Your heart is one of your body's most important organs. Essentially a pump, the heart is a muscle made up of four chambers separated by valves and divided into two halves. Each half contains one chamber called an atrium and one called a ventricle. The atria (plural for atrium) collect blood, and the ventricles contract to push blood out of the heart. The right half of the heart pumps oxygen-poor blood (blood that has a low amount of oxygen) to the lungs where blood cells can obtain more oxygen. Then, the newly oxygenated blood travels from the lungs into the left atrium and the left ventricle. The left ventricle pumps the newly oxygen-rich blood to the organs and tissues of the body. This oxygen provides your body with energy and is essential to keep your body healthy.
The general term used to cover malfunctions of the heart is Heart Disease, or sometimes Cardiac Disease ("Cardiac" is a Latin term for the heart). Though there are multiple forms of heart disease, our discussion focuses on the two most common: Heart Attack and Heart Failure. This document is designed to teach you about heart attacks and heart failure: what causes these diseases, what forms these diseases take, and what can be done to treat these diseases when they occur. As both of these diseases are to some extent avoidable, we have also provided a discussion of preventative steps you can take to decrease your chances of having to deal with heart disease, or to minimize the negative effects of existing heart disease.
Please note that though this information is as accurate as possible, it is no substitute for a qualified physician's advice. Consult with your doctor before making changes to any treatment regimen you may be prescribed, and before beginning any program of exercise or other significant lifestyle change, especially if you have a known heart problem or are a middle-aged or older adult. There is no substitute for your doctor's advice.
Although heart disease can occur in different forms, there is a common set of core risk factors that influence whether someone will ultimately be at risk for heart disease or not. We start our discussion of heart disease by describing these common risk factors, and then move on to cover specific conditions.
There are many factors that can increase your risk of getting heart disease. Some of these factors are out of your control, but many of them can be avoided by choosing to live a healthy lifestyle. Some of the risk factors you cannot control are:
- Gender: Men have a greater risk than women for developing heart disease. Men also are at greater risk of having a heart attack at a younger age. Unfortunately, these facts often mislead women into believing that they are not at risk for heart disease. This is not true; heart disease is the number one killer of women (just like men). Women and men should both take steps to prevent heart disease.
- Age: Simply put, the older you get, the greater risk you run for developing heart disease. It is estimated that four out of five individuals who die of coronary heart disease are 65 years of age or older. Further, at older ages women are much more likely to have a fatal heart attack than men.
- Family History: A family history of heart disease, high blood pressure (hypertension), and diabetes increases the chance you will develop heart disease. People with biological relatives who have heart attacks at a young age (i.e., less than fifty-five years old) are considered to have a "strong" family history of heart disease and are at much higher individual risk.
A person's family history of heart disease risk factors may also be affected by their ethnic background. For example, African Americans have a higher rate of hypertension. Since having uncontrolled high blood pressure increases an individual's chance of developing heart disease, African Americans tend to have a higher risk of developing heart disease. While your family background is not a certain indication that you will get heart disease, it can greatly increase your chances.
Fortunately, there are many other risk factors for heart disease that can be addressed by lifestyle habits and regular preventative medical care. Some of the more controllable risk factors include:
- Obesity: People who are overweight are more likely to have high blood pressure, which increases the heart's overall workload. They also tend to have high cholesterol levels, which increases the chances of developing a blockage in blood flow to the heart. Furthermore, obesity increases a person's chance of developing diabetes, another major risk factor for heart disease. Getting regular exercise and eating a healthy diet are some of the best ways to control obesity and associated medical complications. Any complications caused by obesity should be evaluated and treated by your physician.
- High Cholesterol: Cholesterol, a type of fat molecule, is an essential part of healthy cell membranes, and as such, is an essential part of a healthy body. Too much cholesterol in your blood, however, puts you at increased risk of heart disease. High levels of cholesterol and other fatty substances can cause Atherosclerosis, a disease in which fatty plaques build up on blood vessel walls, restrict blood flow to the heart and can ultimately cause a heart attack.
- Smoking: Smoking is a major risk factor for heart attacks. Among other health consequences, smoking causes people's blood to clot more easily, and raises blood pressure, thereby putting their heart at risk. In terms of a heart disease prevention strategy, your best protection is to never start, or to quit smoking altogether if you already smoke.
