Heart Conditions

Treatment for Heart Conditions in Port Arthur, TX

At Gulf Coast Cardiology Group, we treat a wide spectrum of heart conditions. For more information about the various heart conditions we treat, simply click on a condition to read more about it. These links are for general knowledge and should not substitute for a visit to a physician. Please contact us for appointments and for any additional information regarding heart conditions.
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Abdominal Aortic Aneurysm (AAA)

Abdominal aortic aneurysm is an abnormal dilation of the abdominal portion of the aorta (the major artery from the heart). AAA involves dilation, stretching, or ballooning of the aorta. The exact cause is unknown, but risk factors include atherosclerosis and hypertension. Abdominal aortic aneurysm may be caused by infection, congenital weakening of the connective tissue component of the artery wall, or, rarely, from trauma.

Abdominal aortic aneurysm can affect anyone, but it is most often seen in men 40 to 70 years old. A common complication is ruptured aortic aneurysm. This is a medical emergency in which the aneurysm breaks open, resulting in profuse bleeding into the abdominal cavity. Ruptured aneurysm occurs more frequently in patients with larger (>5 cm) aneurysms. 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.

In children, abdominal aortic aneurysm can result from blunt abdominal injury or from Marfan’s syndrome.

Prevention
Avoid blunt trauma to the abdomen, atherosclerosis, and hypertension.

Symptoms
  • Asymptomatic abdominal aortic aneurysm
    Pulsating abdominal mass (rhythmic throbbing)
Symptoms of Rupture:
  • Pulsating sensation in the abdomen
  • Severe, sudden, persistent, or constant pain in the abdomen
  • Not colicky or spasmodic
  • May radiate to groin, buttocks, or legs
  • Pain may begin suddenly
  • Abdominal rigidity
  • Pain in the lower back
  • Severe, sudden, persistent; may radiate
  • Paleness
  • Rapid pulse
  • Dry skin/mouth
  • Excessive thirst
  • Anxiety
  • Nausea and vomiting
  • Lightheadedness occurs with upright posture
  • Fainting occurs with upright posture
  • Sweating, excessive
  • Skin, clammy
  • Fatigue (tiredness or weariness) developing recently
  • Heartbeat sensations
  • Rapid heart rate (tachycardia) when rising to standing position
  • Impaired ability to concentrate
  • Shock
  • Abdominal mass
Signs and tests
Listening to the abdomen with a stethoscope shows a “blowing” murmur over the aorta or a “whooshing” sound (bruit). Physical examination of the abdomen is performed. If a rupture is suspected, a physical examination for signs of blood loss and an evaluation of lower extremity pulses and circulation are performed.

Abdominal aortic aneurysm may show on these tests:
  • Abdominal X-ray
  • Abdominal ultrasound
  • MRI of abdomen
  • CT scan – abdominal
  • Angiography of aorta

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Angina

Angina literally means “choking pain,” and angina pectoris refers to a painful or uncomfortable sensation in the chest that occurs when part of the heart does not receive enough oxygen due to disease in the coronary arteries that supply blood to the heart.

The coronary arteries supply the heart muscle with oxygen and nutrients. The word “coronary” means crown, and is the name given to the arteries that circle the heart like a crown.

Coronary artery disease (CAD) is the most common form of heart disease. Coronary heart disease develops when, due to the buildup of cholesterol and other substances in the wall of the artery, one or more of the coronary arteries that supply the blood to the heart become narrower than they used to be, affecting the blood flow to the heart muscle. Without an adequate blood supply, heart muscle tissue can be damaged.

Deposits of cholesterol and other fat-like substances can build up in the inner lining of these blood vessels and become coated with scar tissue, forming a cholesterol-rich bump in the blood vessel wall known as plaque. Plaque buildup narrows and hardens the blood vessel, a process called atherosclerosis, or hardening of the arteries.

Eventually, these plaque deposits can build up to significantly reduce or block blood flow to the heart. A person may experience chest pain or discomfort from inadequate blood flow to the heart, especially during exercise when the heart needs more oxygen.

Angina is the body’s warning sign that the heart is being overworked. It can be experienced in a variety of ways.
  • Angina usually manifests as a feeling of pain, pressure, or tightness in the middle chest, especially behind the sternum (breastbone).
  • The sensation may spread to the left shoulder, arm, and hand, or to the neck, throat, and jaw.
  • The attack typically lasts for only a few minutes.
It is very important to distinguish between two types of angina: stable angina and unstable angina. Both types result from problems within the coronary arteries.
  • Stable angina results from a fixed obstruction of blood flow to the heart. It occurs when there is not enough blood for a fast-pumping heart, but sufficient blood can get through when the heart slows down and the individual is at rest. Stable angina typically is caused by widespread, irregular disease throughout the coronary arteries. The blockages that result may not seriously hinder the flow of blood, and they usually do not damage the heart unless a plaque (atheroma; fatty deposit within a blood vessel) suddenly ruptures.
  • Unstable angina is due to a sudden interruption of blood flow to the heart due to a partial or complete blockage of the artery. Unstable angina comes on when a person is resting, asleep, or undergoing physical exertion (unlike stable angina, which usually comes on with physical exertion). Symptoms of moderate or severe discomfort suddenly may develop in a person who has never experienced angina before, and attacks may become more frequent or increase in intensity. Unstable angina can be dangerous, while stable angina generally is less serious. 
In order to identify which condition is present, a physician looks at when the angina pain occurs.
  • Stable angina usually occurs during physical exertion, emotional stress, or excitement. Stable angina doesn’t lead to a heart attack in most people.
  • Unstable angina can occur during rest, can awaken a person from sleep, and can appear suddenly during physical exertion. Unstable angina may quickly progress to a heart attack.
Unstable angina is a much more serious condition than stable angina because it may quickly progress to a heart attack. Some physicians regard unstable angina as a heart attack (until tests prove definitely that it is not), because it is difficult to distinguish with early tests whether there has been damage to the heart muscle.

In unstable angina, cracks develop in the bulging plaque inside the coronary artery. These cracks, or partial ruptures of the plaque, are called plaque fissuring. This sets off an inflammatory reaction that dissolves the layer of tissue separating the plaque from the flowing blood. When the blood comes into direct contact with the plaque, it begins to form a clot around the damaged plaque.

Three things can happen:
  • The clot gets bigger. Depending on how much of the artery it blocks, it will either cause the pain of angina or develop into a heart attack if it completely blocks the artery.
  • The clot moves to another part of the artery and blocks it, causing a heart attack.
  • The clot may simply be washed away after the crack in the plaque has healed.
What was previously a reasonably “stable” narrowing of the coronary artery has become “unstable,” reducing the blood flow through the affected coronary artery and causing symptoms even at rest.

Unstable Angina Facts:
  • The plaques that develop the crack, or rupture, are usually not the same ones that cause the critical narrowing of the coronary arteries.
  • We do not know why a plaque suddenly ruptures.
  • Because the clot is formed by platelets, the treatment initially is to give antiplatelet treatments. This is a very different treatment from the “clot-busters” given for a heart attack.
  • Unstable angina is considered as part of a spectrum called "acute coronary syndrome," which includes unstable angina and heart attack (known as myocardial infarction, either Q-wave or non–Q-wave types). What these conditions have in common is that symptoms result from rupture or erosion of a clot with obstruction of the coronary artery.
  • A heart attack (known as a Q-wave myocardial infarction) generally results from a more extensive rupture of a plaque in which the whole clotting system, not just platelets, becomes involved. The treatment then uses “clot-busters” (called thrombolytics), which are very different drugs from the antiplatelet drugs used for unstable angina.
It is vitally important for the doctor to make the distinction between stable angina, unstable angina, and a heart attack. This cannot always be done immediately.

Because the sensation of angina is alarming, many people believe they are having a heart attack the first time they experience it. But stable angina is NOT a heart attack. In fact, most people with stable angina respond well to modern treatments and live full lives for many years — if they follow their physician’s advice, take medication as prescribed, and learn to look after their hearts.

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Angioplasty

Coronary angioplasty is a medical procedure in which narrowed arteries that supply blood to the heart muscle are widened. This allows for improved flow of blood through these arteries to the heart, without the need for open-heart surgery. The purpose of angioplasty is to widen narrowed or blocked arteries, so that enough blood can get to the heart to deliver the oxygen it needs to function properly.
  • Angioplasty is designed to relieve the chest pain a person usually feels when the heart is not getting enough blood and oxygen.
  • Angioplasty can also reduce the risk of having a heart attack in someone with severely narrowed arteries in the heart.
Arteries become narrowed by a buildup of fat and cholesterol called plaque, and is a sign of coronary artery disease.

In an angioplasty:
  • A specially trained doctor inserts a long, narrow tube (called a catheter) through a small cut in the thigh or the arm.
  • The doctor threads the catheter through blood vessels leading to the heart until it reaches the narrowed part of the artery.
  • The doctor positions a tiny balloon that is attached to the tip of the catheter right at the site of the narrowing, and then inflates it with air. The pressure of the balloon flattens the plaque and allows the artery to open wider.
  • Often, a tiny wire tube called a stent is left inside the artery to hold it open.

Sometimes, instead of flattening the plaque with a balloon, other angioplasty methods are used:
  • Atherectomy is a form of angioplasty that uses tiny blades or a drill-like tip on the end of the catheter to cut away or drill through the plaque.
  • Laser angioplasty uses laser energy to destroy plaque.
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Aortic Regurgitation

The aortic valve is between the heart’s left ventricle (lower chamber that pumps blood to the body) and the aorta (the large artery that receives blood from the heart’s left ventricle and distributes it to the body). Regurgitation means the valve doesn’t close properly, and blood can leak backward through it. This means the left ventricle must pump more blood than normal, and will gradually get bigger because of the extra workload. Aortic regurgitation can range from mild to severe. Some people may have no symptoms for years, but as the condition worsens, symptoms will appear.

Symptoms can include:
  • Fatigue (especially during times of increased activity)
  • Shortness of breath
  • Edema (retention of fluid) in certain parts of the body, such as the ankles
  • Heart arrhythmias (abnormal heartbeats)
  • Angina pectoris (chest pain or discomfort caused by reduced blood supply to the heart muscle)
What causes aortic regurgitation?
Aortic regurgitation can be caused by several things. It may be due to a bicuspid aortic valve, a congenital (existing at birth) deformity of the valve. In it, the valve has two cusps (flaps) rather than the usual three cusps. It can also be found in other kinds of congenital heart disease. Aortic regurgitation can also be caused by infections of the heart, such as rheumatic fever or infective endocarditis. Diseases that can cause the aortic root (the part of the aorta attached to the ventricle) to widen, such as the Marfan syndrome or high blood pressure, are other causes.

What should be done?
Patients with mild aortic regurgitation who have few or no symptoms need to see their physician regularly. As conditions worsen, medications may be used. These drugs can help regulate the heart rhythm, rid the body of fluids to control edema, and/or help the left ventricle pump better.

Serious cases may require surgical treatment. This involves replacing the diseased valve with an artificial one.

