Heart attack illustration
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If you're like most people, you think that heart disease is a problem for others. But heart disease is the number one killer in the U.S. It is also a major cause of disability. There are many different forms of heart disease. The most common cause of heart disease is narrowing or blockage of the coronary arteries, the blood vessels that supply blood to the heart itself.
Heart attack illustration
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Heart disease and Stroke Prevention
The most common form of heart disease is coronary artery disease (CAD). In CAD, plaque builds up on the walls of the arteries that carry blood to the heart. Over time, this buildup causes the arteries to narrow and harden. This keeps the heart from getting all the blood it needs. Blood clots may develop. If the clot mostly or completely blocks blood flow to the heart, it causes a heart attack. Stroke happens when the brain doesn’t get enough blood. Without enough blood, brain cells start to die.
Heart attack, stroke, and other forms of heart disease are a threat to so many women. But you can take steps to protect your heart and lower your risk. Steps include getting regular physical activity, making healthy food choices, knowing your numbers and taking good care of yourself overall. It is also important to make sure you talk to your doctor about heart health and the use of menopausal hormone therapy or aspirin.
You don't have to become a super athlete, but your body needs to move. The 2008 Physical Activity Guidelines for Americans state that an active lifestyle can lower your risk of early death from heart disease, stroke, and many other health problems. It can also boost your mood. Health benefits are gained by doing the following each week:
2 hours and 30 minutes of moderate-intensity aerobic physical activity
or
1 hour and 15 minutes of vigorous-intensity aerobic physical activity
or
A combination of moderate and vigorous-intensity aerobic physical activity
and
Muscle-strengthening activities on 2 or more days
So pick an activity you like, and do it often.
Eating fatty, greasy food can make you put on weight. But that's not the only risk. Unhealthy eating has a direct impact on your arteries, your blood pressure, your glucose level, among other things. You don't need to go on a special diet to eat healthy. Just make sure you focus on eating fruits and vegetables, whole grains, fat-free or low-fat dairy products, fish, beans, peas, nuts, and lean meats. The foods you eat should also be low in saturated fat, trans fat, cholesterol (koh-LESS-tur-ol), salt, and added sugars. If you drink alcohol, do it moderately. Women should drink no more than one alcoholic drink per day.
Ask your doctor to check your blood pressure, cholesterol (total, HDL, LDL, and triglycerides) and blood sugar levels. These simple screening tests will give you important information about your heart health. Your doctor can tell you what your numbers mean and what you need to do to protect your heart. Check out the Screening tests and vaccines section on this site to learn how often you need these screening tests.
Stress, anxiety, depression, and lack of sleep have all been linked to increased risk of heart disease. And they're not doing your mind or the rest of your body any good either. You may feel that you don't have enough time to take a break or get enough sleep now. But the possible results of overloading yourself, including heart attack and stroke, aren't worth it. In the midst of all you do, it's important to make time for yourself. Make sure you get the amount of sleep you need each day to wake up feeling refreshed. Take steps to keep stress in check, such as taking time each day to relax and unwind with friends or loved ones. And if you're having trouble coping because of depression, anxiety, or other emotional health issues, get help. Your doctor or a counselor can teach you healthy ways to reduce stress or suggest treatment for depression or other mental health problems. Although we don't know if treating emotional problems or reducing stress lowers heart disease risk, doing so will boost your overall health and well-being.
Once you reach menopause, your ovaries stop making estrogen, which protects against plaque buildup, and your heart disease risk goes up. You might wonder if menopausal hormone therapy (MHT) can help lower the risk. But recent studies confirmed that women should not use MHT to protect against heart disease. Rather, MHT is good at relieving moderate to severe symptoms of menopause and preventing bone loss. For now, the safest option for MHT is to use the lowest dose that helps for the shortest time you need it. Learn more about study findings and the benefits and risks of MHT in our menopause section.
The U.S. Preventive Services Task Force recommends that women ages 55 to 79 take aspirin to lower their risk of ischemic stroke. This is advised when the benefit outweighs the possible harm of gastrointestinal bleeding. The benefit depends on your personal risk of both stroke and gastrointestinal bleeding. You should discuss your risk with your doctor and decide together if taking aspirin is right for you.
Are you at risk for having a heart attack?
Factors such as your age, cholesterol levels, and blood pressure affect your heart health. Use this Web tool to determine your 10-year risk of having a heart attack.
More information on heart disease: Know your risk
Heart disease is the leading cause of death in the United States. Reading those words may make you feel like you have no control. But many things can affect whether or not you develop heart disease, some of which you can control. That's why it is important to understand your personal risk factors.
Risk factors are conditions, habits, family history, and other facts about yourself that make you more likely to develop certain diseases. The more risk factors you have, the higher your risk of getting certain diseases. Some risk factors such as age or family history can't be controlled. But many can be controlled by making changes in the way you live. In this section you can learn more about the different kinds of risk factors that you can and can't control.
Heart disease risk factors you can control
Heart disease risk factors you can't control
Other possible heart disease risk factors
Did you know?
In women, high triglycerides combined with low HDL cholesterol can mean a very high risk of heart disease.
Poor blood cholesterol and triglyceride levels
High blood pressure
Cigarette smoking
Diabetes
Being overweight or obese
Lack of physical activity
Drinking alcohol
Sleep apnea
Metabolic syndrome
More information on heart disease risk factors you can control
You can control the following risk factors by making lifestyle changes. Your doctor might also suggest medicine to help control some risk factors, such as high blood pressure or high cholesterol.
These are types of fat found in your blood and other parts of your body. The body needs small amounts of them to work, but too much can cause a problem. The extra amounts can cling to, and clog, your arteries. A blood test can measure your levels of:
Low-density lipoprotein (LDL) or “bad” cholesterol – High levels lead to buildup of cholesterol in arteries. To lower your heart disease risk, your LDL level should be less that 100 mg/dL.
High-density lipoprotein (HDL) or “good” cholesterol – High levels of this type are actually good. HDL cholesterol helps lower the total cholesterol level in your body. To lower your heart disease risk, your HDL levels should be above 60 mg/dL.
Total cholesterol – This is your LDL cholesterol plus HDL cholesterol. To lower your heart disease risk, your total cholesterol should be less than 200 mg/dL.
Triglycerides – Another artery clogger. To lower your heart disease risk, your triglyceride level should be less than 150 mg/dL.
Blood pressure is the force your blood makes against your artery walls. If this pressure is too high, over time it can damage your artery walls. There are two kinds of pressure. Systolic (siss-TOL-ihk) is the pressure as your heart pumps blood into your arteries. Diastolic (deye-uh-STOL-ihk) is the pressure between beats, when your heart relaxes. To lower your risk of heart disease, your blood pressure should be less than 120 systolic/80 diastolic.
Smoking hurts your heart. The more you smoke, the higher your risk. About half of all heart attacks in women are due to smoking! And, if you smoke and also take birth control pills, you are at even higher risk.
Diabetes is a disease in which blood glucose (sugar) levels are too high. Type 2 diabetes is the most common type. It usually begins after the age of 40, often in people who are overweight or obese. Uncontrolled diabetes can damage artery walls. This risk is even higher in women than men.
The more overweight you are, the higher your risk of heart disease. This is true even if you have no other risk factors. Being overweight also raises your chances of developing diabetes, high blood pressure, and high cholesterol. To lower your risk, your body mass index (BMI) should be between 18.5 and 24.9. A BMI of 30 or higher is considered obese. Use this calculator to find your BMI.
Related information
Screening tests and vaccines – Learn how often you need screening tests for heart health
Like being overweight, lack of physical activity raises your heart disease risk even if you have no other risk factors. Being inactive also increases your chances of developing high blood pressure and diabetes. It also raises your risk of being overweight or obese.
You can improve your health by doing the following each week:
Aerobic activity that includes:
2 hours and 30 minutes of moderate-intensity aerobic activity, or
1 hour and 15 minutes of vigorous-intensity aerobic activity, or
A combination of moderate and vigorous activity
and
Muscle-strengthening activities on 2 or more days of the week
So pick an activity you like, and do it often.
Depending on how much you drink, alcohol can greatly raise your risk of heart disease, or help lower it. Heavy drinking can cause many heart-related problems. More than three drinks a day can raise blood pressure and triglyceride levels. Too much alcohol can also damage your heart muscle. However, moderate drinkers are less likely to develop heart disease than people who drink heavily or don't drink at all. For women, moderate means no more than one drink a day. Drinking more than one drink a day increases your risk of certain cancers. And if you're pregnant or planning to become pregnant, you should not drink. Your doctor can help you decide if the heart benefits of moderate drinking outweigh the risks.
Has anyone ever told you that you snore? Loud snoring can be a sign of sleep apnea (AP-nee-uh). Sleep apnea is a sleep disorder that can raise your chances of having a heart attack. With obstructive sleep apnea — the most common type — the tissue in the back of the throat relaxes. This blocks airflow to your lungs. This lowers the oxygen level in your blood, which makes your heart work harder. Sleep apnea often leads to high blood pressure. If you think you might have sleep apnea, talk to your doctor.
Having metabolic (met-uh-BOL-ihk) syndrome doubles your risk of getting heart disease or having a stroke. You have it if you have any three of these five risk factors:
Waist measurement of more than 35 inches
Triglyceride level more than 150 mg/dL
HDL cholesterol level less than 50 mg/dL
Systolic blood pressure greater than or equal to 130 mmHg or diastolic blood pressure great than or equal to 85 mmHg.
Blood glucose level after fasting for at least eight hours of greater than 110 mg/dL
Taking steps to eliminate these risk factors will improve your heart and overall health.
