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Learn About Heart

Arrhythmia

Arrhythmias


Definition


An arrhythmia is any disorder of your heart rate or heart rhythm, such as beating too fast (tachycardia), too slow (bradycardia), or irregularly.

Alternative Names


Dysrhythmias; Abnormal heart rhythms; Bradycardia; Tachycardia 


Causes


Normally, the 4 chambers of the heart (2 atria and 2 ventricles) contract in a very specific, coordinated manner.

The electrical impulse that signals your heart to contract in a synchronized manner begins in the sinoatrial node (SA node), which is your heart's natural pacemaker.

The signal leaves the SA node and travels through the 2 upper chambers (atria). Then the signal passes through another node (the AV node), and finally, through the lower chambers (ventricles). This path enables the chambers to contract in a coordinated fashion.

Problems can occur anywhere along this conduction system, causing various arrhythmias. Examples include:

  • Supraventricular tachycardia - a fast heart rate that originates in the upper chambers (atria). The most common are atrial fibrillation or flutter, and atrioventricular nodal reentry tachycardia.
  • Ventricular tachycardia - a fast heart rate that originates in the lower chambers (ventricles).
  • Bradycardia - a slow heart rate due to problems with the SA node's pacemaker ability, or some interruption in conduction through the natural electrical pathways of the heart.

The risks of getting a tachycardia or bradycardia varies greatly, depending on the condition of your heart, prior heart attack, blood chemistry imbalances, or endocrine abnormalities.

Arrhythmias may also be caused by some substances or drugs, including beta blockers, psychotropics, sympathomimetics, caffeine, amphetamines, and cocaine. Sometimes antiarrhythmic medications -- prescribed to treat one type of arrhythmia -- can actually cause another type of arrhythmia.

Some types of arrhythmias may be life-threatening if not promptly and properly treated.

Symptoms

  • Fast or slow heart beat (palpitations)
  • Skipping beats
  • Fainting
  • Light-headedness, dizziness
  • Chest pain
  • Shortness of breath
  • Skipping beats - changes in the pattern of the pulse
  • Paleness
  • Sweating
  • Cardiac arrest

The person may not have symptoms.

Exams and Tests


A doctor will listen to your heart with a stethoscope and feel your pulse. Your blood pressure may be low or normal.

The following tests may be performed to identify arrhythmias:

  • ECG
  • Ambulatory cardiac monitoring with a Holter monitor (used for 24 hours) or loop recorder (worn for 2 weeks or longer)
  • Echocardiogram
  • Electrophysiology study (EPS)
  • Coronary angiography

If an arrhythmia is detected, various tests may be done to confirm or rule out suspected causes. EPS testing may be performed to locate the origin of the arrhythmia and determine the best treatment, especially if a pacemaker implantation or catheter ablation procedure is being considered.

Treatment


When an arrhythmia is serious, urgent treatment may be required to restore a normal rhythm. This may include intravenous medications, electrical "shock" therapy (defibrillation or cardioversion), or implanting a temporary pacemaker to interrupt the arrhythmia.

Supraventricular arrhythmias may be treated with anti-arrhythmic drugs. However, most supraventricular arrhythmias can be treated and cured with radiofrequency ablation, eliminating the need for lifelong drug therapy.

Increasingly, most ventricular tachycardias are treated with an implantable cardioverter-defibrillator (ICD). As soon as arrhythmia begins, the ICD sends a shock to terminate it, or a burst of pacing activity to override it.

Bradycardias that cause symptoms can be treated by implanting a permanent pacemaker.

Outlook (Prognosis)


The outcome is dependent on several factors:

  • The kind of arrhythmia -- whether it is supraventricular tachycardia, or a more dangerous arrhythmia such as ventricular tachycardia or ventricular fibrillation, which are potentially fatal
  • The overall pumping ability of the heart
  • The underlying disease and its ability to be treated

With bradycardias treated with a permanent pacemaker, the outlook is usually good.

Possible Complications

  • Angina (chest pain caused by imbalance of supply and demand for oxygen in the heart muscle)
  • Heart attack
  • Heart failure
  • Stroke
  • Sudden death

When to Contact a Medical Professional

Call your provider if you develop any of the symptoms of a possible arrhythmia. Also call your provider if you have been diagnosed with an arrhythmia and your symptoms worsen or do not improve with treatment.

Prevention

Taking steps to prevent coronary artery disease may reduce your chance of developing an arrhythmia. These steps include not smoking; eating a well-balanced, low-fat diet; and exercising regularly.



Review Date: 11/6/2006
Reviewed By: Glenn Gandelman, MD, MPH, Assistant Clinical Professor of Medicine, New York Medical College, Valhalla, NY. Review provided by VeriMed Healthcare Network.

2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Pulmonary Edema

Pulmonary edema

Definition

Pulmonary edema is an abnormal build up of fluid in the lungs, which leads to swelling.

Alternative Names

Lung/pulmonary congestion; Lung water

Causes

Pulmonary edema is usually caused by heart failure. As the heart fails, pressure in the veins going through the lungs starts to rise. As the pressure in these blood vessels increases, fluid is pushed into the air spaces (alveoli) in the lungs. This fluid interrupts normal oxygen movement through the lungs, resulting in shortness of breath.

Pulmonary edema may be caused by damage directly to the lung, such as that caused by poisonous gas or severe infection. Lung damage with a buildup of body fluid is also seen in kidney failure.

Pulmonary edema may also be a complication of a heart attack, leaking or narrowed heart valves (mitral or aortic valves), or any disease of the heart that results in weakening or stiffening of the heart muscle (cardiomyopathy).

Symptoms

Additional symptoms that may be associated with this disease:

Exams and Tests

The health care provider will perform a physical exam and use a stethoscope to listen to the lungs and heart. You may have:

  • Crackles in the lungs or abnormal heart sounds
  • Increased heart rate
  • Pale or blue skin color
  • Rapid breathing

Possible tests include:

  • Blood oxygen levels -- low in patients with pulmonary edema
  • Chest x-ray -- may reveal fluid in or around the lung space or an enlarged heart
  • Electrocardiogram (ECG) -- to detect abnormal heart rhythm or evidence of a heart attack
  • Ultrasound of the heart (echocardiogram) -- to see if there is a weak heart muscle, leaky or narrow heart valves, or fluid surrounding the heart

Treatment

Oxygen is given through a face mask or tiny plastic tubes (prongs) placed in the nose. A breathing tube may be placed into the windpipe (trachea). A breathing machine (ventilator) may be needed.

The cause of the edema should be rapidly identified and treated. For example, if a heart attack has caused the condition, the heart must be treated and stabilized.

Water pills (diuretics), such as furosemide (Lasix) may be given to help excess water leave the body with the urine. Medications to strengthen the heart muscle, control its rhythm, or to relieve the pressure on the heart may also be given.

Outlook (Prognosis)

Although pulmonary edema is a life-threatening condition, it can be treated. How well a patient does depends on what is causing the edema and what treatment is given.

Possible Complications

Some patients may need to use a breathing machine for a long time. If not treated, this condition can be fatal.

When to Contact a Medical Professional

Go to the emergency room or call 911 if you have breathing problems.

Prevention

If you have a disease that can lead to pulmonary edema, you should be sure to take all medicines as instructed. Following a healthy diet, one usually low in salt, can significantly decrease your risk of this condition.

References

Hess OM, Carroll JD. Clinical assessment of heart failure. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa; Saunders Elsevier; 2007: chap 23.

American College of Cardiology/American Heart Association. ACC/AHA Task Force on Practice Guidelines. Update to the 2001 Guidelines for the Evaluation and Management of Heart Failure. J Am Coll Cardiol. 2005;46(6):e1-82.


Review Date: 9/3/2008
Reviewed By: Larry A. Weinrauch, MD, Assistant Professor of Medicine, Harvard Medical School, Cardiovascular Disease and Clinical Outcomes Research, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Congestive Heart Failure

Heart failure

Definition

Heart failure, also called congestive heart failure, is a life-threatening condition in which the heart can no longer pump enough blood to the rest of the body.

Alternative Names

CHF; Congestive heart failure

Causes

Heart failure is almost always a chronic, long-term condition, although it can sometimes develop suddenly. This condition may affect the right side, the left side, or both sides of the heart.

As the heart's pumping action is lost, blood may back up into other areas of the body, including the:

Heart failure results in a lack of oxygen and nutrition to organs, which damages them and reduces their ability to function properly. Most areas of the body can be affected when both sides of the heart fail.

The most common causes of heart failure are:

Other structural or functional causes of heart failure include:

Heart failure becomes more common with advancing age. You are also at increased risk for developing heart failure if you are overweight, have diabetes, smoke cigarettes, abuse alcohol, or use cocaine.

Symptoms

Infants may sweat during feeding (or other activity).

Some patients with heart failure have no symptoms. In these people, the symptoms may develop only with these conditions:

Exams and Tests

A physical examination may reveal the following:

  • Fluid around the lungs (pleural effusion)
  • Irregular heartbeat
  • Leg swelling (edema)
  • Neck veins that stick out (are distended)
  • Swelling of the liver

Listening to the chest with a stethoscope may reveal lung crackles or abnormal heart sounds. Blood pressure may be normal, high, or low.