People with aortic regurgitation are at increased risk for developing an infection of the heart valve or lining of the heart (endocarditis). In the past, the American Heart Association has recommended patients with aortic regurgitation take a dose of antibiotics before certain dental or surgical procedures. However, our association no longer recommends antibiotics before dental procedures except for patients at the highest level of risk for bad outcomes from endocarditis, such as:
  • Patients with a prosthetic cardiac valve
  • Patients who have previously had endocarditis
  • Patients with certain kinds of congenital heart disease
  • Heart transplant patients who develop a problem with a heart valve
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Aortic Stenosis

When the aortic valve opens, oxygen-rich (red) blood flows from the left ventricle to the aorta (the large artery that sends oxygen-rich blood through the body). Stenosis (narrowing) of the aortic valve makes it hard for the heart to pump blood to the body.

Aortic stenosis occurs when the aortic valve didn’t form properly. A normal valve has three parts (leaflets or cusps), but a stenotic valve may have only one cusp (unicuspid) or two cusps (bicuspid), which are thick and stiff.

Sometimes stenosis is severe and symptoms occur in infancy; usually, though, most children with aortic stenosis have no symptoms. In some children, chest pain, unusual tiring, dizziness, or fainting may occur. The need for surgery depends on how severe the stenosis is. In children, the surgeon may be able to enlarge the valve opening. Although surgery may improve the stenosis, the valve remains deformed. Eventually, replacing the valve with an artificial one may be needed.

A procedure called balloon valvuloplasty has been used in some children who have aortic stenosis. During cardiac catheterization, a special catheter containing a balloon is placed across the constricted or narrowed valve. Then the balloon is inflated, and the valve is stretched open. The long-term results of this procedure are still being studied.

Children with aortic stenosis need lifelong medical follow-up. Even mild stenosis may worsen over time. Also, surgical relief of a blockage is sometimes incomplete. After surgery, the valve keeps working in a mildly abnormal way. Some patients may have to limit how much they can do of some kinds of exercise. Check with your pediatric cardiologist about these exercise limits. Children with aortic stenosis risk an infection of the valve (endocarditis) before and after treatment. It needs to be determined whether your child will need to take antibiotics before certain dental procedures to help prevent endocarditis.
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Atrial Fibrillation

Atrial fibrillation (AF) is a disorder found in about 2.2 million Americans. During atrial fibrillation, the heart’s two small upper chambers (the atria) quiver instead of beating effectively. Blood isn’t pumped completely out of them, so it may pool and clot. If a piece of a blood clot in the atria leaves the heart and becomes lodged in an artery in the brain, a stroke results. About 15 percent of strokes occur in people with atrial fibrillation.

The likelihood of developing atrial fibrillation increases with age. Three to five percent of people over 65 have atrial fibrillation.

How is atrial fibrillation treated?
Several approaches are used to treat and prevent abnormal beating:
  • Medications are used to slow down rapid heart rate associated with AF. These treatments may include drugs such as digoxin, beta blockers (atenolol, metoprolol, propranolol), amiodarone, disopyramide, calcium antagonists (verapamil, diltiazam), sotalol, flecainide, procainamide, quinidine, propafenone, and others.
  • Electrical cardioversion may be used to restore normal heart rhythm with an electric shock, when medication doesn’t improve symptoms.
  • Drugs (such as ibutilide) can sometimes restore the heart’s normal rhythm. These drugs are given under medical supervision, and are delivered through an IV tube into a vein, usually in the patient’s arm.
  • Radiofrequency ablation may be effective in some patients when medications don’t work. In this procedure, thin and flexible tubes are introduced through a blood vessel and directed to the heart muscle. Then a burst of radiofrequency energy is delivered to destroy tissue that triggers abnormal electrical signals, or to block abnormal electrical pathways.
  • Surgery can be used to disrupt electrical pathways that generate AF.
  • Atrial pacemakers can be implanted under the skin to regulate the heart rhythm.
AHA Recommendation for Stroke Prevention
Treating atrial fibrillation is an important way to help prevent stroke. That’s why the American Heart Association recommends aggressive treatment of this heart arrhythmia.

Drugs are also used to help reduce stroke risk in people with AF. Anticoagulant and antiplatelet medications thin the blood and make it less prone to clotting. Warfarin is the anticoagulant now used for this purpose, and aspirin is the antiplatelet drug most often used. Long-term use of warfarin in patients with AF and other stroke risk factors can reduce stroke by 68 percent.

  • Physicians differ on the choice of drugs to prevent embolic stroke: stroke caused by a blood clot. It’s clear that warfarin is more effective against this type of stroke than aspirin; however, warfarin has more side effects than aspirin. Examples include potential bleeding problems or ulcer.
  • Patients at high risk for stroke should likely be treated with warfarin rather than aspirin unless there are clear reasons not to do so.
  • Aspirin is the standard treatment for patients at low risk for stroke and under 75 years of age.
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Atrial Tachycardia

Atrial tachycardia typically arises from an ectopic source in the atrial muscle and produces an atrial rate of 150-250 beats/min slower than that of atrial flutter. The P waves may be abnormally shaped depending on the site of the ectopic pacemaker.

Types of atrial tachycardia:
  • Benign
  • Incessant ectopic
  • Multifocal
  • Atrial tachycardia with block (digoxin toxicity)
Conditions associated with atrial tachycardia:
  • Cardiomyopathy
  • Chronic obstructive pulmonary disease
  • Ischaemic heart disease
  • Rheumatic heart disease
  • Sick sinus syndrome
  • Digoxin toxicity
Multifocal atrial tachycardia occurs when multiple sites in the atria are discharging and is due to increased automaticity. It is characterized by P waves of varying morphologies and PR intervals of different lengths on the electrocardiographic trace. The ventricular rate is irregular. It can be distinguished from atrial fibrillation by an isoelectric baseline between the P waves. It is typically seen in association with chronic pulmonary disease. Other causes include hypoxia or digoxin toxicity.

Atrial tachycardia with atrioventricular block is typically seen with digoxin toxicity. The ventricular rhythm is usually regular, but may be irregular if atrioventricular block is variable. Although often referred to as “paroxysmal atrial tachycardia with block,” this arrhythmia is usually sustained. 

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Cardiac Bypass Surgery

Cardiac bypass surgery is an operation to restore the flow of blood through the arteries that supply blood to the heart, when a blockage or partial blockage occurs in these arteries. 

The arteries that supply the heart muscle with oxygen and nutrients are known as the coronary arteries. The word “coronary” means a crown, and is the name given to these arteries that circle the heart like a crown. The narrowing of the arteries of the heart is known as coronary artery disease, which is the most common form of heart disease.

The operation, also known as a coronary artery bypass graft (CABG), involves rerouting the blood flow around the obstructed part of the artery. This is done by using a portion of a blood vessel taken from another part of the body, usually the leg or chest, and surgically attaching it across a severely narrowed or blocked coronary artery, thus “bypassing” the blockage. These “new” blood vessels carry blood around the obstruction, so the blood supply to and from the heart is restored.

Coronary artery disease develops when one or more of the coronary arteries that supply the blood to the heart become narrower than they used to be, due to the buildup of cholesterol and other substances in the wall of the artery. This affects the blood flow to the heart muscle. Without an adequate blood supply, heart muscle tissue can be damaged.

Deposits of cholesterol and other fat-like substances can build up in the inner lining of these blood vessels and become coated with scar tissue, forming a cholesterol-rich bump in the blood vessel wall known as plaque. Plaque buildup narrows and hardens the blood vessel, a process called atherosclerosis, or hardening of the arteries.

Eventually, these plaque deposits can build up to significantly reduce or block blood flow to the heart. A person may experience chest pain or discomfort from inadequate blood flow to the heart, especially during exercise when the heart needs more oxygen. This is known as angina.

When Is Bypass Surgery Offered?
Bypass surgery is usually performed when a person has two or three blood vessels with blockages, or when the major vessel has a severe blockage. Therefore, bypass surgery may be advised in the following situations:
  • When there is severe narrowing of the left main coronary artery (because this major artery branches into several others, putting too much of the heart at risk if the angioplasty were to fail)
  • If there is severe narrowing of any three arteries in a person who also has a weakly pumping heart
  • If there is severe narrowing of the left anterior descending artery and at least one other coronary artery, plus either diabetes or a weakly pumping heart
  • Following failed coronary angioplasty, a procedure performed to widen a narrowed coronary artery by inserting a balloon-tipped tube into the artery and inflating the balloon
How Does Bypass Surgery Help?
After bypass surgery, the blood supply to the area of the heart that was previously restricted due to narrowing of the artery supplying that area is restored. The blocked artery has now been bypassed.

Bypass surgery may improve quality of life and increase the life span. In some cases, it may do both. In other cases, it may only improve the quality of life.

The important thing to remember is that surgery is not a cure, but just keeps the problem under control. Once your surgeon has done the procedure, there are choices you may take to prevent the condition from recurring. How healthy you are after surgery depends in large part on the steps you take to prevent future problems.

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Cardiomyopathy

Cardiomyopathy is a serious disease in which the heart muscle becomes inflamed and doesn’t work as well as it should. There may be multiple causes, including viral infections. Cardiomyopathy can be classified as primary or secondary. Primary cardiomyopathy can’t be attributed to a specific cause, such as high blood pressure, heart valve disease, artery diseases, or congenital heart defects. Secondary cardiomyopathy is due to specific causes. It’s often associated with diseases involving other organs as well as the heart. There are three main types of cardiomyopathy: dilated, hypertrophic, and restrictive.

What is dilated (congestive) cardiomyopathy?
This is the most common form. In it, the heart cavity is enlarged and stretched (cardiac dilation). The heart is weak and doesn’t pump normally, and most patients develop heart failure. Abnormal heart rhythms, called arrhythmias, and disturbances in the heart’s electrical conduction also may occur.

Blood flows more slowly through an enlarged heart, so blood clots may form. A blood clot that forms in an artery or the heart is called a thrombus. A clot that breaks free, circulates in the bloodstream, and blocks a small blood vessel is called an embolus.
  • Clots that stick to the inner lining of the heart are called mural thrombi.
  • If the clot breaks off the right ventricle (pumping chamber), it can be carried into the pulmonary circulation in the lung, forming pulmonary emboli.
  • Blood clots that form in the heart’s left side may be dislodged and carried into the body's circulation to form cerebral emboli in the brain, renal emboli in the kidney, peripheral emboli, or even coronary artery emboli.
A condition known as Barth syndrome, a rare and relatively unknown genetically linked cardiac disease, can cause dilated cardiomyopathy. This syndrome affects male children, usually during their first year of life. It can also be diagnosed later. (For more information on Barth syndrome, visit the Barth Syndrome Foundation.) In these young patients, the heart condition is often associated with changes in the skeletal muscles, short stature, and an increased likelihood of catching bacterial infections. They also have neutropenia, which is a decrease in the number of white blood cells known as neutrophils. There are clinical signs of the cardiomyopathy in the newborn child or within the first months of life. These children also have metabolic and mitochondrial abnormalities.

How is dilated (congestive) cardiomyopathy treated?
A person with cardiomyopathy may suffer an embolus before any other symptom of cardiomyopathy appears. That’s why anti-clotting (anticoagulant) drug therapy may be needed. Arrhythmias may require antiarrhythmic drugs. Therapy for dilated cardiomyopathy is often aimed at treating the underlying cause, however. If the person is young and otherwise healthy, and if the disease gets worse, a heart transplant may be considered.

