Heart disease

Overview

Heart disease describes a range of conditions that affect your heart. Heart diseases include:

  • Blood vessel disease, such as coronary artery disease
  • Heart rhythm problems (arrhythmias)
  • Heart defects you're born with (congenital heart defects)
  • Heart valve disease
  • Disease of the heart muscle
  • Heart infection

Many forms of heart disease can be prevented or treated with healthy lifestyle choices.

Symptoms

Heart disease symptoms depend on what type of heart disease you have.

Symptoms of heart disease in your blood vessels

A buildup of fatty plaques in your arteries, or atherosclerosis (ath-ur-o-skluh-ROE-sis) can damage your blood vessels and heart. Plaque buildup causes narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke.

Coronary artery disease symptoms may be different for men and women. For instance, men are more likely to have chest pain. Women are more likely to have other signs and symptoms along with chest discomfort, such as shortness of breath, nausea and extreme fatigue.

Signs and symptoms can include:

  • Chest pain, chest tightness, chest pressure and chest discomfort (angina)
  • Shortness of breath
  • Pain, numbness, weakness or coldness in your legs or arms if the blood vessels in those parts of your body are narrowed
  • Pain in the neck, jaw, throat, upper abdomen or back

You might not be diagnosed with coronary artery disease until you have a heart attack, angina, stroke or heart failure. It's important to watch for cardiovascular symptoms and discuss concerns with your doctor. Cardiovascular disease can sometimes be found early with regular evaluations.

Heart disease symptoms caused by abnormal heartbeats (heart arrhythmias)

Your heart may beat too quickly, too slowly or irregularly. Heart arrhythmia signs and symptoms can include:

  • Fluttering in your chest
  • Racing heartbeat (tachycardia)
  • Slow heartbeat (bradycardia)
  • Chest pain or discomfort
  • Shortness of breath
  • Lightheadedness
  • Dizziness
  • Fainting (syncope) or near fainting

Heart disease symptoms caused by heart defects

Serious heart defects that you're born with (congenital heart defects) usually are noticed soon after birth. Heart defect signs and symptoms in children could include:

  • Pale gray or blue skin color (cyanosis)
  • Swelling in the legs, abdomen or areas around the eyes
  • In an infant, shortness of breath during feedings, leading to poor weight gain

Less serious congenital heart defects are often not diagnosed until later in childhood or during adulthood. Signs and symptoms of congenital heart defects that usually aren't immediately life-threatening include:

  • Easily getting short of breath during exercise or activity
  • Easily tiring during exercise or activity
  • Swelling in the hands, ankles or feet

Heart disease symptoms caused by diseased heart muscle (cardiomyopathy)

In early stages of cardiomyopathy, you may have no symptoms. As the condition worsens, symptoms may include:

  • Breathlessness with activity or at rest
  • Swelling of the legs, ankles and feet
  • Fatigue
  • Irregular heartbeats that feel rapid, pounding or fluttering
  • Dizziness, lightheadedness and fainting

Heart disease symptoms caused by heart infection

Endocarditis is an infection that affects the inner lining of your heart chambers and heart valves (endocardium). Heart infection signs and symptoms can include:

  • Fever
  • Shortness of breath
  • Weakness or fatigue
  • Swelling in your legs or abdomen
  • Changes in your heart rhythm
  • Dry or persistent cough
  • Skin rashes or unusual spots

Heart disease symptoms caused by heart valve problems (valvular heart disease)

The heart has four valves — the aortic, mitral, pulmonary and tricuspid valves — that open and close to direct blood flow through your heart. Many things can damage your heart valves, leading to narrowing (stenosis), leaking (regurgitation or insufficiency) or improper closing (prolapse).

Depending on which valve isn't working properly, valvular heart disease signs and symptoms generally include:

  • Fatigue
  • Shortness of breath
  • Irregular heartbeat
  • Swollen feet or ankles
  • Chest pain
  • Fainting (syncope)

When to see a doctor

Seek emergency medical care if you have these heart disease signs and symptoms:

  • Chest pain
  • Shortness of breath
  • Fainting

Always call 911 or emergency medical help if you think you might be having a heart attack.