The following tests may reveal heart swelling or decreased heart function:

This disease may also alter the following test results:

Treatment

If you have heart failure, your doctor will monitor you closely. You will have follow up appointments at least every 3 to 6 months and tests every now and then to check your heart function. For example, an ultrasound of your heart (echocardiogram) will be done once in awhile to see how well your heart pumps blood with each beat.

You will need to carefully monitor yourself and help manage your condition. One important way to do this is to track your weight on a daily basis. Weight gain can be a sign that you are retaining fluid and that the pump function of your heart is worsening. Make sure you weigh yourself at the same time each day and on the same scale, with little to no clothes on.

Other important measures include:

  • Take your medications as directed. Carry a list of medications with you wherever you go.
  • Limit salt intake.
  • Don’t smoke.
  • Stay active. For example, walk or ride a stationary bicycle. Your doctor can provide a safe and effective exercise plan based on your degree of heart failure and how well you do on tests that check the strength and function of your heart. DO NOT exercise on days that your weight has gone up from fluid retention or you are not feeling well.
  • Lose weight if you are overweight.
  • Get enough rest, including after exercise, eating, or other activities. This allows your heart to rest as well. Keep your feet elevated to decrease swelling.

Here are some tips to lower your salt and sodium intake:

  • Look for foods that are labeled “low-sodium,” “sodium-free,” “no salt added,” or “unsalted.” Check the total sodium content on food labels. Be especially careful of canned, packaged, and frozen foods. A nutritionist can teach you how to understand these labels.
  • Don’t cook with salt or add salt to what you are eating. Try pepper, garlic, lemon, or other spices for flavor instead. Be careful of packaged spice blends as these often contain salt or salt products (like monosodium glutamate, MSG).
  • Avoid foods that are naturally high in sodium, like anchovies, meats (particularly cured meats, bacon, hot dogs, sausage, bologna, ham, and salami), nuts, olives, pickles, sauerkraut, soy and Worcestershire sauces, tomato and other vegetable juices, and cheese.
  • Take care when eating out. Stick to steamed, grilled, baked, boiled, and broiled foods with no added salt, sauce, or cheese.
  • Use oil and vinegar, rather than bottled dressings, on salads.
  • Eat fresh fruit or sorbet when having dessert.

Your doctor may consider prescribing the following medications:

  • ACE inhibitors such as captopril, enalapril, lisinopril, and ramipril to open up blood vessels and decrease the work load of the heart
  • Diuretics including thiazide, loop diuretics, and potassium-sparing diuretics to help rid your body of fluid and sodium
  • Digitalis glycosides to increase the ability of the heart muscle to contract properly and help treat some heart rhythm disturbances
  • Angiotensin receptor blockers (ARBs) such as losartan and candesartan to reduce the workload of the heart; this class of drug is especially important for those who cannot tolerate ACE inhibitors
  • Beta-blockers such as such as carvedilol and metoprolol, which are particularly useful for those with a history of coronary artery disease

If you have sudden (acute) heart failure, you may be admitted to the hospital. Treatment may involve:

  • Oxygen
  • Medicines given through a vein, including dobutamine or milrinone, which help the heart pump blood
  • A medication called nesiritide (Natrecor) to help dilate blood vessels

Swan-Ganz catheterization may be needed in some cases. If excessive fluid has gathered around the sac surrounding the heart (pericardium), pericardiocentesis will be done.

Severe heart failure may require the following treatments:

  • Thoracentesis to remove excess fluid
  • Implanted devices such as the intra-aortic balloon pump (IABP) and the left ventricular assist device (LVAD)

These devices can be life-saving, but they are not permanent solutions. Patients who become dependent on circulatory support will need a heart transplant.

Heart failure symptoms may be improved with biventricular pacemaker or cardiac resynchronization therapy. Ask your provider if you are a candidate for this type of treatment.

Outlook (Prognosis)

Heart failure is a serious disorder. It is usually a chronic illness, which may get worse with infection or other physical stress.

Many forms of heart failure can be controlled with medication, lifestyle changes, and treatment of any underlying disorder.

Possible Complications

  • Irregular heart rhythms (can be deadly)
  • Pulmonary edema
  • Total heart failure (circulatory collapse)

Possible side effects of medications include:

When to Contact a Medical Professional

Call your health care provider if weakness, increased cough or sputum production, sudden weight gain or swelling, or other new or unexplained symptoms develop.

Go to the emergency room or call the local emergency number (such as 911) if you experience severe crushing chest pain, fainting, or rapid and irregular heartbeat (particularly if other symptoms accompany a rapid and irregular heartbeat).

Prevention

Follow your health care provider's treatment recommendations and take all medications as directed.

Keep your blood pressure , heart rate, and cholesterol under control as recommended by your doctor. This may involve exercise, a special diet, and medications.

Other important treatment measures:

  • Do not smoke.
  • Do not drink alcohol.
  • Reduce salt intake.
  • Exercise as recommended by your health care provider.

References

Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult. J Am Coll Cardiol. 2005;46:1-82.

Mann DL. Management of heart failure patients with reduced ejection fraction. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Saunders; 2007: chap 25.

Hess OM and Carroll JD. Clinical assessment of heart failure. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Saunders; 2007: chap 23.


Review Date: 9/23/2008
Reviewed By: Larry A. Weinrauch, MD, Assistant Professor of Medicine, Harvard Medical School, and Private practice specializing in Cardiovascular Disease, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Left-Sided Heart Failure

Left-sided heart failure

Definition

Left-sided heart failure is a life-threatening condition in which the left side of the heart cannot pump enough blood to the body.

Alternative Names

Congestive heart failure - left

Causes

Heart failure may affect the right side, the left side, or both sides of the heart. The left side of the heart receives blood rich in oxygen from the lungs and pumps it to the remainder of the body. As the ability to pump blood forward from the left side of the heart is decreased, the remainder of the body does not receive enough oxygen especially when exercising. This results in fatigue.

In addition, the pressure in the veins of the lung increases, which may cause fluid accumulation in the lung. This results in shortness of breath and pulmonary edema.

Common causes of left-sided failure include the following:

  • Drinking too much alcohol
  • Heart attack
  • Heart muscle infections
  • High blood pressure
  • Hypothyroidism
  • Leaking or narrow heart valves
  • Any other disease that damages the heart muscle
  • Poor left-side heart function due to prior heart attacks

In children, common causes include heart birth defects such as abnormal heart valves, abnormal blood vessel connections, or viral infections.

Left-sided heart failure occurs in approximately 1 to 3 of every 100 people and becomes more prevalent with age.

Symptoms

  • Cough (produces frothy or blood-tinged mucus)
  • Decreased urine production
  • Difficulty lying down; need to sleep with the head elevated to avoid shortness of breath
  • Fatigue, weakness, faintness
  • Irregular or rapid pulse
  • Sensation of feeling the heartbeat (palpitations)
  • Shortness of breath
  • Waking up due to shortness of breath (paroxysmal nocturnal dyspnea)
  • Weight gain from fluid retention

Symptoms in infants may include:

Exams and Tests

Physical examination may reveal an irregular or rapid heartbeat and increased breathing rate. The doctor may feel abnormal heart motion when touching the chest wall.

Listening to the heart may reveal heart murmurs or extra heart sounds, and listening to the lungs may reveal crackles or decreased breath sounds at the bottom. The lower legs may be swollen and remain dimpled when pressed.

Tests may include:

Treatment

The goals of treatments are:

  • Treat the disease that is causing the heart failure
  • Reduce symptoms
  • Relieve stress on the heart
  • Reduce risks of worsening heart failure
  • Improve chances of survival

You should see a heart specialist. You may need to stay in the hospital when symptoms are severe.

Treatment may involve:

  • Lifestyle changes such as stopping drinking alcohol
  • Medicines for high blood pressure
  • Surgery or cardiac catheterization to open blocked heart arteries

Persons with heart failure should eat less salt, avoid alcohol, and exercise moderately.

Medicines that may be used include:

  • Beta-blockers to prevent death in certain patients
  • Digitalis to help slow heart rhythms and increase the heart beat
  • Diuretics to help the body get rid of extra fluid
  • Spironolactone or epleronone to prevent salt retention and help patients with severe heart failure
  • ARBs, ACE inhibitors, long-acting nitrates, and hydralazine to reduce the stress on the heart and to prevent further muscle damage and scarring
  • Digoxin to increase muscle strength and slow down abnormally fast heart rates

In severe cases, medicines are given through a vein.

When heart function decreases significantly, a defibrillator may be recommended to prevent sudden cardiac death. A defibrillator is used to prevent dangerous heart rhythms, which often occur in people with very weak hearts.

A number of studies have shown that heart failure symptoms can be improved with a special type of pacemaker. It paces both the right and left sides of heart. This is referred to as biventricular pacing or cardiac resynchronization therapy. Ask your provider if you are a candidate for this.

In very severe cases, when medicines alone do not work, a heart pump (ventricular assist device) can be implanted. A heart transplant may be needed.

Outlook (Prognosis)

Heart failure is a serious condition that can result in early death. How well a person does depends on the cause of the heart failure, as well as the person's age and ability to tolerate exercise.