When cardiomyopathy results in a significantly enlarged heart, the mitral and tricuspid valves may not be able to close properly, resulting in murmurs. Blood pressure may increase because of increased sympathetic nerve activity. These nerves can also cause arteries to narrow. This mimics hypertensive heart disease (high blood pressure). That’s why some people have high blood pressure readings. Because the blood pressure determines the heart’s workload and oxygen needs, one treatment approach is to use vasodilators (drugs that “relax” the arteries). They lower blood pressure and thus the left ventricle’s workload.

What is hypertrophic cardiomyopathy?
In this condition, the muscle mass of the left ventricle enlarges, or “hypertrophies.”

In one form of the disease, the wall (septum) between the two ventricles (pumping chamber) becomes enlarged and obstructs the blood flow from the left ventricle. The syndrome is known as hypertrophic obstructive cardiomyopathy (HOCM) or asymmetric septal hypertrophy (ASH). It’s also called idiopathic hypertrophic subaortic stenosis (IHSS).

Besides obstructing blood flow, the thickened wall sometimes distorts one leaflet of the mitral valve, causing it to leak. Hypertrophic cardiomyopathy is the most common inherited heart defect, occurring in one of 500 individuals. Close blood relatives (parents, children, or siblings) of such persons often have enlarged septums, although they may have no symptoms. This disease is most common in young adults.

In the other form of the disease, non-obstructive hypertrophic cardiomyopathy, the enlarged muscle doesn’t obstruct blood flow.

The symptoms of hypertrophic cardiomyopathy include shortness of breath on exertion, dizziness, fainting, and angina pectoris. (Angina is chest pain or discomfort caused by reduced blood supply to the heart muscle.) Some people have cardiac arrhythmias; these are abnormal heart rhythms that in some cases can lead to sudden death. Often, an implanted cardioverter defibrillator (ICD) is needed to shock the heart to restart a normal heart rhythm and prevent sudden dealth. The obstruction to blood flow from the left ventricle increases the ventricle’s work, and a heart murmur may be heard.

How is hypertrophic cardiomyopathy treated?
The usual treatment involves taking a drug known as a beta blocker (such as propranolol) or a calcium channel blocker. If a person has an arrhythmia, an antiarrhythmic drug may also be used. Surgical treatment of the obstructive form is possible in some cases if the drug treatment fails.

Alcohol ablation is a type of nonsurgical treatment for hypertrophic obstructive cardiomyopathy. It involves injecting alcohol down a small branch of one of the heart arteries to deaden the extra heart muscle. This allows the extra heart muscle to thin out without having to remove it surgically.

What is restrictive cardiomyopathy?
This is the least common type in the United States. The myocardium (heart muscle) of the ventricles becomes excessively “rigid,” so it's harder for the ventricles to fill with blood between heartbeats. A person with restrictive cardiomyopathy often complains of being tired, may have swollen hands and feet, and may have difficulty breathing on exertion. This type of cardiomyopathy is usually seen in the elderly and may be due to another disease process.

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Congestive Heart Failure

Congestive heart failure (CHF), or heart failure, is a condition in which the heart can’t pump enough blood to the body’s other organs. This can result from:
  • Narrowed arteries that supply blood to the heart muscle – coronary artery disease
  • Past 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
  • Heart defects present at birth – congenital heart defects
  • Infection of the heart valves and/or heart muscle itself – endocarditis and/or myocarditis
The “failing” heart keeps working but not as efficiently as it should. People with heart failure can’t exert themselves because they become short of breath and tired.

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 often, there’s swelling in the legs and ankles, but it can happen in other parts of the body, too. Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath, especially when a person is lying down.

Heart failure also affects the kidneys’ ability to dispose of sodium and water. The retained water increases the edema.

How do you diagnose and treat congestive heart failure?
Your doctor is the best person to make the diagnosis. The most common signs of congestive heart failure are swollen legs or ankles or difficulty breathing. Another symptom is weight gain when fluid builds up.

CHF usually requires a treatment program of:
  • Rest
  • Proper diet
  • Modified daily activities
  • Drugs such as
    • ACE (angiotensin-converting enzyme) inhibitors
    • beta blockers
    • digitalis
    • diuretics
    • vasodilators
Various drugs are used to treat congestive heart failure; they perform different functions. ACE inhibitors and vasodilators expand blood vessels and decrease resistance. This allows blood to flow more easily and makes the heart’s work easier or more efficient. Beta blockers can improve how well the heart’s left lower chamber (left ventricle) pumps. 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, some cases of congestive heart failure can be treated by treating high blood pressure. If the heart failure is caused by an abnormal heart valve, the valve can be surgically replaced. 

If the heart becomes so damaged that it can’t be repaired, a more drastic approach should be considered. A heart transplant could be an option.

Most people with mild and moderate congestive heart failure can be treated. Proper medical supervision can prevent them from becoming invalids.

What should I watch out for?
Tell your doctor right away if…
  • You gain 3 or more pounds in a day or so.
  • You see that your feet, ankles, or other parts of your body are puffy.
  • It’s hard to breathe.
  • You can’t do what you could do the day before.
  • You have the flu.
  • You get a fever.
  • You have chest pain.
What will help me get better?
  • Visit the doctor and follow his or her advice.
  • Read food labels and avoid foods high in salt or sodium.
  • Start an aerobic exercise plan as your doctor advises.
  • Keep up your interests and be upbeat!
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Coronary Heart Disease

Coronary heart disease (CHD), also called coronary artery disease, affects about 14 million men and women in the United States.

Disease develops when a combination of fatty material, calcium, and scar tissue (plaque) builds up in the arteries that supply the heart with blood. Through these arteries, called the coronary arteries, the heart muscle (myocardium) receives the oxygen and other nutrients it needs to pump blood.
  • The plaque often narrows the artery so that the heart does not get enough blood.
  • This slowing of blood flow causes chest pain, or angina.
  • If plaque completely blocks blood flow, it may cause a heart attack (myocardial infarction) or a fatal rhythm disturbance (sudden cardiac arrest).
  • A major cause of death and disability, coronary heart disease claims more lives in the United States than the next 7 leading causes of death combined.
The heart consists of 4 chambers: an atrium and a ventricle on the right, and an atrium and ventricle on the left.
  • Blood returning to the heart from veins all over the body flows into the right atrium.
  • From there, the blood flows into the right ventricle, which pumps it out to the lungs for oxygenation.
  • The oxygen-rich blood returns to the left atrium.
  • From there, the blood flows into the left ventricle, which pumps it at high pressure into the arteries.
  • This entire process constitutes one heartbeat.
The pumping, or contraction, of the left ventricle must be very powerful, because that’s what keeps the blood flowing throughout the body.
  • The strength of the heart muscle depends on the oxygen and nutrient supply coming via the coronary arteries.
  • These arteries are usually strong, elastic, and quite flexible.
The heart has 3 major coronary arteries.
  • Two of these arteries arise from a common stem, called the left main coronary artery.
  • The left main coronary artery supplies the left side of the heart.
  • Its left anterior descending (LAD) branch supplies the front part of the heart.
  • The left circumflex (LCX) branch supplies the left lateral and back side of the heart.
  • Finally, the right coronary artery (RCA) is separate, and supplies the right and the bottom parts of the heart.
In children, the inner lining of the coronary arteries is quite smooth, allowing blood to flow easily. As a person ages, the cholesterol and calcium content in the walls of the coronary arteries increases, making them thicker and less elastic.
  • Unhealthy habits, such as a diet high in cholesterol and other fats, smoking, and lack of exercise, accelerate the deposit of fat and calcium within the inner lining of coronary arteries.
  • This process is known as atherosclerosis, or hardening of the arteries. The deposits, or plaques, eventually obstruct the blood vessel, which begins to restrict blood flow.
Plaque is like a firm shell with a soft inner core containing cholesterol. As blood hits it during each heartbeat, the plaque may crack open and expose its inner cholesterol core, which promotes blood clotting. Clots may further reduce blood flow, causing severe pain (angina), or even block it altogether.

Coronary Heart Disease Causes
Coronary heart disease is caused by any problem with the coronary arteries that keeps the heart from getting enough oxygen- and nutrient-rich blood. The most common cause by far is atherosclerosis. Lack of sufficient blood is called ischemia, so coronary heart disease is sometimes called ischemic heart disease.

The cause of coronary heart disease is related to multiple risk factors. The following are the most common:
  • Heredity coronary heart disease runs in the family.
  • High cholesterol: Levels of cholesterol in the blood are above healthy levels. This usually involves high levels of low-density lipoprotein (LDL), the bad cholesterol, and low levels of high-density lipoprotein (HDL), the good cholesterol.
  • Tobacco abuse: This includes not only smoking any form of tobacco (cigarettes, cigars, pipes), but also chewing tobacco.
  • Obesity
  • High blood pressure (hypertension)
  • Diabetes
  • Lack of regular exercise
  • High-fat diet
  • Emotional stress
  • Type A personality (impatient, aggressive, competitive)
Coronary Heart Disease Symptoms
The most devastating sign of coronary heart disease is abrupt, unexpected cardiac arrest.
  • Cardiac arrest commonly occurs in people who have had previous heart attacks, but it may occur as the first symptom of heart disease.
  • Most people exhibit some symptom or discomfort.
  • Symptoms usually occur during exercise or activity because the heart muscle’s increased demand for nutrients and oxygen is not being met by the blocked coronary blood vessel.
More common symptoms of coronary heart disease include the following. No one person usually has all of these symptoms.
  • Chest pain on exertion (angina pectoris), which may be relieved by rest
  • Shortness of breath on exertion
  • Jaw, back, or arm pain, especially on left side, either during exertion or at rest
  • Palpitations (a sensation of rapid or very strong heart beats in your chest)
  • Dizziness, lightheadedness, or fainting
  • Weakness on exertion or at rest
  • Irregular heartbeat
Silent ischemia is a condition in which no symptoms occur, even though an electrocardiogram (ECG, or heart tracing) and/or other tests show evidence of ischemia. Arteries may be blocked 50% or more without causing any symptoms.

When to Seek Medical Care
Call your healthcare provider if you notice any of the following symptoms, which suggest angina:
  • Chest pain, pressure, or feeling of indigestion after physical exertion, which may or may not be relieved by rest
  • Shoulder or arm pain involving left, right, or both sides during physical or mentally stressful activity
  • Jaw pain unexplained by another cause, like a sore tooth
  • Shortness of breath after exertion or walking uphill
  • Fainting spell
  • Pain in the upper part of your abdomen
  • Unexplained nausea, vomiting, or sweating
  • Palpitations or dizziness
Call 911 or have someone take you immediately to a hospital emergency department if you have signs of a heart attack.
  • The most crucial factor is time. Each year, thousands of Americans die because they do not seek medical attention quickly.
  • Err on the side of caution and go to the hospital.
  • This may prove to be the difference between life and death.
The most common symptoms of heart attack include the following:
  • Unremitting or prolonged chest pain, chest pressure, or a feeling like heartburn
  • Shoulder or arm pains (left or right) or upper abdominal pain that won’t go away
  • Shortness of breath after minimal activity or while resting
  • Blackout spells
  • Unexplained profuse sweating with or without nausea or vomiting
  • Frequent chest pain or discomfort at rest
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Deep Vein Thrombosis

Deep vein thrombosis, commonly referred to as DVT, occurs when a blood clot, or thrombus, develops in the large veins of the legs or pelvic area. Some DVTs may cause no pain, whereas others can be quite painful. With prompt diagnosis and treatment, the majority of DVTs are not life threatening. However, a blood clot that forms in the invisible “deep veins” can be an immediate threat to your life, as compared to a clot that forms in the visible “superficial” veins, the ones beneath your skin. A clot that forms in the large, deep veins is more likely to break free and travel through the vein; it is then called an embolus. When an embolus travels from the legs or pelvic areas and lodges in a lung artery, the condition is known as a “pulmonary embolism,” or PE, a potentially fatal condition if not immediately diagnosed and treated.

