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Coronary Artery Disease Risk Assessment
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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 pectoris—or simply angina—is chest pain or discomfort that keeps coming back. It happens when some part of your heart doesn't 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 because of atherosclerosis or a blood clot. It can also occur because of 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. They are:
Variant angina pectoris(or Prinzmetal's angina)
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.
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.
These are the most common symptoms of angina:
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.
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:
Your healthcare provider will determine specific treatment, based on:
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. Don't 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.
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.
Maintaining a healthy lifestyle can help to delay or prevent angina pectoris. A healthy lifestyle includes:
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.
Tips to help you get the most from a visit to your healthcare provider:
Angina is a type of chest discomfort caused by poor blood flow through to the heart muscle.
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.
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.
Risk factors for atherosclerosis, include:
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.
First, your doctor will do a complete medical history and physical exam. You may also have one or more of these tests:
Your healthcare provider will figure out the best treatment based on:
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 that may be used to treat atherosclerosis include:
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:
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.
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.
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.
If your symptoms get worse or you have new symptoms, let your healthcare provider know.
Arteriosclerosis occurs when fatty material collects along the walls of arteries, leading to blocked arteries.
A heart attack (myocardial infarction) happens when one or more areas of the heart muscle don't get enough oxygen. This happens when blood flow to the heart muscle is blocked.
The blockage is caused by a buildup of plaque in the arteries (atherosclerosis). Plaque is made up of deposits, cholesterol, and other substances. When a plaque breaks (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 heart muscle affected by the lack of oxygen no longer works as it should.
There are two types of risk factors for heart attack.
Inherited (or genetic)
Inherited or genetic risk factors are risk factors you are born with that can't be changed. They can be improved with medicine and lifestyle changes.
Acquired risk factors are caused by activities that a person chooses to do. These can be managed through lifestyle changes and medical care.
These groups are most at risk:
People with inherited high blood pressure (hypertension)
People with inherited low levels of HDL cholesterol, high levels of LDL cholesterol, or high levels of triglycerides
People with a family history of heart disease. This is especially true if the heart disease started before age 55.
Older men and women
People with type 1 diabetes
Women who have gone through menopause. Generally, men are at risk at a younger age than women. After menopause, women are equally at risk.
People with acquired high blood pressure (hypertension)
People with acquired low levels of HDL cholesterol, high levels of LDL cholesterol, or high levels of triglycerides
People who are under a lot of stress
People who drink too much alcohol
People who lead a sedentary lifestyle
People overweight by 30% or more
People who eat a diet high in saturated fat
People with type 2 diabetes
A heart attack can happen to anyone. When you take the time to learn which risk factors apply to you, you can take steps to eliminate or reduce them.
Here are ways to manage your risks for a heart attack:
Look at which risk factors apply to you, then take steps to eliminate or reduce them.
Learn about high blood pressure and high cholesterol levels. These may be "silent killers."
Change risk factors that aren't inherited by making lifestyle changes. Talk with your healthcare provider to find out how to do so.
Talk with your healthcare provider to find out if you have risk factors that can't be changed. These can be managed with medicine and lifestyle changes.
The following are the most common symptoms of a heart attack. But each person may have slightly different symptoms.
Severe pressure, fullness, squeezing, pain, 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 gets worse
Chest pain that doesn't get better with rest or by taking nitroglycerin
Chest pain that happens along with any of these symptoms:
Sweating, cool, clammy skin, 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 other conditions. These include indigestion, pleurisy, pneumonia, tenderness of the cartilage that attaches the front of the ribs to the breastbone, and heartburn. Always see your healthcare provider for a diagnosis.
If you or someone you know has any of the above warning signs, act right away. Call 911, or your local emergency number.
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:
Intravenous therapy, such as nitroglycerin and morphine
Continuous monitoring of the heart and vital signs
Oxygen therapy to improve oxygenation to the damaged heart muscle
Pain medicine to decrease pain. This, in turn, decreases the workload of the heart. The oxygen demand of the heart decreases.
Cardiac medicine such as beta-blockers to promote blood flow to the heart, improve the blood supply, prevent arrhythmias, and decrease heart rate and blood pressure
Fibrinolytic therapy. This is the intravenous infusion of a medicine that dissolves the blood clot, restoring blood flow.
Antithrombin or antiplatelet therapy with aspirin or clopidogrel. This is used to prevent further blood clotting.
Antihyperlipidemics. These medicines lower lipids (fats) in the blood, particularly low density lipid (LDL) cholesterol. Statins are a group of antihyperlipidemic medicines. They include simvastatin, atorvastatin, and pravastatin. Bile acid sequestrants—colesevelam, cholestyramine, and colestipol—and nicotinic acid (niacin) are two other types of medicines that may be used to lower cholesterol levels.
You may need other procedures to restore blood flow to the heart. Those procedures are described below.
