prescribed if there is a bacterial infection. Antiarrhythmics may be needed to control irregular rhythms. Vasodilators reduce the workload of the heart. Digitalis may be used to strengthen heartbeat, and diuretics to remove excess fluid such as fluid in the lungs. Anticoagulants or antiplatelet medications may be used to prevent clot formation if atrial fibrillation is present. When blood pressure cannot be maintained, in emergency situations, the intra-aortic balloon pump (IABP) reduces backflow by lowering resistance in the aorta.
The outcome varies and depends on the severity of the acute regurgitation. It can sometimes be controlled with medications, but surgery is often necessary, as it may become a chronic condition.
- Chronic mitral regurgitation.
- Heart failure
- Pulmonary emboli.
- Clots of other areas.
- Arrhythmias, including atrial fibrillation and lethal.
What is a Pacemaker?
Your heartbeat is controlled by the heart’s own bioelectrical triggering system. When that system ceases to work properly, the solution may be a pacemaker. A pacemaker is a small, battery-operated device that helps the heart beat in a regular rhythm. It is used to replace a faulty natural pacemaker or blocked pathway. There are two types of pacemakers, permanent and temporary. Permanent pacemakers are called internal while the temporary type is called external.
- A pacemaker uses batteries to send electrical impulses to the heart to help it pump properly. An electrode is placed next to the heart wall and small electrical charges travel through the wire to the heart.
- Most pacemakers have a sensing device that turns itself off when the heartbeat is above a certain level. It turns back on when the heartbeat is too slow. These are called demand pacemakers.
The pacemaker has two parts, a battery-powered generator and the wires that connect it to the heart. The silver-dollar-size generator, which has an effective life of seven to 12 years, is implanted just beneath the skin below the collarbone. The leads are threaded into position through veins leading back to the heart. The entire implantation procedure requires only a local anesthetic and takes about an hour.
Most patients with pacemakers suffer from a condition in which the heart beats too slowly (bradyarrhythmia). This is most commonly a result of deterioration in the heart’s own pacing system in elderly patients, though high blood pressure, coronary artery disease or scarring from a heart attack can also cause bradyarrhythmias.
The most commonly installed pacing device is a demand pacemaker. It monitors the heart’s activity and takes control only when the heart rate falls below a programmed minimum – usually 60 beats per minute.
Other conditions that require pacemakers include heart block in which the heart stops beating altogether for several seconds and tachyarrhythmia, an overly rapid heartbeat.
A more sophisticated type of pacemaker actually monitors a number of physical changes in the body, which signal an increase or decrease with activity. If the heart’s own pacing system fails to respond properly, these rate-responsive pacemakers slowly raise or lower the heartbeat to the appropriate level from 60 to 150 beats per minute.
If the patient’s condition dictates reprogramming the implanted generator, the cardiologist signals the changes to its tiny on-board computer with an electromagnetic signaling device placed on the surface of the skin above the pacemaker.
Most patients are able to resume their normal daily activities after recovering from surgery for a pacemaker. However, people with pacemakers need to be aware of important recommendations and precautions about electricity and magnets.
Always tell any medical or dental personnel that you have a pacemaker. Guidelines help you become aware of medical procedures that do and do not pose risks to the proper functioning of your pacemaker.
When walking through an airport and other security systems, people with a pacemaker should be aware that certain security systems might detect the metal of their device.
Being aware of these guidelines will help ensure your highest levels of comfort and ease after receiving a pacemaker.
The warning signs posted advising pacemaker patients that a microwave oven is installed is no longer necessary. Modern pacemakers are shielded from stray electromagnetic forces and have a backup mode that takes over if a really strong electromagnetic field disrupts the main circuit’s programming.
What is a stent and how is it used?
A stent is a permanent implant in an artery or vein. It is expanded against the inner wall where there is a build-up of fatty substances that reduce the flow of blood. This build-up is known as arteriosclerosis. If it is left untreated, total blockage can occur resulting in a heart attack. Stent procedure uses a wire mesh tube (a stent) to prop open an artery that has recently been cleared using angioplasty. The stent is collapsed to a small diameter, placed over an angioplasty balloon catheter and moved into the area of the blockage. When the balloon is inflated, the stent expands, locks in place and forms a rigid support to hold the artery open. The stent remains in the artery permanently, holds it open, improves blood flow to the heart muscle and relieves symptoms (often chest pain).
When are stents used?
The stent procedure is fairly common and sometimes used as an alternative to coronary artery bypass surgery. A stent may be used as an alternative or in combination with angioplasty. Certain features of the artery blockage make it suitable for using a stent, such as the size of the artery and location of the blockage.
Stent Implantation Step-by-Step.
- The stent, which is mounted on a balloon catheter, is inserted into the artery and directed to the site of the previous obstruction.
- When the balloon and stent are precisely in place, the balloon is inflated and the stent expands. One or more stents may be used in the vessel to span the length of the lesion.
- The balloon catheter is deflated and removed, along with the guidewire and guiding catheter.
- The stent will remain in place permanently, keeping the artery open.
What are the advantages of using a stent?