What are the causes of DVT?
Generally, a DVT is caused by a combination of two or three underlying conditions:
  • Slow or sluggish blood flow through a deep vein
  • A tendency for a person’s blood to clot quickly
  • Irritation or inflammation of the inner lining of the vein
There are a variety of settings in which this clotting process can occur. First, individuals on bed rest (such as during or after a surgical procedure or medical illness, like a heart attack or stroke), or confined and unable to walk (such as during prolonged air or car travel) are common settings. It can occur in certain families in which there is a history of parents or siblings who have suffered from prior blood clots. It can also occur in individuals in whom active cancer or its treatment may predispose the blood to clotting.

Having a recent major surgical procedure, especially hip and knee orthopedic surgeries or those requiring prolonged bed rest, predispose the blood to clotting. Irritation or inflammation occurs when a leg vein is injured by a major accident or medical procedure.

Also, there are specific medical conditions that may increase your risk of developing a DVT via these three mechanisms, such as congestive heart failure, severe obesity, chronic respiratory failure, a history of smoking, varicose veins, pregnancy and estrogen treatment. If you are concerned you may be at risk due to any of these conditions, please consult with your physician.

Why is deep vein thrombosis dangerous?
DVT is potentially life threatening. In it, blood clots form in the body’s deep veins, particularly veins in the legs. Sometimes the clot breaks off, travels through the bloodstream, and obstructs a vessel in the lungs, restricting blood flow. This condition is called pulmonary embolism. This damages tissues and causes poor lung function, which can be fatal.

People who survive their first episode of DVT may have chronic swelling in their leg and pain from the blockage of blood flow through the vein. This can reduce their ability to live a full, active life. People who have had one DVT episode are also prone to have more.

How do I prevent DVT during air travel?
Studies in healthy people have shown that wearing compression stockings may help minimize the risk of developing DVT after long flights. These stockings put pressure on leg muscles and help return blood flow from the legs to the heart.

People with cardiovascular disease and those at risk for clots in their legs may benefit from a single dose of heparin. This drug prevents clots from forming and is effective in reducing the risk of DVT in high-risk patients.

Drinking extra water, walking if feasible, and avoiding alcohol intake are also good advice. These steps aren’t scientifically proven to prevent traveler’s thrombosis, but they are common sense.
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Heart Attack

A heart attack occurs when the blood supply to part of the heart muscle itself — the myocardium — is severely reduced or stopped. The reduction or stoppage happens when one or more of the coronary arteries supplying blood to the heart muscle is blocked. This is usually caused by the buildup of plaque (deposits of fat-like substances), a process called atherosclerosis. The plaque can eventually burst, tear, or rupture, creating a “snag” where a blood clot forms and blocks the artery. This leads to a heart attack.

If the blood supply is cut off for more than a few minutes, muscle cells suffer permanent injury and die. This can kill or disable someone, depending on how much heart muscle is damaged.

Sometimes a coronary artery temporarily contracts or goes into spasm. When this happens, the artery narrows and blood flow to part of the heart muscle decreases or stops. We’re not sure what causes a spasm. A spasm can occur in normal-appearing blood vessels, as well as in vessels partly blocked by atherosclerosis. A severe spasm can cause a heart attack.

The medical term for heart attack is myocardial infarction. A heart attack is also sometimes called a coronary thrombosis or coronary occlusion.

What Are the Warning Signs of Heart Attack?
Heart and blood vessel disease is our nation’s No. 1 killer. Around half of the deaths from heart and blood vessel disease are from coronary heart disease, which includes heart attack. About 325,000 people a year die of coronary attack before they get to a hospital or in the emergency room, but many of those deaths can be prevented — by acting fast! Some heart attacks are sudden and intense, but most start slowly, with mild pain or discomfort. Here are some of the signs that can mean a heart attack is happening:
  • Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness, or pain.
  • Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach.
  • Shortness of breath. This may occur with or without chest discomfort.
  • Other signs. These may include breaking out in a cold sweat, nausea, or lightheadedness.
As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.

What should I do if I suspect a heart attack?
  • Don’t wait more than five minutes before calling for help. Call 911 or the local emergency medical services (EMS), such as the fire department or ambulance. Get to a hospital right away.
  • If you’re the one having symptoms and you can’t access the EMS, have someone drive you to the hospital right away. Don’t drive yourself unless you have absolutely no other option.

What else can I do?
  • If you’re properly trained and if it’s necessary, you can give CPR (mouth-to-mouth rescue breathing and chest compressions) to a victim until help arrives.
  • Before there’s an emergency, it’s a good idea to find out which hospitals in your area have 24-hour emergency cardiac care. Also, keep a list of emergency phone numbers next to your phone and with you at all times, just in case. Take these steps NOW.
Why don’t people act fast enough?
Half of all people having a heart attack wait more than two hours before getting help. Some people feel it would be embarrassing to have a “false alarm”; others are so afraid of having a heart attack that they tell themselves they aren’t having one. These feelings are easy to understand, but they’re also very dangerous. If you or someone close to you shows signs of a heart attack, call 911 and get help right away!

How can I help to avoid a heart attack?
  • Don’t smoke, and avoid other people’s tobacco smoke.
  • Treat high blood pressure if you have it.
  • Eat foods that are low in saturated fat, trans fat, cholesterol, and salt.
  • Be physically active.
  • Keep your weight under control.
  • Get regular medical check-ups.
  • Take medicine as prescribed.
  • Control your blood sugar if you have diabetes.
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Heart Disease

Heart disease refers to a number of abnormal conditions affecting the heart and the blood vessels in the heart. Types of heart disease include the following:
  • Coronary artery disease (CAD) is the most common type and is the leading cause of heart attacks. When you have CAD, your arteries become hard and narrow. Blood has a difficult time getting to the heart, so the heart does not get all the blood it needs. CAD can lead to:
    • Angina – Angina is chest pain or discomfort that happens when the heart does not get enough blood. It may feel like a pressing or squeezing pain, often in the chest, but sometimes the pain is in the shoulders, arms, neck, jaw, or back. It can also feel like indigestion (upset stomach). Angina is not a heart attack, but having angina means you are more likely to have a heart attack.
    • Heart attack – A heart attack occurs when an artery is severely or completely blocked, and the heart does not get the blood it needs for more than 20 minutes.
Heart failure occurs when the heart is not able to pump blood through the body as well as it should. This means that other organs, which normally get blood from the heart, do not get enough blood. It does NOT mean the heart stops. Signs of heart failure include:
  • Shortness of breath (feeling like you can’t get enough air)
  • Swelling in feet, ankles, and legs
  • Extreme tiredness
Heart arrhythmias are changes in the beat of the heart. Most people have felt dizzy, faint, or out of breath or had chest pains at one time. These changes in heartbeat are, for most people, harmless. As you get older, you are more likely to have arrhythmias. Don’t panic if you have a few flutters or if your heart races once in a while. If you have flutters AND other symptoms such as dizziness or shortness of breath (feeling like you can't get enough air), call 911 right away.

How do I know if I have heart disease?
Heart disease often has no symptoms, but there are some signs to watch for. Chest or arm pain or discomfort can be a symptom of heart disease and a warning sign of a heart attack. Shortness of breath (feeling like you can’'t get enough air), dizziness, nausea (feeling sick to your stomach), abnormal heartbeats, or feeling very tired also are signs. Talk with your doctor if you’re having any of these symptoms. Your doctor will take a medical history, do a physical exam, and may order tests.

What can I do to prevent heart disease?
You can reduce your chances of getting heart disease by taking these steps:

Know your blood pressure. Your heart moves blood through your body. If it’s hard for your heart to do this, your heart works harder and your blood pressure will rise. People with high blood pressure often have no symptoms, so have your blood pressure checked every 1 to 2 years. If you have high blood pressure, your doctor may suggest you make some lifestyle changes, such as eating less salt (DASH Eating Plan) and exercising more. Your doctor may also prescribe medicine to help lower your blood pressure.

Don't smoke. If you smoke, try to quit. If you’re having trouble quitting, there are products and programs that can help:
  • Nicotine patches and gums
  • Support groups
  • Programs to help you stop smoking
Ask your doctor or nurse for help. For more information on quitting, visit Quitting Smoking.

Get tested for diabetes. People with diabetes have high blood glucose (often called blood sugar). People with high blood sugar often have no symptoms, so have your blood sugar checked regularly. Having diabetes raises your chances of getting heart disease. If you have diabetes, your doctor will decide if you need diabetes pills or insulin shots. Your doctor can also help you make a healthy eating and exercise plan.

Get your cholesterol and triglyceride levels tested. High blood cholesterol can clog your arteries and keep your heart from getting the blood it needs; this can cause a heart attack. Triglycerides are a form of fat in your blood stream. High levels of triglycerides are linked to heart disease in some people. People with high blood cholesterol or high blood triglycerides often have no symptoms, so have your blood cholesterol and triglyceride levels checked regularly. If your cholesterol or triglyceride levels are high, talk to your doctor about what you can do to lower them. You may be able to lower your cholesterol and triglyceride levels by eating better and exercising more. Your doctor may prescribe medication to help lower your cholesterol.

Maintain a healthy weight. Being overweight raises your risk for heart disease. Calculate your Body Mass Index (BMI) to see if you are at a healthy weight. Eat a healthy diet and exercise at a moderate intensity for at least 30 minutes most days of the week. Start by adding more fruits, vegetables, and whole grains to your diet. Take a brisk walk on your lunch break or take the stairs instead of the elevator.

If you drink alcohol, limit it to no more than one drink (one 12-oz. beer, one 5-oz. glass of wine, or one 1.5-oz. shot of hard liquor) a day.

Find healthy ways to cope with stress. Lower your stress level by talking to your friends, exercising, or writing in a journal.
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Heart Failure

Congestive heart failure (CHF), or heart failure, is a condition in which the heart can’t pump enough blood to the body’s other organs. This can result from:
  • Narrowed arteries that supply blood to the heart muscle – coronary artery disease
  • Past 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.
  • Heart defects present at birth – congenital heart defects.
  • Infection of the heart valves and/or heart muscle itself – endocarditis and/or myocarditis
The “failing” heart keeps working, but not as efficiently as it should. People with heart failure can’t exert themselves because they become short of breath and tired.

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 often, there’s swelling in the legs and ankles, but it can happen in other parts of the body, too. Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath, especially when a person is lying down.