In many cases, there is little chance that the heart will fully recover. However, many forms of heart failure are well controlled with medication and the condition can remain stable for many years with only occasional flare ups of symptoms.

Possible Complications

  • Pulmonary edema
  • Total failure of the heart to function (circulatory collapse)
  • Abnormal heart rhythms
  • Side effects of medications
    • Low blood pressure (hypotension)
    • Lightheadedness, fainting
    • Headache
    • Chronic cough
    • Low electrolyte levels
    • Difficulty with sexual intercourse

When to Contact a Medical Professional

Call your health care provider if symptoms indicating congestive heart failure occur.

Call your health care provider or get to the emergency room if symptoms are severe or if you experience chest pain, weakness, fainting, rapid or irregular heartbeat, increased cough or sputum production, sudden weight gain, or swelling.

Call your baby's health care provider if the infant has weight loss, poor feeding, or does not appear to be growing or developing normally.

Prevention

Follow your health care provider's advice for treatment of conditions that may cause congestive heart failure. Follow dietary guidelines and minimize or eliminate smoking and alcohol consumption.


Review Date: 9/23/2008
Reviewed By: Larry A. Weinrauch, MD, Assistant Professor of Medicine, Harvard Medical School, and Private practice specializing in Cardiovascular Disease, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Right-Sided Heart Failure

Right-Sided heart failure

Definition

Right-sided heart failure is a condition in which the right side of the heart loses its ability to pump blood efficiently.

Alternative Names

Congestive heart failure - right-sided

Causes

Right-sided heart failure occurs in about 1 in 20 people. Coronary artery disease is the most common cause of heart failure in the United States, but it can be a complication of other conditions.

Heart failure may affect the right side of the heart (right ventricle), the left side (left ventricle), or both sides. In right-sided heart failure, the right ventricle loses its pumping function, and blood may back up into other areas of the body, producing congestion. Congestion affects the liver, the gastrointestinal tract, and the limbs. In addition, the right ventricle may be unable to pump blood efficiently to the lungs and to the left ventricle.

Causes of right-sided heart failure include left-sided heart failure and lung diseases such as chronic bronchitis and emphysema. Other causes include congenital heart disease, clots in pulmonary arteries, pulmonary hypertension, and heart valve disease.

Symptoms

A variety of different situations may trigger an episode of heart failure, including:

Many people admitted to the hospital with heart failure do not follow a recommended low-salt diet or take heart failure medicines as prescribed.

Exams and Tests

A physical examination may reveal:

Common tests may include:

The following lab tests may be performed:

Cardiac catheterization may also be done.

Treatment

Heart failure requires periodic monitoring by your health care provider. The goals of treatment include controlling the symptoms, reducing the heart's workload, and improving your heart's ability to function. Any underlying disorders and causes should be treated, if possible.

The most common therapy for right-sided heart failure is treating left-sided heart failure.

Valve replacements and procedures such as bypass surgery (CABG) and angioplasty may help some people.

LIFESTYLE

Generally, you must reduce the salt in your food and the amount of liquids you drink. You should also consider losing weight if you are overweight, stopping smoking, and avoiding too much alcohol.

MEDICATION

Diuretics (water pills) can help reduce fluid accumulation. Furosemide, torsemide, or bumetanide can help moderate to severe symptoms. Hydrochlorothiazide, chlorthalidone, and chlorothiazide may be used for mild symptoms. Another drug, spironolactone, can prevent salt retention and help patients with severe heart failure.

Medications that reduce your heart's workload include ACE inhibitors, ARBs, and drugs such as hydralazine and long-acting nitrates. They can prolong the life of very sick patients with failing hearts.

Beta-blockers (such as metoprolol or carvedilol) can help prevent death in some heart failure patients.

Digitalis may be prescribed to increase the muscle contraction of the heart and help prevent hospitalization.

IMPLANTED DEVICES

Some patients with ECG abnormalities may benefit from a a biventricular pacemaker, which helps both ventricles contract at the same time (CRT, cardiac resynchronization therapy). A defibrillation device such as an implantable cardioverter-defibrillator (ICD) helps some patients. CRT and ICD may be combined and implanted in a single device (biventricular pacemaker-ICD).

TRANSPLANTS

A patient with severe heart failure that does not respond to these therapies may require a heart transplant.

Outlook (Prognosis)

Heart failure is a serious disorder. Everything possible should be done to prevent the heart's pumping problems from getting worse.

There is no cure, but many forms of heart failure can be controlled with medication, addressing the underlying disorders, and using implanted devices with defibrillation capabilities.

Possible Complications

  • Arrhythmias (abnormal heart rhythms), which may be life-threatening
  • Repeat hospitalizations
  • Side effects of heart failure medications

When to Contact a Medical Professional

Call your health care provider if you notice symptoms of congestive heart failure and your symptoms change, worsen, or do not improve with treatment.

Also call if chest pain, weakness, fainting, rapid or irregular heartbeat, sudden weight gain, swelling, or other new or unexplained symptoms develop.

Prevention

Follow your health care provider's recommendations for treating conditions that may cause congestive heart failure. Follow dietary guidelines -- in particular, reduce salty foods and avoid adding salt to meals -- stop smoking, and cut alcohol use.


Review Date: 9/23/2008
Reviewed By: Larry A. Weinrauch, MD, Assistant Professor of Medicine, Harvard Medical School, and Private practice specializing in Cardiovascular Disease, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Pulmonary Hypertension

Pulmonary hypertension

Definition

Pulmonary hypertension is abnormally high blood pressure in the arteries of the lungs.

Alternative Names

Pulmonary arterial hypertension; Sporadic primary pulmonary hypertension; Familial primary pulmonary hypertension; Idiopathic pulmonary arterial hypertension; Primary pulmonary hypertension; PPH; Secondary pulmonary hypertension

Causes

Pulmonary hypertension is usually caused by a narrowing of the small arteries of the lung, which makes it hard for blood to flow. Blood pressure increases. The right side of the heart must work harder to pump blood, and may become enlarged over time. Eventually, heart failure may develop.

Pumonary hypertension may be caused by:

  • A genetic defect
  • Certain diet medications
  • History of a blood clot in the lung
  • Lung or heart valve disease
  • Obstructive sleep apnea

In some cases, the cause is unknown.

If it occurs without a known cause, it is called primary pulmonary hypertension. If it is caused by a medicine or medical condition, it is called secondary pulmonary hypertension.

Primary pulmonary hypertension is rare. It affects more women than men.

Symptoms

Exams and Tests

A physical examination may show:

  • Enlargement of the veins in the neck
  • Feeling of a pulse over the breastbone
  • Heart murmur
  • Leg swelling
  • Liver and spleen swelling
  • Normal breathing sounds

In early stages of the disease, the exam may be normal or almost normal. The condition may take several months to diagnose. Asthma causes similiar symptoms and must be ruled out.

Tests may include:

Treatment

There is no known cure. The goal of treatment is to control symptoms.

Medicines used to treat pulmonary hypertension include:

  • Ambrisentan (Letairis)
  • Bosentan (Tracleer)
  • Calcium channel blockers
  • Diuretics
  • Prostacyclin
  • Sildenafil

Your doctor will decide which medicine is best for you.

Some patients are put on blood thinners to reduce the risk of blood clots in leg veins and lung arteries.

People with advanced cases of pulmonary hypertension may need oxygen. If treatment with medications fails, suitable candidates may be helped by a lung or heart-lung transplant.

Outlook (Prognosis)

The outlook has been poor, but new therapies may produce better results. Some people with this condition may develop heart failure that worsens and may lead to death.

When to Contact a Medical Professional

Call your health care provider if:

  • You begin to develop shortness of breath when you are active
  • Shortness of breath worsens
  • You develop chest pain
  • You develop other symptoms

Most patients with primary pulmonary hypertension are treated at centers that specialize in the care of these patients.

References

McGoon M, Gutterman D, Steen V, et al. Screening, early detection, and diagnosis of pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest. 2004 Jul;126(1 Suppl):14S-34S.

Hayes D Jr. Idiopathic pulmonary arterial hypertension misdiagnosed as asthma. J Asthma. 2007 Jan-Feb;44(1):19-22.

Barst RJ. Pulmonary hypertension. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 67.


Review Date: 11/12/2008
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Benjamin Medoff, MD, Assistant Professor of Medicne, Harvard Medical School, Pulmonary and Critical Care Unit, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Angioplasty

Angioplasty

Definition

Angioplasty is a medical procedure to open narrowed or blocked blood vessels of the heart. These blood vessels are called the coronary arteries.

Angioplasty is not considered to be a type of surgery. It is called a percutaneous coronary intervention (PCI).

See also:

Alternative Names

Balloon angioplasty; Coronary angioplasty; Coronary artery angioplasty; Cardiac angioplasty; PTCA; Percutaneous transluminal coronary angioplasty; Heart artery dilatation; Percutaneous coronary intervention; PCI

Description

Arteries can become narrowed or blocked by deposits called plaque. Plaque is made up of fat and cholesterol that builds up on the inside of the artery walls. This condition is called atherosclerosis.