In certain selected patients, stents have been shown to reduce the narrowing that occurs in many patients following balloon angioplasty or other procedures using catheters. Stents are also useful to restore normal blood flow and keep an artery open if it has been torn or injured by the balloon catheter.
Can stented arteries reclose?
Reclosure (restenosis) can be a problem with the stent procedure. In recent years doctors have used new stents, some of which are covered with drugs that help prevent the blood vessel from reclosing. These new stents have shown some promise for improving the long-term success of this procedure.
What precautions should be taken after a stent procedure?
After a stent procedure has been done, a patient may need to be on blood thinning medication to help prevent blood clots. For the next six to eight weeks a magnetic resonance imaging (MRI) scan should not be done without a cardiologist’s approval. However, metal detectors do not affect the stent.
Having a stent implanted will not change your normal life. If patients with stents work closely with their healthcare providers, many can live very full and productive lives.
What is a stroke?
A stroke occurs when blood flow to the brain is blocked, either by narrowed blood vessels or blood clots or when there is bleeding in the brain. Deprived of nutrients, brain nerve cells begin to die within a few minutes. As a result, stroke can cause vision and sensory loss, problems with walking and talking or difficulty in thinking clearly. In many cases, the effects of stroke are irreversible.
Some people are more at risk for stroke than others. Chronic health conditions such as high blood pressure and diabetes can increase your risk, as well as lifestyle choices such as smoking cigarettes, being overweight, or drinking excessively. Men, African Americans, and people with a family history of stroke have a higher risk as well. Warning signs include sudden unexplained numbness, tingling or odd sensations (especially on one side), slurred speech, blurred vision, weakness or problems with balance or coordination.
If you have atrial fibrillation, the upper left chamber of your heart beats rapidly and unpredictably, making it hard for all the blood in the chamber to empty. The remaining blood tends to form clots that can travel to any part of your body. If they travel to the brain, these clots can cause a stroke. Treatment with anticoagulants (or blood-thinners) can prevent these clots from forming. Aspirin also is used to reduce the risk of stroke. Current studies show that treatment with anticoagulants can prevent over half of the 80,000 strokes that are caused annually by atrial fibrillation.
If you have atrial fibrillation, your health care provider may recommend that you take an anticoagulant. If you do, you need to know:
- They may increase the risk of bleeding. Careful regular monitoring of blood levels and proper dosage should keep this risk in check. Your health care provider will tell you where to go for monitoring.
- When properly administered, they can prevent 20 strokes for every major bleeding complication caused by medicine.
- Most bleeding incidents are preventable and treatable.
- Certain drugs can interfere with proper anticoagulation. Antibiotics and anticonvulsants are examples of drugs that can cause problems. Talk to your physician or pharmacist for more complete information
It is now believed that a stroke is as preventable as a heart attack. In addition to primary prevention tactics such as quitting smoking, drinking only in moderation, and exercising, there are medical interventions that can decrease your risk of stroke if you are in a high-risk group. Recent studies show that if you have conditions known as atrial fibrillation or carotid artery disease, there are interventions that can dramatically lower your risk of stroke.
Carotid Artery Disease.
The carotid arteries run through the neck and supply blood to the brain. When fatty deposits known as plaque, small clots in the blood, narrow the walls of the carotid arteries can cut off blood supply to the brain and cause a stroke. A surgical procedure known as a carotid endarterectomy clears arteries of plaque. If you have had a minor stroke or symptoms that suggest you are at high risk for a stroke, and there is evidence of a severe blockage in your carotid arteries, your health care provider may suggest you consider carotid endarterectomy as a preventive procedure.
If you are considering this surgery, you should know:
- Certain tests may be required to confirm the diagnosis of carotid artery disease. With angiography, a dye is injected into the artery, followed by an x-ray to check for blockage. Magnetic resonance imaging (MRI) and ultrasonic scans also can test for blockage without entering the arteries.
- Carotid endarterectomy carries some risks. There can be complications if parts of the plaque break away during the procedure and block an artery to the brain or if artery incisions leak.
It is much easier to prevent a stroke than to treat a patient who has had one. Since strokes are preventable by following the simple prevention tactics, being aware of the symptoms and working with your healthcare professional, you can greatly minimize your risk of stroke.
Symptoms and Treatment of Varicose Veins
- Sclerotherapy is an injection of medication that eliminates the unsightly skin veins. This treatment works best on spider veins.
- Vein stripping is an outpatient procedure in which the saphenous vein is stripped (removed).
- Laser treatment uses a fine optical fiber to heat up the saphenous vein and cause the vein tissue to seal shut.
- Radio-frequency (RF) treatment involves controlled delivery of radio-frequency energy by a small catheter causing the vein to close.
- Mini-phlebectomy (stab avulsions) is used to remove varicose veins outside the main vein through a 1-mm incision with a small hook. The small scars usually disappear after a few months.
- All procedures for varicose veins are performed as out-patient procedures and the recovery time is very short, allowing return to full activity immediately.
How to delay the progression and symptoms of varicose veins
- Be active and exercise regularly!
- Keep your blood pressure under control!
- Control your weight!
- Wear your prescription compression stockings as specified by your doctor!
- For temporary relief, lie down and raise your legs at least 6 inches above the level of your heart. Hold this position for 10 minutes a few times each day.