- High Blood Pressure: Uncontrolled blood pressure increases your risk of heart disease. The higher your blood pressure, the harder it is for your heart to pump blood throughout your body. Like any other stressed muscle, an overloaded heart responds to exertion by growing bigger; by thickening its walls and increasing it's overall size. While these changes sound positive, they actually are harmful and are signs of heart disease. As the walls of the heart thicken, the heart chamber's volume becomes greatly reduced and less blood can be pumped each time the heart beats. Also, the thickened muscle walls make it harder for the heart to pump out what blood it is able to collect. Exercise, a healthy diet and medication (if needed) can all help maintain a healthy blood pressure and therefore, a healthy heart.
- Diabetes: As mentioned above, diabetes is a major risk factor for heart disease. A diabetic person's risk of developing heart disease is equivalent to the risk of a person who has had a previous heart attack. Diabetes is a disease of blood sugar regulation. People with diabetes are at greater risk for heart disease if their blood sugar is not kept under good control. In addition, diabetics also need to control their blood pressure and cholesterol levels. In fact, the cholesterol goal for a diabetic is as low as the goal for a person who has had a previous heart attack.
- Other Factors: Stress, drinking too much alcohol, and depression have all been linked to cardiovascular disease. Stress may cause some individuals to overeat, smoke, and/or drink excessively. Drinking can lead to higher blood pressure and obesity. While some studies have suggested that daily moderate alcohol intake (one drink a day) can reduce the risk of heart disease, there is a balance. Alcohol can be an addictive drug, and it is a source of 'empty' (i.e., with limited nutritional value) calories. These extra calories can cause weight problems and diabetes, both of which are associated with heart risks of their own. Any decisions about alcohol consumption as it relates to your heart should be discussed with your doctor.
There are two different types of cholesterol: LDL (the so-called "bad cholesterol") and HDL (the "good" cholesterol). High levels of LDLs increase your chance of having a heart attack. In contrast, the higher your HDLs, the more protection you have against heart attacks. Your cholesterol levels are determined by a combination of age, gender, heredity, dietary choices and exercise. LDL cholesterol can be decreased through exercise and dietary changes such as avoiding saturated and trans fats. The best way to raise your HDL cholesterol is through exercising.
If your cholesterol levels cannot be kept at a safe level (the optimal number depends on your age, family history, and medical history such as whether you have diabetes or a history of heart attacks) with diet and exercise changes, then you and your physician can consider a prescription for cholesterol-lowering medications. People with a history of diabetes or heart attacks need to keep their LDL cholesterol lower than individuals who do not have that history.
Unlike cardiovascular disease, which describes problems with the blood vessels and circulatory system as well as the heart, heart disease refers only issues and deformities in the heart itself.
According to the Centers for Disease Control (CDC), heart disease is the leading cause of death in the United Kingdom, United States, Canada, and Australia. One in every four deaths in the U.S. occurs as a result of heart disease.
- One in every four deaths in the U.S. is related to heart disease.
- Coronary heart disease, arrhythmia, and myocardial infarction are some examples of heart disease.
- Heart disease might be treated with medication or surgery.
- Quitting smoking and exercising regularly can help prevent heart disease.
There are many different types of heart disease.
There are many types of heart disease that affect different parts of the organ and occur in different ways.
Congenital heart disease
This is a general term for some deformities of the heart that have been present since birth. Examples include:
- Septal defects: There is a hole between the two chambers of the heart.
- Obstruction defects: The flow of blood through various chambers of the heart is partially or totally blocked.
- Cyanotic heart disease: A defect in the heart causes a shortage of oxygen around the body.
Arrhythmia is an irregular heartbeat.
There are several ways in which a heartbeat can lose its regular rhythm. These include:
- tachycardia, when the heart beats too fast
- bradycardia, when the heart beats too slowly
- premature ventricular contractions, or additional, abnormal beats
- fibrillation, when the heartbeat is irregular
Arrhythmias occur when the electrical impulses in the heart that coordinate the heartbeat do not work properly. These make the heart beat in a way it should not, whether that be too fast, too slowly, or too erratically.