If the blockage is not too severe, an angioplasty procedure can be used to open the artery. Traditional angioplasty involves the use of a balloon catheter -- a small, hollow, flexible tube that has a balloon near the end of it.

Before the balloon angioplasty procedure begins, you will be given some pain medicine. Occasionally, blood thinning medicines are also given to prevent formation of a blood clot.

You will lie down on a padded table. The health care provider will make a small cut on your body, usually near the groin, and insert the catheter into an artery. You will be awake during the procedure.

The health care provider will use x-rays to look at your heart and arteries. Dye will be injected into your body to highlight blood flow through the arteries. This helps reveal any blockages in the vessels leading to the heart. The balloon catheter is moved into or near the blockage, and the balloon on the end is blown up (inflated). This opens the blocked vessel and restores proper blood flow to the heart.

In some cases, a device called a stent is also placed at the site of narrowing or blockage in order to keep the artery open. A common type of stent is made of self-expanding, stainless steel mesh.

Rarely, a special device with a small, diamond tip is used to drill through the hard plaque and calcium that are causing the blockage. This is called rotational atherectomy.

Why the Procedure is Performed

Angioplasty may be used to treat:

  • Persistent chest pain (angina)
  • Blockage of one or more coronary arteries
  • Blockage in a coronary artery during or after a heart attack

Note: Recent studies show that medicine and angioplasty with stenting have equal benefits. Angioplasty with stenting does not help you live longer, but it can reduce angina or other symptoms of coronary artery disease. Angioplasty with stenting, however, can be a life-saving procedure if you are having a heart attack

Risks

Risks of angioplasty include:

  • Allergic reaction to the x-ray dye
  • Bleeding in area where the catheter was inserted
  • Blockage of blood flow to an area of the heart (very rare)
  • Damage to a heart valve or blood vessel
  • Death
  • Kidney failure (higher risk in those with existing kidney problems)
  • Irregular heart beats (arrhythmias)
  • Stroke (rare)

The risks for any anesthesia are:

The risks for any surgery are:

  • Bleeding
  • Infection

Outlook (Prognosis)

Angioplasty greatly improves blood flow through the coronary arteries and the heart in most patients. It may eliminate the need for coronary artery bypass surgery (CABG). However, CABG may be recommended for persons whose arteries can not be widened enough with angioplasty or who have severe blockages.

Angioplasty does not cure the cause of the blockage. The arteries may become narrow again, which may or may not require another procedure. Stents coated with medicines (drug-eluting stents) may help prevent future narrowing (drug-eluting stents) and reduce the rates of repeated angioplasty.

You should diet, exercise, stop smoking (if you smoke), and reduce stress to help lower your chances of re-narrowing. Your health care provider may prescribe medicine to help lower your cholesterol.

Most patients receive aspirin and another medicine called clopidogrel (Plavix) after this procedure. It is very important to take the medicines exactly as your doctor tells you. Failure to do so can result in blood clotting in the stent (stent thrombosis) and a heart attack.

Recovery

Usually, the average hospital stay is less than 2 days. Some people may not have to stay overnight in the hospital at all.

In general, persons who have angioplasty are able to walk around within 6 hours after the procedure. Complete recovery takes a week or less. Keep the area where the catheter was inserted dry for 24 to 48 hours.

References

Boden WE, O'rourke RA, Teo KK, et al. Optimal Medical Therapy with or without PCI for Stable Coronary Disease. N Engl J Med. 2007 Mar 26; [Epub ahead of print].


Review Date: 9/3/2008
Reviewed By: Larry A. Weinrauch MD, Assistant Professor of Medicine, Harvard Medical School, Cardiovascular Disease and Clinical Outcomes Research, Watertown, MA.. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Abdominal Aortic Aneurysm

Abdominal aortic aneurysm

Definition

An abdominal aortic aneurysm is when the large blood vessel that supplies blood to the abdomen, pelvis, and legs becomes abnormally large or balloons outward.

Alternative Names

Aneurysm - aortic

Causes

The exact cause is unknown, but risk factors for developing an aortic aneurysm include:

An abdominal aortic aneurysm can develop in anyone, but is most often seen in males over 60 who have one or more risk factors. The larger the aneurysm, the more likely it is to rupture.

When an abdominal aortic aneurysm ruptures, it is a true medical emergency. Aortic dissection occurs when the innermost lining of the artery tears and blood leaks into the wall of the artery. This most commonly occurs in the aorta within the chest.

Symptoms

Aneurysms develop slowly over many years and often have no symptoms. If an aneurysm expands rapidly, tears open (ruptured aneurysm), or blood leaks along the wall of the vessel (aortic dissection), symptoms may develop suddenly.

The symptoms of rupture include:

Exams and Tests

Your doctor will examine your abdomen. The exam also will include an evaluation of pulses and sensation in your legs.

Abdominal aortic aneurysm may be diagnosed with these tests:

Treatment

If the aneurysm is small and there are no symptoms (for example, if it was discovered during a routine physical), your doctor may recommend periodic evaluation. This usually includes a yearly ultrasound, to see if the aneurysm is getting bigger.

Aneurysms that cause symptoms usually require surgery to prevent complications.

Surgery is recommended for patients with aneurysms bigger than 5.5 cm in diameter and aneurysms that rapidly increase in size. The goal is to perform surgery before complications or symptoms develop.

There are two approaches to surgery:

  • In a traditional (open) repair, a large cut is made in your abdomen. The abnormal vessel is replaced with a graft made of synthetic material, such as Dacron.
  • The other approach is called endovascular stent grafting. An endovascular stent graft is a tube made of metal mesh that helps support the artery. Small, hollow tubes called catheters are inserted through arteries in your groin. The stent graft is sent through a catheter, and permanently placed into the artery. Endovascular stent grafting can be done without making a large cut in your abdomen, so you may get well faster. However, not all patients with abdominal aortic aneurysms can have this type of surgery.

Outlook (Prognosis)

The outcome is usually good if an experienced surgeon repairs the aneurysm before it ruptures. However, less than 40% of patients survive a ruptured abdominal aneurysm.

Possible Complications

When to Contact a Medical Professional

Go to the emergency room or call 911 if you develop severe abdominal pain or any of the other symptoms of an aneurysm.

Prevention

To reduce the risk of developing aneurysms:

  • Avoid tobacco
  • Eat well
  • Exercise
  • Get regular physical exams

Men over age 65 who have ever smoked should have a screening ultrasound performed once.

References

Isselbacher EM. Diseases of the aorta. In: Libby P, Bonow RO, mann DL, Zipes DP. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 56.

Fleming C, Whitlock EP, Beil TL, Lederle FA. Screening for abdominal aortic aneurysm: a best-evidence systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2005;142:203-211.

Hunt SA, Abraham WT, Chin, MH, Feldman AM, Francis GS, Ganiats TG, et al. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult. Circulation. 2005;112:1825-1852.


Review Date: 8/28/2008
Reviewed By: Larry A. Weinrauch, MD, Assistant Professor of Medicine, Harvard Medical School, and Private practice specializing in Cardiovascular Disease, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Aneurysm

Aneurysm

Definition

An aneurysm is an abnormal widening or ballooning of a portion of an artery due to weakness in the wall of the blood vessel.

See also:

Causes

It is not clear exactly what causes aneurysms. Some aneurysms are present at birth (congenital). Defects in some of the parts of the artery wall may be responsible.

Common locations for aneurysms include:

  • The major artery from the heart (the aorta)
  • The brain (cerebral aneurysm)
  • In the leg behind the knee popliteal artery aneurysm)
  • Intestine (mesenteric artery aneurysm)
  • An artery in the spleen (Splenic artery aneurysm)

High blood pressure and high cholesterol may raise your risk of certain types of aneurysms. High blood pressure is thought to play a role in abdominal aortic aneurysms. Atherosclerotic disease (cholesterol buildup in arteries) may also lead to the formation of some aneurysms.

Pregnancy is often linked to the formation and rupture of splenic artery aneurysms.

Symptoms

The symptoms depend on the location of the aneurysm. If the aneurysm occurs near the body's surface, pain and swelling with a throbbing mass is often seen.

Aneurysms within the body or brain often cause no symptoms.

If an aneurysm ruptures, low blood pressure, high heart rate, and lightheadedness may occur. The risk of death after a rupture is high.

Exams and Tests

The health care provider will perform a physical exam.

Tests used to diagnose an aneurysm include:

  • CT scan
  • Ultrasound

Treatment

Surgery is generally recommended. The type of surgery and when you need it depends on your symptoms and the size and type of aneurysm.

Some patients may have endovascular stent repair. A stent is a tiny tube used to prop open a vessel or reinforce it's wall. . This procedure can be done without a major cut, so you recover faster than you would with open surgery. Not all patients with aneurysms are candidates for stenting, however. See: Endovascular embolization

Outlook (Prognosis)

With successful surgical repair, the outlook is often excellent.

Possible Complications

The main complications of aneurysm include:

  • Compression of nearby structures such as nerves, which may lead to weakness and numbness (most common with aneurysms that occur in the artery behind the knee)
  • Infection, can lead to body-wide illness and rupture
  • Rupture, which can cause massive bleeding that may lead to death

Massive bleeding is commonly seen with abdominal aortic aneurysms, mesenteric artery aneurysms, and splenic artery aneurysms.