Heart disease is easier to treat when detected early, so talk to your doctor about your concerns regarding your heart health. If you're concerned about developing heart disease, talk to your doctor about steps you can take to reduce your heart disease risk. This is especially important if you have a family history of heart disease.

If you think you may have heart disease, based on new signs or symptoms you're having, make an appointment to see your doctor.

Causes

Heart disease causes depend on your specific type of heart disease. There are many different types of heart disease. To understand the causes of heart disease, it helps to understand how the heart works.

How the heart works

Your heart is a pump. It's a muscular organ about the size of your fist, located slightly left of center in your chest. Your heart is divided into the right and the left sides.

  • The right side of the heart includes the right atrium and ventricle. It collects and pumps blood to the lungs through the pulmonary arteries.
  • The lungs give the blood a new supply of oxygen. The lungs also breathe out carbon dioxide, a waste product.
  • Oxygen-rich blood then enters the left side of the heart, including the left atrium and ventricle.
  • The left side of the heart pumps blood through the largest artery in the body (aorta) to supply tissues throughout the body with oxygen and nutrients.

Heart valves

Four heart valves keep your blood moving the right way by opening only one way and only when they need to. To work properly, the valves must be formed properly, must open all the way and must close tightly so there's no leakage. The four valves are:

  • Tricuspid
  • Mitral
  • Pulmonary
  • Aortic

Heartbeats

A beating heart squeezes (contracts) and relaxes in a continuous cycle.

  • During contraction (systole), your ventricles squeeze tight, forcing blood into the vessels to your lungs and body.
  • During relaxation (diastole), the ventricles are filled with blood coming from the upper chambers (left and right atria).

Electrical system

Your heart's electrical wiring keeps it beating. Your heartbeat controls the continuous exchange of oxygen-rich blood with oxygen-poor blood. This exchange keeps you alive.

  • Electrical signals begin high in the upper right chamber (right atrium) and travel through specialized pathways to the ventricles, delivering the signal for the heart to pump.
  • The system keeps your heart beating in a coordinated and normal rhythm, which keeps blood flowing.

Causes of coronary artery disease

A buildup of fatty plaques in your arteries (atherosclerosis) is the most common cause of coronary artery disease. Unhealthy lifestyle habits, such as a poor diet, lack of exercise, being overweight and smoking, can lead to atherosclerosis.

Causes of heart arrhythmia

Common causes of arrhythmias or conditions that can lead to arrhythmias include:

  • Coronary artery disease
  • Diabetes
  • Drug abuse
  • Excessive use of alcohol or caffeine
  • Heart defects you're born with (congenital heart defects)
  • High blood pressure
  • Smoking
  • Some over-the-counter medications, prescription medications, dietary supplements and herbal remedies
  • Stress
  • Valvular heart disease

In a healthy person with a normal, healthy heart, it's unlikely for a deadly arrhythmia to develop without some outside trigger, such as an electrical shock or the use of illegal drugs. However, in a heart that's diseased or deformed, the heart's electrical signals may not properly start or travel through the heart, making arrhythmias more likely to develop.

Causes of congenital heart defects

Congenital heart defects usually develop while a baby is in the womb. Heart defects can develop as the heart develops, about a month after conception, changing the flow of blood in the heart. Some medical conditions, medications and genes may play a role in causing heart defects.

Heart defects can also develop in adults. As you age, your heart's structure can change, causing a heart defect.

Causes of cardiomyopathy

The cause of cardiomyopathy, a thickening or enlarging of the heart muscle, may depend on the type:

  • Dilated cardiomyopathy. The cause of this most common type of cardiomyopathy often is unknown. The condition usually causes the left ventricle to widen. Dilated cardiomyopathy may be caused by reduced blood flow to the heart (ischemic heart disease) resulting from damage after a heart attack, infections, toxins and certain drugs, including those used to treat cancer. It may also be inherited from a parent.
  • Hypertrophic cardiomyopathy. This type usually is passed down through families (inherited). It can also develop over time because of high blood pressure or aging.
  • Restrictive cardiomyopathy. This least common type of cardiomyopathy, which causes the heart muscle to become rigid and less elastic, can occur for no known reason. Or it may be caused by diseases, such as connective tissue disorders or the buildup of abnormal proteins (amyloidosis).