With this procedure, a balloon is used to create a bigger opening in the vessel to increase blood flow. This is often followed by inserting a stent into the coronary artery to help keep the vessel open. Although angioplasty is done in other blood vessels elsewhere in the body, percutaneous coronary intervention (PCI) refers to angioplasty in the coronary arteries. This lets more blood flow into the heart. PCI is also called percutaneous transluminal coronary angioplasty (PTCA). There are several types of PTCA procedures:
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. The stent 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.
This surgery is most commonly referred to as simply bypass surgery or CABG (pronounced "cabbage"). It is often done in people who have chest pain (angina) and coronary artery disease. Coronary artery disease is when plaque has built up in the arteries. During the surgery, the surgeon makes a bypass by grafting a piece of a vein above and below the blocked area of a coronary artery. This lets blood flow around the blockage. The surgeon usually takes veins from a leg, but he or she may also use arteries from the chest or an arm. Sometimes, you may need more than one bypass surgery to restore blood flow to all areas of the heart.
Heart attacks are caused by a blockage of blood flow to the heart, usually as a result of plaque build up in the arteries.
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:
140 mm Hg to 159 mm Hg systolic pressure—higher number
90 mm Hg to 99 mm Hg diastolic pressure—lower number
160 mm Hg or higher systolic pressure
100 mm Hg or higher diastolic pressure
The NHLBI defines prehypertension as:
120 mm Hg to 139 mm Hg systolic pressure
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
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.
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
Heavy drinkers of alcohol
Women who are taking oral contraceptives
People with depression
The following conditions contribute to high blood pressure:
Excessive sodium intake
A lack of exercise and physical activity
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 (high blood pressure) occurs when a person's blood pressure is consistently higher than the normal range.
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.
Usually, the cause of pericarditis is unknown, but may include:
The following are the most common signs of pericarditis:
The symptoms of pericarditis may look like other conditions. See a healthcare provider for a diagnosis.
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:
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:
Pericarditis may last from 2 to 6 weeks, and it may come back.
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.
If your symptoms get worse or you have new symptoms, call your healthcare provider.
Pericarditis means the protective sac around the heart becomes inflamed. Pericarditis is usually a complication stemming from viral, fungal or bacterial infections.
An arrhythmia is an abnormal heart rhythm.
Some arrhythmias can cause problems with contractions of your heart chambers by:
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.
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.
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.
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:
The symptoms of arrhythmias may look like other conditions. Always see your healthcare provider for a diagnosis.
There are several tests that may be used to diagnose arrhythmias. Some of these include:
There are several variations of the ECG test:
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:
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 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.
Tell your healthcare provider if:
Arrhythmias occur when there is a disruption in the normal pace of the heartbeat.
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.
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.
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.
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 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
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.
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.
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 refers to a problem with the heart's structure and function due to abnormal heart development before birth.
Heart failure occurs when the heart cannot pump sufficient blood to the rest of body's organs.
Peripheral vascular disease (PVD) is a slow and progressive circulation disorder. Narrowing, blockage, or spasms in a blood vessel can cause PVD.
PVD may affect any blood vessel 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.
Peripheral vascular disease is also called peripheral arterial disease.
The most common cause of PVD is atherosclerosis, the buildup of plaque inside the artery wall. Plaque reduces the amount of blood flow to the limbs. It also decreases the oxygen and nutrients available to the tissue. Blood clots may form on the artery walls, further decreasing the inner size of the blood vessel and block off major arteries.
Other causes of PVD may include:
People with coronary artery disease (CAD) often also have PVD.
A risk factor increases your chance of developing a disease. Some can be changed, others cannot. Risk factors that you can’t change:
Risk factors that may be changed or treated include:
Those who smoke or have diabetes have the highest risk of complications from PVD because these risk factors also cause impaired blood flow.
About half the people diagnosed with PVD are symptom free. For those with symptoms, the most common first symptom is painful leg cramping that occurs with exercise and is relieved by rest (intermittent claudication). 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 PVD may include:
The symptoms of PVD may look like other conditions. See your healthcare provider for a diagnosis.
Along with a complete medical history and physical exam, other tests may include:
The main goals for treatment of PVD are to control the symptoms and halt the progression of the disease to lower the risk for heart attack, stroke, and other complications.
Treatment may include:
An angiogram may be done before angioplasty and vascular surgery.
Complications of PVD most often occur because of decreased or absent blood flow. Such complications may include:
Following an aggressive treatment plan for PVD can help prevent complications.
To prevent PVD, take steps to manage the risk factors. A prevention program for PVD may include:
To prevent or lessen the progress of PVD, your doctor may recommend a prevention plan.
If your symptoms get worse or you get new symptoms, let your healthcare provider know.
Peripheral vascular disease(PVD) is a slow and progressive circulation disorder that involves disease in any of the blood vessels outside of the heart.
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:
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.
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.
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.
Mild to moderate heart valve disease may not cause any symptoms. These are the most common symptoms of heart valve disease:
Palpitations caused by irregular heartbeats
Low or high blood pressure, depending on which valve disease is present
Abdominal pain due to an enlarged liver (if there is tricuspid valve malfunction)
Symptoms of heart valve disease may look like other medical problems. Always see your doctor for a diagnosis.
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
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.
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.
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.
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.
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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