Rupture of brain aneurysms can cause stroke, disability, and death. For more information, see: Cerebral aneurysm

When to Contact a Medical Professional

Call your health care provider for if you develop a lump on your body, whether or not it is painful and throbbing.

Prevention

Control of high blood pressure may help prevent some aneurysms. Following a healthy diet, getting regular exercise, and keeping your cholesterol at a healthy level may also help prevent aneurysms or their complications.

References

Isselbacher EM. Diseases of the aorta. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 78.

Zivin JA. Hemorrhagic cerebrovascular disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 432.

Hauser SC. Vascular diseases of the gastrointestinal tract. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 146.


Review Date: 9/13/2008
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Hypertension

High blood pressure (Hypertension)


Definition


Hypertension is the term doctors use for high blood pressure.

Blood pressure readings are measured in millimeters of mercury (mmHg) and usually given as 2 numbers. For example, 140 over 90 (written as 140/90).

  • The top number is your systolic pressure, the pressure created when your heart beats. It is considered high if it is consistently over 140.
  • The bottom number is your diastolic pressure, the pressure inside blood vessels when the heart is at rest. It is considered high if it is consistently over 90.

Either or both of these numbers may be too high.

Pre-hypertension is when your systolic blood pressure is between 120 and 139 or your diastolic blood pressure is between 80 and 89 on multiple readings. If you have pre-hypertension, you are more likely to develop high blood pressure at some point.

See also: Blood pressure

Alternative Names


Hypertension; HBP; Blood pressure - high

Causes


Blood pressure measurements are the result of the force of the blood produced by the heart and the size and condition of the arteries.

Many factors can affect blood pressure, including how much water and salt you have in your body, the condition of your kidneys, nervous system, or blood vessels, and the levels of different body hormones.

High blood pressure can affect all types of people. You have a higher risk of high blood pressure if you have a family history of the disease. High blood pressure is more common in African Americans than Caucasians.

Most of the time, no cause is identified. This is called essential hypertension. High blood pressure that results from a specific condition, habit, or medication is called secondary hypertension.

Too much salt in your diet can lead to high blood pressure. Secondary hypertension may also be due to:

  • Adrenal gland tumor
  • Alcohol poisoning
  • Anxiety and stress
  • Appetite suppressants
  • Arteriosclerosis
  • Birth control pills
  • Certain cold medicines
  • Coarctation of the aorta
  • Cocaine use
  • Cushing syndrome
  • Diabetes
  • Kidney disease, including:
    • Glomerulonephritis (inflammation of kidneys)
    • Kidney failure
    • Renal artery stenosis
    • Renal vascular obstruction or narrowing
  • Migraine medicines
  • Hemolytic-uremic syndrome
  • Henoch-Schonlein purpura
  • Obesity
  • Pain
  • Periarteritis nodosa
  • Pregnancy (called gestational hypertension)
  • Radiation enteritis
  • Renal artery stenosis
  • Retroperitoneal fibrosis
  • Wilms' tumor

Symptoms


Most of the time, there are no symptoms. Symptoms that may occur include:

  • Confusion
  • Chest pain
  • Ear noise or buzzing
  • Irregular heartbeat
  • Nosebleed
  • Tiredness
  • Vision changes

If you have a severe headache or any of the symptoms above, see your doctor right away. This may be a signs of a complication or dangerously high blood pressure called malignant hypertension.

Exams and Tests


Your health care provider will perform a physical exam and check your blood pressure. If the measurement is high, your doctor may think you have high blood pressure. The measurements need to be repeated over time, so that the diagnosis can be confirmed.

If you monitor your blood pressure at home, you may be asked the following questions:

  • What was your most recent blood pressure reading?
  • What was the previous blood pressure reading?
  • What is the average systolic (top number) and diastolic (bottom number)?
  • Has your blood pressure increased recently?

Other tests may be done to look for blood in urine or heart failure. Your doctor will look for signs of complications to your heart, kidneys, eyes, and other organs in your body.

These tests may include:

  • Chem-20
  • Echocardiogram
  • Urinalysis
  • X-ray of the kidneys

Treatment


The goal of treatment is to reduce blood pressure so that you have a lower risk of complications.

There are many different medicines that can be used to treat high blood pressure. Such medicines include:

  • Alpha blockers
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin receptor blockers (ARBs)
  • Beta-blockers
  • Calcium channel blockers
  • Central alpha agonists
  • Diuretics
  • Renin inhibitors, including aliskiren (Tekturna)
  • Vasodilators

Medicines used if the blood pressure is very high may include:

  • Clonidine
  • Diazoxide
  • Furosemide
  • Hydralazine
  • Minoxidil
  • Nitroprusside

Your doctor may also tell you to exercise, lose weight, and follow a healthier diet. If you have pre-hypertension, your doctor will recommend the same lifestyle changes to bring your blood pressure down to normal range.

Outlook (Prognosis)


Most of the time, high blood pressure can be controlled with medicine and lifestyle changes.

Possible Complications

  • Aortic dissection
  • Blood vessel damage (arteriosclerosis)
  • Brain damage
  • Congestive heart failure
  • Kidney damage
  • Kidney failure
  • Heart attack
  • Hypertensive heart disease
  • Stroke
  • Vision loss

When to Contact a Medical Professional


If you have high blood pressure, you will have regularly scheduled appointments with your doctor.

Even if you have not been diagnosed with high blood pressure, it is important to have your blood pressure checked during your yearly check-up, especially if someone in your family has or had high blood pressure.

Call your health care provider right away if home monitoring shows that your blood pressure remains high or you have any of the following symptoms:

  • Chest pain
  • Confusion
  • Excessive tiredness
  • Nausea and vomiting
  • Severe headache
  • Shortness of breath
  • Significant sweating
  • Vision changes

Prevention

Lifestyle changes may help control your blood pressure:

  • Lose weight if you are overweight. Excess weight adds to strain on the heart. In some cases, weight loss may be the only treatment needed.
  • Exercise regularly.
  • Eat a healthy diet. Eat less fat and sodium. Salt, MSG, and baking soda all contain sodium. Eat more fruits, vegetables, and fiber.
  • Avoid smoking.
  • If you have diabetes, keep your blood sugar under control.

Follow your health care provider's recommendations to modify, treat, or control possible causes of secondary hypertension.


References


Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). Rockville, Md. National Heart, Lung, and Blood Institute, US Department of Health and Human Services; August 2004. National Institutes of Health Publication No. 04-5230.

Wang Y, Wang QJ. The prevalence of prehypertension and hypertension among US adults according to the new joint national committee guidelines: new challenges of the old problem. Arch Intern Med. 2004;164(19):2126-34.

Eyre H, Kahn R, Robertson RM, et al. Preventing cancer, cardiovascular disease, and diabetes: A common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association. Circulation. 2004;109(25):3244-55.

Berg AO. Screening for High Blood Pressure Recommendations and Rationale U.S. Preventive Services Task Force. USPSTF Guide to Clin Preventive Services. June 1, 2003; 1.

Whelton PK, He J, Appel LJ, et al. Primary prevention of hypertension: Clinical and public health advisory from The National High Blood Pressure Education Program. JAMA. 2002;288(15):1882-8.



Review Date: 6/4/2007
Reviewed By: Larry A. Weinrauch, MD, Assistant Professor of Medicine, Harvard Medical School, and Private practice specializing in Cardiovascular Disease,Watertown, MA. Review provided by VeriMed Healthcare Network.
2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Atherosclerosis

Atherosclerosis


Definition


Atherosclerosis is a condition in which fatty material collects along the walls of arteries. This fatty material thickens, hardens, and may eventually block the arteries.

Atherosclerosis is a type of arteriosclerosis. The two terms are often used to mean the same thing.

Alternative Names


Arteriosclerosis; Hardening of the arteries; Plaque buildup - arteries

Causes


Atherosclerosis is a common disorder of the arteries. It occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard substances called plaque.

Eventually, the plaque deposits can make the artery narrow and less flexible. This makes it harder for blood to flow. If the coronary arteries become narrow, blood flow to the heart can slow down or stop, causing chest pain (stable angina), shortness of breath, heart attack, and other symptoms.

Pieces of plaque can break apart and move through the bloodstream. This is a common cause of heart attack and stroke. Blood clots can also form around the plaque deposits. Clots block blood flow. If the clot moves into the heart, lungs, or brain, it can cause a stroke, heart attack, or pulmonary embolism.

Risk factors for atherosclerosis include:

  • Diabetes
  • High blood pressure
  • High cholesterol
  • High-fat diet
  • Obesity
  • Personal or family history of heart disease
  • Smoking

The following conditions have also been linked to atherosclerosis:

  • Cerebrovascular disease
  • Kidney disease involving dialysis
  • Peripheral vascular disease

Symptoms


Symptoms usually do not occur until blood flow becomes slowed or blocked. If this happens, you may have chest pain or leg pain, depending on which artery is involved. Sometimes symptoms occur only with activity.

Exams and Tests


A health care provider will perform a physical exam and listen to the heart and lungs with a stethoscope. Early atherosclerosis can create a whooshing or blowing sound ("bruit") over an artery.