Cleveland Clinic, Abu Dhabi
Age
Family history of early heart disease
Race and ethnicity
More information on heart disease risk factors you can't control
You can't control these risk factors. But knowing what they are can help you understand your overall risk for heart disease.
Women usually develop heart disease about 10 to 15 years later than men. This is because until menopause, the ovaries produce estrogen. Estrogen protects women against plaque buildup. But at menopause the ovaries stop making estrogen, and your risk goes up. By age 70, women have about the same risk for heart disease as same-aged men. Menopause isn't the only reason getting older is a risk factor. As people age, arteries get stiffer and thicker. Also, systolic blood pressure (the top number) often goes up. These changes contribute to plaque buildup in artery walls.
Women with a father or brother who developed heart disease before age 55 are at higher risk. Women with a mother or sister who developed heart disease before age 65 are also at higher risk. However, young women with a family history may not be aware of this risk. So, they may be less careful about living a heart-healthy lifestyle than men with a family history.
As a group, African Americans are more likely to develop high blood pressure. Research also suggests that racial and ethnic minorities are generally more likely to develop heart disease. The reasons for this greater risk are unclear.
Depression, stress, and anxiety
Not enough sleep
Lower income
More information on other possible heart disease risk factors
Emotional and environmental factors can also contribute to your heart disease risk.
Negative emotions like depression, stress, and anxiety can raise your risk of developing heart disease. Researchers aren't exactly sure why this is. Perhaps these emotions lead to unhealthy ways of coping, such as smoking, drink too much, or eating high-fat foods — all which can put your heart health at risk. Research also suggests that depression itself is a risk factor for heart disease. Depression, stress, and other negative emotions may affect the body in ways that trigger plaque buildup or clot formation within the arteries. So, taking care of your emotional health is also an important part of taking care of your heart health. Talk to your doctor or a counselor if you have symptoms of depression or problems coping with daily stressors.
Not getting enough sleep won't just make you cranky, it can also raise your risk of heart disease. Most adults need seven to nine hours of sleep every night. In adults between the ages of 32 and 59, sleeping less than five hours each day can double the risk of high blood pressure. So make sure you're getting enough sleep to wake up feeling refreshed. If you're having trouble sleeping, don't drink caffeine or alcohol before bed and make sure your bedroom is cool and dark. Also, try doing something relaxing before bed and use your bed for sleep and sex only.
Research shows that lower income adults have an increased risk of heart disease. Children born into lower income families are also more likely to have heart disease as adults. This may be because low-income adults are less likely to be physically active, eat a heart-healthy diet, and are more likely to smoke. It can be difficult to eat a heart-healthy diet in lower income neighborhoods. It may also be hard to find a safe place to be physically active. Check with religious or community centers, or the parks department to see if there are any physical activity groups you can join.
Related information
Make the Call. Don't Miss a Beat. Heart attack information for women
More information on signs of a heart attack
Many people think a heart attack is sudden, like a "movie" heart attack, where someone clutches her chest and falls over. But the truth is that many heart attacks start slowly as mild pain or discomfort. These feelings may even come and go. A heart attack is very serious and you should get to the hospital right away by calling 9-1-1. Learn what to expect at the hospital when you're having a heart attack.
For both women and men, the most common sign of a heart attack is pain or discomfort in the center of the chest. The pain or discomfort can be mild or strong. It can last more than a few minutes, or it can go away and come back. See the figure, "Signs of a Heart Attack," for a full list of heart attack signs.
Women are more likely than men to have the "other" common signs of a heart attack. These include shortness of breath, nausea or vomiting, and pain in the back, neck, or jaw. Sometimes the signs of a heart attack happen suddenly. But they can also develop slowly, over hours, days, and even weeks before a heart attack.
The more heart attack signs that you have, the more likely it is that you are having a heart attack. Also, if you've already had a heart attack, your symptoms may not be the same for another one. Even if you're not sure you're having a heart attack, you should still have it checked out.
If you think you, or someone else, may be having a heart attack, wait no more than a few minutes — five at most — before calling 911. Do not drive yourself or let a friend drive you. You may need medical help on the way to the hospital. Paramedics are trained to treat you on the way to the emergency room.
Getting there quickly is very important. Treatments for opening clogged arteries work best within the first hour after a heart attack starts. Women are more likely than men to die of a heart attack. One reason is that women often have the less-common signs. This can lead to misdiagnosis. If you think you're having a heart attack, get emergency help right away. Don't let anyone tell you that you are overreacting or to wait and see. Ask for tests that can show if you're having a heart attack. It's better to be safe than sorry.
Cardiac arrest
A heart attack is not the same as cardiac arrest. In a heart attack, the heart does not usually stop beating. During cardiac arrest, the heart totally stops beating.
With cardiac arrest, the only way to restart the heart is with a defibrillator (dee-FIB-ruh-lay-tur), a machine that sends an electrical shock to the heart to restore normal rhythm. This treatment must be given as soon as possible. Call 911 and begin CPR immediately. The American Heart Association says that with "hands only" CPR, anyone can give lifesaving treatment to someone having cardiac arrest. Push hard and fast in the center of the chest and keep going until emergency personnel arrive. Do not give CPR for heart attack.
Make the Call, Don't Miss a Beat - Not all women have chest discomfort or other common symptoms during their heart attack. Use this website to learn more about the symptoms of a heart attack in women and what to do if you think you are experiencing a heart attack.
A stroke happens when part of your brain doesn't get the blood that it needs. It is sometimes called a "brain attack." This is because, like a heart attack, a stroke causes a lack of blood flow. Without blood, your brains cells will start to die within minutes. A stroke is very serious and you should get to the hospital right away by calling 9-1-1. Learn what to expect at the hospital when you're having a stroke.
Strokes happen fast. Some of the most common signs are sudden numbness or weakness on one side of the body, confusion, and trouble walking or speaking. See the figure, "Signs of a Stroke," for a full list of stroke signs.
If you have stroke signs that don't last long, you might have had a "mini-stroke." These small strokes — called a transient ischemic attack (TIA) — may not last long, but they still require treatment. Also, a TIA could be a sign that you are about to have a major stroke. "Mini" or not, these symptoms are an emergency.
If you have or see someone having any stroke symptoms, call 911 right away. Every minute counts! Current stroke treatments can raise the chances of recovering with few or no disabilities. But you must get help right away. These treatments will work only if you get them no later than three hours after your symptoms began. Do not drive yourself or let a friend drive you. You may need medical help on the way to the hospital. Paramedics are trained to treat you on the way to the emergency room.
If you're having a stroke, you may not be able to call 911. In fact, you may not even be able to move or talk! In most stroke cases, it's a family member, coworker, or other bystander who calls 911. That's why everyone should know the signs of stroke and how to react.
Choosing a hospital
The hospital you go to can really matter. You have a better chance of having a good outcome if you're taken to a certified stroke center. They have the staff, equipment, and experience need to treat stroke quickly and correctly. Find the nearest certified stroke center, and give the name and address to your family or caregivers. Tell them that if you have a stroke, you want to be taken to that hospital. Even if you live in a rural area, emergency personnel might be able to take you to a certified center by helicopter.
You've had a sudden onset of numbness and paralysis or other symptoms of stroke, and you or a companion have called 911. Now what? What happens when you get to the hospital?
Once you get to the hospital, these things will happen quickly:
A doctor or nurse will ask you or your companion about your symptoms and when they began.
You'll be asked to do several physical and mental tasks. This helps identify the parts of your brain that might be affected by the stroke.
You will be given several other tests to rule out other causes of your symptoms.
What happens if the doctor decides I've had a stroke?
The next step will be to use one or more brain imaging tests to see where the stroke is located. The two main methods are computed tomography (tuh-MOG-ruh-fee) (CT) scan and magnetic resonance imaging (MRI).
How will my stroke be treated?
This depends upon the type of stroke you have had and how quickly you receive medical care.
If you have the most common type of stroke (ischemic), you might get a clot-busting drug called t-PA. It is injected into one of your veins. This drug travels in the blood to your brain and breaks up the clot. To work properly and safely, t-PA must be given within three hours from the time your stroke started. In fact the sooner t-PA is given, the better it works.
A new therapy for ischemic strokes is the Mechanical Embolus Removal for Cerebral Ischemia (MERCI) system. A thin wire is guided into the blood vessels and to the blocked artery in the brain. The doctors use the wire to pull the clot out. The MERCI system can be used for up to eight hours after stroke onset.
If you've had the kind of stroke that involves bleeding into the brain, there are fewer treatment options. Usually, little can be done to stop the bleeding. But treatment usually involves trying to reduce pressure with drugs or surgery.
Once your condition is stable, your doctor will talk to you about next steps. This might involve therapy, such as physical therapy or speech therapy, medicines, or surgery.
Aspirin for Reducing Your Risk of Heart Attack and Stroke: Know the Facts - Before you decide to use aspirin to lower your risk of heart attack and stroke, the Center for Drug Evaluation and Research suggests that you talk with your health care provider to learn the effects of aspirin on your health.
Coronary Heart Disease Risk Factors (Copyright © Journal of the American Medical Association) - This fact sheet describes the main risk factors of coronary heart disease. Some factors you can control, and some you cannot, but it is important to do what you can to keep your heart healthy and strong.
Five Medication-Free Strategies to Help Prevent Heart Disease (Copyright © Mayo Foundation) - If you are at risk of developing heart disease because of family history or lifestyle factors, follow these five simple steps for preventing heart disease. These steps include stopping tobacco use, eating a healthy diet, and exercising.
Healthy Living After Stroke (Copyright © American Stroke Association) - People who have had a stroke in the past are at higher risk of having another. These tips from the American Heart Association discuss how nutrition, physical activity, following your doctor’s orders, and other factors can help reduce your risk.