Heart failure also affects the kidneys’ ability to dispose of sodium and water. The retained water increases the edema.

How do you diagnose and treat congestive heart failure?
Your doctor is the best person to make the diagnosis. The most common signs of congestive heart failure are swollen legs or ankles or difficulty breathing. Another symptom is weight gain when fluid builds up.

CHF usually requires a treatment program of:
  • Rest
  • Proper diet
  • Modified daily activities
  • Drugs such as
    • ACE (angiotensin-converting enzyme) inhibitors
    • beta blockers
    • digitalis
    • diuretics
    • vasodilators
Various drugs are used to treat congestive heart failure, with each performing different functions. ACE inhibitors and vasodilators expand blood vessels and decrease resistance. This allows blood to flow more easily and makes the heart’s work easier or more efficient. Beta blockers can improve how well the heart’s left lower chamber (left ventricle) pumps. 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, some cases of congestive heart failure can be treated by treating high blood pressure. If the heart failure is caused by an abnormal heart valve, the valve can be surgically replaced.

If the heart becomes so damaged that it can’t be repaired, a more drastic approach should be considered. A heart transplant could be an option.

Most people with mild and moderate congestive heart failure can be treated. Proper medical supervision can prevent them from becoming invalids.
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Heart Valve Surgery

The heart has four chambers: The upper two are the right and left atria. The lower two are the right and left ventricles. Blood is pumped through the chambers, aided by four heart valves. The valves open and close to let the blood flow in only one direction.

Operations to replace poorly functioning heart valves are common procedures. They’re done to improve the health and vigor of people with heart valve diseases. The surgeon who will perform the operation is the best person to talk to about specific questions or concerns. He or she can best explain the details of the surgical procedure and recovery period. A replacement valve may be taken from another human heart (cadaver valve) or pig (porcine valve), or it can be a mechanical one.

People who have damaged, repaired, or replaced heart valves are at increased risk for developing an infection of the valve (endocarditis). Until recently, the American Heart Association recommended giving antibiotics to prevent endocarditis to these patients before they had dental work. However, those guidelines have changed: The American Heart Association no longer recommends antibiotics before dental procedures, except for patients at the highest risk for bad outcomes from endocarditis, including:
  • Those with prosthetic heart valves
  • Patients who have had endocarditis in the past
  • Patients with certain types of congenital heart defects
  • Heart-transplant patients who develop a problem with a heart valve
For all people with prosthetic heart valves, it’s very important to receive antibiotics before certain types of dental work involving the gum tissues, teeth, or other soft tissues inside the mouth. This includes routine professional cleaning.

If a person has had heart valve surgery but has not had a heart valve replaced, the cardiologist or surgeon will tell them if they need antibiotics. People who have had heart valve surgery will probably be placed on an anticoagulant to prevent blood clots from forming.

High blood pressure, or hypertension, is defined in an adult as a systolic pressure of 140 mmHg or higher and/or a diastolic pressure of 90 mmHg or higher. Blood pressure is measured in millimeters of mercury (mmHg).

Blood pressure (mmHg)      Normal                   Prehypertension         Hypertension
Systolic (top number)           less than 120       120-139                        140 or higher
Diastolic (bottom number)  less than 80          80-89                             90 or higher
   
mmHg = millimeters of mercury

High blood pressure directly increases the risk of coronary heart disease (which leads to heart attack) and stroke, especially along with other risk factors.

High blood pressure can occur in children or adults. It’s particularly prevalent in African Americans, middle-aged and elderly people, obese people, and heavy drinkers. People with diabetes mellitus, gout ,or kidney disease have hypertension more often.

High blood pressure usually has no symptoms; it’s truly a “silent killer.” But a simple, quick, painless test can detect it.

How Can I Reduce High Blood Pressure?
  • Lose weight if you’re overweight.
  • Eat a healthy diet low in saturated fat, cholesterol, and salt.
  • Be more physically active.
  • Limit alcohol to no more than one drink per day for women or two drinks a day for men.
  • Take medicine the way your doctor tells you.
  • Know what your blood pressure should be and work to keep it at that level.
What should I know about medicine?
Your doctor may prescribe different types of medicine for you. Don’t be discouraged if you need to take blood pressure medicine from now on. Sometimes you can take smaller doses after your blood pressure is under control, but you may always need some treatment. What’s most important is that you take your medicine exactly the way your doctor tells you to. Never stop treatment on your own. If you have problems or side effects with your medicine, talk to your doctor.

If you have heart disease or have had a stroke, members of your family also may be at higher risk. It’s very important for them to make changes now to lower their risk. Talk to your doctor, nurse, or other healthcare professionals.
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High Cholesterol

Cholesterol is a soft, fat-like, waxy substance found in the bloodstream and in all your body’s cells. It’s normal to have cholesterol. Cholesterol is an important part of a healthy body because it’s used for producing cell membranes and some hormones, and serves other needed bodily functions. But too much cholesterol in the blood is a major risk for coronary heart disease (which leads to heart attack) and for stroke. Hypercholesterolemia is the medical term for high levels of blood cholesterol.

Too much cholesterol in the blood can lead to heart disease and stroke: America’s No. 1 and No. 3 killers. Even though there’s much you can do to lower your cholesterol levels and protect yourself, half of American adults still have levels that are too high (over 200 mg/dL). You can reduce cholesterol in your blood by eating healthful foods, losing weight if you need to, and being physically active. Some people also need to take medicine because changing their diet isn’t enough. Your doctor and nurses will help you set up a plan for reducing your cholesterol — and keeping yourself healthy!

Most heart and blood vessel disease is caused by a buildup of cholesterol, plaque, and other fatty deposits in artery walls. The arteries that feed the heart can become so clogged that the blood flow is reduced, causing chest pain. If a blood clot forms and blocks the artery, a heart attack can occur. Similarly, if a blood clot blocks an artery leading to or located in the brain, a stroke results.

Cholesterol can’t dissolve in the blood; it has to be transported to and from the cells by carriers called lipoproteins. Low-density lipoprotein, or LDL, is known as “bad” cholesterol. High-density lipoprotein, or HDL, is known as “good” cholesterol. These two types of lipids, along with triglycerides and Lp(a) cholesterol, make up your total cholesterol count, which can be determined through a blood test. 

LDL (Bad) Cholesterol
When too much LDL (bad) cholesterol circulates in the blood, it can slowly build up in the inner walls of the arteries that feed the heart and brain. Together with other substances, it can form plaque, a thick, hard deposit that can narrow the arteries and make them less flexible. This condition is known as atherosclerosis. If a clot forms and blocks a narrowed artery, heart attack or stroke can result.

HDL (Good) Cholesterol
About one-fourth to one-third of blood cholesterol is carried by high-density lipoprotein (HDL). HDL cholesterol is known as “good” cholesterol, because high levels of HDL seem to protect against heart attack. Low levels of HDL (less than 40 mg/dL) also increase the risk of heart disease. Medical experts think HDL tends to carry cholesterol away from the arteries and back to the liver, where it’s passed from the body. Some experts believe HDL removes excess cholesterol from arterial plaque, slowing its buildup.

What should I eat?
Focus on low-saturated fat, trans fat-free, low-cholesterol foods such as these:
  • A variety of fruits and vegetables (choose 8 to 10 servings per day)
  • A variety of grain products like bread, cereal, rice, and pasta, including whole grains (choose 6 or more servings per day)
  • Fat-free and low-fat milk products (2 to 3 servings per day)
  • Lean meats and poultry without skin (choose up to 5 to 6 total ounces per day)
  • Fatty fish (enjoy at least 2 servings baked or grilled each week)
  • Beans and peas
  • Nuts and seeds in limited amounts (4 to 5 servings per week)
  • Unsaturated vegetable oils like canola, corn, olive, safflower, and soybean oils (but a limited amount of margarines and spreads made from them)
What should I limit?
  • Whole milk, cream, and ice cream
  • Butter, egg yolks, and cheese — and foods made with them
  • Organ meats like liver, sweetbreads, kidney, and brain
  • High-fat processed meats like sausage, bologna, salami, and hot dogs
Cholesterol Questions to Ask Your Doctor
Many people have questions for their doctors about tests, drug treatments, risk factors, and lifestyle changes. Below are examples of common questions. For a printable version to take to your doctor’s office, click the link in the right column of this page.

About Blood Cholesterol
  • What do my cholesterol numbers mean?
  • What is my cholesterol goal?
  • How long will it take to reach my cholesterol goals?
  • How often should I have my levels checked?
  • How does exercise affect my cholesterol levels?
  • How does smoking affect my cholesterol levels?
  • What type of foods should I eat?
  • Do I need to lose weight, and if so, how much?
  • Will I need cholesterol-lowering medicine?
About Drug Treatment 
  • What kind of medicine should I take?
  • Can I take the generic form of the medicine?
  • What should I know about the medicine?
  • What are the side effects?
  • How do I know if it’s working?
  • How can I remember when to take the medicine?
  • What if I forget to take a medicine?
  • Should I avoid any foods or other medicines?
  • Can I drink alcohol?
  • How long will I need to take my medicine?
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High Triglyceride

Triglyceride is a form of fat made in the body. Elevated triglycerides can be due to overweight/obesity, physical inactivity, cigarette smoking, excess alcohol consumption and a diet very high in carbohydrates (60 percent of total calories or more). People with high triglycerides often have a high total cholesterol level, including a high LDL (bad) level and a low HDL (good) level. Many people with heart disease and/or diabetes also have high triglyceride levels.

What are triglycerides?
Triglycerides are the chemical form in which most fat exists in food as well as in the body. They’re also present in blood plasma and, in association with cholesterol, form the plasma lipids. 

Triglycerides in plasma are derived from fats eaten in foods or made in the body from other energy sources like carbohydrates. Calories ingested in a meal and not used immediately by tissues are converted to triglycerides and transported to fat cells to be stored. Hormones regulate the release of triglycerides from fat tissue so they meet the body’s needs for energy between meals.

How is an excess of triglycerides harmful?
Excess triglycerides in plasma is called hypertriglyceridemia. It’s linked to the occurrence of coronary artery disease in some people. Elevated triglycerides may be a consequence of other disease, such as untreated diabetes mellitus. Like cholesterol, increases in triglyceride levels can be detected by plasma measurements. These measurements should be made after an overnight food and alcohol fast.

The National Cholesterol Education Program guidelines for triglycerides are:
  • Normal – Less than 150 mg/dL
  • Borderline high – 150-199 mg/dL
  • High – 200-499 mg/dL
  • Very high – 500 mg/dL or higher
These are based on fasting plasma triglyceride levels.

