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Heart & Vascular Conditions Treated 

Heart disease is the number one cause of death in this country. But it’s also one of the most preventable. The choices you make every day - what to eat, how you respond to stress, whether or not to get up off the couch and exercise - affect how much you’re at risk. Click on a condition below to learn more.

Angina PectorisAngina de Pecho

Angina Pectoris

What is angina pectoris?

Angina pectoris (or simply angina) is recurring chest pain or discomfort that happens when some part of your heart does not get enough blood and oxygen. Angina can be a symptom of coronary artery disease (CAD). This occurs when arteries that carry blood to your heart become narrowed and blocked due to atherosclerosis or a blood clot. It can also occur due to unstable plaques, poor blood flow through a narrowed heart valve, a decreased pumping function of the heart muscle, as well as a coronary artery spasm.

There are 2 other forms of angina pectoris, including:

Variant angina pectoris
(or Prinzmetal's angina)

Microvascular angina

  • Is rare
  • Occurs almost exclusively when a person is at rest
  • Often does not follow a period of physical exertion or emotional stress
  • Attacks can be very painful and usually occur between midnight and 8 a.m.
  • Is related to spasm of the artery
  • Is more common in women
  • Can be helped by medicines such as calcium channel blockers that help dilate the coronary arteries and prevent spasm
  • A recently discovered type of angina
  • People with this condition have chest pain but have no apparent coronary artery blockages
  • Doctors have found that the pain results from poor function of tiny blood vessels nourishing the heart as well as the arms and legs
  • Can be treated with some of the same medications used for angina pectoris
  • Was once called Syndrome X
  • Is more common in women

What causes angina pectoris?

Angina pectoris occurs when your heart muscle (myocardium) does not get enough blood and oxygen for a given level of work. Insufficient blood supply is called ischemia.

Who is at risk for angina pectoris?

Anything that causes your heart muscle to need more blood or oxygen supply can result in angina. Risk factors include physical activity, emotional stress, extreme cold and heat, heavy meals, drinking excessive alcohol, and cigarette smoking.

What are the symptoms of angina pectoris?

These are the most common symptoms of angina:

  • A pressing, squeezing, or crushing pain, usually in the chest under your breastbone
  • Pain may also occur in your upper back, both arms, neck, or ear lobes 
  • Pain radiating in your arms, shoulders, jaw, neck, or back
  • Shortness of breath
  • Weakness and fatigue
  • Feeling faint

Angina chest pain is usually relieved within a few minutes by resting or by taking prescribed cardiac medicine, such as nitroglycerin.

An episode of angina means some part of the heart is not getting enough blood supply. If you have angina, you have an increased risk for a heart attack. Note the pattern of your symptoms—what causes the chest pain, what it feels like, how long it lasts, and whether medicine relieves the pain. If angina symptoms change sharply, or if they happen when you are resting or they start to occur unpredictably, call 911. You may be having a heart attack. Do not drive yourself to the emergency department.

The symptoms of angina pectoris may look like other medical conditions or problems. Always see your healthcare provider for a diagnosis.

How is angina pectoris diagnosed?

In addition to a complete medical history and medical exam, your healthcare provider can often diagnose angina from your symptoms and how and when they occur. Other tests may include:

  • Electrocardiogram (ECG). Records the electrical activity of the heart, shows abnormal rhythms (arrhythmias), and detects heart muscle damage.
  • Stress test (usually with ECG; also called treadmill or exercise ECG). Given while you walk on a treadmill or pedal a stationary bike, to monitor your heart's ability to function when placed under stress such as during exercise. Breathing and blood pressure rates are also monitored. A stress test may be used to detect coronary artery disease, or to determine safe levels of exercise after a heart attack or heart surgery. A special type of stress test uses medicine to stimulate the heart as if you were exercising.
  • Cardiac catheterization. With this procedure, a wire is passed into the coronary arteries. Next a contrast agent is injected into your artery. X-ray images are taken to locate the narrowing, blockages, and other abnormalities of specific arteries.
  • Cardiac MRI. This test can find the amount of blood flow to the heart muscle. It may not be available at all medical centers.
  • Coronary CT scan. This test looks at the amount of calcium and plaque inside of the blood vessels of the heart.

How is angina pectoris treated?

Your healthcare provider will determine specific treatment, based on:

  • Your age, overall health, and medical history
  • Extent of the disease
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

Your healthcare provider may prescribe medicines if you have angina. The most common is nitroglycerin, which helps to relieve pain by widening your blood vessels. This allows more blood flow to your heart muscle and decreases the workload of your heart. Nitroglycerin may be taken as a long-acting form daily to prevent angina. Or, it may be taken as a nose spray, or under the tongue when angina occurs.

Do not take sildenafil (for erectile dysfunction) with nitroglycerin. This can cause a dangerous drop in blood pressure. Talk to your healthcare provider if you are taking erectile dysfunction medicines before taking nitroglycerin.

Beta-blockers and calcium channel blockers are also used to treat angina.

Your healthcare provider may recommend other medicines to help treat or prevent angina.

What are the complications of angina pectoris?

Angina means that you have coronary artery disease and that some part of your heart is not getting enough blood supply. If you have angina, you have an increased risk for a heart attack.

Can angina pectoris be prevented?

Maintaining a healthy lifestyle can help to delay or prevent angina pectoris. Healthy lifestyle management includes:

  • A healthy diet
  • Physical activity and exercise
  • Stress management
  • Not smoking or quitting smoking if you do smoke
  • Keeping or working toward a healthy weight
  • Taking medicines as prescribed
  • Treating any related conditions (such as high blood pressure, high cholesterol, diabetes,  and overweight) appropriately. 
 

Living with angina pectoris

If you have angina, note the patterns of your symptoms. For example, pay attention to what causes your chest pain, what it feels like, how long episodes usually last, and whether medicine relieves your pain. Call 911 if your angina episode symptoms change sharply. This is called unstable angina.

It is important to work with your healthcare provider to treat your underlying coronary artery disease, which causes angina. You need to control your risk factors: high blood pressure, cigarette smoking, high blood cholesterol levels, lack of exercise, excess weight, and a diet high in saturated fat. Taking you medicines as your healthcare provider directs is an important part of living with angina. If your provider prescribes nitroglycerin, it important that you have it with you at all times and follow his or her directions for using it whenever you have an episode of angina.

When should I call my healthcare provider?

Call 911
  • If angina symptoms change sharply
  • If they happen when you are resting
  • If symptoms continue after using nitroglycerin
  • Symptoms last longer than usual
  • Symptoms start to occur unpredictably
You may be having a heart attack. Do not drive yourself to the emergency department.

Call your healthcare provider right away if:
  • Your angina symptoms become worse or you notice new symptoms
  • You have side effects from your medicines

Key points

  • Angina is recurring chest pain or discomfort that happens when some part of your heart does not receive enough blood and oxygen.
  • Angina is a symptom of coronary artery disease. This occurs when arteries that carry blood to your heart become narrowed and blocked, due to atherosclerosis or a blood clot.
  • Angina can present as a pressing, squeezing, or crushing pain in the chest under your breast bone or upper back, both arms, neck, or ear lobes. It may also include shortness of breath, weakness, or fatigue 
  • Nitroglycerin is the most common medication prescribe for angina
  • Managing angina includes managing high blood pressure, stopping cigarette smoking, reducing high blood cholesterol levels, decreasing your intake of high saturated fat diet, exercising, and losing weight

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Angina

Angina is a type of chest discomfort caused by poor blood flow through to the heart muscle.

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AtherosclerosisAterosclerosis

Atherosclerosis

What is atherosclerosis?

Atherosclerosis thickening or hardening of the arteries. It is caused by a buildup of plaque in the inner lining of an artery. 

Plaque is made up of deposits of fatty substances, cholesterol, cellular waste products, calcium, and fibrin. As it builds up in the arteries, the artery walls become thickened and stiff.

Atherosclerosis is a slow, progressive disease that may start as early as childhood. However, it can progress rapidly.

What causes atherosclerosis?

It's not clear exactly how atherosclerosis starts or what causes it. However, a gradual buildup of plaque or thickening due to inflammation occurs on the inside of the walls of the artery. This reduces blood flow and oxygen supply to the vital body organs and extremities.