Heart Attack Risk Assessment (Copyright © American Heart Association) - The American Heart Association has developed a heart attack and interactive coronary heart disease assessment tool for people aged 20 years and older who do not already have heart disease or diabetes. After completing your assessment, you can print your results and use them to help reduce your risk of developing heart disease.
Heart Disease and Heart Attacks: What Women Need to Know (Copyright © American Academy of Family Physicians) - Women are at risk of heart attack just like men, but the signs and symptoms can be different. This fact sheet describes the difference in symptoms between men and women and explains how you can protect yourself from heart disease.
Lifestyle Changes (Copyright © American Heart Association) - this web page explains the ABCs of preventing heart attack and stroke: Avoiding tobacco, becoming more active, and choosing good nutrition.
Your Guide to Physical Activity and Your Heart - You know you should be more physically active. But are you confused, concerned, or just can't get started? This guide uses science-based information to help adults develop a safe and effective program of physical activity that can be sustained. Find out about the importance of physical activity in reducing heart disease risk and how to begin or maintain an activity program that's right for you!
National Center for Chronic Disease Prevention and Health Promotion, CDC
National Institute of Neurological Disorders and Stroke, NIH, HHS
U.S. Food and Drug Administration
Source: Office on Women's Health, HHS
What Is the Heart?
Your heart is a muscular organ that pumps blood to your body. Your heart is at the center of your circulatory system. This system consists of a network of blood vessels, such as arteries, veins, and capillaries. These blood vessels carry blood to and from all areas of your body.
An electrical system controls your heart and uses electrical signals to contract the heart's walls. When the walls contract, blood is pumped into your circulatory system. Inlet and outlet valves in your heart chambers ensure that blood flows in the right direction.
Your heart is vital to your health and nearly everything that goes on in your body. Without the heart's pumping action, blood can't move throughout your body.
Your blood carries the oxygen and nutrients that your organs need to work well. Blood also carries carbon dioxide (a waste product) to your lungs so you can breathe it out.
A healthy heart supplies your body with the right amount of blood at the rate needed to work well. If disease or injury weakens your heart, your body's organs won't receive enough blood to work normally.
Your heart is located under your ribcage in the center of your chest between your right and left lungs. Its muscular walls beat, or contract, pumping blood to all parts of your body.
The size of your heart can vary depending on your age, size, and the condition of your heart. A normal, healthy, adult heart usually is the size of an average clenched adult fist. Some diseases can cause the heart to enlarge.
Figure A shows the location of the heart in the body. Figure B shows the front surface of the heart, including the coronary arteries and major blood vessels.
In figure B, the heart is the muscle in the lower half of the picture. The heart has four chambers. The heart's upper chambers, the right and left atria (AY-tree-uh), are shown in purple. The heart's lower chambers, the right and left ventricles (VEN-trih-kuls), are shown in red.
Some of the main blood vessels (arteries and veins) that make up your circulatory system are directly connected to the heart.
In figure B above, the superior and inferior vena cavae are shown in blue to the left of the heart muscle as you look at the picture. These veins are the largest veins in your body.
After your body's organs and tissues have used the oxygen in your blood, the vena cavae carry the oxygen-poor blood back to the right atrium of your heart.
The superior vena cava carries oxygen-poor blood from the upper parts of your body, including your head, chest, arms, and neck. The inferior vena cava carries oxygen-poor blood from the lower parts of your body.
The oxygen-poor blood from the vena cavae flows into your heart's right atrium and then to the right ventricle. From the right ventricle, the blood is pumped through the pulmonary (PULL-mun-ary) arteries (shown in blue in the center of figure B) to your lungs.
Once in the lungs, the blood travels through many small, thin blood vessels called capillaries. There, the blood picks up more oxygen and transfers carbon dioxide to the lungs—a process called gas exchange. To learn more about gas exchange, go to the Health Topics How the Lungs Work article.
The oxygen-rich blood passes from your lungs back to your heart through the pulmonary veins (shown in red to the left of the right atrium in figure B).
Oxygen-rich blood from your lungs passes through the pulmonary veins (shown in red to the right of the left atrium in figure B above). The blood enters the left atrium and is pumped into the left ventricle.
From the left ventricle, the oxygen-rich blood is pumped to the rest of your body through the aorta. The aorta is the main artery that carries oxygen-rich blood to your body.
Like all of your organs, your heart needs oxygen-rich blood. As blood is pumped out of your heart's left ventricle, some of it flows into the coronary arteries (shown in red in figure B).
Your coronary arteries are located on your heart's surface at the beginning of the aorta. They carry oxygen-rich blood to all parts of your heart.
Below is a picture of the inside of a normal, healthy, human heart.
Figure A shows the location of the heart in the body. Figure B shows a cross-section of a healthy heart and its inside structures. The blue arrow shows the direction in which oxygen-poor blood flows through the heart to the lungs. The red arrow shows the direction in which oxygen-rich blood flows from the lungs into the heart and then out to the body.
Figure B shows the inside of your heart and how it's divided into four chambers. The two upper chambers of your heart are called the atria. They receive and collect blood.
The two lower chambers of your heart are called ventricles. The ventricles pump blood out of your heart to other parts of your body.
An internal wall of tissue divides the right and left sides of your heart. This wall is called the septum.
The area of the septum that divides the atria is called the atrial or interatrial septum. The area of the septum that divides the ventricles is called the ventricular or interventricular septum.
Figure B shows your heart's four valves. Shown counterclockwise in the picture, the valves include the aortic (ay-OR-tik) valve, the tricuspid (tri-CUSS-pid) valve, the pulmonary valve, and the mitral (MI-trul) valve.
The arrows in figure B show the direction that blood flows through your heart. The light blue arrow shows that blood enters the right atrium of your heart from the superior and inferior vena cavae.
From the right atrium, blood is pumped into the right ventricle. From the right ventricle, blood is pumped to your lungs through the pulmonary arteries.
The light red arrow shows oxygen-rich blood coming from your lungs through the pulmonary veins into your heart's left atrium. From the left atrium, the blood is pumped into the left ventricle. The left ventricle pumps the blood to the rest of your body through the aorta.
For the heart to work well, your blood must flow in only one direction. Your heart's valves make this possible. Both of your heart's ventricles have an "in" (inlet) valve from the atria and an "out" (outlet) valve leading to your arteries.
Healthy valves open and close in exact coordination with the pumping action of your heart's atria and ventricles. Each valve has a set of flaps called leaflets or cusps that seal or open the valve. This allows blood to pass through the chambers and into your arteries without backing up or flowing backward.
The animation below shows how your heart pumps blood. Click the "start" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.
The animation shows how blood flows through the heart as it contracts and relaxes.
Almost everyone has heard the real or recorded sound of a heartbeat. When your heart beats, it makes a "lub-DUB" sound. Between the time you hear "lub" and "DUB," blood is pumped through your heart and circulatory system.
A heartbeat may seem like a simple, repeated event. However, it's a complex series of very precise and coordinated events. These events take place inside and around your heart.
Each side of your heart uses an inlet valve to help move blood between the atrium and ventricle. The tricuspid valve does this between the right atrium and ventricle. The mitral valve does this between the left atrium and ventricle. The "lub" is the sound of the tricuspid and mitral valves closing.
Each of your heart's ventricles also has an outlet valve. The right ventricle uses the pulmonary valve to help move blood into the pulmonary arteries. The left ventricle uses the aortic valve to do the same for the aorta. The "DUB" is the sound of the aortic and pulmonary valves closing.
Each heartbeat has two basic parts: diastole (di-AS-toe-lee) and systole (SIS-toe-lee).
During diastole, the atria and ventricles of your heart relax and begin to fill with blood. At the end of diastole, your heart's atria contract (atrial systole) and pump blood into the ventricles.
The atria then begin to relax. Next, your heart's ventricles contract (ventricular systole) and pump blood out of your heart.
Your heart uses its four valves to ensure your blood flows in only one direction. Healthy valves open and close in coordination with the pumping action of your heart's atria and ventricles.
Each valve has a set of flaps called leaflets or cusps that seal or open the valve. The cusps allow pumped blood to pass through the chambers and into your blood vessels without backing up or flowing backward.
Oxygen-poor blood from the vena cavae fills your heart's right atrium. The atrium contracts (atrial systole). The tricuspid valve located between the right atrium and ventricle opens for a short time and then shuts. This allows blood to enter the right ventricle without flowing back into the right atrium.
When your heart's right ventricle fills with blood, it contracts (ventricular systole). The pulmonary valve located between your right ventricle and pulmonary artery opens and closes quickly.
This allows blood to enter into your pulmonary arteries without flowing back into the right ventricle. This is important because the right ventricle begins to refill with more blood through the tricuspid valve. Blood travels through the pulmonary arteries to your lungs to pick up oxygen.
Oxygen-rich blood returns from the lungs to your heart's left atrium through the pulmonary veins. As your heart's left atrium fills with blood, it contracts. This event is called atrial systole.
The mitral valve located between the left atrium and left ventricle opens and closes quickly. This allows blood to pass from the left atrium into the left ventricle without flowing backward.
As the left ventricle fills with blood, it contracts. This event is called ventricular systole. The aortic valve located between the left ventricle and aorta opens and closes quickly. This allows blood to flow into the aorta. The aorta is the main artery that carries blood from your heart to the rest of your body.
The aortic valve closes quickly to prevent blood from flowing back into the left ventricle, which already is filling up with new blood.
When your heart pumps blood through your arteries, it creates a pulse that you can feel on the arteries close to the skin's surface. For example, you can feel the pulse on the artery inside of your wrist, below your thumb.
You can count how many times your heart beats by taking your pulse. You will need a watch with a second hand.