Irregular heartbeats are common, and all people experience them. They feel like a fluttering or a racing heart. However, when they change too much or occur because of a damaged or weak heart, they need to be taken more seriously and treated.
Arrhythmias can become fatal.
Coronary artery disease
The coronary arteries supply the heart muscle with nutrients and oxygen by circulating blood.
Coronary arteries can become diseased or damaged, usually because of plaque deposits that contain cholesterol. Plaque buildup narrows the coronary arteries, and this causes the heart to receive less oxygen and nutrients.
The heart chambers become dilated as a result of heart muscle weakness and cannot pump blood properly. The most common reason is that not enough oxygen reaches the heart muscle, due to coronary artery disease. This usually affects the left ventricle.
This is also known as a heart attack, cardiac infarction, and coronary thrombosis. An interrupted blood flow damages or destroys part of the heart muscle. This is usually caused by a blood clot that develops in one of the coronary arteries and can also occur if an artery suddenly narrows or spasms.
Also known as congestive heart failure, heart failure occurs when the heart does not pump blood around the body efficiently.
The left or right side of the heart might be affected. Rarely, both sides are. Coronary artery disease or high blood pressure can, over time, leave the heart too stiff or weak to fill and pump properly.
This is a genetic disorder in which the wall of the left ventricle thickens, making it harder for blood to be pumped out of the heart. This is the leading cause of sudden death in athletes. A parent with hypertrophic cardiomyopathy has a 50 percent chance of passing the disorder on to their children.
Also known as mitral valve regurgitation, mitral insufficiency, or mitral incompetence, this occurs when the mitral valve in the heart does not close tightly enough. This allows blood to flow back into the heart when it should leave. As a result, blood cannot move through the heart or the body efficiently.
People with this type of heart condition often feel tired and out of breath.
Mitral valve prolapse
The valve between the left atrium and left ventricle does not fully close, it bulges upwards, or back into the atrium. In most people, the condition is not life-threatening, and no treatment is required. Some people, especially if the condition is marked by mitral regurgitation, may require treatment.
It becomes hard for the heart to pump blood from the right ventricle into the pulmonary artery because the pulmonary valve is too tight. The right ventricle has to work harder to overcome the obstruction. An infant with severe stenosis can turn blue. Older children will generally have no symptoms.
Treatment is needed if the pressure in the right ventricle is too high, and a balloon valvuloplasty or open-heart surgery may be performed to clear an obstruction.
The symptoms of heart disease depend on which condition is affecting an individual.
However, common symptoms include chest pain, breathlessness, and heart palpitations. The chest pain common to many types of heart disease is known as angina, or angina pectoris, and occurs when a part of the heart does not receive enough oxygen.
Angina can be triggered by stressful events or physical exertion and normally lasts under 10 minutes.
Heart attacks can also occur as a result of different types of heart disease. The signs of a heart attack are similar to angina except that they can occur during rest and tend to be more severe.
The symptoms of a heart attack can sometimes resemble indigestion. Heartburn and a stomach ache can occur, as well as a heavy feeling in the chest.
Other symptoms of a heart attack include:
- pain that travels through the body, for example from the chest to the arms, neck, back, abdomen, or jaw
- lightheadedness and dizzy sensations
- profuse sweating
- nausea and vomiting
Heart failure is also an outcome of heart disease, and breathlessness can occur when the heart becomes too weak to circulate blood.
Some heart conditions occur with no symptoms at all, especially in older adults and individuals with diabetes.
The term 'congenital heart disease' covers a range of conditions, but the general symptoms include:
- high levels of fatigue
- fast heartbeat and breathing
- chest pain
- a blue tint to the skin
- clubbed fingernails
In severe cases, symptoms can occur from birth. However, these symptoms might not develop until a person is older than 13 years.
Heart disease is caused by damage to all or part of the heart, damage to the coronary arteries, or a poor supply of nutrients and oxygen to the organ.
Some types of heart disease, such as hypertrophic cardiomyopathy, are genetic. These, alongside congenital heart defects, can occur before a person is born.
There are a number of lifestyle choices that can increase the risk of heart disease. These include:
- high blood pressure and cholesterol
- overweight and obesity
- family history
- a diet of junk food
- a history of preeclampsia during pregnancy
- staying in a stationary position for extended periods of time, such as sitting at work
Having any of these risk factors greatly increases the risk of heart disease. Some, such as age, are unavoidable. For example, once a woman reaches 55 years of age, heart disease becomes more likely.