What are the risk factors for atherosclerosis?

Risk factors for atherosclerosis, include:

  • High cholesterol and triglyceride levels
  • High blood pressure
  • Smoking
  • Type 1 diabetes
  • Obesity
  • Physical inactivity
  • High saturated fat diet

What are the symptoms of atherosclerosis?

Signs and symptoms of atherosclerosis may develop gradually, and may be few, as the plaque gradually builds up in the artery. Symptoms may also vary depending on the affected artery. However, when a major artery is blocked, signs and symptoms may be severe, such as those occurring with heart attack, stroke, or blood clot.

The symptoms of atherosclerosis may look like other heart conditions. See your healthcare provider for a diagnosis.

How is atherosclerosis diagnosed?

First, your doctor will do a complete medical history and physical exam. You may also have one or more of these tests:

  • Cardiac catheterization. With this procedure, a long thin tube (catheter) is passed into the coronary arteries. X-rays are taken after a dye is injected into an artery to locate the narrowing, blockages, and other abnormalities of specific arteries.
  • Doppler sonography. A special probe is used to direct sound waves into a blood vessel to evaluate blood flow. An audio receiver amplifies the sound of the blood moving though the vessel. Faintness or absence of sound may mean there is a blockage. This is used to identify narrowing of the blood vessels of the abdomen, neck, or legs.
  • Blood pressure comparison. Comparing blood pressure measurements in the ankles and in the arms helps determine any constriction in blood flow. Significant differences may mean blood vessels are narrowed due to atherosclerosis.
  • MUGA/radionuclide angiography. This is a nuclear scan to see how the heart wall moves and how much blood is expelled with each heartbeat, while the person is at rest.
  • Thallium/myocardial perfusion scan. This is a nuclear scan given while the person is at rest or after exercise that may reveal areas of the heart muscle that are not getting enough blood.
  • Computerized tomography or CT. This is a type of X-ray test that can see if there is coronary calcification that may suggest a future heart problem. 
CT scan
CT scan

 

How is atherosclerosis treated?

Your healthcare provider will figure out the best treatment based on:

  • How old you are
  • Your overall health and medical history
  • How sick you are
  • How well you can handle specific medicines, procedures, or therapies
  • How long the condition is expected to last
  • Your opinion or preference
Treatment may include:

Lifestyle changes

You can change some risk factors for atherosclerosis such as smoking, high cholesterol levels, high blood sugar (glucose) levels, lack of exercise, poor dietary habits, and high blood pressure.

Medicines

Medicines that may be used to treat atherosclerosis include:

  • Antiplatelet medicines. These are medicines used to decrease the ability of platelets in the blood to stick together and cause clots. Aspirin, clopidogrel, ticlopidine, and dipyridamole are examples of antiplatelet medicines.
  • Anticoagulants. Also called blood thinners, these medicines work differently from antiplatelet medicines to decrease the ability of the blood to clot. Warfarin and heparin are examples of anticoagulants.
  • Cholesterol-lowering medicines. These are medicines used to lower fats (lipids) in the blood, particularly low density lipid (LDL) cholesterol. Statins are a group of cholesterol-lowering medicines. They include simvastatin, atorvastatin, and pravastatin among others. Bile acid sequestrants—colesevelam, cholestyramine and colestipol—and nicotinic acid are other types of medicine that may be used to reduce cholesterol levels. Your doctor may also prescribe fibrates to help improve your cholesterol and triglyceride levels.
  • Blood pressure medicines. Several different groups of medicines act in different ways to lower blood pressure.

Coronary angioplasty

With this procedure, a long thin tube (catheter) is thread through a blood vessel to the heart. There, a balloon is inflated to create a bigger opening in the vessel to increase blood flow. Although angioplasty is done in other blood vessels elsewhere in the body, percutaneous coronary intervention (PCI) refers to angioplasty in the coronary arteries to permit more blood flow into the heart. There are several types of PCI procedures, including:

  • Balloon angioplasty. A small balloon is inflated inside the blocked artery to open the blocked area.
  • Atherectomy. The blocked area inside the artery is shaved away by a tiny device on the end of a catheter.
  • Laser angioplasty. A laser used to vaporize the blockage in the artery.
  • Coronary artery stent. A tiny mesh coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open.

Coronary artery bypass

Most commonly referred to as bypass surgery, this surgery is often done in people who have angina (chest pain) due to coronary artery disease (where plaque has built up in the arteries). During the surgery, a bypass is created by grafting a piece of a healthy vein from elsewhere in the body and attaching it above and below the blocked area of a coronary artery. This lets blood flow around the blockage. Veins are usually taken from the leg or from the chest wall. Sometimes more than one artery needs to be bypassed during the same surgery.

What are the complications of atherosclerosis?

Plaque buildup inside the arteries reduces the blood flow. A heart attack may occur if the blood supply is reduced to the heart. A stroke may occur if the blood supply is cut off to the brain. Severe pain and tissue death may occur if the blood supply is reduced to the arms and legs.

Can atherosclerosis be prevented?

You can prevent or delay atherosclerosis by reducing risk factors. This includes adopting a healthy lifestyle.  A healthy diet, losing weight, being physically active, and not smoking can help reduce your risk of atherosclerosis. A healthy diet includes fruits, vegetables, whole grains, lean meats, skinless chicken, seafood, and fat-free or low-fat dairy products. A healthy diet also limits sodium, refined sugars and grains, and solid fats.

If you are at risk for atherosclerosis because of family history, or high cholesterol, it is important that you take medicines as directed by your healthcare provider.

When should I call my healthcare provider?

If your symptoms get worse or you have new symptoms, let your healthcare provider know.

Key points of atherosclerosis

  • Atherosclerosis is thickening or hardening of the arteries caused by a buildup of plaque in the inner lining of an artery.
  • Risk factors may include high cholesterol and triglyceride levels, high blood pressure, smoking, diabetes, obesity, physical activity, and eating saturated fats.
  • Atherosclerosis can cause a heart attack, stroke, aneurysm, or blood clot.
  • You may need medicine, treatments, or surgery to reduce the complications of atherosclerosis.

 

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Arteriosclerosis

Arteriosclerosis occurs when fatty material collects along the walls of arteries, leading to blocked arteries.

Learn More

Heart Attack Dolor en el Pecho / Síntomas de Ataque al Corazón

Heart Attack

What is a heart attack (myocardial infarction)?

A heart attack, or myocardial infarction, occurs when one or more regions of the heart muscle experience a severe or prolonged lack of oxygen caused by blocked blood flow to the heart muscle.

Normal heart and artery; artery with plaque buildup
Click image to enlarge

The blockage is often a result of atherosclerosis—a buildup of plaque composed of fat deposits, cholesterol, and other substances. When a plaque ruptures, a blood clot quickly forms. The blood clot is the actual cause of the heart attack.

If the blood and oxygen supply is cut off, muscle cells of the heart begin to suffer damage and start to die. Irreversible damage begins within 30 minutes of blockage. The result is dysfunction of the heart muscle in the area affected by the lack of oxygen or cell death.

What are the risk factors for heart attack?

There are two types of risk factors for heart attack, including the following:

Inherited (or genetic)

Acquired

Inherited or genetic risk factors are risk factors you are born with that cannot be changed, but can be improved with medical management and lifestyle changes.

Acquired risk factors are caused by activities that we choose to include in our lives that can be managed through lifestyle changes and clinical care.

Inherited (genetic) factors: Who is most at risk?

  • People with inherited hypertension (high blood pressure)

  • People with inherited low levels of HDL (high-density lipoproteins), high levels of LDL (low-density lipoprotein) blood cholesterol or high levels of triglycerides

  • People with a family history of heart disease (especially with onset before age 55)

  • Aging men and women

  • People with type 1 diabetes

  • Women, after the onset of menopause (generally, men are at risk at an earlier age than women, but after the onset of menopause, women are equally at risk)

Acquired risk factors: Who is most at risk?