To find your pulse, gently place your index and middle fingers on the artery located on the inner wrist of either arm, below your thumb. You should feel a pulsing or tapping against your fingers.
Watch the second hand and count the number of pulses you feel in 30 seconds. Double that number to find out your heart rate or pulse for 1 minute.
The usual resting pulse for an adult is 60 to 100 beats per minute. To find your resting pulse, count your pulse after you have been sitting or resting quietly for at least 10 minutes.
Your heart and blood vessels make up your overall blood circulatory system. Your blood circulatory system is made up of four subsystems.
Arterial circulation is the part of your circulatory system that involves arteries, like the aorta and pulmonary arteries. Arteries are blood vessels that carry blood away from your heart. (The exception is the coronary arteries, which supply your heart muscle with oxygen-rich blood.)
Healthy arteries are strong and elastic (stretchy). They become narrow between heartbeats, and they help keep your blood pressure consistent. This helps blood move through your body.
Arteries branch into smaller blood vessels called arterioles (ar-TEER-e-ols). Arteries and arterioles have strong, flexible walls that allow them to adjust the amount and rate of blood flowing to parts of your body.
Venous circulation is the part of your circulatory system that involves veins, like the vena cavae and pulmonary veins. Veins are blood vessels that carry blood to your heart.
Veins have thinner walls than arteries. Veins can widen as the amount of blood passing through them increases.
Capillary circulation is the part of your circulatory system where oxygen, nutrients, and waste pass between your blood and parts of your body.
Capillaries are very small blood vessels. They connect the arterial and venous circulatory subsystems.
The importance of capillaries lies in their very thin walls. Oxygen and nutrients in your blood can pass through the walls of the capillaries to the parts of your body that need them to work normally.
Capillaries' thin walls also allow waste products like carbon dioxide to pass from your body's organs and tissues into the blood, where it's taken away to your lungs.
Pulmonary circulation is the movement of blood from the heart to the lungs and back to the heart again. Pulmonary circulation includes both arterial and venous circulation.
Oxygen-poor blood is pumped to the lungs from the heart (arterial circulation). Oxygen-rich blood moves from the lungs to the heart through the pulmonary veins (venous circulation).
Pulmonary circulation also includes capillary circulation. Oxygen you breathe in from the air passes through your lungs into your blood through the many capillaries in the lungs. Oxygen-rich blood moves through your pulmonary veins to the left side of your heart and out of the aorta to the rest of your body.
Capillaries in the lungs also remove carbon dioxide from your blood so that your lungs can breathe the carbon dioxide out into the air.
he animation below shows how your heart's electrical system works. Click the "start" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.
The animation shows how the heart's internal electrical system causes the heart to pump blood.
Your heart's electrical system controls all the events that occur when your heart pumps blood. The electrical system also is called the cardiac conduction system. If you've ever seen the heart test called an EKG (electrocardiogram), you've seen a graphical picture of the heart's electrical activity.
Your heart's electrical system is made up of three main parts:
The sinoatrial (SA) node, located in the right atrium of your heart
The atrioventricular (AV) node, located on the interatrial septum close to the tricuspid valve
The His-Purkinje system, located along the walls of your heart's ventricles
A heartbeat is a complex series of events. These events take place inside and around your heart. A heartbeat is a single cycle in which your heart's chambers relax and contract to pump blood. This cycle includes the opening and closing of the inlet and outlet valves of the right and left ventricles of your heart.
Each heartbeat has two basic parts: diastole and systole. During diastole, the atria and ventricles of your heart relax and begin to fill with blood.
At the end of diastole, your heart's atria contract (atrial systole) and pump blood into the ventricles. The atria then begin to relax. Your heart's ventricles then contract (ventricular systole), pumping blood out of your heart.
Each beat of your heart is set in motion by an electrical signal from within your heart muscle. In a normal, healthy heart, each beat begins with a signal from the SA node. This is why the SA node sometimes is called your heart's natural pacemaker. Your pulse, or heart rate, is the number of signals the SA node produces per minute.
The signal is generated as the vena cavae fill your heart's right atrium with blood from other parts of your body. The signal spreads across the cells of your heart's right and left atria.
This signal causes the atria to contract. This action pushes blood through the open valves from the atria into both ventricles.
The signal arrives at the AV node near the ventricles. It slows for an instant to allow your heart's right and left ventricles to fill with blood. The signal is released and moves along a pathway called the bundle of His, which is located in the walls of your heart's ventricles.
From the bundle of His, the signal fibers divide into left and right bundle branches through the Purkinje fibers. These fibers connect directly to the cells in the walls of your heart's left and right ventricles (see yellow on the picture in the animation).
The signal spreads across the cells of your ventricle walls, and both ventricles contract. However, this doesn't happen at exactly the same moment.
The left ventricle contracts an instant before the right ventricle. This pushes blood through the pulmonary valve (for the right ventricle) to your lungs, and through the aortic valve (for the left ventricle) to the rest of your body.
As the signal passes, the walls of the ventricles relax and await the next signal.
This process continues over and over as the atria refill with blood and more electrical signals come from the SA node.
Your heart is made up of many parts working together to pump blood. In a healthy heart, all the parts work well so that your heart pumps blood normally. As a result, all parts of your body that depend on the heart to deliver blood also stay healthy.
Heart disease can disrupt a heart's normal electrical system and pumping functions. Diseases and conditions of the heart's muscle make it hard for your heart to properly pump blood.
Damaged or diseased blood vessels make the heart work harder than normal. Problems with the heart's electrical system, called arrhythmias (ah-RITH-me-ahs), can make it hard for the heart to pump blood efficiently.
Health Topics has many articles about heart diseases and conditions. For more information, go to the Health Topics home page.
Source: NHLBI, NIH
A stroke is serious, just like a heart attack. Each year in the United States, approximately 795,000 people have a stroke. About 610,000 of these are first or new strokes. On average, one American dies from stroke every four minutes. Stroke is the fourth leading cause of death in the United States, and causes more serious long-term disabilities than any other disease.
Nearly three-quarters of all strokes occur in people over the age of 65. And the risk of having a stroke more than doubles each decade between the ages of 55 and 85.
Stroke occurs in all age groups, in both sexes, and in all races in every country. It can even occur before birth, when the fetus is still in the womb.
Learning about stroke can help you act in time to save a relative, neighbor, or friend. And making changes in your lifestyle can help you prevent stroke.
A stroke is sometimes called a "brain attack." Most often, stroke occurs when blood flow to the brain stops because it is blocked by a clot. When this happens, the brain cells in the immediate area begin to die.
Some brain cells die because they stop getting the oxygen and nutrients they need to function. Other brain cells die because they are damaged by sudden bleeding into or around the brain. The brain cells that don't die immediately remain at risk for death. These cells can linger in a compromised or weakened state for several hours. With timely treatment, these cells can be saved.
New treatments are available that greatly reduce the damage caused by a stroke. But you need to arrive at the hospital as soon as possible after symptoms start to prevent disability and to greatly improve your chances for recovery. Knowing stroke symptoms, calling 911 immediately, and getting to a hospital as quickly as possible are critical.
There are two kinds of stroke. The most common kind of stroke is called ischemic stroke. It accounts for approximately 80 percent of all strokes. An ischemic stroke is caused by a blood clot that blocks or plugs a blood vessel supplying blood to the brain. Blockages that cause ischemic strokes stem from three conditions:
the formation of a clot within a blood vessel of the brain or neck, called thrombosis
the movement of a clot from another part of the body, such as from the heart to the neck or brain, called an embolism
a severe narrowing of an artery (stenosis) in or leading to the brain, due to fatty deposits lining the blood vessel walls.
The other kind of stroke is called hemorrhagic stroke. A hemorrhagic stroke is caused by a blood vessel that breaks and bleeds into the brain.
One common cause of a hemorrhagic stroke is a bleeding aneurysm. An aneurysm is a weak or thin spot on an artery wall. Over time, these weak spots stretch or balloon out due to high blood pressure. The thin walls of these ballooning aneurysms can rupture and spill blood into the space surrounding brain cells.
Artery walls can also break open because they become encrusted, or covered with fatty deposits called plaque, eventually lose their elasticity and become brittle, thin, and prone to cracking. Hypertension, or high blood pressure, increases the risk that a brittle artery wall will give way and release blood into the surrounding brain tissue.
The brain is the most complex organ in the human body. It is the seat of intelligence, interpreter of the senses, initiator of all movement, and the controller of behavior. How a stroke affects us depends on which part of the brain is damaged.
Stroke damage in the brain can affect the entire body -- resulting in mild to severe disabilities. These include paralysis, problems with thinking, trouble speaking, and emotional problems.
A common disability that results from stroke is complete paralysis on one side of the body, called hemiplegia. A related disability that is not as debilitating as paralysis is one-sided weakness, or hemiparesis. The paralysis or weakness may affect only the face, an arm, or a leg, or it may affect one entire side of the body and face.
A stroke patient may have problems with the simplest of daily activities, such as walking, dressing, eating, and using the bathroom. Movement problems can result from damage to the part of the brain that controls balance and coordination. Some stroke patients also have trouble swallowing, called dysphagia.
Stroke may cause problems with thinking, awareness, attention, learning, judgment, and memory.
In some cases of stroke, the patient suffers a "neglect" syndrome. The neglect syndrome means that the stroke patient has no knowledge of one side of his or her body, or one side of the visual field, and is unaware of the problem. A stroke patient may be unaware of his or her surroundings, or may be unaware of the mental problems that resulted from the stroke.
Stroke victims often have a problem forming or understanding speech. This problem is called aphasia. Aphasia usually occurs along with similar problems in reading and writing. In most people, language problems result from damage to the left hemisphere of the brain.