American Heart Association (AHA) Recommendation – Dietary treatment goals

Changes in lifestyle habits are the main therapy for hypertriglyceridemia. These are the changes you need to make:
  • If you’re overweight, cut down on calories to reach your ideal body weight. This includes all sources of calories from fats, proteins, carbohydrates, and alcohol. 
  • Reduce the saturated fat, trans fat, and cholesterol content of your diet. 
  • Reduce your intake of alcohol considerably. Even small amounts of alcohol can lead to large changes in plasma triglyceride levels.
  • Eat fruits, vegetables, and nonfat or low-fat dairy products most often. 
  • Get at least 30 minutes of moderate-intensity physical activity on five or more days each week. 
  • People with high triglycerides may need to substitute monounsaturated and polyunsaturated fats — such as those found in canola oil, olive oil, or liquid margarine — for saturated fats. Substituting carbohydrates for fats may raise triglyceride levels and may decrease HDL (“good”) cholesterol in some people.
  • Substitute fish high in omega-3 fatty acids instead of meats high in saturated fat, like hamburger. Fatty fish like mackerel, lake trout, herring, sardines, albacore tuna, and salmon are high in omega-3 fatty acids.
Because other risk factors for coronary artery disease multiply the hazard from hyperlipidemia, control high blood pressure and avoid cigarette smoking. If drugs are used to treat hypertriglyceridemia, dietary management is still important. Patients should follow the specific plans laid out by their physicians and nutritionists.
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Mitral Stenosis

Mitral stenosis (mitral valve stenosis) is a narrowing of the mitral valve opening that increases resistance to blood flow from the left atrium to the left ventricle.
  • Mitral stenosis usually results from rheumatic fever, but infants can be born with the condition.
  • Mitral stenosis does not usually cause symptoms unless it is severe.
  • Doctors make the diagnosis after hearing a characteristic heart murmur through a stethoscope placed over the heart.
  • Treatment includes use of diuretics and beta blockers or calcium channel blockers.
In mitral stenosis, blood flow through the narrowed valve opening is reduced. As a result, the volume and pressure of blood in the left atrium increases, and the left atrium enlarges. The enlarged left atrium often beats rapidly in an irregular pattern (a disorder called atrial fibrillation). As a result, the heart’s pumping efficiency is reduced. If mitral stenosis is severe, pressure increases in the blood vessels of the lungs, resulting in heart failure with fluid accumulation in the lungs and a low level of oxygen in the blood. If a woman with severe mitral stenosis becomes pregnant, heart failure may develop rapidly.

Cause
Mitral stenosis almost always results from rheumatic fever, a childhood illness that sometimes occurs after untreated strep throat or scarlet fever. Rheumatic fever is now rare in North America, Australasia, and Western Europe because antibiotics are widely used to treat infection. Thus, in these regions, mitral stenosis occurs mostly in older people who had rheumatic fever and who did not have the benefit of antibiotics during their youth or in people who have moved from regions where antibiotics are not widely used. In such regions, rheumatic fever is common, and it leads to mitral stenosis in adults, teenagers, and sometimes even children. Typically, when rheumatic fever is the cause of mitral stenosis, the mitral valve cusps are partially fused together.

Mitral stenosis can rarely be present at birth (congenital). Infants born with the disorder rarely live beyond age 2, unless they have surgery.

Three rare conditions unrelated to mitral stenosis can produce the same effects as the stenosis. They include a myxoma (a noncancerous tumor in the left atrium), cor triatriatum (a rare developmental abnormality in which a membrane goes across the left atrium), and pulmonary veno-occlusive disease (a narrowing of the veins that lead from the lungs into the left atrium).

Symptoms and Diagnosis
Mild mitral stenosis does not usually cause symptoms. Some people with more severe mitral stenosis have atrial fibrillation or heart failure. People with atrial fibrillation may feel palpitations (awareness of heartbeats). People with heart failure become easily fatigued and short of breath. Shortness of breath may occur only during physical activity at first, but later, it may occur even during rest. Some people can breathe comfortably only when they are propped up with pillows or sitting upright. Those people with a low level of oxygen in the blood and high blood pressure in the lungs may have a plum-colored flush in the cheeks (called mitral facies). People may cough up blood (hemoptysis) if the high pressure causes a vein or capillaries in the lungs to burst. The resulting bleeding into the lungs is usually slight, but if hemoptysis occurs, the person should be evaluated by a doctor promptly because hemoptysis indicates severe mitral stenosis or another serious problem.

With a stethoscope, doctors may hear the characteristic heart murmur as blood tries to pass through the narrowed valve opening from the left atrium into the left ventricle. Unlike a normal valve, which opens silently, the abnormal valve often makes a snapping sound as it opens to allow blood into the left ventricle. The diagnosis is usually confirmed by electrocardiography (ECG), a chest X-ray showing an enlarged atrium, and echocardiography, which uses ultrasound waves to produce an image of the narrowed valve and the blood passing through it.

Prevention and Treatment
Mitral stenosis will not occur if rheumatic fever is prevented by promptly treating strep throat with antibiotics. Treatment includes use of diuretics and beta blockers or calcium channel blockers. Diuretics, which increase urine formation, can reduce blood pressure in the lungs by reducing the volume of circulating blood. Beta blockers and calcium channel blockers help control heart rhythms. Anticoagulants may be needed to prevent clot formation in people with atrial fibrillation.

If drug therapy does not reduce the symptoms satisfactorily, the valve may be repaired or replaced. Sometimes the valve can be stretched open using a procedure called balloon valvuloplasty. In this procedure, a balloon-tipped catheter is threaded through a vein and eventually into the heart. Once inside the valve, the balloon is inflated, separating the valve cusps. Alternately, heart surgery may be performed to separate the fused cusps. If the valve is too badly damaged, it may be surgically replaced with an artificial valve.

People with mitral stenosis are given antibiotics before a surgical, dental, or medical procedure to reduce the small risk of developing a heart valve infection (infective endocarditis).
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Mitral Valve Prolapse

The mitral (MI'tral) valve is between the heart’s left atrium (upper, holding chamber) and left ventricle (lower, pumping chamber). The mitral valve has two flaps, or cusps.

What is mitral valve prolapse (MVP)?
In MVP, one or both valve flaps are enlarged, and some of their supporting “strings” may be too long. When the heart pumps (contracts), the mitral valve flaps don’t close smoothly or evenly. Instead, part of one or both flaps collapses backward into the left atrium. This sometimes lets a small amount of blood leak backward through the valve. This may cause a heart murmur.

Mitral valve prolapse is also known as click-murmur syndrome, Barlow’s syndrome, balloon mitral valve, and floppy valve syndrome.

Does mitral valve prolapse need to be treated?
Most people with mitral valve prolapse don’t have symptoms, won’t have problems, and won’t need treatment. However, those who have leaky (regurgitant) prolapsing valves are at increased risk of developing an infection of the lining of the heart or heart valve known as endocarditis. In the past, some people with MVP have been given antibiotics before certain dental or surgical procedures to help prevent an infection called bacterial endocarditis (BE). However, the American Heart Association no longer recommends routine antibiotics before dental procedures except for patients at the highest level of risk for BE, such as patients with a prosthetic cardiac valve, patients who have had BE before, or patients with specific types of congenital heart disease. Also, the American Heart Association no longer recommends routine antibiotics to prevent BE in patients undergoing procedures of the gastrointestinal or genitourinary tract.

Medicine may be used in a small number of MVP patients with chest pain, angina pectoris, or abnormal heart rhythms (arrhythmias).
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Myocardial Infarction

Myocardial infarction (MI) is the rapid development of myocardial necrosis caused by a critical imbalance between oxygen supply and demand of the myocardium. This usually results from plaque rupture with thrombus formation in a coronary vessel, resulting in an acute reduction of blood supply to a portion of the myocardium.

Although the clinical presentation of a patient is a key component in the overall evaluation of the patient with MI, many events are either “silent” or are clinically unrecognized, evidencing that patients, families, and healthcare providers often do not recognize symptoms of MI. The appearance of cardiac markers in the circulation generally indicates myocardial necrosis and is a useful adjunct to diagnosis.

Cardiac markers help to categorize MI, which is considered part of a spectrum referred to as acute coronary syndrome that includes ST-elevation MI (STEMI), non-elevation MI (NSTEMI), and unstable angina. This categorization is valuable because patients with ischemic discomfort may or may not have ST-segment elevations on their electrocardiogram. Those without ST elevations may ultimately be diagnosed with NSTEMI or with unstable angina based on the presence or absence of cardiac enzymes. Additionally, therapeutic decisions, such as administering an intravenous thrombolytic or performing percutaneous coronary intervention (PCI), are often made based on this categorization.

Pathophysiology
The most common cause of MI is narrowing of the epicardial blood vessels due to atheromatous plaques. Plaque rupture with subsequent exposure of the basement membrane results in platelet aggregation, thrombus formation, fibrin accumulation, hemorrhage into the plaque, and varying degrees of vasospasm. This can result in partial or complete occlusion of the vessel and subsequent myocardial ischemia. Total occlusion of the vessel for more than 4 to 6 hours results in irreversible myocardial necrosis, but reperfusion within this period can salvage the myocardium and reduce morbidity and mortality.

Nonatherosclerotic causes of MI include coronary vasospasm as seen in variant (Prinzmetal) angina and in patients using cocaine and amphetamines; coronary emboli from sources such as an infected heart valve; occlusion of the coronaries due to vasculitis; or other causes leading to mismatch of oxygen supply and demand, such as acute anemia from GI bleeding. MI induced by chest trauma has also been reported, usually following severe chest trauma such as motor vehicle accidents and sports injuries.

History
The history is critical in making the diagnosis of MI and sometimes may provide the only clues that lead to the diagnosis in the initial phases of the patient presentation.
  • Chest pain, usually across the anterior precordium, is typically described as tightness, pressure, or squeezing.
  • Pain may radiate to the jaw, neck, arms, back, and epigastrium. The left arm is more frequently affected; however, a patient may experience pain in both arms.
  • Dyspnea, which may accompany chest pain or occur as an isolated complaint, indicates poor ventricular compliance in the setting of acute ischemia. Dyspnea may be the patient’s anginal equivalent and, in an elderly person or a patient with diabetes, may be the only complaint.
  • Nausea, abdominal pain, or both often are present in infarcts involving the inferior or posterior wall.
  • Anxiety
  • Lightheadedness with or without syncope
  • Cough
  • Nausea with or without vomiting
  • Diaphoresis
  • Wheezing
  • Elderly patients and those with diabetes may have particularly subtle presentations and may complain of fatigue, syncope, or weakness. The elderly may also present with only altered mental status. Those with preexisting altered mental status or dementia may have no recollection of recent symptoms and may have no complaints whatsoever.
  • As many as half of MIs are clinically silent in that they do not cause the classic symptoms described above and consequently go unrecognized by the patient. A high index of suspicion should be maintained for MI, especially when evaluating women, patients with diabetes, older patients, patients with dementia, and those with a history of heart failure. Patients with a permanent pacemaker in place may confound recognition of STEMI by 12-lead ECG due to the presence of paced ventricular contractions.
Physical
The physical examination can often be unremarkable.
  • Patients with ongoing symptoms usually lie quietly in bed and appear pale and diaphoretic.
  • Hypertension may precipitate MI, or it may reflect elevated catecholamine levels due to anxiety, pain, or exogenous sympathomimetics.
  • Hypotension may indicate ventricular dysfunction due to ischemia. Hypotension in the setting of MI usually indicates a large infarct secondary to either decreased global cardiac contractility or a right ventricular infarct.
  • Acute valvular dysfunction may be present. Valvular dysfunction usually results from infarction that involves the papillary muscle. Mitral regurgitation due to papillary muscle ischemia or necrosis may be present.
  • Rales may represent congestive heart failure.
  • Neck vein distention may represent pump failure. With right ventricular failure, cannon jugular venous A waves may be noted.
  • Third heart sound (S3) may be present.
  • A fourth heart sound is a common finding in patients with poor ventricular compliance that is due to preexisting heart disease or hypertension.
  • Dysrhythmias may present as an irregular heartbeat or pulse.
  • Low-grade fever is not uncommon.
Causes
The most frequent cause of MI is rupture of an atherosclerotic plaque within a coronary artery with subsequent arterial spasm and thrombus formation.