  • People with acquired hypertension (high blood pressure)

  • People with acquired low levels of HDL (high-density lipoproteins), high levels of LDL (low-density lipoprotein) blood cholesterol, or high levels of triglycerides

  • Cigarette smokers

  • People who are under a lot of stress

  • People who drink too much alcohol

  • People who lead a sedentary lifestyle

  • People overweight by 30 percent or more

  • People who eat a diet high in saturated fat

  • People with type 2 diabetes

A heart attack can happen to anyone—it is only when we take the time to learn which of the risk factors apply to us, specifically, can we then take steps to eliminate or reduce them.

Managing heart attack risk factors

Managing your risks for a heart attack begins with:

  • Examining which of the risk factors apply to you, and then taking steps to eliminate or reduce them.

  • Becoming aware of conditions like hypertension or abnormal cholesterol levels, which may be "silent killers."

  • Modifying risk factors that are acquired (not inherited) through lifestyle changes. Consult your doctor as the first step in starting right away to make these changes.

  • Consulting your health care provider soon to determine if you have risk factors that are genetic or inherited and cannot be changed, but can be managed medically and through lifestyle changes.

What are the warning signs of a heart attack?

The following are the most common symptoms of a heart attack. However, each individual may experience symptoms differently. Symptoms may include:

  • Severe pressure, fullness, squeezing, pain and/or discomfort in the center of the chest that lasts for more than a few minutes

  • Pain or discomfort that spreads to the shoulders, neck, arms, or jaw

  • Chest pain that increases in intensity

  • Chest pain that is not relieved by rest or by taking nitroglycerin

  • Chest pain that occurs with any/all of the following (additional) symptoms:

    • Sweating, cool, clammy skin, and/or paleness

    • Shortness of breath

    • Nausea or vomiting

    • Dizziness or fainting

    • Unexplained weakness or fatigue

    • Rapid or irregular pulse

Although chest pain is the key warning sign of a heart attack, it may be confused with indigestion, pleurisy, pneumonia, or other disorders.

The symptoms of a heart attack may resemble other medical conditions or problems. Always consult your health care provider for a diagnosis.

Responding to heart attack warning signs

If you or someone you know exhibits any of the above warning signs, act immediately. Call 911, or your local emergency number.

Treatment for a heart attack

The goal of treatment for a heart attack is to relieve pain, preserve the heart muscle function, and prevent death.

Treatment in the emergency department may include:

Image of a man on a gurney being wheeled down a hallway at a hospital

  • Intravenous therapy such as nitroglycerin and morphine.

  • Continuous monitoring of the heart and vital signs.

  • Oxygen therapy improves oxygenation to the damaged heart muscle.

  • Pain medication decreases pain, and, in turn, decreases the workload of the heart, thus, the oxygen demand of the heart decreases.

  • Cardiac medication, such as beta-blockers, promote blood flow to the heart, improve the blood supply, prevent arrhythmias, and decrease heart rate and blood pressure.

  • Fibrinolytic therapy is the intravenous infusion of a medication which dissolves the blood clot, thus, restoring blood flow.

  • Antithrombin/antiplatelet therapy is used to prevent further blood clotting.

  • Antihyperlipidemics are medications used to lower lipids (fats) in the blood, particularly Low Density Lipid (LDL) cholesterol. Statins are a group of antihyperlipidemic medications, and include simvastatin (Zocor), atorvastatin (Lipitor), and pravastatin (Pravachol), among others. Bile acid sequestrants—colesevelam, cholestyramine, and colestipol—and nicotinic acid (niacin) are two other types of medications that may be used to reduce cholesterol levels.

Additional procedures to restore coronary blood flow may be used. Those procedures include:

  • Coronary angioplasty. With this procedure, a balloon is used to create a bigger opening in the vessel to increase blood flow. This is often followed by the insertion of a stent into the coronary artery to help keep the vessel open. Although angioplasty is performed in other blood vessels elsewhere in the body, percutaneous coronary intervention (PCI) refers to angioplasty in the coronary arteries to permit more blood flow into the heart. PCI is also called percutaneous transluminal coronary angioplasty (PTCA). There are several types of PTCA procedures, including:

    • Balloon angioplasty. A small balloon is inflated inside the blocked artery to open the blocked area.

    • Coronary artery stent. A tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open.

    • Atherectomy. The blocked area inside the artery is cut away by a tiny device on the end of a catheter.

    • Laser angioplasty. A laser used to "vaporize" the blockage in the artery.

  • Coronary artery bypass. Most commonly referred to as simply "bypass surgery" or CABG (pronounced "cabbage"), this surgery is often performed in people who have angina (chest pain) and coronary artery disease (where plaque has built up in the arteries). During the surgery, a bypass is created by grafting a piece of a vein above and below the blocked area of a coronary artery, enabling blood to flow around the obstruction. Veins are usually taken from the leg, but arteries from the chest or arm may also be used to create a bypass graft.

Heart Attack

Heart attacks are caused by a blockage of blood flow to the heart, usually as a result of plaque build up in the arteries.

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High Blood Pressure/HypertensionPresión Sanguínea Alta / Hipertensión

High Blood Pressure/Hypertension

What is blood pressure?

Blood pressure is the force of the blood pushing against the artery walls. The force is generated with each heartbeat as blood is pumped from the heart into the blood vessels. The size and elasticity of the artery walls also affect blood pressure. Each time the heart beats (contracts and relaxes), pressure is created inside the arteries.

The pressure is greatest when blood is pumped out of the heart into the arteries. When the heart relaxes between beats (blood is not moving out of the heart), the pressure falls in the arteries.

Two numbers are recorded when measuring blood pressure.

  • The top number, or systolic pressure, refers to the pressure inside the artery when the heart contracts and pumps blood through the body.

  • The bottom number, or diastolic pressure, refers to the pressure inside the artery when the heart is at rest and is filling with blood.

Both the systolic and diastolic pressures are recorded as "mm Hg" (millimeters of mercury). This recording represents how high the mercury column in the blood pressure cuff is raised by the pressure of the blood.

Blood pressure is measured with a blood pressure cuff and stethoscope by a nurse or other healthcare provider. You can also take your own blood pressure with an electronic blood pressure monitor. These are available at most pharmacies.

High blood pressure, or hypertension, directly increases the risk of heart attack and stroke. With high blood pressure, the arteries may have an increased resistance against the flow of blood, causing the heart to pump harder to circulate the blood. Usually, high blood pressure has no signs or symptoms. However, you can know if your blood pressure is high by checking it yourself or by having it checked regularly by your healthcare provider.

The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) has determined 2 levels of high blood pressure for adults:

  • Stage 1

    • 140 mm Hg to 159 mm Hg systolic pressure—higher number

      and

    • 90 mm Hg to 99 mm Hg diastolic pressure—lower number 

  • Stage 2

    • 160 mm Hg or higher systolic pressure

      and

    • 100 mm Hg or higher diastolic pressure

The NHLBI defines prehypertension as:

  • 120 mm Hg to 139 mm Hg systolic pressure

    and

  • 80 mm Hg to 89 mm Hg diastolic pressure

The NHLBI guidelines define normal blood pressure as follows:

  • Less than 120 mm Hg systolic pressure

    and

  • Less than 80 mm Hg diastolic pressure

Use these numbers as a guide only. A single elevated blood pressure measurement is not necessarily an indication of a problem. Your healthcare provider will want to see multiple blood pressure measurements over several days or weeks before making a diagnosis of high blood pressure and starting treatment. If you normally run a lower-than-usual blood pressure, you may be diagnosed with high blood pressure with blood pressure measurements lower than 140/90.

What are the risk factors for high blood pressure?

Nearly one-third of all Americans have high blood pressure, but it is particularly prevalent in:

  • People who have diabetes, gout, or kidney disease

  • African Americans (particularly those who live in the southeastern U.S.)

  • People in their early to middle adult years; men in this age group have higher blood pressure more often than women in this age group

  • People in their middle to later adult years; women in this age group have higher blood pressure more often than men in this age group (more women have high blood pressure after menopause than men of the same age)

  • Middle-aged and elderly people; more than half of all Americans age 60 and older have high blood pressure

  • People with a family history of high blood pressure

  • People consuming a high salt diet

  • Overweight people

  • Heavy drinkers of alcohol

  • Women who are taking oral contraceptives

  • People with depression

How does blood pressure increase?