Slurred speech due to weakness or incoordination of the muscles involved in speaking is called dysarthria, and is not a problem with language. Because it can result from any weakness or incoordination of the speech muscles, dysarthria can arise from damage to either side of the brain.
A stroke can also lead to emotional problems. Stroke patients may have difficulty controlling their emotions or may express inappropriate emotions in certain situations. One common disability that occurs with many stroke patients is depression.
Post-stroke depression may be more than a general sadness resulting from the stroke incident. It is a serious behavioral problem that can hamper recovery and rehabilitation and may even lead to suicide. Post-stroke depression is treated as any depression is treated, with antidepressant medications and therapy.
Stroke patients may experience pain, uncomfortable numbness, or strange sensations after a stroke. These sensations may be due to many factors, including damage to the sensory regions of the brain, stiff joints, or a disabled limb.
An uncommon type of pain resulting from stroke is called central stroke pain or central pain syndrome or CPS. CPS results from damage to an area called the thalamus. The pain is a mixture of sensations, including heat and cold, burning, tingling, numbness, and sharp stabbing and underlying aching pain.
The pain is often worse in the hands and feet and is made worse by movement and temperature changes, especially cold temperatures. Unfortunately, since most pain medications provide little relief from these sensations, very few treatments or therapies exist to combat CPS.
The brain stem controls vital bodily functions such as breathing, blood pressure and heartbeat. A stroke in the brain stem can be fatal or can leave someone in a “locked-in” state in which the person cannot control anything below the neck. As with other types of stroke, early treatment is crucial.
Knowing the warning signs of stroke and controlling stroke's risk factors can lower your risk of death or disability. If you suffer a stroke, you may not realize it at first. The people around you might not know it, either. Your family, friends, or neighbors may think you are unaware or confused. You may not be able to call 911 on your own. That's why everyone should know the signs of stroke and know how to act fast.
Warning signs are clues your body sends to tell you that your brain is not receiving enough oxygen. If you observe one or more of the following signs of a stroke or "brain attack," don't wait. Call 911 right away!
These are warning signs of a stroke:
sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
sudden confusion, trouble speaking or understanding
sudden trouble seeing in one or both eyes
sudden trouble walking, dizziness, loss of balance or coordination
sudden severe headache with no known cause.
Other danger signs that may occur include double vision, drowsiness, and nausea or vomiting.
Sometimes the warning signs of stroke may last only a few moments and then disappear. These brief episodes, known as transient ischemic attacks or TIAs, are sometimes called "mini-strokes."
Although brief, TIAs identify an underlying serious condition that isn't going away without medical help. Unfortunately, since they clear up, many people ignore them. Don't ignore them. Heeding them can save your life.
Stroke is a medical emergency. Every minute counts when someone is having a stroke. The longer blood flow is cut off to the brain, the greater the damage. Immediate treatment can save people’s lives and enhance their chances for successful recovery.
Ischemic strokes, the most common type of strokes, can be treated with a drug called t-PA that dissolves blood clots obstructing blood flow to the brain. The window of opportunity to start treating stroke patients is three hours, but to be evaluated and receive treatment, patients need to get to the hospital within 60 minutes.
Don't wait for the symptoms of stroke to improve or worsen. If you believe you are having a stroke, call 911 immediately. Making the decision to call for medical help can make the difference in avoiding a lifelong disability and in greatly improving your chances for recovery.
If you observe someone having a stroke – if he or she suddenly loses the ability to speak, or move an arm or leg on one side, or experiences facial paralysis on one side – call 911 immediately.
A risk factor is a condition or behavior that increases your chances of getting a disease. Having a risk factor for stroke doesn't mean you'll have a stroke. On the other hand, not having a risk factor doesn't mean you'll avoid a stroke. But your risk of stroke grows as the number and severity of risk factors increase.
These risk factors for stroke cannot be changed by medical treatment or lifestyle changes.
Age. Although stroke risk increases with age, stroke can occur at any age. Recent studies have found that stroke rates among people under 55 grew from 13 percent in 1993-1994, to 19 percent in 2005. Experts speculate the increase may be due to a rise in risk factors such as diabetes, obesity, and high cholesterol.
Gender. Men have a higher risk for stroke, but more women die from stroke.
Race. People from certain ethnic groups have a higher risk of stroke. For African Americans, stroke is more common and more deadly – even in young and middle-aged adults – than for any ethnic or other racial group in the U.S. Studies show that the age-adjusted incidence of stroke is about twice as high in African Americans and Hispanic Americans as in Caucasians. An important risk factor for African Americans is sickle cell disease, which can cause a narrowing of arteries and disrupt blood flow.
Family history of stroke. Stroke seems to run in some families. Several factors may contribute to familial stroke. Members of a family might have a genetic tendency for stroke risk factors, such as an inherited predisposition for high blood pressure (hypertension) or diabetes. The influence of a common lifestyle among family members could also contribute to familial stroke.
Some of the most important risk factors for stroke that CAN be treated are
high blood pressure
smoking
heart disease
high blood cholesterol
warning signs or history of a stroke
diabetes.
High blood pressure, also called hypertension, is by far the most potent risk factor for stroke. If your blood pressure is high, you and your doctor need to work out an individual strategy to bring it down to the normal range. Here are some ways to reduce blood pressure:
Maintain proper weight.
Avoid drugs known to raise blood pressure.
Cut down on salt.
Eat fruits and vegetables to increase potassium in your diet.
Exercise more.
Your doctor may prescribe medicines that help lower blood pressure. Controlling blood pressure will also help you avoid heart disease, diabetes, and kidney failure.
Cigarette smoking has been linked to the buildup of fatty substances in the carotid artery, the main neck artery supplying blood to the brain. Blockage of this artery is the leading cause of stroke in Americans. Also, nicotine raises blood pressure, carbon monoxide reduces the amount of oxygen your blood can carry to the brain, and cigarette smoke makes your blood thicker and more likely to clot.
Your doctor can recommend programs and medications that may help you quit smoking. By quitting -- at any age -- you also reduce your risk of lung disease, heart disease, and a number of cancers including lung cancer.
Heart disease, including common heart disorders such as coronary artery disease, valve defects, irregular heart beat, and enlargement of one of the heart's chambers, can result in blood clots that may break loose and block vessels in or leading to the brain. The most common blood vessel disease, caused by the buildup of fatty deposits in the arteries, is called atherosclerosis, also known as hardening of the arteries.
Your doctor will treat your heart disease and may also prescribe medication, such as aspirin, to help prevent the formation of clots. Your doctor may recommend surgery to clean out a clogged neck artery if you match a particular risk profile.
A high level of total cholesterol in the blood is a major risk factor for heart disease, which raises your risk of stroke. Your doctor may recommend changes in your diet or medicines to lower your cholesterol.
Experiencing warning signs and having a history of stroke are also risk factors for stroke. Transient ischemic attacks, or TIAs, are brief episodes of stroke warning signs that may last only a few moments and then go away. If you experience a TIA, get help at once. Call 911.
If you have had a stroke in the past, it's important to reduce your risk of a second stroke. Your brain helps you recover from a stroke by drawing on body systems that now do double duty. That means a second stroke can be twice as bad.
Having diabetes is another risk factor for stroke. You may think this disorder affects only the body's ability to use sugar, or glucose. But it also causes destructive changes in the blood vessels throughout the body, including the brain.
Also, if blood glucose levels are high at the time of a stroke, then brain damage is usually more severe and extensive than when blood glucose is well-controlled. Treating diabetes can delay the onset of complications that increase the risk of stroke.
Stroke is preventable and treatable. A better understanding of the causes of stroke has helped people make lifestyle changes that have cut the stroke death rate nearly in half in the last two decades.
While family history of stroke plays a role in your risk, there are many risk factors you can control:
If you have high blood pressure, work with your doctor to get it under control.
If you smoke, quit.
If you have diabetes, learn how to manage it. Many people do not realize they have diabetes, which is a major risk factor for heart disease and stroke.
If you are overweight, start maintaining a healthy diet and exercising regularly.
If you have high cholesterol, work with your doctor to lower it. A high level of total cholesterol in the blood is a major risk factor for heart disease, which raises your risk of stroke.
Physicians have several diagnostic techniques and imaging tools to help diagnose stroke quickly and accurately. The first step in diagnosis is a short neurological examination, or an evaluation of the nervous system.
When a possible stroke patient arrives at a hospital, a health care professional, usually a doctor or nurse, will ask the patient or a companion what happened and when the symptoms began. Blood tests, an electrocardiogram, and a brain scan such as computed tomography or CT, or magnetic resonance imaging or MRI, will often be done.
One test that helps doctors judge the severity of a stroke is the standardized NIH Stroke Scale, developed by the National Institute of Neurological Disorders and Stroke at the National Institutes of Health, or NIH. Health care professionals use the NIH Stroke Scale to measure a patient's neurological deficits by asking the patient to answer questions and to perform several physical and mental tests.
Other scales include the Glasgow Coma Scale, the Hunt and Hess Scale, the Modified Rankin Scale, and the Barthel Index.
Health care professionals also use a variety of imaging techniques to evaluate acute stroke patients. The most widely used is computed tomography or CT scan, sometimes pronounced “CAT” scan, which is comprised of a series of cross-sectional images of the head and brain.
CT scans are sensitive for detecting hemorrhage and are therefore useful for differentiating hemorrhagic stroke, caused by bleeding in the brain, from ischemic stroke, caused by a blockage of blood flow to the brain.
Hemorrhage is the primary reason for avoiding thrombolytic therapy (drugs that break up or dissolve blood clots), the only proven therapy for acute ischemic stroke.
Because thrombolytic therapy might make a hemorrhagic stroke worse, doctors must confirm that the acute symptoms are not due to hemorrhage prior to giving the drug.