There are two main lines of treatment for heart disease. Initially, a person can attempt to treat the heart condition using medications. If these do not have the desired effect, surgical options are available to help correct the issue.
A very wide range of medication is available for the majority of heart conditions. Many are prescribed to prevent blood clots, but some serve other purposes.
The main medications in use are:
- statins, for lowering cholesterol
- aspirin, clopidogrel, and warfarin, for preventing blood clots
- beta-blockers, for treating heart attack, heart failure, and high blood pressure
- angiotensin-converting enzyme (ACE) inhibitors, for heart failure and high blood pressure
Your doctor will work with you to find a medication that is safe and effective. They will also use medications to treat underlying conditions that can affect the heart, such as diabetes before they become problematic.
Heart surgery is an option for people with heart disease, but it can be debilitating.
Heart surgery is an intensive option from which it can take a long time to recover.
However, they can be effective in treating blockages and heart problems for which medications may not be effective, especially in the advanced stages of heart disease.
The most common surgeries include:
- angioplasty, in which a balloon catheter is inserted to widen narrowed blood vessels that might be restricting blood flow to the heart
- coronary artery bypass surgery, which allows blood flow to reach a blocked part of the heart in people with blocked arteries
- surgery to repair or replace faulty heart valves
- pacemakers, or electronic machines that regulate a heartbeat for people with arrhythmia
Heart transplants are another option. However, it is often difficult to find a suitable heart of the right size and blood type in the required time. People are put on a waiting list for donor organs and can sometimes wait years.
Some types of heart disease, such as those that are present from birth, cannot be prevented.
Other types, however, can be prevented by taking the following measures:
- Eat a balanced diet. Stick to low-fat, high-fiber foods and be sure to consume five portions of fresh fruit and vegetables each day. Increase your intake of whole grains and reduce the amount of salt and sugar in the diet. Make sure the fats in the diet are mostly unsaturated.
- Exercise regularly. This will strengthen the heart and circulatory system, reduce cholesterol, and maintain blood pressure.
- Maintain a healthy body weight for your height. Click here to calculate your current and target body mass index (BMI).
- If you smoke, quit. Smoking is a major risk factor for heart and cardiovascular conditions.
- Reduce the intake of alcohol. Do not drink more than 14 units per week.
- Control conditions that affect heart health as a complication, such as high blood pressure or diabetes.
While these steps do not completely eliminate the risk of heart disease, they can help improve overall health and greatly reduce the chances of heart complications.
Exercise is one easy way to keep heart disease at bay.
Heart disease is the most common cause of death for both sexes. Here are some statistics demonstrating the scale of heart disease in the U.S.
- Heart disease causes the deaths of around 630,000 people in the U.S. each year.
- In the U.S., a person has a heart attack every 40 seconds, and at least one person dies per minute from an event related to heart problems.
- The health burden placed by heart disease on the U.S. economy is around $200 billion.
- The most common type of heart disease is coronary heart disease.
- Mississippi is the state with the highest rate of death from heart disease at 233.1 deaths per 100,000 members of the population. The state is closely followed by Oklahoma, Arkansas, Alabama, and Louisiana. Minnesota, Hawaii, and Colorado have the lowest rates.
Advances are being made every day in the research and treatment of heart disease.
A recent study, to be presented at 2018's annual Radiological Society of North America meeting, has shown that fat distribution across the body increases the risk of heart disease and other cardiometabolic conditions in women.
The 69th Annual Conference of the Cardiological Society of India recently saw the presentation of findings that showed the risk of heart disease increase by 500 percent with baldness and gray hair in men.
Smoking just one cigarette each day can increase the risk of heart disease, according to a new study in the BMJ. The research suggests that cutting out cigarettes completely is the only way to reduce this risk, as opposed to simply cutting down the number of cigarettes.
In other news, a study in the New England Journal of Medicinehas linked flu to heart attacks in groups of people who are at risk of heart disease.
A new study also suggests that restless leg syndrome (RLS) may also increase the risk of death from heart-related conditions, especially in older women.
To keep up with the developments on heart disease, click here for all the latest news and research.