The following conditions contribute to high blood pressure:

  • Being overweight

  • Excessive sodium intake

  • A lack of exercise and physical activity

How is high blood pressure controlled?

These steps can help you control your blood pressure:

  • Take prescribed medicine exactly as directed by your healthcare provider

  • Choose foods that are low in sodium (salt)

  • Choose foods low in calories and fat

  • Choose foods high in fiber

  • Maintain a healthy weight, or losing weight if overweight

  • Limit serving sizes

  • Increase physical activity

  • Reduce or omit alcoholic beverages

Sometimes daily medicine is needed to control high blood pressure. If you have high blood pressure, have your blood pressure checked routinely and see your healthcare provider to monitor the condition.

Hypertensive Heart Disease

Hypertensive heart disease (high blood pressure) occurs when a person's blood pressure is consistently higher than the normal range.

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PericarditisPericarditis

Pericarditis

What is pericarditis?

Pericarditis is inflammation of the pericardium, the thin sac (membrane) that surrounds the heart.

The pericardium holds the heart in place and helps it work properly. There is a small amount of fluid between the inner and outer layers of the pericardium. This fluid keeps the layers from rubbing as the heart moves to pump blood.

What causes pericarditis?

Usually, the cause of pericarditis is unknown, but may include: 

  • Infection (by viruses, bacteria, a fungus, or parasites)
  • Autoimmune disorders (such as lupus, rheumatoid arthritis, or scleroderma)
  • Inflammation after a heart attack
  • Chest  injury
  • Cancer
  • HIV/AIDS
  • Tuberculosis (TB)
  • Kidney failure
  • Medical treatments (such as certain medicines or radiation therapy to the chest)
  • Heart surgery

What are the symptoms of pericarditis?

The following are the most common signs of pericarditis:

  • Chest pain that:
    • Can especially be felt behind the breastbone, and sometimes beneath the clavicle (collarbone), neck, and left shoulder
    • Is a sharp, piercing pain over the center or left side of the chest that gets worse when you take a deep breath and usually gets better if you sit up or lean forward
    • Feels a lot like a heart attack
  • Fever
  • Weakness and tiredness
  • Coughing
  • Trouble breathing
  • Pain when swallowing
  • Palpitations (irregular heartbeats)

The symptoms of pericarditis may look like other conditions. See a healthcare provider for a diagnosis.

How is pericarditis diagnosed?

If your healthcare provider suspects pericarditis, he or she will listen to your heart very carefully. A common sign of pericarditis is a pericardial rub. This is the sound of the pericardium rubbing against the outer layer of your heart. Other chest sounds that are signs of fluid in the pericardium (pericardial effusion) or the lungs (pleural effusion) may also be heard.

Along with a complete medical history and physical exam, tests used to diagnose pericarditis may include:

  • Echocardiogram (echo). This test uses sound waves to check your heart's size and shape. The echo sound waves create a picture on a screen as an ultrasound transducer is passed over the skin over the heart. Echo can show how well your heart is working and whether fluid has built up around your heart.
  • Electrocardiogram (ECG). This test records the strength and timing of the electrical activity of the heart. It shows abnormal rhythms and can sometimes detect heart muscle damage. Small sensors are taped to your skin to pick up the electrical activity.
  • Chest X-ray. An X-ray may be done to check your lungs and see if your heart is enlarged.
  • Cardiac MRI. This is an imaging test that takes detailed pictures of the heart. It may be used to look for thickening or other changes in the pericardium.
  • Cardiac CT. This type of X-ray takes a clear, detailed picture of your heart and pericardium. It may be used to help rule out other causes of chest pain.
  • Blood tests. Certain blood tests can help rule out other heart problems, such as heart attack, and can tell the doctor how much inflammation there is in your pericardium.

 

How is pericarditis treated?

Your healthcare provider will figure out the best treatment based on:

  • How old you are
  • Your overall health and medical history
  • How sick you are
  • How well you can handle specific medicines, procedures, or therapies
  • How long the condition is expected to last
  • Your opinion or preference

The goal of treatment for pericarditis is to determine and eliminate the cause of the disease. Treatment often involves medicines, such as pain medicines, anti-inflammatory drugs, or antibiotics.

If serious heart problems develop, treatment may include:

  • Aspiration or removal of excess fluid around the heart
  • Surgery

Pericarditis may last from 2 to 6 weeks, and it may come back.

What are the complications of pericarditis?

There is a small amount of fluid between the inner and outer layers of the pericardium. Often, when the pericardium becomes inflamed, the amount of fluid between these layers increases. This is called a pericardial effusion. If the amount of fluid increases quickly, the effusion can keep the heart from working properly. This complication of pericarditis is called cardiac tamponade and is a serious emergency. A thin needle or tube (called a catheter) is put into the chest to remove the fluid in the pericardium and relieve pressure on the heart.

Chronic constrictive pericarditis occurs when scar-like tissue forms throughout the pericardium. It’s a rare disease that can develop over time in people with pericarditis. The scar tissue causes pericardial sac to stiffen and not move properly. In time, the scar tissue squeezes the heart and keeps it from working well. The only way to treat this is to remove the pericardium with a special type of heart surgery.

When should I call my healthcare provider?

If your symptoms get worse or you have new symptoms, call your healthcare provider.

Key points

  • Pericarditis is inflammation of the pericardium, the thin sac that surrounds the heart.
  • Pericarditis may be caused by infection, autoimmune disorders, inflammation after a heart attack, chest injury, cancer, HIV/AIDS, tuberculosis (TB), kidney failure, medical treatments (such as certain medicines or radiation therapy to the chest), or heart surgery.
  • The most common signs of pericarditis include chest pain, fever, weakness and tiredness, coughing, trouble breathing, pain when swallowing, and palpitations (irregular heartbeats).
  • If pericarditis is suspected, the healthcare provider will listen to your heart very carefully. A common sign of pericarditis is a pericardial rub -- the sound of the pericardium rubbing against the outer layer of your heart.
  • The goal of treatment for pericarditis is to determine and eliminate the cause of the disease. Treatment often involves medicines, such as pain medicines, anti-inflammatory drugs, or antibiotics. If serious heart problems develop, treatment may include removal of excess fluid around the heart or surgery.
  • Pericarditis may last from 2 to 6 weeks, and it may come back.
  • Pericarditis can lead to complications such pericardial effusion (a buildup of fluid around the heart that can keep it from working properly) and chronic constrictive pericarditis (scar-like tissue forms throughout the pericardium which squeezes the heart and keeps it from working well).

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Pericardial Disorders

Pericarditis means the protective sac around the heart becomes inflamed. Pericarditis is usually a complication stemming from viral, fungal or bacterial infections.

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ArrhythmiasArritmias

Arrhythmias

What is an arrhythmia?

An arrhythmia is an abnormal heart rhythm.

Some arrhythmias can cause problems with contractions of your heart chambers by:

  • Not allowing the lower chambers (ventricles) to fill with enough blood, because an abnormal electrical signal is causing your heart to pump too fast or too slow.
  • Not allowing enough blood to be pumped out to your body, because an abnormal electrical signal is causing your heart to pump too slowly or too irregularly.
  • Not allowing the top chambers (atria) to work properly. 

An arrhythmia can occur in the sinus node, the atria, or the atrioventricular node. These are supraventricular arrhythmias. A ventricular arrhythmia is caused by an abnormal electrical focus within your ventricles. This results in abnormal conduction of electrical signals within your ventricles. Arrhythmias can also be classified as slow (bradyarrhythmia) or fast (tachyarrhythmia). "Brady-" means slow, while "tachy-" means fast.

In any of these situations, your body's vital organs may not get enough blood to meet their needs.

What causes an arrhythmia?

An arrhythmia occurs when there is a problem with the electrical system that is supposed to regulate a steady heartbeat. With an impaired electrical system, your heart may beat too fast, too slow, or irregularly.

What are the risk factors for an arrhythmia?

Many risk factors can affect the electrical system of your heart and, therefore, cause an arrhythmia. Substances including caffeine, alcohol, tobacco, illegal drugs, diet drugs, some herbs, and even prescription medicines can trigger an arrhythmia. Health conditions including coronary heart disease, high blood pressure, and diabetes contribute to developing arrhythmias. Arrhythmias become more common with age.