Tests that may be used to diagnose atherosclerosis or complications include:

  • Ankle/brachial index (ABI)
  • Arteriography
  • Cardiac stress testing
  • CT scan
  • Doppler study
  • Intravascular ultrasound (IVUS)
  • Magnetic resonance arteriography (MRA)

Treatment


Your doctor will probably suggest a low-fat diet, weight loss if you are overweight, and exercise.

There are many different medicines used to treat atherosclerosis. Blood thinners may be given to prevent clot formation. Medications may be also recommended to lower cholesterol and to keep your blood pressure at a healthy level.

Atherosclerosis can lead to coronary heart disease (CHD). If you have CHD that does not cause symptoms, you can be treated with either medicine or angioplasty with stenting. Recent studies show that medicine and angioplasty with stenting have equal benefits. Angioplasty with stenting does not help you live longer, but it can reduce angina or other symptoms of coronary artery disease.

Angioplasty with stenting, however, can be a life-saving procedure if you are having a heart attack

Some people may need a procedure called an endarterectomy to remove plaque build up.

See also:

  • Coronary artery bypass surgery
  • Minimally invasive heart surgery

Outlook (Prognosis)


Everyone starts to develop some amount of atherosclerosis as they grow older. In some people, the condition can cause complications such as a heart attack or stroke.

Possible Complications


  • Coronary artery disease
  • Damage to organs (such as the kidneys, brain, liver, and intestines)
  • Heart attack
  • Stroke
  • Too little blood to the legs and feet
  • Transient ischemic attack (TIA)

When to Contact a Medical Professional


Call for an appointment with your health care provider if you are at risk for atherosclerosis, especially if symptoms occur.

Talk to your doctor before starting a new exercise plan, especially if you have been diagnosed with coronary artery disease or if you have ever had a heart attack.

Prevention


The following lifestyle changes can help prevent atherosclerosis:

  • Eat a low-fat, low-cholesterol, and low-salt diet.
  • Eat fish. Adding fish to the diet at least twice a week has been shown to be helpful. Do not fry the fish, as this destroys the benefit.
  • If you don't like to eat fish, try a fish oil supplement.
  • Exercise 30 minutes every day. If you are overweight, you should get 60 to 90 minutes of exercise a day.
  • Lose weight if you are overweight.
  • Stop smoking.
  • Mild to moderate consumption of alcohol or wine (1-2 drinks per day) may also reduce the risk of cardiovascular events. Too much alcohol, however, does more harm than good.
  • If you have one or more risk factors for heart attack or stroke, ask your doctor if you should take aspirin every day. Aspirin can help some people reduce the risk of heart disease and stroke.

Work with your doctor to bring the blood pressure into the normal range. This may require medication. Follow your doctor's recommendations for treatment and control of diabetes and other diseases.

Do not take hormonal replacement therapy, folic acid supplements, vitamin C or E, or antioxidants to decrease the risk of heart disease or stroke. These methods have not been proven to prevent these conditions.


References


Boden WE, O'rourke RA, Teo KK, et al. Optimal Medical Therapy with or without PCI for Stable Coronary Disease. N Engl J Med. 2007 Mar 26; [Epub ahead of print].

Mosca L, Banka CL, Benjamin EJ, et al. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update. Circulation. 2007; Published online before print February 19, 2007.

Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed. St. Louis, Mo: WB Saunders; 2005:921-935.



Review Date: 3/30/2007
Reviewed By: Larry A. Weinrauch, MD, Assistant Professor of Medicine, Harvard Medical School, and Private practice specializing in Cardiovascular Disease, Watertown, MA, and Glenn Gandelman, MD, MPH, Assistant Clinical Professor of Medicine, New York Medical College, Valhalla, NY. Review provided by VeriMed Healthcare Network.
2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Marfan Syndrome

Marfan syndrome


Definition


Marfan syndrome is a disorder of connective tissue, the tissue that strengthens the body's structures. Disorders of connective tissue affect the skeletal system, cardiovascular system, eyes, and skin.

Causes


Marfan syndrome is caused by defects in a gene called fibrillin-1. Fibrillin-1 plays an important role as the building blocks for elastic tissue in the body. A problem with this gene results in changes in elastic tissues, particularly in the aorta, eye, and skin. The gene defect also causes overgrowth of the long bones of the body. resulting in the tall height and long arms and legs seen in persons with this syndrome. How this overgrowth happens is not well understood.

In most cases, Marfan syndrome is inherited, which means it is passed down through families. However, up to 30% of cases have no family history. Such cases are called "sporadic." In sporadic cases, the syndrome is believed to result from a spontaneous new gene defect.

Symptoms


Persons with Marfan syndrome are usually tall with long, thin arms and legs and spider-like fingers -- a condition called arachnodactyly. When they stretch out their arms, the lenght of their arms is significantly greater than their height.

Other symptoms include:

  • Highly arched palate and crowded teeth
  • Nearsightedness
  • Dislocation of the lens of the eye
  • Funnel chest (pectus excavatum) or pigeon breast (pectus carinatum)
  • Scoliosis
  • Flat feet
  • Learning disability
  • Thin, narrow face
  • Micrognathia (small lower jaw)
  • Coloboma of iris
  • Hypotonia

Exams and Tests


The doctor will perform a physical exam. There may be hypermobile joints and signs of heart valve problems, aneurysms, or a collapsed lung.

An eye exam may show vision problems, defects of the lens or cornea, or retinal detachment.

The following tests may be performed:

  • Echocardiogram
  • Fibrillin-1 mutation testing (in some individuals)

An echocardiogram should be done every year to look at the base of the aorta.

Treatment


Visual problems should be corrected when possible. Care should be taken to prevent the development of scoliosis, especially during adolescence.

Medicine to slow the heart rate may help prevent stress on the aorta. Competitive athletics and contact sports should be discouraged so that injury to the heart does not occur. In some cases, surgical replacement of the aortic root and valve is needed.

People with Marfan syndrome should take antibiotics before dental procedures in order to prevent endocarditis. Pregnant women with Marfan syndrome must be monitored very closely because of the increased stress on the heart and aorta.

Support Groups


National Marfan Foundation -- www.marfan.org

Outlook (Prognosis)


Heart-related complications may shorten the lifespan of persons with this disease. However, many patients survive well into their 60s. The lifespan may be extended further with good care and heart surgery.

Possible Complications


Complications may include:

  • Aortic regurgitation
  • Aortic rupture
  • Bacterial endocarditis
  • Dissecting aortic aneurysm
  • Enlargement of the base of the aorta
  • Heart failure
  • Mitral valve prolapse
  • Scoliosis
  • Vision problems

When to Contact a Medical Professional


Experts recommend genetic counseling for couples with a history of this syndrome who wish to have children.

Prevention


Spontaneous new mutations leading to Marfan (less than 1/3 of cases) cannot be prevented.



Review Date: 5/16/2007
Reviewed By: Brian Kirmse, MD, Mount Sinai School of Medicine, Department of Human Genetics, New York, NY. Review provided by VeriMed Healthcare Network.
2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Coronary Disease

Coronary heart disease


Definition


Coronary heart disease (CHD) is a narrowing of the small blood vessels that supply blood and oxygen to the heart. CHD is also called coronary artery disease.


Alternative Names


Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD


Causes


Coronary heart disease is usually caused by a condition called atherosclerosis, which occurs when fatty material and a substance called plaque builds up on the walls of your arteries. This causes them to get narrow. As the coronary arteries narrow, blood flow to the heart can slow down or stop, causing chest pain (stable angina), shortness of breath, heart attack, and other symptoms.

Coronary heart disease (CHD) is the leading cause of death in the United States for men and women. According to the American Heart Association, more than 15 million people have some form of the condition.

Men in their 40s have a higher risk of CHD than women. But, as women get older, their risk increases so that it is almost equal to a man's risk. See: Heart disease and women

Many things increase your risk for CHD. Bad genes (heredity) can increase your risk. You're more likely to develop the condition if someone in your family has had it -- especially if they had it before age 50. Your risk for CHD goes up the older you get.

The following factors also increase your risk of CHD:

  • Diabetes
  • High blood pressure
  • High LDL "bad" cholesterol
  • Low HDL "good" cholesterol
  • Menopause
  • Not getting enough physical activity or exercise
  • Obesity
  • Smoking

Higher-than-normal levels of inflammation-related substances may also increase your risk for a heart attack. Such substances include C-reactive protein and fibrinogen. Increased levels of a chemical called homocysteine, an amino acid, are also linked to an increased risk of a heart attack.

Symptoms


Symptoms may be very noticeable, but sometimes you can have the disease and not have any symptoms.

Chest pain or discomfort (angina) is the most common symptom. You feel this pain when the heart is not getting enough blood or oxygen. How bad the pain is varies from person to person.

There are two main types of chest pain:

  • Atypical chest pain -- often sharp and comes and goes. You can feel it in your left chest, abdomen, back, or arm. It is unrelated to exercise and not relieved by rest or a medicine called nitroglycerin. Atypical chest pain is more common in women.
  • Typical chest pain -- feels heavy or like someone is squeezing you. You feel it under your breast bone (sternum). The pain usually occurs with activity or emotion, and goes away with rest or a medicine called nitroglycerin.