Causes of heart infection

A heart infection, such as endocarditis, is caused when germs reach your heart muscle. The most common causes of heart infection include:

  • Bacteria
  • Viruses
  • Parasites

Causes of valvular heart disease

Many things can cause diseases of your heart valves. You may be born with valvular disease, or the valves may be damaged by conditions such as:

  • Rheumatic fever
  • Infections (infectious endocarditis)
  • Connective tissue disorders
Chambers and valves of the heart Chambers and valves of the heart

Risk factors

Risk factors for developing heart disease include:

  • Age. Growing older increases your risk of damaged and narrowed arteries and a weakened or thickened heart muscle.
  • Sex. Men are generally at greater risk of heart disease. The risk for women increases after menopause.
  • Family history. A family history of heart disease increases your risk of coronary artery disease, especially if a parent developed it at an early age (before age 55 for a male relative, such as your brother or father, and 65 for a female relative, such as your mother or sister).
  • Smoking. Nicotine tightens your blood vessels, and carbon monoxide can damage their inner lining, making them more susceptible to atherosclerosis. Heart attacks are more common in smokers than in nonsmokers.
  • Poor diet. A diet that's high in fat, salt, sugar and cholesterol can contribute to the development of heart disease.
  • High blood pressure. Uncontrolled high blood pressure can result in hardening and thickening of your arteries, narrowing the vessels through which blood flows.
  • High blood cholesterol levels. High levels of cholesterol in your blood can increase the risk of plaque formation and atherosclerosis.
  • Diabetes. Diabetes increases your risk of heart disease. Both conditions share similar risk factors, such as obesity and high blood pressure.
  • Obesity. Excess weight typically worsens other heart disease risk factors.
  • Physical inactivity. Lack of exercise also is associated with many forms of heart disease and some of its other risk factors as well.
  • Stress. Unrelieved stress may damage your arteries and worsen other risk factors for heart disease.
  • Poor dental health. It's important to brush and floss your teeth and gums often, and have regular dental checkups. If your teeth and gums aren't healthy, germs can enter your bloodstream and travel to your heart, causing endocarditis.

Complications

Complications of heart disease include:

  • Heart failure. One of the most common complications of heart disease, heart failure occurs when your heart can't pump enough blood to meet your body's needs. Heart failure can result from many forms of heart disease, including heart defects, cardiovascular disease, valvular heart disease, heart infections or cardiomyopathy.
  • Heart attack. A blood clot blocking the blood flow through a blood vessel that feeds the heart causes a heart attack, possibly damaging or destroying a part of the heart muscle. Atherosclerosis can cause a heart attack.
  • Stroke. The risk factors that lead to cardiovascular disease can also lead to an ischemic stroke, which happens when the arteries to your brain are narrowed or blocked so that too little blood reaches your brain. A stroke is a medical emergency — brain tissue begins to die within just a few minutes of a stroke.
  • Aneurysm. A serious complication that can occur anywhere in your body, an aneurysm is a bulge in the wall of your artery. If an aneurysm bursts, you may face life-threatening internal bleeding.
  • Peripheral artery disease. When you develop peripheral artery disease, your extremities — usually your legs — don't receive enough blood flow. This causes symptoms, most notably leg pain when walking (claudication). Atherosclerosis also can lead to peripheral artery disease.
  • Sudden cardiac arrest. Sudden cardiac arrest is the sudden, unexpected loss of heart function, breathing and consciousness, often caused by an arrhythmia. Sudden cardiac arrest is a medical emergency. If not treated immediately, it results in sudden cardiac death.