A CT scan may show evidence of early ischemia – an area of tissue that is dead or dying due to a loss of blood supply. Ischemic strokes generally show up on a CT scan about six to eight hours after the start of stroke symptoms. Though not as common in practice, CT scans also can be performed with a contrast agent to help visualize a blockage in the large arteries supplying the brain, or detect areas of decreased blood flow to the brain.
Because CT is readily available at all hours at most major hospitals, produces images quickly, and is good for ruling out hemorrhage prior to starting thrombolytic therapy, CT is the most widely used diagnostic imaging technique for acute stroke.
Another imaging technique used in acute stroke patients is the magnetic resonance imaging or MRI scan. MRI uses magnetic fields to detect a variety of changes in the brain and blood vessels caused by a stroke. One effect of ischemic stroke is the slowing of water movement through the injured brain tissue. Because MRI can show this type of injury very soon after stroke symptoms start, MRI has proven useful for diagnosing acute ischemic stroke before it is visible on CT. MRI also allows doctors to visualize blockages in the arteries, identify sites of prior stroke, and create a stroke treatment and prevention plan.
MRI and CT are equally accurate for determining when hemorrhage is present. The benefit of MRI over a CT scan is more accurate and earlier diagnosis of ischemic stroke, especially for smaller strokes and transient ischemic attacks (TIAs). MRI can be more sensitive than CT for detecting other types of neurological disorders that mimic the symptoms of stroke. However, MRI cannot be performed in patients with certain types of metallic or electronic implants, such as pacemakers for the heart.
Although increasingly used in the emergency diagnosis of stroke, MRI is not immediately available at all hours in most hospitals, where CT is used for acute stroke diagnosis. MRI typically takes longer to perform than CT, and therefore may not be the first choice when minutes count.
With stroke, treatment depends on the stage of the disease. There are three treatment stages for stroke: prevention, therapy immediately after stroke, and rehabilitation after stroke. Stroke therapies include medications, surgery, and rehabilitation.
Medication or drug therapy is the most common treatment for stroke. The most popular kinds of drugs to prevent or treat stroke are antithrombotics -- which include antiplatelet agents and anticoagulants -- and thrombolytics.
In treating a stroke that has just occurred, every minute counts. Ischemic strokes -- the most common kind -- can be treated with thrombolytic drugs. These drugs halt the stroke by dissolving the blood clot that is blocking blood flow to the brain. But a person needs to be at the hospital as soon as possible after stroke symptoms start to be evaluated and receive treatment.
A thrombolytic drug known as t-PA can be effective if a person receives it intravenously (in a vein) within 3 hours after his or her stroke symptoms have started. Because there is such a narrow time window for giving t-PA, it is important to note the time any stroke symptoms appear. Since thrombolytic drugs can increase bleeding, t-PA should be used only after the doctor is certain that the patient has suffered an ischemic and not a hemorrhagic stroke.
Antithrombotics prevent the formation of blood clots that can become stuck in an artery of the brain and cause strokes. Antiplatelet drugs prevent clotting by decreasing the activity of platelets, which are blood cells that help blood clot. By reducing the risk of blood clots, these drugs lower the risk of ischemic stroke.
In the case of stroke, doctors prescribe antiplatelet drugs mainly for prevention. The most widely known and used antiplatelet drug is aspirin. Other antiplatelet drugs include clopidogrel, ticlopidine, and dipyridamole
Anticoagulants reduce the risk of stroke by reducing the clotting property of the blood. The most commonly used oral anticoagulants include warfarin, also known as Coumadin®, dabigatran (Pradaxa) and rivaroxaban (Xarelto). Injectable anticoagulants include heparin, enoxaparin (Lovenox), and dalteparin (Fragmin)
Neuroprotectants are medications or other treatments that protect the brain from secondary injury caused by stroke. Although the FDA (Food and Drug Administration) has not approved any neuroprotectants for use in stroke at this time, many have been tested or are being tested in clinical trials. Cooling of the brain (hypothermia) is beneficial for improving neurological function after a cardiac arrest.
Surgery and vascular procedures can be used to prevent stroke, to treat stroke, or to repair damage to the blood vessels or malformations in and around the brain.
Carotid endarterectomy is a surgical procedure in which a surgeon removes fatty deposits, or plaque, from the inside of one of the carotid arteries. The procedure is performed to prevent stroke. The carotid arteries are located in the neck and are the main suppliers of blood to the brain
In addition to surgery, a variety of techniques have been developed to allow certain vascular problems to be treated from inside the artery using specialized catheters with the goal of improving blood flow. Vascular is a word that refers to blood vessels, arteries, and veins that carry blood throughout the body.
A catheter is a very thin, flexible tube that can be inserted into one of the major arteries of the leg or arm and then directed through the blood vessels to the diseased artery. Physicians trained in this technique called angiography undergo additional training to treat problems in the arteries of the brain or spinal cord. These physicians are called neurointerventionalists
Angioplasty, is widely used by angiographers to open blocked heart arteries, and is also used to prevent stroke. Angioplasty is a procedure in which a special catheter is inserted into the narrowed artery and then a balloon at the tip of the catheter is inflated to open the blocked artery. The procedure improves blood flow to the brain.
Another procedure used to prevent stroke is called stenting. In this procedure an angiographer inserts a catheter into the artery in the groin and then positions the tip of the catheter inside the narrowed artery. A stent is a tube-like device made of a mesh-like material that can be slipped into position over the catheter. When positioned inside the narrowed segment the stent is expanded to widen the artery and the catheter is removed. Angioplasty or stenting of the carotid artery can cause pieces of the diseased plaque to loosen. An umbrella-like device is often temporarily expanded above to prevent these pieces from traveling to the brain.
Angiographers also sometimes use clot removal devices to treat stroke patients in the very early stage. One device involves threading a catheter through the artery to the site of the blockage and then vacuuming out the clot. Another corkscrew-like device can be extended from the tip of a catheter and used to grab the clot and pull it out. Drugs can also be injected through the catheter directly into the clot to help dissolve the clot.
The NINDS study, Carotid Revascularization Endarterectomy vs. Stenting Trial, (CREST), compared carotid artery stenting with endarterectomy and found that these two surgical procedures are equally effective in preventing future strokes. Your physician can talk to you about the best option for you. For more information about treating arterial stenosis and preventing stroke, visit http://www.ninds.nih.gov/disorders/stroke/arterial_stenosis_backgrounder.htm.
One useful surgical procedure for treatment of brain aneurysms to prevent hemorrhage, or bleeding around the brain, is a technique called "clipping." An aneurysm is a weak or thin spot that develops on the wall of an artery or vein. Clipping involves an operation to apply a metal clip that closes off the aneurysm from the blood vessel, which greatly reduces the chance that it will bleed.
The detachable coil technique is used by angiographers to treat intracranial aneurysms, or aneurysms that occur inside the skull. Angiographers use a catheter to insert a small platinum coil into the aneurysm, where it triggers clotting of the aneurysm. Stents are sometimes used to keep the normal artery open while the aneurysm clots off.
Arteriovenous malformations are a tangle of blood vessels inside the brain which may carry risk of bleeding. Surgery to remove the blood vessels may be possible in some patients. Angiographers can also sometimes insert a glue-like material to close off the feeding arteries to the tangled vessels. Radiation therapy can be used in small arteriovenous malformations to cause scarring and closing of the malformation over time.
Stroke is the number one cause of serious adult disability in the United States. Stroke disability is devastating to the stroke patient and family, but therapies are available to help rehabilitate patients after stroke.
For most stroke patients, rehabilitation mainly involves physical therapy. The aim of physical therapy is to have the stroke patient relearn simple motor activities such as walking, sitting, standing, lying down, and the process of switching from one type of movement to another.
To achieve this, stroke patients work with physical therapists who use training, exercises, and physical manipulation of the stroke patient's body to restore movement, balance, and coordination.
Another type of therapy to help patients relearn daily activities is occupational therapy. This type of therapy also involves exercise and training. Its goal is to help the stroke patient relearn everyday activities such as eating, drinking and swallowing, dressing, bathing, cooking, reading and writing, and toileting. Occupational therapists seek to help the patient become independent or semi-independent.
Speech and language problems arise when brain damage occurs in the language centers of the brain. Due to the brain's great ability to learn and change, which is called brain plasticity, other areas can adapt to take over some of the lost functions.
Speech therapy helps stroke patients relearn language and speaking skills, or learn other forms of communication. Speech therapy is appropriate for patients who have no problems with cognition or thinking, but have problems understanding speech or written words, or problems forming speech.
Besides helping with language skills, speech therapy also helps stroke patients develop coping skills to deal with the frustration of not being able to communicate fully. With time and patience, a stroke survivor should be able to regain some, and sometimes all, language and speaking abilities.
Many stroke patients require psychological or psychiatric help after a stroke. Psychological problems such as depression, anxiety, frustration, and anger are common disabilities in people who have suffered a stroke.
Talk therapy, along with the right medication, can help ease some of the mental and emotional problems that result from stroke. Sometimes it is helpful for family members of the stroke patient to seek psychological help for themselves as well.
The National Institute of Neurological Disorders and Stroke sponsors a wide range of basic and clinical research aimed at finding better ways to prevent, diagnose, and treat stroke, and to restore functions lost as a result of stroke.
Currently, scientists are studying the risk factors for stroke and the process of brain damage that results from stroke. Some brain damage may be secondary, occurring after the initial death of brain cells caused by the lack of blood flow to the brain tissue.
This secondary brain damage results from a toxic reaction to the primary damage. Researchers are studying this toxic reaction and ways to prevent secondary injury to the brain. Scientists hope to develop neuroprotective agents, or drugs that protect the brain, to prevent this damage.