Adults with typical chest pain have a higher risk of CHD than those with atypical chest pain.

Other symptoms include:

  • Shortness of breath
  • Heart attack -- in some cases, the first sign of CHD is a heart attack

Exams and Tests


Many tests help diagnose CHD. Usually, your doctor will order more than one test before making a definite diagnosis.

Tests may include:

  • Electrocardiogram (ECG)
  • Exercise stress test
  • Echocardiogram
  • Nuclear scan
  • Coronary angiography/arteriography
  • Electron-beam computed tomography (EBCT) to look for calcium in the lining of the arteries -- the more calcium, the higher your chance for CHD
  • Coronary CT angiography
  • Magnetic resonance angiography

Treatment


Treatment depends on your symptoms and how severe the disease is.

If you have coronary artery disease that does not cause symptoms, you can be treated with either medicine or angioplasty with stenting. Recent studies show that medicine and angioplasty with stenting have equal benefits. Angioplasty with stenting does not help you live longer, but it can reduce angina or other symptoms of CHD.

Angioplasty with stenting, however, can be a life-saving procedure if you are having a heart attack.

Medications used to treat CHD include:

  • ACE inhibitors to lower blood pressure
  • Blood thinners (antiplatelet drugs) to reduce your risk of blood clots
  • Beta-blockers to lower heart rate, blood pressure, and oxygen use by the heart
  • Calcium channel blockers to relax arteries, lowering blood pressure and reducing strain on the heart
  • Diuretics to lower blood pressure
  • Nitrates (such as nitroglycerin) to stop chest pain and improve blood supply to the heart
  • Statins to lower cholesterol

Procedures to treat and diagnose CHD are called percutaneous coronary interventions, or PCIs. Angioplasty and stenting are types of PCIs. Other types include:

  • Coronary atherectomy
  • Coronary radiation implant or coronary brachytherapy

Coronary brachytherapy delivers radiation into the coronary arteries. This treatment is only for patients who have had a stent-related problems.

Surgeries used to treat CHD include:

  • Coronary artery bypass surgery
  • Minimally invasive heart surgery

Lifestyle changes are very important. Your doctor may tell you to:

  • Avoid or reduce the amount of salt (sodium) you eat
  • Eat a heart healthy diet -- one that is low in saturated fats, cholesterol, and trans fat
  • Get regular exercise and maintain a healthy weight
  • Keep your blood sugar strictly under control if you have diabetes
  • Stop smoking

Outlook (Prognosis)


Everyone recovers differently. Some people can maintain a healthy life by changing their diet, stopping smoking, and taking medications exactly as the doctor prescribes. Others may need medical procedures such as angioplasty or surgery.

Although everyone is different, early detection of CHD generally results in a better outcome.

Possible Complications


  • Heart attack
  • Heart failure
  • Unstable angina
  • Sudden death

When to Contact a Medical Professional


If you have any of the risk factors for CHD, set up an appointment with your doctor to discuss prevention and possible treatment.

If you have angina, shortness of breath, or symptoms of a heart attack, immediately contact your health care provider, call the local emergency number (such as 911), or go to the emergency room.


Prevention


See your health care provider regularly. Tips for preventing CHD or lowering your risk of the disease:

  • Avoid or reduce stress as best as you can.
  • Don't smoke.
  • Eat well-balanced meals that are low in fat and cholesterol and include several daily servings of fruits and vegetables.
  • Get regular exercise. If your weight is considered normal, get at least 30 minutes of exercise every day. If you are overweight or obese, experts say you should get 60 to 90 minutes of exercise every day.
  • Keep your blood pressure, blood sugar, and cholesterol under control.

Moderate amounts of alcohol (1 glass a day for women, 2 for men) may reduce your risk of cardiovascular problems. However, drinking larger amounts does more harm than good.

If you have one or more risk factors for coronary heart disease, talk to your doctor about possibly taking an aspirin a day to help prevent a heart attack or stroke. Low-dose aspirin therapy may be prescribed if the benefit is likely to outweigh the risk of gastrointestinal side effects.

New guidelines no longer recommend hormone replacement therapy, vitamins E or C, antioxidants, or folic acid to prevent heart disease.

References


Mosca L, Banka CL, Benjamin EJ, et al. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update. Circulation. 2007; Published online before print February 19, 2007.

Smith SC Jr, Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute. Circulation. 2006 May 16;113(19):2363-72. Erratum in: Circulation. 2006 Jun 6;113(22):e847.

Boden WE, O'rourke RA, Teo KK, et al. Optimal Medical Therapy with or without PCI for Stable Coronary Disease. N Engl J Med. 2007 Mar 26; [Epub ahead of print].

American Heart Association. Heart Disease and Stroke Statistics — 2007 Update. Dallas, Texas: American Heart Association; 2007.



Review Date: 3/30/2007
Reviewed By: Glenn Gandelman, MD, MPH, Assistant Clinical Professor of Medicine, New York Medical College, Valhalla, NY, and Larry A. Weinrauch, MD, Assistant Professor of Medicine, Harvard Medical School, and Private practice specializing in Cardiovascular Disease, Watertown, MA. Review provided by VeriMed Healthcare Network.
2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Heart Attack

Heart attack


Definition


A heart attack is when low blood flow causes the heart to starve for oxygen. Heart muscle dies or becomes permanently damaged. Your doctor calls this a myocardial infarction.

Alternative Names


Myocardial infarction; MI; Acute MI

Causes


Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. The coronary arteries bring blood and oxygen to the heart. If the blood flow is blocked, the heart starves for oxygen and heart cells die.

A clot most often forms in a coronary artery that has become narrow because of the build-up of a substance called plaque along the artery walls. (See: atherosclerosis) Sometimes, the plaque cracks and triggers a blood clot to form.

Occasionally, sudden overwhelming stress can trigger a heart attack.

It is difficult to estimate exactly how common heart attacks are because as many as 200,000 to 300,000 people in the United States die each year before medical help is sought. It is estimated that approximately 1 million patients visit the hospital each year with a heart attack. About 1 out of every 5 deaths are due to a heart attack.

Risk factors for heart attack and coronary artery disease include:

  • Bad genes (hereditary factors)
  • Being male
  • Diabetes
  • Getting older
  • High blood pressure
  • Smoking
  • Too much fat in your diet
  • Unhealthy cholesterol levels, especially high LDL ("bad") cholesterol and low HDL ("good") cholesterol

Higher-than-normal levels of homocysteine, C-reactive protein, and fibrinogen may also increase your risk for a heart attack. Homocysteine is an amino acid. C-reactive protein and fibrinogen are linked to inflammation. Fibrinogen is also involved in blood clotting.

Symptoms


Chest pain is a major symptom of heart attack. However, some people may have little or no chest pain, especially the elderly and those with diabetes. This is called a silent heart attack.

The pain may be felt in only one part of the body or move from your chest to your arms, shoulder, neck, teeth, jaw, belly area, or back.

The pain can be severe or mild. It can feel like:

  • Squeezing or heavy pressure
  • A tight band around the chest
  • Something heavy sitting on your chest
  • Bad indigestion

Pain usually lasts longer than 20 minutes. Rest and a medicine called nitroglycerine do not completely relieve the pain of a heart attack.

Other symptoms of a heart attack include:

  • Shortness of breath
  • Nausea or vomiting
  • Anxiety
  • Cough
  • Fainting
  • Lightheadedness - dizziness
  • Palpitations (feeling like your heart is beating too fast)
  • Sweating, which may be extreme

Exams and Tests


A heart attack is a medical emergency. If you have symptoms of a heart attack, seek immediate medical help.

The health care provider will perform a physical exam and listen to your chest using a stethoscope. The doctor may hear abnormal sounds in your lungs (called crackles), a heart murmur, or other abnormal sounds.

You may have a rapid pulse. Blood pressure may be normal, high, or low.

Tests to look at your heart include:

  • Coronary angiography
  • CT scan
  • Echocardiography
  • Electrocardiogram (ECG) -- once or repeated over several hours
  • MRI
  • Nuclear ventriculography

Blood tests can help show if you have substances produced by heart tissue damage or a high risk for heart attack. These include:

  • Troponin I and troponin T
  • CPK and CPK-MB
  • Serum myoglobin

Treatment


If you had a heart attack, you will need to stay in the hospital, possibly in the intensive care unit (ICU). You will be hooked up to an ECG machine, so the health care team can look at how your heart is beating. Life-threatening arrhythmias (irregular heart beats) are the leading cause of death in the first few hours of a heart attack.

The health care team will give you oxygen, even if your blood oxygen levels are normal. This is done so that your body tissues have easy access to oxygen, so your heart doesn't have to work as hard.

An intravenous line (IV) will be placed into one of your veins. Medicines and fluids pass through this IV. You may need a tube inserted into your bladder (urinary catheter) so that doctors can see how much fluid your body gets rid of.

THROMBOLYTIC THERAPY

Depending on the results of the ECG, certain patients may be given blood thinners within 12 hours of when they first felt the chest pain. This is called thrombolytic therapy. The medicine is first given through an IV. Blood thinners taken by mouth may be prescribed later to prevent clots from forming.