What are the symptoms of arrhythmias?

The effects on the body are often the same, however, whether the heartbeat is too fast, too slow, or too irregular. Some symptoms of arrhythmias include:

  • Palpitations (a sensation of fluttering or irregularity of the heartbeat) 
  • Weakness
  • Fatigue
  • Low blood pressure
  • Dizziness
  • Fainting
  • Heart failure
  • Collapse and cardiac arrest
  • Difficulty feeding (in babies)

The symptoms of arrhythmias may look like other conditions. Always see your healthcare provider for a diagnosis.

How are arrhythmias diagnosed?

There are several tests that may be used to diagnose arrhythmias. Some of these include:

  • Electrocardiogram (ECG). An electrocardiogram is a measurement of the electrical activity of your heart. By placing electrodes at specific locations on your body (chest, arms, and legs), a graphic representation, or tracing, of the electrical activity can be made as the electrical activity is received and interpreted by an ECG machine. An ECG can show the presence of arrhythmias, damage to your heart caused by ischemia (lack of oxygen to the heart muscle), or myocardial infarction (MI, or heart attack), a problem with one or more of the heart valves, or other types of heart conditions.

There are several variations of the ECG test:

  • Resting ECG. For this procedure, the clothing on your upper body is removed and small sticky patches called electrodes are attached to your chest, arms, and legs. These electrodes are connected to the ECG machine by wires. The ECG machine is then started and records your heart's electrical activity for a minute or so. You are lying down during this ECG.
  • Exercise ECG, or stress test. You are attached to the ECG machine as described above. However, rather than lying down, you exercise by walking on a treadmill or pedaling a stationary bike while the ECG is recorded. This test is done to assess changes in the ECG during stress, such as exercise.
  • Signal-averaged ECG. This procedure is done in the same manner as a resting ECG, except that your heart's electrical activity is recorded over a longer period of time, usually 15 to 20 minutes. Signal-averaged ECGs are done when arrhythmia is suspected, but not seen on a resting ECG. The signal-averaged ECG has increased sensitivity to abnormal ventricular activity called "late potentials." Signal-averaged ECG is used in research and seldom used in clinical practice.
  • Electrophysiologic studies (EPS). A nonsurgical but invasive test in which a small, thin tube (catheter) is inserted into a large blood vessel in your leg or arm and advanced to your heart. This lets your doctor find the site of the arrhythmia's origin within your heart tissue. Your doctor is then able to determine how to best treat it. Sometimes, your doctor can treat the arrhythmia by doing an ablation at the time of the study. 
  • Holter monitor. A continuous ECG recording done over a period of 24 or more hours. Electrodes are attached to your chest and connected to a small portable ECG recorder by lead wires.  Holter monitoring may be done when an arrhythmia is suspected, but not seen on a resting ECG. Arrhythmias may be transient in nature and not seen during the shorter recording times of the resting ECG. You go about your daily activities, except those that cause an excessive amount of sweating. This could cause the electrodes to become loose or fall off during the procedure. These activities include taking a shower or swimming. 
  • Event monitor. This is similar to a Holter monitor, except that you start the ECG recording only when you feel symptoms. Event monitors are typically worn longer than Holter monitors. You can remove the monitor to shower or bathe. 
  • Mobile cardiac monitoring. This is similar to both a Holter and event monitor. The ECG is monitored constantly to allow for detection of arrhythmias, which are recorded and sent to your doctor regardless of whether you have symptoms. You can also start recordings yourself when you have symptoms. These monitors can be worn up to 30 days. 
  • Implantable loop recorder. This is a miniature heart recording device that is implanted underneath the skin overlying your heart. It can record the heart rhythm for up to 2 years and it useful in diagnosing intermittent or rarely occurring arrhythmias.

How is an arrhythmia treated?

Some arrhythmias may cause few, if any, problems. In this case, you may not need treatment. When the arrhythmia causes symptoms, you have several different choices for treatment. Your healthcare provider will choose a treatment based on the type of arrhythmia you have, how severe your symptoms are, and whether you have other conditions such as diabetes, kidney failure, or heart failure. These can affect the course of the treatment.

Some treatments for arrhythmias include:

  • Lifestyle changes. Stress, caffeine, and alcohol can cause arrhythmias. Your healthcare provider may recommend that you avoid caffeine, alcohol, or any other things that may be causing the problem. If your provider thinks that stress is a cause, he or she may recommend meditation, stress-management classes, an exercise program, or psychotherapy to ease stress.
  • Medicine. Medicine is available to treat arrhythmias. Your healthcare provider will recommend a medicine based on to the type of arrhythmia you have, whether you have other health conditions, or whether you take other medicines.
  • Cardioversion. In this procedure, the healthcare provider sends an electrical shock to your heart through the chest. This will stop certain very fast arrhythmias such as atrial fibrillation, supraventricular tachycardia, or atrial flutter. You are connected to an ECG monitor, which is also connected to the defibrillator. The electrical shock is delivered at the point during the ECG cycle to change the rhythm to a normal one.
  • Ablation. This is an invasive but nonsurgical procedure done in the electrophysiology lab. The healthcare provider puts a thin, flexible tube (catheter) into your heart through a vessel in your groin or arm. The provider uses a method such as radio frequency ablation to destroy the site of the arrhythmia. The procedure uses very high frequency radio waves to heat the tissue until the site is destroyed. Cryoablation is another procedure that is used. For this an ultra-cold substance is put on the site. This freezes the tissue and destroys the site.
  • Pacemaker. A permanent pacemaker is a small device that is put under the skin, often in the chest region just under the collarbone. It sends electrical signals to start or regulate a slow heartbeat. A permanent pacemaker may be used to make the heart beat if the heart's natural pacemaker (the SA node) is not working as it should, or if the electrical pathways are blocked. Pacemakers are often used for slow arrhythmias such as sinus bradycardia, sick sinus syndrome, or heart block.
  • Implantable cardioverter defibrillator (ICD). An ICD is a small device similar to a pacemaker. It is put under the skin, often just under the collarbone. An ICD senses the rate of the heartbeat. When your heart rate goes higher than the level entered into the device, it sends an electrical shock to the heart. This corrects the rhythm to a slower, more normal heart rhythm. ICDs are used with a pacemaker to send an electrical signal to regulate a slow heart rate. ICDs are used for life-threatening fast arrhythmias such as ventricular tachycardia or ventricular fibrillation.
  • Surgery. Surgery is usually done only when all other treatments have failed. Surgical ablation is a major surgery that needs general anesthesia. The surgeon opens your chest to reach your heart. The surgeon destroys or removes the tissue causing the arrhythmia.

 

What are the complications of an arrhythmia?

Some arrhythmias have no complications. However, arrhythmias that are more serious can result in heart failure, stroke, or even cardiac arrest.

 

Living with an arrhythmia

Living with an arrhythmia includes making lifestyle changes (avoiding caffeine, alcohol, or other triggers) and taking medicines as directed. It may also include having a pacemaker or implantable cardioverter defibrillator inserted. If you have a pacemaker or implantable cardioverter defibrillator, make sure that you ask your healthcare providers about any restrictions or lifestyle changes you may need to make. Working with your provider can promote your health and well-being.

 

When should I call my healthcare provider?

Tell your healthcare provider if:

  • Your symptoms get worse or you start to have new symptoms
  • You have side effects from your medicine
  • Need help with managing stress or emotions

Key points about arrhythmias

An arrhythmia is an abnormal heart rhythm.

  • An arrhythmia can occur in the sinus node, the atria, or the atrioventricular node, or the ventricle.
  • Some arrhythmias cause few, if any, problems.
  • Other arrhythmias can cause serious complications such as heart failure, stroke, or even cardiac arrest.
  • Many treatment options are available to treat arrhythmia, including medicines, devices, cardiac ablation, and surgery. Many arrhythmias can be cured with procedures.

 

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Arrhythmias

Arrhythmias occur when there is a disruption in the normal pace of the heartbeat.

Learn More

Congenital Heart DefectsDefectos Congénitos del Corazón

Congenital Heart Defects

What is a congenital heart defect?