Other causes include the following:
  • Coronary artery vasospasm
  • Ventricular hypertrophy (e.g., left ventricular hypertrophy [LVH], idiopathic hypertrophic subaortic stenosis [IHSS], underlying valve disease)
  • Hypoxia due to carbon monoxide poisoning or acute pulmonary disorders (Infarcts due to pulmonary disease usually occur when demand on the myocardium dramatically increases relative to the available blood supply.)
  • Coronary artery emboli, secondary to cholesterol, air, or the products of sepsis
  • Cocaine, amphetamines, and ephedrine
  • Arteritis
  • Coronary anomalies, including aneurysms of the coronary arteries
  • Increased afterload or inotropic effects, which increase the demand on the myocardium
  • Aortic dissection, with retrograde involvement of the coronary arteries
  • Although rare, pediatric coronary artery disease may be seen with Marfan syndrome, Kawasaki disease, Takayasu arteritis, progeria, and cystic medial necrosis (see Myocardial Infarction in Childhood).
Risk factors for atherosclerotic plaque formation include the following:
  • Age
  • Male gender
  • Smoking
  • Hypercholesterolemia and hypertriglyceridemia, including inherited lipoprotein disorders
  • Diabetes mellitus
  • Poorly controlled hypertension
  • Type A personality
  • Family history
  • Sedentary lifestyle
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Palpitations

Palpitations are unpleasant sensations of irregular and/or forceful beating of the heart. Some persons with palpitations have no heart disease or abnormal heart rhythms and the reasons for their palpitations are unknown. In others, palpitations result from abnormal heart rhythms (arrhythmias).
  • Arrhythmias refer to heartbeats that are too slow, too rapid, irregular, or too early.
  • Rapid arrhythmias (greater than 100 beats per minute) are called tachycardias.
  • Slow arrhythmias (slower than 60 beats per minute) are called bradycardias.
  • Irregular heart rhythms are called fibrillations (as in atrial fibrillation).
  • When a single heartbeat occurs earlier than normal, it is called a premature contraction, and this can cause the sensation of a forceful heartbeat.
  • Abnormalities in the atria, the ventricles, and the electrical conducting system (the Sino-atrial [SA] node, and the Atrio-ventricular [AV] node) of the heart can lead to arrhythmias that cause palpitations.
How are palpitations evaluated?
The first step in the evaluation of patients with palpitations is to determine whether their symptoms are actually due to arrhythmias. Because the treatment of varying types of arrhythmias can differ, it is also important to determine the type of arrhythmias involved. Since arrhythmias can be related to underlying disease of the heart valves, heart muscle, and coronary arteries, tests are often performed to exclude heart abnormalities. Blood tests are also obtained to measure blood sodium, potassium, calcium, magnesium, thyroid hormone levels, and medication levels (such as digoxin levels).

Tests for arrhythmias include resting electrocardiogram (EKG), 24-hour rhythm monitoring (Holter), and a treadmill exercise test.

A resting EKG is a short recording of the heart’s electrical activity, usually performed in the doctor’s office. An EKG is useful only if the arrhythmia causing the palpitations is occurring when the EKG is being recorded. Often, the resting EKG cannot catch the arrhythmias and a 24-hour Holter monitor is required. The 24-hour Holter is a cassette tape worn by the patient continuously while carrying out his/her usual activities. The patient simultaneously keeps a diary of palpitations or other symptoms during the recording period. Symptoms of palpitations can later be correlated with the presence or absence of arrhythmias on the Holter tape. If suspected arrhythmias causing palpitations still cannot be captured by the 24-hour Holter, a small, patient-activated event monitor is worn by the patient for 1 to 2 weeks. When the patient experiences palpitation, he/she presses a button to record the heart rhythm prior to, during, and after the episode. The recordings can be analyzed by a doctor at a later date.

In some patients, exercise treadmill is used to detect arrhythmias that occur only with exertion. Exercise treadmill is a continuous EKG recording of the heart as the patient performs increasing levels of exercise. In addition to detecting arrhythmias, exercise treadmill is a useful screening test for the presence of narrowed coronary arteries that can limit supply of oxygenated blood to the heart muscle during exercise.

Echocardiography uses ultrasound waves to obtain images of the heart chambers, valves, and surrounding structures. Echocardiography is useful in detecting diseases of the heart valves, such as mitral valve prolapse, mitral stenosis, and aortic stenosis (examples of valve diseases that can cause arrhythmias and palpitations). Echocardiography is also useful in evaluating the size of heart chambers, as well as the health and contractions of the muscle of the ventricles. Combining echocardiography with exercise stress testing (stress echocardiography) is an accurate screening test for significant coronary artery disease. The portion of the ventricles supplied by the narrowed arteries does not contract as well as the rest of the ventricles during exercise.

Occasionally, cardiac catheterization with angiography is performed to detect disease in the coronary arteries or in the heart valves which is triggering an arrhythmia. Coronary arteries supply oxygenated blood from the aorta to the heart muscle. During this procedure, a small hollow plastic tube is advanced under X-ray guidance from an artery in the groin to the openings of the two main coronary arteries located above the aortic valve. A contrast agent, made of iodine, is then injected into the arteries while X-ray pictures are recorded. It is an accurate test in detecting, mapping, and assessing the extent and severity of coronary artery disease. For further information, please read the Angina and Angioplasty articles.

Blood tests are performed to measure the levels of thyroid hormone, potassium, magnesium, and medications, such as digoxin. Excess thyroid hormone can lead to rapid arrhythmias, such as atrial fibrillation. Low blood levels of potassium and magnesium can lead to other arrhythmias. Digoxin (Lanoxin) toxicity can cause serious arrhythmias, such as bradycardia and ventricular tachycardias. Digoxin toxicity can be enhanced by low blood levels of potassium and magnesium.

How are palpitations managed?
Palpitations without associated arrhythmias and heart diseases may not require specific treatment. Patients are often advised simply to reduce emotional and physical stress while monitoring their symptoms.

Palpitations resulting from premature contractions (PACs and PVCs) often require no specific treatment. The frequency of premature contractions can be reduced by stress reduction, quitting smoking, and reducing caffeine and alcohol consumption. High blood adrenaline levels can lead to premature contractions, while stress reduction helps to lower blood adrenaline levels. For patients with persistent palpitations and premature contractions, medications, such as beta-blockers, can be used to block the effect of adrenaline on the heart, thus reducing premature contractions. Examples of beta-blockers include propranolol (Inderal), metoprolol (Lopressor), and atenolol (Tenormin). Side effects of beta blockers include worsening of asthma, excessive lowering of heart rate and blood pressure, depression, fatigue, and impotence.
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Peripheral Vascular Disease

This refers to diseases of blood vessels outside the heart and brain. It’s often a narrowing of vessels that carry blood to the legs, arms, stomach, or kidneys. There are two types of these circulation disorders:
  • Functional peripheral vascular diseases don’t have an organic cause. They don’t involve defects in blood vessels’ structure. They’re usually short-term effects related to “spasm” that may come and go. Raynaud'’s disease is an example. It can be triggered by cold temperatures, emotional stress, working with vibrating machinery, or smoking.
  • Organic peripheral vascular diseases are caused by structural changes in the blood vessels, such as inflammation and tissue damage. Peripheral artery disease is an example. It’s caused by fatty buildups in arteries that block normal blood flow. 
What is peripheral artery disease?
Peripheral artery disease (PAD) is a condition similar to coronary artery disease and carotid artery disease. In PAD, fatty deposits build up in the inner linings of the artery walls. These blockages restrict blood circulation, mainly in arteries leading to the kidneys, stomach, arms, legs, and feet. In its early stages, a common symptom is cramping or fatigue in the legs and buttocks during activity. Such cramping subsides when the person stands still. This is called “intermittent claudication.” People with PAD often have fatty buildup in the arteries of the heart and brain. Because of this association, most people with PAD have a higher risk of death from heart attack and stroke.

How is peripheral artery disease diagnosed and treated?
Techniques used to diagnose PAD include a medical history, physical exam, ultrasound, X-ray angiography, and magnetic resonance imaging angiography (MRA).

Most people with PAD can be treated with lifestyle changes, medications, or both. Lifestyle changes to lower your risk include:
  • Stop smoking (smokers have a particularly strong risk of PAD).
  • Control diabetes.
  • Control blood pressure.
  • Be physically active (including a supervised exercise program).
  • Eat a low-saturated fat, low-cholesterol diet.
PAD may require drug treatment, too. Drugs include:
  • Medicines to help improve walking distance (cilostazol and pentoxifylline)
  • Antiplatelet agents
  • Cholesterol-lowering agents (statins)
In a minority of patients, lifestyle modifications alone aren’t sufficient. In these cases, angioplasty or surgery may be necessary.

Angioplasty is a non-surgical procedure that can be used to dilate (widen) narrowed or blocked peripheral arteries. A thin tube called a catheter with a deflated balloon on its tip is passed into the narrowed artery segment. The balloon is then inflated, compressing the plaque and dilating the narrowed artery so that blood can flow more easily. Then the balloon is deflated and the catheter is withdrawn.

Often a stent — a cylindrical, wire mesh tube — is placed in the narrowed artery with a catheter. There, the stent expands and locks open. It stays in that spot, keeping the diseased artery open.

If the narrowing involves a long portion of an artery, surgery may be necessary. A vein from another part of the body or a synthetic blood vessel is used. It’s attached above and below the blocked area to detour blood around the blocked spot.
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Pulmonary Valve Stenosis

Pulmonary valve stenosis is a congenital heart defect in which blood flow from the heart to the pulmonary artery is blocked.

Description
Pulmonary valve stenosis is an obstruction in the pulmonary valve, located between the right ventricle and the pulmonary artery. Normally, the pulmonary valve opens to let blood flow from the right ventricle to the lungs. When the pulmonary valve is malformed, it forces the right ventricle to pump harder to overcome the obstruction. In its most severe form, pulmonary valve stenosis can be life threatening.

Patients with pulmonary valve stenosis are at increased risk for getting valve infections and must take antiobiotics to help prevent this before certain dental and surgical procedures. Pulmonary valve stenosis is also called pulmonary stenosis.

Causes and symptoms
Pulmonary valve stenosis is caused by a congenital malformation in which the pulmonary valve does not open properly. In most cases, scientists don’t know why it occurs. In cases of mild or moderate stenosis, there are often no symptoms. With more severe obstruction, symptoms include a bluish skin tint and signs of heart failure.