Scientists are also conducting stroke studies in animals. By studying stroke in animals, researchers hope to get a better picture of what might be happening in human stroke patients. Scientists can also use animal models to test promising therapies for stroke. If a therapy proves helpful for animals, scientists can consider testing the therapy in humans.
One promising area of animal research involves hibernation. The dramatic decrease of blood flow to the brain in hibernating animals is so extensive that it would kill a non-hibernating animal. If scientists can discover how animals hibernate without experiencing brain damage, they may discover ways to stop the brain damage associated with decreased blood flow in stroke patients.
Another study used a vaccine that interferes with inflammation inside blood vessels to reduce the frequency and severity of strokes in animals with high blood pressure and a genetic predisposition to stroke. Researchers hope that the vaccine will work in humans and could be used to prevent many of the strokes that occur each year in people with high risk factors.
Scientists also are working to develop new and better ways to help the brain repair itself to restore important functions to stroke patients. New advances in imaging and rehabilitation have shown that the brain can compensate for functions lost as a result of stroke.
When cells in an area of the brain responsible for a particular function die after a stroke, the patient becomes unable to perform that function. However, the brain's ability to learn and change, called plasticity, and its ability to rewire the connections between its nerve cells means that it can compensate for lost functions. One part of the brain can actually change functions and take up the more important functions of a disabled part.
Clinical trials are scientific studies using volunteers that give researchers a way to test medical advances in humans. Clinical trials test surgical devices and procedures, medications, and rehabilitation therapies. They also test methods to improve lifestyles and mental and social skills.
Clinical trials may compare a new medical approach to a standard one that is already available or to a placebo that contains no active ingredients or to no intervention. Some clinical trials compare interventions that are already available to each other. When a new product or approach is being studied, it is not usually known whether it will be helpful, harmful, or no different than available alternatives (including no intervention). The investigators try to determine the safety and usefulness of the intervention by measuring certain outcomes in the participants.
Scientists are using clinical trials to
develop new and more effective treatments for stroke
discover ways to restore blood flow to the brain after stroke
improve recovery after stroke
learn more about the risk factors for stroke.
Participating in a clinical study contributes to medical knowledge. The results of these studies can make a difference in the care of future patients by providing information about the benefits and risks of therapeutic, preventative, or diagnostic products or interventions.
You can find more information about current stroke clinical trials at the NIH Clinical Trials Registry at www.clinicaltrials.gov. You can search for a trial using criteria such as condition or disease, medication or therapy. Each entry includes a trial description, sponsors, purpose, estimated completion date, eligibility criteria, and contact information.
You can also call the NIH research study information line at 1-800-411-1222, TTY-1-866-411-1010, or e-mail prpl@mail.cc.nih.gov
For more information on stroke, including research sponsored by the National Institute of Neurological Disorders and Stroke, call 1-800-352-9424 or visit the Web site at www.ninds.nih.gov.
Source: NIHSenior, NIH
Chronic Obstructive Pulmonary Disease (COPD)
What Is COPD?
COPD, or chronic obstructive pulmonary (PULL-mun-ary) disease, is a progressive disease that makes it hard to breathe. "Progressive" means the disease gets worse over time.
COPD can cause coughing that produces large amounts of mucus (a slimy substance), wheezing, shortness of breath, chest tightness, and other symptoms.
Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke or used to smoke. Long-term exposure to other lung irritants—such as air pollution, chemical fumes, or dust—also may contribute to COPD.
To understand COPD, it helps to understand how the lungs work. The air that you breathe goes down your windpipe into tubes in your lungs called bronchial (BRONG-ke-al) tubes or airways.
Within the lungs, your bronchial tubes branch into thousands of smaller, thinner tubes called bronchioles (BRONG-ke-ols). These tubes end in bunches of tiny round air sacs called alveoli (al-VEE-uhl-eye).
Small blood vessels called capillaries (KAP-ih-lare-ees) run through the walls of the air sacs. When air reaches the air sacs, oxygen passes through the air sac walls into the blood in the capillaries. At the same time, carbon dioxide (a waste gas) moves from the capillaries into the air sacs. This process is called gas exchange.
The airways and air sacs are elastic (stretchy). When you breathe in, each air sac fills up with air like a small balloon. When you breathe out, the air sacs deflate and the air goes out.
In COPD, less air flows in and out of the airways because of one or more of the following:
The airways and air sacs lose their elastic quality.
The walls between many of the air sacs are destroyed.
The walls of the airways become thick and inflamed.
The airways make more mucus than usual, which can clog them.
Figure A shows the location of the lungs and airways in the body. The inset image shows a detailed cross-section of the bronchioles and alveoli. Figure B shows lungs damaged by COPD. The inset image shows a detailed cross-section of the damaged bronchioles and alveolar walls.
In the United States, the term "COPD" includes two main conditions—emphysema (em-fih-SE-ma) and chronic bronchitis (bron-KI-tis). (Note: The Health Topics article about bronchitis discusses both acute and chronic bronchitis.)
In emphysema, the walls between many of the air sacs are damaged. As a result, the air sacs lose their shape and become floppy. This damage also can destroy the walls of the air sacs, leading to fewer and larger air sacs instead of many tiny ones. If this happens, the amount of gas exchange in the lungs is reduced.
In chronic bronchitis, the lining of the airways is constantly irritated and inflamed. This causes the lining to thicken. Lots of thick mucus forms in the airways, making it hard to breathe.
Most people who have COPD have both emphysema and chronic bronchitis. Thus, the general term "COPD" is more accurate.
COPD is a major cause of disability, and it's the third leading cause of death in the United States. Currently, millions of people are diagnosed with COPD. Many more people may have the disease and not even know it.
COPD develops slowly. Symptoms often worsen over time and can limit your ability to do routine activities. Severe COPD may prevent you from doing even basic activities like walking, cooking, or taking care of yourself.
Most of the time, COPD is diagnosed in middle-aged or older adults. The disease isn't passed from person to person—you can't catch it from someone else.
COPD has no cure yet, and doctors don't know how to reverse the damage to the airways and lungs. However, treatments and lifestyle changes can help you feel better, stay more active, and slow the progress of the disease.
Chronic bronchitis
Chronic obstructive airway disease
Chronic obstructive lung disease
Emphysema
Long-term exposure to lung irritants that damage the lungs and the airways usually is the cause of COPD.
In the United States, the most common irritant that causes COPD is cigarette smoke. Pipe, cigar, and other types of tobacco smoke also can cause COPD, especially if the smoke is inhaled.
Breathing in secondhand smoke, air pollution, or chemical fumes or dust from the environment or workplace also can contribute to COPD. (Secondhand smoke is smoke in the air from other people smoking.)
Rarely, a genetic condition called alpha-1 antitrypsin deficiency may play a role in causing COPD. People who have this condition have low levels of alpha-1 antitrypsin (AAT)—a protein made in the liver.
Having a low level of the AAT protein can lead to lung damage and COPD if you're exposed to smoke or other lung irritants. If you have this condition and smoke, COPD can worsen very quickly.
Although uncommon, some people who have asthma can develop COPD. Asthma is a chronic (long-term) lung disease that inflames and narrows the airways. Treatment usually can reverse the inflammation and narrowing. However, if not, COPD can develop.
The main risk factor for COPD is smoking. Most people who have COPD smoke or used to smoke. People who have a family history of COPD are more likely to develop the disease if they smoke.
Long-term exposure to other lung irritants also is a risk factor for COPD. Examples of other lung irritants include secondhand smoke, air pollution, and chemical fumes and dust from the environment or workplace. (Secondhand smoke is smoke in the air from other people smoking.)
Most people who have COPD are at least 40 years old when symptoms begin. Although uncommon, people younger than 40 can have COPD. For example, this may happen if a person has alpha-1 antitrypsin deficiency, a genetic condition.
At first, COPD may cause no symptoms or only mild symptoms. As the disease gets worse, symptoms usually become more severe. Common signs and symptoms of COPD include:
An ongoing cough or a cough that produces a lot of mucus (often called "smoker's cough")
Shortness of breath, especially with physical activity
Wheezing (a whistling or squeaky sound when you breathe)
Chest tightness
If you have COPD, you also may have colds or the flu (influenza) often.
Not everyone who has the symptoms above has COPD. Likewise, not everyone who has COPD has these symptoms. Some of the symptoms of COPD are similar to the symptoms of other diseases and conditions. Your doctor can find out whether you have COPD.
If your symptoms are mild, you may not notice them, or you may adjust your lifestyle to make breathing easier. For example, you may take the elevator instead of the stairs.
Over time, symptoms may become severe enough to see a doctor. For example, you may get short of breath during physical exertion.
The severity of your symptoms will depend on how much lung damage you have. If you keep smoking, the damage will occur faster than if you stop smoking.
Severe COPD can cause other symptoms, such as swelling in your ankles, feet, or legs; weight loss; and lower muscle endurance.
Some severe symptoms may require treatment in a hospital. You—with the help of family members or friends, if you're unable—should seek emergency care if:
You're having a hard time catching your breath or talking.
Your lips or fingernails turn blue or gray. (This is a sign of a low oxygen level in your blood.)
You're not mentally alert.
Your heartbeat is very fast.
The recommended treatment for symptoms that are getting worse isn't working.
Your doctor will diagnose COPD based on your signs and symptoms, your medical and family histories, and test results.
Your doctor may ask whether you smoke or have had contact with lung irritants, such as secondhand smoke, air pollution, chemical fumes, or dust.
If you have an ongoing cough, let your doctor know how long you've had it, how much you cough, and how much mucus comes up when you cough. Also, let your doctor know whether you have a family history of COPD.