When the heart or blood vessels near the heart do not develop normally before birth, a condition called congenital heart defect occurs (congenital means "existing at birth").

Congenital heart defects occur in close to 1% of infants. Most young people with congenital heart defects are living into adulthood now.

In most cases, the cause is unknown. Sometimes a viral infection in the mother causes the condition. The condition can be genetic (hereditary). Some congenital heart defects are the result of alcohol or drug use during pregnancy.

Most heart defects either cause an abnormal blood flow through the heart, or obstruct blood flow in the heart or vessels (obstructions are called stenoses and can occur in heart valves, arteries, or veins). A hole between 2 chambers of the heart is an example of a very common type of congenital heart defect.

More rare defects include those in which:

  • The right or left side of the heart is incompletely formed (hypoplastic)

  • Only one ventricle is present.

  • Both the pulmonary artery and aorta arise from the same ventricle.

  • The pulmonary artery and aorta arise from the "wrong" ventricles. 

Types of congenital heart defects

There are many disorders of the heart that require clinical care by a doctor or other healthcare professional. Listed below are some of the conditions, for which we have provided a brief overview.

Obstructive defects

  • Aortic stenosis (AS). In this condition, the aortic valve between the left ventricle and the aorta did not form properly and is narrowed, making it difficult for the heart to pump blood to the body. A normal valve has 3 leaflets or cusps, but a stenotic valve may have only one cusp (unicuspid) or 2 cusps (bicuspid).

    In some children, chest pain, unusual tiring, dizziness, or fainting may occur. Otherwise, most children with aortic stenosis have no symptoms. But, even mild stenosis may worsen over time, and a catheter-based procedure or surgery may be needed to correct the blockage or the valve may need to be replaced with an artificial one.

  • Pulmonary stenosis (PS). The pulmonary, or pulmonic, valve, located between the right ventricle and the pulmonary artery, opens to allow blood to flow from the right ventricle to the lungs. When a defective pulmonary valve does not open properly, it causes the heart to pump harder than normal to overcome the obstruction. Usually, the obstruction can be corrected by a catheter-based procedure known as balloon valvuloplasty, although some people need open heart surgery.

  • Bicuspid aortic valve. In this condition, an infant is born with a bicuspid valve which has only 2 flaps. (A normal aortic valve has 3 flaps that open and close). If the valve becomes narrowed, it is more difficult for the blood to flow through, and often the blood leaks backward. Symptoms usually do not develop during childhood, but are often detected during the adult years.

  • Subaortic stenosis. This condition refers to a narrowing of the left ventricle just below the aortic valve. Normally, blood passes through it to go into the aorta. However, subaortic stenosis limits the blood flow out of the left ventricle, often resulting in an increased workload for the left ventricle. Subaortic stenosis may be congenital or caused by a form of cardiomyopathy (disease of the heart muscle).

  • Coarctation of the aorta (COA). In this condition, the aorta is narrowed or constricted, obstructing blood flow to the lower part of the body and increasing blood pressure above the constriction. Usually there are no symptoms at birth, but they can develop as early as the first week after birth. If severe symptoms of high blood pressure and heart failure develop, surgery is necessary. Less severe cases may not be detected until a child is older but can result in long-term health problems if not corrected.

Septal defects

Some congenital heart defects allow blood to flow between the right and left chambers of the heart because an infant is born with an opening in the wall (or septum) that separates the right and left sides of the heart.

  • Atrial septal defect (ASD). In this condition, there is an opening between the 2 upper chambers of the heart--the right and left atria--causing an abnormal blood flow through the heart. Children with an ASD have few symptoms. The ASD may be closed by catheter-based techniques or open-heart surgery. Closing the atrial defect by open heart surgery in childhood can often prevent serious problems later in life.

  • Ventricular septal defect (VSD). In this condition, a hole is present between the 2 lower chambers of the heart. Because of this hole, blood from the left ventricle flows into the right ventricle, due to higher pressure in the left ventricle. This causes extra blood to be pumped into the lungs by the right ventricle, which can create congestion in the lungs. while most small VSDs close on their own, larger ones require surgery to repair the hole.

Cyanotic defects

Cyanotic defects are defects in which blood pumped to the body contains less-than-normal amounts of oxygen. It causes a blue discoloration of the skin. Infants with cyanosis are often called "blue babies."

  • Tetralogy of Fallot. This condition is characterized by four defects, including the following:

    • Ventricular septal defect which allows blood to pass from the right ventricle to the left ventricle.

    • A narrowing (stenosis) at or above the pulmonary valve that partially blocks the flow of blood from the right side of the heart to the lungs

    • The right ventricle is more muscular (hypertrophy) than normal

    • The aorta lies directly over the ventricular septal defect

    Tetralogy of Fallot is the most common defect causing cyanosis in people beyond 2 years of age. Most children with tetralogy of Fallot have open-heart surgery before school age (frequently in infancy) to close the ventricular septal defect and remove the obstructing muscle. Lifelong medical follow-up is needed.

  • Tricuspid atresia. In this condition, there is no tricuspid valve, therefore, no blood flows from the right atrium to the right ventricle. Tricuspid atresia is characterized by the following:

    • A small right ventricle

    • Diminished pulmonary circulation

    • Cyanosis

    A surgical shunting procedure is often necessary to increase the blood flow to the lungs.

  • Transposition of the great arteries. In this embryologic defect, the positions of the pulmonary artery and the aorta are reversed, thus:

    • The aorta originates from the right ventricle, so the oxygen-poor blood returning to the heart from the body is pumped back out to the aorta without first going to the lungs to pick up oxygen.

    • The pulmonary artery originates from the left ventricle, so that the oxygen-rich blood returning from the lungs goes back out to the pulmonary artery and to the lungs again.

    Immediate medical intervention is necessary to correct this condition.

Other defects

  • Hypoplastic left heart syndrome (HLHS). In this condition, the left side of the heart, including the aorta, aortic valve, left ventricle, and mitral valve, is underdeveloped. Blood reaches the aorta through a patent ductus arteriosus, and if this ductus closes, as is normal, the baby will die. The baby often seems normal at birth, but the condition will become noticeable within a few days of birth, as the ductus closes. Babies with this syndrome become ashen (gray), have diminished or absent pulses in the legs, have difficulty breathing, and are unable to feed. Treatment is surgical and typically requires three operations. 

  • Patent ductus arteriosus (PDA). This condition results from failure of the PDA to close normally after birth, allowing blood to mix between the pulmonary artery and the aorta. When it does not close, extra blood may flood the lungs and cause pulmonary congestion. Patent ductus arteriosus is often seen in premature infants.

  • Ebstein's anomaly. In this defect, there is a downward displacement of the tricuspid valve (located between the upper and lower chambers on the right side of the heart) into the right bottom chamber of the heart (or right ventricle). This means the atrium is larger than normal and the ventricle is smaller than normal, which can lead to rhythm abnormalities and heart failure. It is usually associated with an atrial septal defect.  

Who treats congenital heart defects?

Babies with congenital heart problems are followed by specialists called pediatric cardiologists. These doctors diagnose heart defects and help manage the health of children before and after surgical repair of the heart problem. Specialists who correct heart problems in the operating room are known as pediatric cardiovascular or cardiothoracic surgeons.

To achieve and maintain the highest possible level of wellness, it is imperative that people born with CHD who have reached adulthood transition to the appropriate type of cardiac care. The type of care required is based on the type of CHD a person has. Those people with simple CHD can often be cared for by a community adult cardiologist. Those with more complex types of CHD will need to be cared for at a center that specializes in adult CHD.

For adults with CHD, guidance is necessary for planning key life issues such as college, career, employment, insurance, activity, lifestyle, inheritance, family planning, pregnancy, chronic care, disability, and end of life. Knowledge about specific congenital heart conditions and expectations for long-term outcomes and potential complications, and risks must be reviewed as part of the successful transition from pediatric care to adult care. Parents should help pass on the responsibility for this knowledge and accountability for ongoing care to their young adult children to help ensure the transition to adult specialty care and optimize the health status of the young adult with CHD.

Congenital Heart Disease

Congenital refers to a problem with the heart's structure and function due to abnormal heart development before birth.