Prevention

Certain types of heart disease, such as heart defects, can't be prevented. However, the same lifestyle changes that can improve your heart disease can help you prevent it, including:

  • Don't smoke.
  • Control other health conditions, such as high blood pressure, high cholesterol and diabetes.
  • Exercise at least 30 minutes a day on most days of the week.
  • Eat a diet that's low in salt and saturated fat.
  • Maintain a healthy weight.
  • Reduce and manage stress.
  • Practice good hygiene.

Diagnosis

Your doctor will perform a physical exam and ask about your personal and family medical history. The tests you'll need to diagnose your heart disease depend on what condition your doctor thinks you might have. Besides blood tests and a chest X-ray, tests to diagnose heart disease can include:

  • Electrocardiogram (ECG or EKG). An ECG is a quick and painless test that records the electrical signals in your heart. It can spot abnormal heart rhythms. You may have an ECG while you're at rest or while exercising (stress electrocardiogram).
  • Holter monitoring. A Holter monitor is a portable ECG device you wear to continuously record your heart rhythm, usually for 24 to 72 hours. Holter monitoring is used to detect heart rhythm problems that aren't found during a regular ECG exam.
  • Echocardiogram. This noninvasive exam uses sound waves to produce detailed images of your heart's structure. It shows how your heart beats and pumps blood.
  • Stress test. This type of test involves raising your heart rate with exercise or medicine while performing heart tests and imaging to check how your heart responds.
  • Cardiac catheterization. In this test, a short tube (sheath) is inserted into a vein or artery in your leg (groin) or arm. A hollow, flexible and longer tube (guide catheter) is then inserted into the sheath. Using X-ray images on a monitor as a guide, your doctor carefully threads the catheter through the artery until it reaches your heart.

    During cardiac catheterization, the pressures in your heart chambers can be measured, and dye can be injected. The dye can be seen on an X-ray, which helps your doctor see the blood flow through your heart, blood vessels and valves to check for problems.

  • Cardiac computerized tomography (CT) scan. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest.
  • Cardiac magnetic resonance imaging (MRI). A cardiac MRI uses a magnetic field and computer-generated radio waves to create detailed images of your heart.

Treatment

The type of treatment you receive depends on the type of heart disease you have. In general, treatment for heart disease usually includes:

  • Lifestyle changes. You can lower your risk of heart disease by eating a low-fat and low-sodium diet, getting at least 30 minutes of moderate exercise on most days of the week, quitting smoking, and limiting alcohol intake.
  • Medications. If lifestyle changes alone aren't enough, your doctor may prescribe medications to control your heart disease. The type of medication you receive will depend on the type of heart disease.
  • Medical procedures or surgery. If medications aren't enough, it's possible your doctor will recommend specific procedures or surgery. The type of procedure or surgery will depend on the type of heart disease and the extent of the damage to your heart.

Lifestyle and home remedies

Heart disease can be improved — or even prevented — by making certain lifestyle changes. The following changes can help anyone who wants to improve heart health:

  • Stop smoking. Smoking is a major risk factor for heart disease, especially atherosclerosis. Quitting is the best way to reduce your risk of heart disease and its complications.
  • Control your blood pressure. Ask your doctor for a blood pressure measurement at least every two years. He or she may recommend more frequent measurements if your blood pressure is higher than normal or you have a history of heart disease. Optimal blood pressure is less than 120 systolic and 80 diastolic, as measured in millimeters of mercury (mm Hg).
  • Check your cholesterol. Ask your doctor for a baseline cholesterol test when you're in your 20s and then at least every five years. You may need to start testing earlier if high cholesterol is in your family. If your test results aren't within desirable ranges, your doctor may recommend more-frequent measurements.

    Most people should aim for a low-density lipoprotein (LDL) level below 130 milligrams per deciliter (mg/dL), or 3.4 millimoles per liter (mmol/L). If you have other risk factors for heart disease, you should aim for an LDL level below 100 mg/dL (2.6 mmol/L). If you're at very high risk of heart disease — if you've already had a heart attack or have diabetes, for example — aim for an LDL level below 70 mg/dL (1.8 mmol/L).