Thrombolytic therapy is not appropriate for people who have:

  • Bleeding inside their head (intracranial hemorrhage)
  • Brain abnormalities such as tumors or blood vessel malformations
  • Stroke within the past 3 months (or possibly longer)
  • Head injury within the past 3 months

Thrombolytic therapy is extremely dangerous in women who are pregnant or persons who have:

  • Severe high blood pressure
  • Had major surgery or a major injury within the past 3 weeks
  • Internal bleeding within the past 2-4 weeks
  • Peptic ulcer disease
  • A history of using blood thinners such as coumadin

MEDICINES FOR HEART ATTACKS

Many different medicines are used to treat and prevent heart attacks. Nitroglycein helps reduce chest pain. You may also receive strong medicines to relieve pain.

Antiplatelet medicines help prevent clot formation. Aspirin is an antiplatelet drug. Another one is clopidogrel (Plavix).

Beta-blockers (such as metoprolol, atenolol, and propranolol) help reduce the strain on the heart and lower blood pressure.

ACE inhibitors (such as ramipril, lisinopril, enalapril, or captopril) are used to prevent heart failure and lower blood pressure.

SURGERY AND OTHER PROCEDURES

A procedure called angioplasty may be needed to open blocked coronary arteries. This procedure may be used instead of thrombolytic therapy. Angioplasty with stenting can be a life-saving procedure if you are having a heart attack. However, for persons with coronary heart disease, recent studies show that medicine and angioplasty with stenting have equal benefits. Angioplasty with stenting does not help you live longer, but it can reduce angina or other symptoms of coronary artery disease.

Some people may need emergency coronary artery bypass surgery (CABG).

Outlook (Prognosis)


How well you do after a heart attack depends on the amount and location of damaged tissue. Your outcome is worse if the heart attack caused damage to the signaling system that tells the heart to contract.

About a third of heart attacks are deadly. If you live 2 hours after an attack, you are likely to survive, but you may have complications. Those who do not have complications may fully recover.

Usually a person who has had a heart attack can slowly go back to normal activities, including sexual activity.

Possible Complications


  • Blood clot in the lungs (pulmonary embolism)
  • Cardiogenic shock
  • Congestive heart failure
  • Damage extending past heart tissue (infarct extension)
  • Damage to heart valves or the wall between the two sides of the heart
  • Inflammation around the lining of the heart (pericarditis)
  • Irregular heart beats, including ventricular tachycardia and ventricular fibrillation
  • Side effects of drug treatment

When to Contact a Medical Professional


Immediately call your local emergency number (such as 911) or go to the hospital emergency room if you have symptoms of a heart attack.

Prevention


To prevent a heart attack:

  • Keep your blood pressure, blood sugar, and cholesterol under control.
  • Don't smoke.
  • Consider drinking 1 to 2 glasses of alcohol or wine each day. Moderate amounts of alcohol may reduce your risk of cardiovascular problems. However, drinking larger amounts does more harm than good.
  • Eat a low fat diet rich in fruits and vegetables and low in animal fat.
  • Eat fish twice a week. Baked or grilled fish is better than fried fish. Frying can destroy some of the benefits.
  • Exercise daily or several times a week. Walking is a good form of exercise. Talk to your doctor before starting an exercise routine.
  • Lose weight if you are overweight.

If you have one or more risk factors for heart disease, talk to your doctor about possibly taking aspirin to help prevent a heart attack. Aspirin therapy (dose 75 mg to 325 mg a day) or a drug called clopidogrel may be prescribed for women at high risk for heart disease. Aspirin therapy is recommended for women over age 65 to prevent heart attack and stroke as long as blood pressure is controlled and the benefit is likely to outweigh the risk of gastrointestinal side effects. Regular use of aspirin is not recommended for healthy women under age 65 to prevent heart attacks.

New guidelines no longer recommend hormone replacement therapy, vitamins E or C, antioxidants, or folic acid to prevent heart disease.

After a heart attack, you will need regular follow-up care to reduce the risk of having a second heart attack. Often, a cardiac rehabilitation program is recommended to help you gradually return to a normal lifestyle. Always follow the exercise, diet, and medication plan prescribed by your doctor.

References


Mosca L, Banka CL, Benjamin EJ, et al. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update. Circulation. 2007; Published online before print February 19, 2007.

Pollack CV Jr. 2004 American College of Cardiology/American Heart Association guidelines for the management of patients with ST-elevation myocardial infarction: implications for emergency department practice. Ann Emerg Med. 2005; 45(4): 363-76.

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Clinical Guidelines/Evidence Reports. 2003 May; 3(5233); 1.

Boden WE, O'rourke RA, Teo KK, et al. Optimal Medical Therapy with or without PCI for Stable Coronary Disease. N Engl J Med. 2007 Mar 26; [Epub ahead of print].



Review Date: 3/30/2007
Reviewed By: Larry A. Weinrauch, MD, Assistant Professor of Medicine, Harvard Medical School, and Private practice specializing in Cardiovascular Disease, Watertown, MA, and Glenn Gandelman, MD, MPH, Assistant Clinical Professor of Medicine, New York Medical College, Valhalla, NY. Review provided by VeriMed Healthcare Network.
2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com
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Heart Murmurs

Heart murmurs and other sounds


Definition


Murmurs are blowing, whooshing, or rasping sounds produced by turbulent blood flow through the heart valves or near the heart.

Alternative Names


Chest sounds - murmurs; Heart sounds - abnormal

Considerations


A doctor can check heart sounds by listening with a stethoscope. These sounds can be further tested with an echocardiogram to find the exact cause of the murmur.

The heart has four chambers -- two upper chambers (atria) and two lower chambers (ventricles). The heart has valves that temporarily close to limit blood flow to only one direction. The valves are located between the atria and ventricles, and between the ventricles and the major vessels from the heart.

Normal heart sounds are called S1 and S2. They are the "lubb-dupp" sounds that are thought of as the heartbeat. These sounds occur when the heart valves close.

Because the heart is also divided into a "right side" and a "left side," sometimes these sounds may be somewhat divided. Most commonly noted is a "split S2," caused when the right and left ventricles relax, and valves close at very slightly different times. This is normal, but occasionally the nature of the split can indicate an abnormality, such as enlargement of one of the ventricles.

Murmurs occur when a valve does not close tightly (such as with mitral regurgitation) and blood leaks backward, or when the blood flows through a narrowed or stiff valve (such as with aortic stenosis).

A murmur does not necessarily indicate a disease or disorder, and not all heart disorders cause murmurs. Murmurs are classified ("graded") depending on their ability to be heard by the examiner. The grading is on a scale in which grade I is barely detectable. An example of a murmur description is a "grade II/VI murmur." (This means the murmur is grade 2 on a scale of 1 to 6).In addition, a murmur is described by the stage of the heartbeat when the murmur is heard.

The following are important clues to the cause of the murmur:

  • Does the murmur occur in the resting stage (diastole) or contracting stage (systole)?
  • Does it occur early or late in the stage?
  • Does it occur throughout the heartbeat?

For example, a presystolic murmur is heard just BEFORE systole and is usually caused by narrowing of the mitral or tricuspid valve (the valves between the atria and the ventricles).

The location where the health care provider hears the murmur loudest is also often noted.

Causes


Significant murmurs can be caused by:

  • Aortic regurgitation
  • Aortic stenosis
  • Mitral regurgitation - acute
  • Mitral regurgitation - chronic
  • Mitral stenosis
  • Pulmonary regurgitation (backflow of blood into the right ventricle, caused by failure of the pulmonary valve to close completely)
  • Pulmonary stenosis
  • Tricuspid regurgitation
  • Tricuspid stenosis

Significant murmurs in children are more likely to be caused by:

  • Anomalous pulmonary venous return (an abnormal formation of the pulmonary veins)
  • Atrial septal defect (ASD)
  • Coarctation of the aorta
  • Patent ductus arteriosus (PDA)
  • Ventricular septal defect (VSD)

Children often have murmurs that are a normal part of development and do not require treatment. These murmurs include:

  • Pulmonary flow murmurs
  • Still's murmur
  • Venous hum

What to Expect at Your Office Visit


A health care provider will usually discover a heart murmur during a physical examination. You may or may not have been aware of its presence. The physical examination will include careful attention to heart sounds.

The doctor may ask the following questions:

  • Have other family members had murmurs or other abnormal heart sounds?
  • Is there any family history of heart problems?
  • What other symptoms do you have, such as bluish skin color (cyanosis), liver enlargement, distended neck veins, lung sound changes, weight gain, swelling, or shortness of breath?

Diagnostic testing to determine the cause of a "new" murmur or other abnormal heart sound may include:

  • Chest x-ray
  • ECG
  • Echocardiography


  • Review Date: 3/30/2007
    Reviewed By: Larry A. Weinrauch, MD, Assistant Professor of Medicine, Harvard Medical School, and Private practice specializing in Cardiovascular Disease, Watertown, MA, and Glenn Gandelman, MD, MPH, Assistant Clinical Professor of Medicine, New York Medical College, Valhalla, NY. Review provided by VeriMed Healthcare Network.
    2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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