Diagnosis
Diagnosis of pulmonary valve stenosis begins with the patient’s medical history and a physical exam. Tests to confirm the diagnosis include chest X-ray, echocardiogram, electrocardiogram, and catherization. An electrocardiograph shows the heart’s activity. Electrodes covered with conducting jelly are placed on the patient. The electrodes send impulses that are traced on a recorder. Echocardiography uses sound waves to create an image of the heart’s chambers and valves. The technician applies gel to a wand (transducer) and presses it against the patient’s chest. The returning sound waves are converted into an image displayed on a monitor. Catherization is an invasive procedure used to diagnose, and in some cases treat, heart problems. A thin tube, called a catheter, is inserted into a blood vessel and threaded up into the heart, enabling physicians to see and sometimes correct the problems.

Treatment
Patients with mild to moderate pulmonary valve stenosis, and few or no symptoms, do not require treatment. In more severe cases, the blocked valve will be opened surgically, either through balloon valvuloplasty or surgical valvulotomy. For initial treatment, balloon valvuloplasty is the procedure of choice. This is a catherization procedure in which a special catheter containing a deflated balloon is inserted in a blood vessel and threaded up into the heart. The catheter is positioned in the narrowed heart valve and the balloon is inflated to stretch the valve open.

In some cases, surgical valvulotomy may be necessary. This is open heart surgery performed with a heart-lung machine. The valve is opened with an incision and, in some cases, hypertrophied muscle in the right ventricle is removed. Rarely does the pulmonary valve need to be replaced.

Alternative treatment
Pulmonary valve stenosis can be life threatening and always requires a physician’s care. In mild to moderate cases of pulmonary valve stenosis, general lifestyle changes, including dietary modifications, exercise, and stress reduction, can contribute to maintaining optimal wellness.

Prognosis
Patients with the most severe form of pulmonary valve stenosis may die in infancy. The prognosis for children with more severe stenosis who undergo balloon valvuloplasty or surgical valvulotomy is favorable. Patients with mild to moderate pulmonary stenosis can lead a normal life, but they require regular medical care.

Prevention
Pulmonary valve stenosis cannot be prevented.
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Renal Artery Stenosis

Renal artery stenosis is a blockage or narrowing of the major arteries that supply blood to the kidneys. Renal artery stenosis occurs when the flow of blood from the arteries leading to the kidneys is constricted by tissue or artherosclerotic plaque. This narrowing of the arteries diminishes the blood supply to the kidneys, which can cause them to atrophy and may ultimately lead to kidney failure. It may also cause renovascular hypertension, or high blood pressure related to renal artery blockage.

Causes and symptoms
The two main causes of renal artery stenosis are atherosclerosis and fibromuscular disease. Fibromuscular diseases such as fibromuscular dysplasia cause growth of fibrous tissues on the arterial wall. Stenosis may also occur when scar tissue forms in the renal artery after trauma to the kidney.

Renal arterial stenosis has no overt symptoms. Eventually, untreated renal arterial stenosis causes secondary complications such as chronic kidney failure, which may be characterized by frequent urination, anemia, edema, headaches, hypertension, lower back pain, and other signs and symptoms.

Diagnosis
The high blood pressure that is sometimes associated with renal artery stenosis may be the first sign that it is present, particularly if the hypertension is not responding to standard treatment. Presence of a bruit, a swooshing sound from the artery that indicates an obstruction, may be heard through a stethoscope.

An arteriogram — an X-ray study of the arteries that uses a radiopaque substance, or dye, to make the arteries visible under X-ray — may also be performed. This test is used with caution in patients with impaired kidney function, as the contrast medium may cause further kidney damage.

Treatment
Treatment for renal artery stenosis is either surgical, pharmaceutical, or with angioplasty or stenting. Angioplasty involves guiding a balloon catheter down into the renal artery and inflating the balloon to clear the blockage. A stent may be inserted into the artery to widen the opening. Some patients may be candidates for surgical revascularization, which involves restoring blood flow with an arterial bypass. Drugs known as angiotension-converting enzyme (ACE) inhibitors may be prescribed for some patients. The chosen treatment approach depends on the cause of the stenosis and factors such as the patient’s kidney function and blood pressure control.

Alternative treatment
Renal artery stenosis is a serious and potentially life-threatening condition, and should always be treated by a healthcare professional familiar with the disorder.

Prognosis
Untreated renal artery stenosis can cause hypertension (high blood pressure) and may ultimately lead to chronic kidney failure (end-stage renal disease).

Prevention
Maintaining a heart healthy lifestyle can help prevent cases of renal arterial stenosis attributable to artherosclerosis. Strategies for avoiding vascular disease include eating right, maintaining a desirable weight, quitting smoking, managing stress, and exercising regularly.
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Stroke

A stroke occurs when a blood vessel in the brain is blocked or bursts. Without blood and the oxygen it carries, part of the brain starts to die. The part of the body controlled by the damaged area of the brain can’t work properly. Brain damage can begin within minutes, so it is important to know the symptoms of stroke and act fast. Quick treatment can help limit damage to the brain and increase the chance of a full recovery.

What are the symptoms?
Symptoms of a stroke happen quickly. A stroke may cause sudden:
  • Numbness, weakness, or paralysis of the face, arm, or leg, especially on one side of the body.
  • Trouble seeing in one or both eyes. You may have double vision, or things may look dim or blurry.
  • Confusion or trouble understanding.
  • Slurred or garbled speech.
  • Trouble walking. You may feel unsteady, dizzy, or clumsy.
  • Severe headache.
If you have any of these symptoms, call 911 or other emergency services right away.

See your doctor if you have symptoms that seem like a stroke, even if they go away quickly. You may have had a transient ischemic attack (TIA), sometimes called a mini-stroke. A TIA is a warning that a stroke may happen soon. Getting early treatment for a TIA can help prevent a stroke.

There are two types of stroke:
  • An ischemic stroke develops when a blood clot blocks a blood vessel in the brain. The clot may form in the blood vessel or travel from somewhere else in the blood system. About 8 out of 10 strokes are ischemic strokes. They are the most common type of stroke in older adults.
  • A hemorrhagic stroke develops when an artery in the brain leaks or bursts. This causes bleeding inside the brain or near the surface of the brain. Hemorrhagic strokes are less common but more deadly than ischemic strokes.
How is a stroke diagnosed?
Seeing a doctor right away is very important. If a stroke is diagnosed quickly — within the first 3 hours of when symptoms start — doctors may be able to use medicines that can lead to a better recovery.

The first thing the doctor needs to find out is what kind of stroke it is: ischemic or hemorrhagic. This is important because the medicine given to treat a stroke caused by a blood clot could be deadly if used for a stroke caused by bleeding in the brain.

To find out what kind of stroke it is, the doctor will do a type of X-ray called a CT scan of the brain, which can show if there is bleeding. The doctor may order other tests to find the location of the clot or bleeding, check for the amount of brain damage, and check for other conditions that can cause symptoms similar to a stroke.

How is it treated?
For an ischemic stroke, treatment focuses on restoring blood flow to the brain. If less than 3 hours have passed since your symptoms began, doctors may use a medicine that dissolves blood clots. Research shows that this medicine can improve recovery from a stroke, especially if given within 90 minutes of the first symptoms. Other medicines may be given to prevent blood clots and control symptoms.

A hemorrhagic stroke can be hard to treat. Doctors may do surgery or other treatments to stop bleeding or reduce pressure on the brain. Medicines may be used to control blood pressure, brain swelling, and other problems.

After your condition is stable, treatment shifts to preventing other problems and future strokes. You may need to take a number of medicines to control conditions that put you at risk for stroke, such as high blood pressure, high cholesterol, and diabetes. Some people need to have a surgery to remove plaque buildup from the blood vessels that supply the brain (carotid arteries).

The best way to get better after a stroke is to start stroke rehab. The goal of stroke rehab is to help you regain skills you lost or to make the most of your remaining abilities. Stroke rehab can also help you take steps to prevent future strokes. You have the greatest chance of regaining abilities during the first few months after a stroke, so it is important to start rehab soon after a stroke and do a little every day.

Can you prevent a stroke?
After you have had a stroke, you are at risk for having another one. You can make some important lifestyle changes that can reduce your risk of stroke and improve your overall health.
  • Don't smoke. Smoking can more than double your risk of stroke. Avoid secondhand smoke, too.
  • Eat a heart-healthy diet that includes plenty of fish, fruits, vegetables, beans, high-fiber grains and breads, and olive oil. Eat less salt, too.
  • Get exercise on most, preferably all, days of the week. Your doctor can suggest a safe level of exercise for you.
  • Stay at a healthy weight.
  • Control your cholesterol and blood pressure.
  • If you have diabetes, keep your blood sugar as close to normal as possible.
  • Limit alcohol. Having more than 2 drinks a day increases the risk of stroke.
  • Take a daily aspirin or other medicines if your doctor advises it.
  • Avoid getting sick from the flu. Get a flu shot every year.
Work closely with your doctor, go to all your appointments, and take your medicines just the way your doctor says to.
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Ventricular Tachycardia

Ventricular tachycardia (V-tach) is a rapid heart beat that originates in one of the lower chambers (ventricles) of the heart. To be classified as tachycardia, the heart rate is usually at least 100 beats per minute.

A rapid heart rate can originate in either the left or right ventricle. Ventricular tachycardia that lasts more than 30 seconds is referred to as sustained ventricular tachycardia. A period of three to five rapid beats is called a salvo, and six beats or more lasting less than 30 seconds is called non-sustained ventricular tachycardia. Rapid ventricular rhythms are more serious than rapid atrial rhythms because they make the heart extremely inefficient. They also tend to cause more severe symptoms, and have a much greater tendency to result in death.

Although generally considered to be among the life-threatening abnormal rhythms, harmless forms of sustained V-tach do exist. These occur in people without any structural heart disease.

Causes and symptoms
Most ventricular tachycardias are associated with serious heart disease such as coronary artery blockage, cardiomyopathy, or valvular heart disease. V-tach is often triggered by an extra beat originating in either the right or left ventricle. It also occurs frequently in connection with a heart attack. V-tach commonly occurs within 24 hours of the start of the attack, and must be treated quickly to prevent fibrillation. After 48 to 72 hours of the heart attack, the risk of ventricular tachycardia is small. However, people who have suffered severe damage to the larger anterior wall of the heart have a second danger period, because V-tach often occurs during convalescence from this type of heart attack.

Sustained ventricular tachycardia prevents the ventricles from filling adequately so the heart can not pump normally. This results in loss of blood pressure, and can lead to a loss of consciousness and heart failure.

The individual with V-tach almost always experiences palpitation, though some episodes cause no symptoms at all.

Diagnosis
Diagnosis is easily made with an electrocardiogram.

Treatment
Any episode of ventricular tachycardia that causes symptoms needs to be treated. An episode that lasts more than 30 seconds, even without symptoms, also needs to be treated. Drug therapy can be given intravenously to suppress episodes of V-tach. If blood pressure falls below normal, a person will need electric cardioversion (“shock”) immediately.

Prognosis
With appropriate drug or surgical treatment, ventricular tachycardia can be controlled in most people.

Prevention
A person susceptible to sustained ventricular tachycardia often has a small abnormal area in the ventricles that is the source of the trigger event. This area can sometimes be surgically removed. If surgery is not an option and drug therapy is not effective, a device called an automatic cardioverter-defibrillator may be implanted.
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