  • Keep diabetes under control. If you have diabetes, tight blood sugar control can help reduce the risk of heart disease.
  • Exercise. Physical activity helps you achieve and maintain a healthy weight and control diabetes, high cholesterol and high blood pressure — all risk factors for heart disease. If you have a heart arrhythmia or heart defect, there may be some restrictions on the activities you can do, so talk to your doctor. With your doctor's OK, aim for 30 to 60 minutes of physical activity most days of the week.
  • Eat healthy foods. A heart-healthy diet based on fruits, vegetables and whole grains — and low in saturated fat, cholesterol, sodium and added sugar — can help you control your weight, blood pressure and cholesterol.
  • Maintain a healthy weight. Being overweight increases your risk of heart disease. A body mass index (BMI) of less than 25 and a waist circumference of 35 inches (88.9 centimeters) or less is the goal for preventing and treating heart disease.
  • Manage stress. Reduce stress as much as possible. Practice techniques for managing stress, such as muscle relaxation and deep breathing.
  • Get treatment for depression. Being depressed can increase your risk of heart disease significantly. Talk to your doctor if you feel hopeless or uninterested in your life.
  • Practice good hygiene. Regularly wash your hands and brush and floss your teeth to keep yourself well.

Also, get regular medical checkups. Early detection and treatment can set the stage for a lifetime of better heart health.

Coping and support

You may feel frustrated, upset or overwhelmed upon learning that you or your loved one has heart disease. Here are some ways to help cope with heart disease or improve your condition:

  • Cardiac rehabilitation. For people who have cardiovascular disease that's caused a heart attack or has required surgery to correct, cardiac rehabilitation is often recommended as a way to improve treatment and speed recovery. Cardiac rehabilitation involves levels of monitored exercise, nutritional counseling, emotional support, and support and education about lifestyle changes to reduce your risk of heart problems.
  • Support groups. Turning to friends and family for support is essential, but if you need more help, talk to your doctor about joining a support group. You may find that talking about your concerns with others in similar situations can help.
  • Continued medical checkups. If you have a recurring or long-term (chronic) heart condition, regularly check in with your doctor to make sure you're properly managing your heart condition.

Preparing for an appointment

Some types of heart disease will be discovered without an appointment — for example, if a child is born with a serious heart defect, it will be detected soon after birth. In other cases, your heart disease may be diagnosed in an emergency situation, such as a heart attack.

If you think you have heart disease or are worried about your heart disease risk because of your family history, see your family doctor. You may be referred to a heart specialist (cardiologist).

Here's some information to help you prepare for your appointment.

What you can do

  • Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet. You may need to avoid eating or drinking (fast) before a cholesterol test, for example.
  • Write down symptoms you're experiencing, including any that seem unrelated to heart disease.
  • Write down key personal information — including a family history of heart disease, stroke, high blood pressure or diabetes — and major stresses or recent life changes.
  • Make a list of medications, vitamins or supplements you're taking.
  • Take someone along, if possible. Someone who goes with you can help you remember information you're given.
  • Be prepared to discuss your diet and your smoking and exercise habits. If you don't already follow a diet or exercise routine, talk to your doctor about getting started.
  • Write down questions to ask your doctor.

For heart disease, some basic questions to ask your doctor include:

  • What is likely causing my symptoms or condition?
  • What are other possible causes for my symptoms or condition?
  • What tests will I need?
  • What's the best treatment?
  • Is there a generic alternative to the medicine you're prescribing?
  • What are alternatives to the primary approach you're suggesting?
  • What foods should I eat or avoid?
  • What's an appropriate level of physical activity?
  • How often should I be screened for heart disease? For example, how often do I need a cholesterol test?
  • I have other health conditions. How do I manage them together?
  • Are there restrictions that I need to follow?
  • Should I see a specialist?
  • Are there brochures or other materials that I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

  • When did your symptoms begin?
  • Are your symptoms continuous or do they come and go?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Do you have a family history of heart disease, diabetes, high blood pressure or other serious illness?

What you can do in the meantime

It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and becoming more physically active. A healthy lifestyle is the main protection against heart disease and its complications.


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