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Heart Failure

Heart failure occurs when the heart cannot pump sufficient blood to the rest of body's organs.

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Peripheral Vascular DiseaseEnfermedad Vascular Periférica

Peripheral Vascular Disease

What is peripheral vascular disease?

Peripheral vascular disease (PVD) is a slow and progressive circulation disorder caused by narrowing, blockage, or spasms in a blood vessel.

PVD may involve disease in any of the blood vessels outside of the heart including the arteries, veins, or lymphatic vessels. Organs supplied by these vessels, such as the brain, and legs, may not get enough blood flow for proper function. However, the legs and feet are most commonly affected, thus the name peripheral vascular disease.

The terms "peripheral vascular disease" and "peripheral arterial disease" are often used interchangeably. 

What causes peripheral vascular disease?

PVD is often characterized by a narrowing of the vessels that carry blood to the leg and arm muscles. The most common cause is atherosclerosis, the buildup of plaque inside the artery wall. Plaque reduces the amount of blood flow to the limbs and decreases the oxygen and nutrients available to the tissue. Clots may form on the artery walls, further decreasing the inner size of the vessel and potentially blocking off major arteries.

Other causes of peripheral vascular disease may include:

  • Injury to the arms or legs
  • Irregular anatomy of muscles or ligaments
  • Infection

People with coronary artery disease often also have peripheral vascular disease. 

Who is at risk for peripheral vascular disease?

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, diet, family history, or many other things. Risk factors for peripheral vascular disease include factors which can be changed or treated and factors that cannot be changed.

Risk factors that you can’t change:

  • Age (especially older than age 50)
  • History of heart disease
  • Male gender
  • Diabetes
  • Postmenopausal women
  • Family history of high cholesterol, high blood pressure, or peripheral vascular disease

Risk factors that may be changed or treated include:

  • Coronary artery disease
  • High blood sugar
  • High cholesterol
  • High blood pressure
  • Obesity
  • Physical inactivity
  • Smoking or use of tobacco products

Those who smoke or have diabetes mellitus have the highest risk of complications from peripheral vascular disease because these risk factors also cause impaired blood flow. 

What are the symptoms of peripheral vascular disease?

Approximately half the people diagnosed with peripheral vascular disease are symptom free. For those experiencing symptoms, the most common first symptom is intermittent claudication in the calf (leg discomfort described as painful cramping that occurs with exercise and is relieved by rest). During rest, the muscles need less blood flow, so the pain disappears. It may occur in one or both legs depending on the location of the clogged or narrowed artery.

Other symptoms of peripheral vascular disease may include:

  • Changes in the skin, including decreased skin temperature, or thin, brittle shiny skin on the legs and feet
  • Diminished pulses in the legs and the feet
  • Gangrene (dead tissue due to lack of blood flow)
  • Hair loss on the legs
  • Impotence
  • Non-healing wounds over pressure points, such as heels or ankles
  • Numbness, weakness, or heaviness in muscles
  • Pain (described as burning or aching) at rest, commonly in the toes and at night while lying flat
  • Pallor (paleness) when the legs are elevated
  • Reddish-blue discoloration of the extremities
  • Restricted mobility
  • Severe pain when the narrowing of the artery is significant or totally blocked
  • Thickened, opaque toenails

The symptoms of peripheral vascular disease may resemble other conditions. Consult your physician for a diagnosis. 

How is peripheral vascular disease diagnosed?

In addition to a complete medical history and physical exam, other tests may include:

  • Angiogram. This is an X-ray of the arteries and veins to detect blockage or narrowing of the vessels. This procedure involves inserting a thin, flexible tube into an artery in the leg and injecting a contrast dye. The contrast dye makes the arteries and veins visible on the X-ray.
  • Ankle-brachial index (ABI). An ABI is a comparison of the blood pressure in the ankle with the blood pressure in the arm using a regular blood pressure cuff and a Doppler ultrasound device. To determine the ABI, the systolic blood pressure (the top number of the blood pressure measurement) of the ankle is divided by the systolic blood pressure of the arm. 
  • Doppler ultrasound flow studies. This uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Doppler technique is used to measure and assess the flow of blood. Faintness or absence of sound may indicate an obstruction in the blood flow.
  • Magnetic resonance angiography (MRA). This noninvasive diagnostic procedure uses a combination of a large magnet, radio frequencies, and a computer to produce detailed images of organs and structures within the body. An MRA is often used to examine the brain and other soft tissues and to assess blood flow.
  • Treadmill exercise test. This test is given while a patient walks on a treadmill to monitor circulation during exercise.
  • Photoplethysmography (PPG). This exam is comparable to the ankle brachial index except that it uses a very tiny blood pressure cuff around the toe and a PPG sensor (infrared light to evaluate blood flow near the surface of the skin) to record waveforms and blood pressure measurements. These measurements are then compared to the systolic blood pressure in the arm.
  • Pulse volume recording (PVR) waveform analysis. This technique is used to calculate blood volume changes in the legs using a recording device that displays the results as a waveform.
  • Reactive hyperemia test. This test is similar to an ABI or a treadmill test but used for people who are unable to walk on a treadmill. While a person is lying on his or her back, comparative blood pressure measurements are taken on the thighs and ankles to determine any decrease between the two sites. 

What is the treatment for peripheral vascular disease?

The main goals for treatment of peripheral vascular disease are to control the symptoms and halt the progression of the disease to lower the risk for heart attack, stroke, and other complications. 

Specific treatment will be determined by your health care provider based on:

  • Your age, overall health, and medical history
  • Extent of the disease
  • Your signs and symptoms
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

Treatment may include:

  • Lifestyle changes to control risk factors, including regular exercise, proper nutrition, and smoking cessation
  • Aggressive treatment of existing conditions that may worsen PVD, such as diabetes, high blood pressure, and high cholesterol
  • Medications for improving blood flow, such as antiplatelet agents (blood thinners) and medications that relax the blood vessel walls
  • Vascular surgery —a bypass graft using a blood vessel from another part of the body or a tube made of synthetic material is placed in the area of the blocked or narrowed artery to reroute the blood flow
  • Angioplasty — a catheter (long hollow tube) is used to create a larger opening in an artery to increase blood flow. Angioplasty may be done in many of the arteries in the body. There are several types of angioplasty procedures, including:
    • Balloon angioplasty (a small balloon is inflated inside the blocked artery to open the blocked area)
    • Atherectomy (the blocked area inside the artery is "shaved" away by a tiny device on the end of a catheter)
    • Laser angioplasty (a laser is used to "vaporize" the blockage in the artery)
    • Stent (a tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open)

With both angioplasty and vascular surgery, an angiogram is often done before the procedure. 

What are the complications of peripheral vascular disease?

Complications of peripheral vascular disease most often occur because of decreased or absent blood flow. Such complications may include:

  • Amputation (loss of a limb)
  • Poor wound healing
  • Restricted mobility due to pain or discomfort with exertion
  • Severe pain in the affected extremity
  • Stroke (three times more likely in people with PVD)

By following an aggressive treatment plan for peripheral vascular disease, complications such as these may be prevented.

Can I prevent peripheral vascular disease?

Steps to prevent PVD are primarily aimed at management of the risk factors for PVD. A prevention program for PVD may include:

  • Smoking cessation, including avoidance of second hand smoke and use of any tobacco products
  • Dietary changes including reduced fat, cholesterol, and simple carbohydrates (such as sweets), and increased amounts of fruits and vegetables, low-fat dairy, and lean meats
  • Treatment of high blood cholesterol with medications as determined by your health care provider
  • Weight reduction
  • Moderation in alcohol intake
  • Medications as determined by your health care provider to reduce your risk for blood clots
  • Exercise plan of a minimum of 30 minutes daily
  • Control of diabetes
  • Control of high blood pressure

A prevention plan for PVD may also be used to prevent or lessen the progress of PVD once it has been diagnosed. Consult your doctor for diagnosis and treatment.

Living with peripheral vascular disease

It’s important to follow your health care provider’s recommendation for managing PVD to manage the symptoms and stop the disease from progressing.

When should I call my health care provider?

If your symptoms get worse or you get new symptoms, let your health care provider know.

Key points

  • Peripheral vascular disease affects all types of blood vessels.
  • Blood flow is restricted to the tissue because of spasm or narrowing of the vessel.
  • This disease more often affects the blood vessels in the legs.
  • The most common symptom is pain, which becomes worse as the circulation more limited.
  • Treatment is focused on restoring the blood flow and preventing disease progression.

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Peripheral Vascular Disease

Peripheral vascular disease(PVD) is a slow and progressive circulation disorder that involves disease in any of the blood vessels outside of the heart.

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Heart Valve DiseasesEnfermedades Valvulares del Corazón

Heart Valve Diseases

What are heart valves?

The heart consists of 4 chambers--2 atria (upper chambers) and 2 ventricles (lower chambers). Blood passes through a valve as it leaves each chamber of the heart. The valves prevent the backward flow of blood. They act as one-way inlets of blood on one side of a ventricle and one-way outlets of blood on the other side of a ventricle. The 4 heart valves include the following:

Anatomy of the heart showing the heart valves
Click image to enlarge

  • Tricuspid valve. Located between the right atrium and the right ventricle.

  • Pulmonary valve. Located between the right ventricle and the pulmonary artery.

  • Mitral valve. Located between the left atrium and the left ventricle.

  • Aortic valve. Located between the left ventricle and the aorta.

How do the heart valves function?

As the heart muscle contracts and relaxes, the valves open and close, letting blood flow into the ventricles and out to the body at alternate times. The following is a step-by-step explanation of blood flow through the heart.

  • The left and right atrium contract once they are filled with blood. This pushes open the mitral and tricuspid valves. Blood is then pumped into the ventricles.

  • The left and right ventricles contact. This closes the mitral and tricuspid valves preventing back blood flow. At the same time, the aortic and pulmonic valves open to let blood be pumped out of the heart.

  • The left and right ventricles relax. The aortic and pulmonic valves close preventing backward blood flow into the heart. The mitral and tricuspid valves then open to allow forward blood flow within the heart to fill the ventricles again.

What is heart valve disease?

Heart valve disorders can arise from 2 main types of problems:

  • Regurgitation (or leakage of the valve). When the valve(s) do not close completely, it causes blood to flow backward through the valve. This reduces forward blood flow and can lead to volume overload in the heart.

  • Stenosis (or narrowing of the valve). When the valve(s) opening becomes narrowed, it limits the flow of blood out of the ventricles or atria. The heart is forced to pump blood with increased force to move blood through the narrowed or stiff (stenotic) valve(s).

Heart valves can develop both regurgitation and stenosis at the same time. Also, more than one heart valve can be affected at the same time. When heart valves fail to open and close properly, the effects on the heart can be serious, possibly hampering the heart's ability to pump enough blood through the body. Heart valve problems are one cause of heart failure.

What are the symptoms of heart valve disease?

Mild to moderate heart valve disease may not cause any symptoms. These are the most common symptoms of heart valve disease:

  • Chest pain

  • Palpitations caused by irregular heartbeats

  • Fatigue

  • Dizziness

  • Low or high blood pressure, depending on which valve disease is present

  • Shortness of breath

  • Abdominal pain due to an enlarged liver (if there is tricuspid valve malfunction)

  • Leg swelling

Symptoms of heart valve disease may look like other medical problems. Always see your doctor for a diagnosis.

What causes heart valve damage?

The causes of heart valve damage vary depending on the type of disease present, and may include the following:

  • Changes in the heart valve structure due to aging

  • Coronary artery disease and heart attack

  • Heart valve infection

  • Birth defect

  • Syphilis (a sexually-transmitted infection)

  • Myxomatous degeneration (an inherited connective tissue disorder that weakens the heart valve tissue)

The mitral and aortic valves are most often affected by heart valve disease. Some of the more common heart valve diseases include:

Heart valve disease

Symptoms and causes

Bicuspid aortic valve

With this birth defect, the aortic valve has only 2 leaflets instead of 3. If the valve becomes narrowed, it is harder for the blood to flow through, and often the blood leaks backward. Symptoms usually don't until the adult years.

Mitral valve prolapse (also known as click-murmur syndrome, Barlow's syndrome, balloon mitral valve, or floppy valve syndrome)

With this defect, the mitral valve leaflets bulge and don't close properly during the contraction of the heart. This lets blood to leak backward. This may result in a mitral regurgitation murmur.

Mitral valve stenosis

With this valve disease, the mitral valve opening is narrowed. It is often caused by a past history of rheumatic fever. It increases resistance to blood flow from the left atrium to the left ventricle.

Aortic valve stenosis

This valve disease occurs mainly in the elderly. It causes the aortic valve opening to narrow. This increases resistance to blood flow from the left ventricle to the aorta.

Pulmonary stenosis

With this valve disease, the pulmonary valve does not open sufficiently. This forces the right ventricle to pump harder and enlarge. This is usually a congenital condition.

How is heart valve disease diagnosed?

Your doctor may think you have heart valve disease if your heart sounds heard through a stethoscope are abnormal. This is usually the first step in diagnosing a heart valve disease. A characteristic heart murmur (abnormal sounds in the heart due to turbulent blood flow across the valve) can often mean valve regurgitation or stenosis. To further define the type of valve disease and extent of the valve damage, doctors may use any of the following tests:

  • Electrocardiogram (ECG). A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias), and can sometimes detect heart muscle damage.

  • Echocardiogram (echo).  This noninvasive test uses sound waves to evaluate the heart's chambers and valves. The echo sound waves create an image on a monitor as an ultrasound transducer is passed over the heart. This is the best test to evaluate heart valve function.

  • Transesophageal echocardiogram (TEE).This test involves passing a small ultrasound transducer down into the esophagus. The sound waves create an image of the valves and chambers of the heart on a computer monitor without the ribs or lungs getting in the way.

  • Chest X-ray. This test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. An X-ray can show enlargement in any area of the heart.

  • Cardiac catheterization. This test involves the insertion of a tiny, hollow tube (catheter) through a large artery in the leg or arm leading to the heart to provide images of the heart and blood vessels. This procedure is helpful in determining the type and extent of certain valve disorders.

  • Magnetic resonance imaging (MRI). This test uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

What is the treatment for heart valve disease?

In some cases, your doctor may just want to closely watch the heart valve problem for a period. However, other options include medicine, or surgery to repair or replace the valve. Treatment varies, depending on the type of heart valve disease, and may include:

  • Medicine. Medicines are not a cure for heart valve disease, but treatment can often relieve symptoms. These medicines may include:

    • Beta-blockers, digoxin, and calcium channel blockers to reduce symptoms of heart valve disease by controlling the heart rate and helping to prevent abnormal heart rhythms.

    • Medications to control blood pressure, such as diuretics (remove excess water from the body by increasing urine output) or vasodilators (relax the blood vessels, decreasing the force against which the heart must pump) to ease the work of the heart.

  • Surgery. Surgery may be needed to repair or replace the malfunctioning valve(s). Surgery may include:

    • Heart valve repair. In some cases, surgery on the malfunctioning valve can help ease symptoms. Examples of heart valve repair surgery include remodeling abnormal valve tissue so that the valve works properly, or inserting prosthetic rings to help narrow a dilated valve. In many cases, heart valve repair is preferable, because a person's own tissues are used.

    • Heart valve replacement. When heart valves are severely malformed or destroyed, they may need to be replaced with a new valve. Replacement valves may be either tissue (biologic) valves, which include animal valves and donated human aortic valves, or mechanical valves, which can consist of metal, plastic, or another artificial material. This usually requires heart surgery. But, certain valve diseases such as aortic valve stenosis or mitral valve regurgitation may be managed using non- surgical methods.

Another treatment option that is less invasive than valve repair or replacement surgery is balloon valvuloplasty. This is a non-surgical procedure in which a special catheter (hollow tube) is threaded into a blood vessel in the groin and guided into the heart. At the tip of the catheter is a deflated balloon that is inserted into the narrowed heart valve. Once in place, the balloon is inflated to stretch the valve open, and then removed. This procedure is sometimes used to treat pulmonary stenosis and, in some cases, aortic stenosis.

Valve Disease & Disorders

A condition where one or more of the heart's valves do not work properly due to disease or structural defect.

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