Your doctor will examine you and use a stethoscope to listen for wheezing or other abnormal chest sounds. He or she also may recommend one or more tests to diagnose COPD.
Lung function tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood.
The main test for COPD is spirometry (spi-ROM-eh-tre). Other lung function tests, such as a lung diffusion capacity test, also might be used. (For more information, go to the Health Topics Lung Function Tests article.)
During this painless test, a technician will ask you to take a deep breath in. Then, you'll blow as hard as you can into a tube connected to a small machine. The machine is called a spirometer.
The machine measures how much air you breathe out. It also measures how fast you can blow air out.
The image shows how spirometry is done. The patient takes a deep breath and then blows hard into a tube connected to a spirometer. The spirometer measures the amount of air breathed out. It also measures how fast the air is blown out.
Your doctor may have you inhale medicine that helps open your airways and then blow into the tube again. He or she can then compare your test results before and after taking the medicine.
Spirometry can detect COPD before symptoms develop. Your doctor also might use the test results to find out how severe your COPD is and to help set your treatment goals.
The test results also may help find out whether another condition, such as asthma or heart failure, is causing your symptoms.
Your doctor may recommend other tests, such as:
A chest x ray or chest CT scan. These tests create pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. The pictures can show signs of COPD. They also may show whether another condition, such as heart failure, is causing your symptoms.
An arterial blood gas test. This blood test measures the oxygen level in your blood using a sample of blood taken from an artery. The results from this test can show how severe your COPD is and whether you need oxygen therapy.
COPD has no cure yet. However, lifestyle changes and treatments can help you feel better, stay more active, and slow the progress of the disease.
The goals of COPD treatment include:
Relieving your symptoms
Slowing the progress of the disease
Improving your exercise tolerance (your ability to stay active)
Preventing and treating complications
Improving your overall health
To assist with your treatment, your family doctor may advise you to see a pulmonologist. This is a doctor who specializes in treating lung disorders.
Quitting smoking is the most important step you can take to treat COPD. Talk with your doctor about programs and products that can help you quit.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit.
Also, try to avoid secondhand smoke and places with dust, fumes, or other toxic substances that you may inhale.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's "Your Guide to a Healthy Heart." Although these resources focus on heart health, they include basic information about how to quit smoking.
If you have COPD, you may have trouble eating enough because of your symptoms, such as shortness of breath and fatigue. (This issue is more common with severe disease.)
As a result, you may not get all of the calories and nutrients you need, which can worsen your symptoms and raise your risk for infections.
Talk with your doctor about following an eating plan that will meet your nutritional needs. Your doctor may suggest eating smaller, more frequent meals; resting before eating; and taking vitamins or nutritional supplements.
Also, talk with your doctor about what types of activity are safe for you. You may find it hard to be active with your symptoms. However, physical activity can strengthen the muscles that help you breathe and improve your overall wellness.
Bronchodilators relax the muscles around your airways. This helps open your airways and makes breathing easier.
Depending on the severity of your COPD, your doctor may prescribe short-acting or long-acting bronchodilators. Short-acting bronchodilators last about 4–6 hours and should be used only when needed. Long-acting bronchodilators last about 12 hours or more and are used every day.
Most bronchodilators are taken using a device called an inhaler. This device allows the medicine to go straight to your lungs. Not all inhalers are used the same way. Ask your health care team to show you the correct way to use your inhaler.
If your COPD is mild, your doctor may only prescribe a short-acting inhaled bronchodilator. In this case, you may use the medicine only when symptoms occur.
If your COPD is moderate or severe, your doctor may prescribe regular treatment with short- and long-acting bronchodilators.
If your COPD is more severe, or if your symptoms flare up often, your doctor may prescribe a combination of medicines that includes a bronchodilator and an inhaled steroid. Steroids help reduce airway inflammation.
In general, using inhaled steroids alone is not a preferred treatment.
Your doctor may ask you to try inhaled steroids with the bronchodilator for a trial period of 6 weeks to 3 months to see whether the addition of the steroid helps relieve your breathing problems.
The flu (influenza) can cause serious problems for people who have COPD. Flu shots can reduce your risk of getting the flu. Talk with your doctor about getting a yearly flu shot.
This vaccine lowers your risk for pneumococcal pneumonia (NU-mo-KOK-al nu-MO-ne-ah) and its complications. People who have COPD are at higher risk for pneumonia than people who don't have COPD. Talk with your doctor about whether you should get this vaccine.
Pulmonary rehabilitation (rehab) is a broad program that helps improve the well-being of people who have chronic (ongoing) breathing problems.
Rehab may include an exercise program, disease management training, and nutritional and psychological counseling. The program's goal is to help you stay active and carry out your daily activities.
Your rehab team may include doctors, nurses, physical therapists, respiratory therapists, exercise specialists, and dietitians. These health professionals will create a program that meets your needs.
If you have severe COPD and low levels of oxygen in your blood, oxygen therapy can help you breathe better. For this treatment, you're given oxygen through nasal prongs or a mask.
You may need extra oxygen all the time or only at certain times. For some people who have severe COPD, using extra oxygen for most of the day can help them:
Do tasks or activities, while having fewer symptoms
Protect their hearts and other organs from damage
Sleep more during the night and improve alertness during the day
Live longer
Surgery may benefit some people who have COPD. Surgery usually is a last resort for people who have severe symptoms that have not improved from taking medicines.
Surgeries for people who have COPD that's mainly related to emphysema include bullectomy (bul-EK-toe-me) and lung volume reduction surgery (LVRS). A lung transplant might be an option for people who have very severe COPD.
When the walls of the air sacs are destroyed, larger air spaces called bullae (BUL-e) form. These air spaces can become so large that they interfere with breathing. In a bullectomy, doctors remove one or more very large bullae from the lungs.
In LVRS, surgeons remove damaged tissue from the lungs. This helps the lungs work better. In carefully selected patients, LVRS can improve breathing and quality of life.
During a lung transplant, your damaged lung is removed and replaced with a healthy lung from a deceased donor.
A lung transplant can improve your lung function and quality of life. However, lung transplants have many risks, such as infections. The surgery can cause death if the body rejects the transplanted lung.
If you have very severe COPD, talk with your doctor about whether a lung transplant is an option. Ask your doctor about the benefits and risks of this type of surgery.
COPD symptoms usually worsen slowly over time. However, they can worsen suddenly. For instance, a cold, the flu, or a lung infection may cause your symptoms to quickly worsen. You may have a much harder time catching your breath. You also may have chest tightness, more coughing, changes in the color or amount of your sputum (spit), and a fever.
Call your doctor right away if your symptoms worsen suddenly. He or she may prescribe antibiotics to treat the infection and other medicines, such as bronchodilators and inhaled steroids, to help you breathe.
Some severe symptoms may require treatment in a hospital. For more information, go to "What Are the Signs and Symptoms of COPD?"
You can take steps to prevent COPD before it starts. If you already have COPD, you can take steps to prevent complications and slow the progress of the disease.
The best way to prevent COPD is to not start smoking or to quit smoking. Smoking is the leading cause of COPD. If you smoke, talk with your doctor about programs and products that can help you quit.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit.
Also, try to avoid lung irritants that can contribute to COPD. Examples include secondhand smoke, air pollution, chemical fumes, and dust. (Secondhand smoke is smoke in the air from other people smoking.)
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's "Your Guide to a Healthy Heart." Although these resources focus on heart health, they include basic information about how to quit smoking.
If you have COPD, the most important step you can take is to quit smoking. Quitting can help prevent complications and slow the progress of the disease. You also should avoid exposure to the lung irritants mentioned above.
Follow your treatments for COPD exactly as your doctor prescribes. They can help you breathe easier, stay more active, and avoid or manage severe symptoms.
Talk with your doctor about whether and when you should get flu (influenza) and pneumonia vaccines. These vaccines can lower your chances of getting these illnesses, which are major health risks for people who have COPD.
COPD has no cure yet. However, you can take steps to manage your symptoms and slow the progress of the disease. You can:
Avoid lung irritants
Get ongoing care
Manage the disease and its symptoms
Prepare for emergencies
If you smoke, quit. Smoking is the leading cause of COPD. Talk with your doctor about programs and products that can help you quit.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's "Your Guide to a Healthy Heart." Although these resources focus on heart health, they include basic information about how to quit smoking.
Also, try to avoid lung irritants that can contribute to COPD. Examples include secondhand smoke, air pollution, chemical fumes, and dust. (Secondhand smoke is smoke in the air from other people smoking.)
Keep these irritants out of your home. If your home is painted or sprayed for insects, have it done when you can stay away for a while.
Keep your windows closed and stay at home (if possible) when there's a lot of air pollution or dust outside.
If you have COPD, it's important to get ongoing medical care. Take all of your medicines as your doctor prescribes. Make sure to refill your prescriptions before they run out. Bring a list of all the medicines you're taking when you have medical checkups.
Talk with your doctor about whether and when you should get flu (influenza) and pneumonia vaccines. Also, ask him or her about other diseases for which COPD may increase your risk, such as heart disease, lung cancer, and pneumonia.
You can do things to help manage COPD and its symptoms. For example:
Do activities slowly.
Put items that you need often in one place that's easy to reach.
Find very simple ways to cook, clean, and do other chores. For example, you might want to use a small table or cart with wheels to move things around and a pole or tongs with long handles to reach things.
Ask for help moving things around in your house so that you won't need to climb stairs as often.
Keep your clothes loose, and wear clothes and shoes that are easy to put on and take off.
Depending on how severe your disease is, you may want to ask your family and friends for help with daily tasks.
If you have COPD, know when and where to seek help for your symptoms. You should get emergency care if you have severe symptoms, such as trouble catching your breath or talking. (For more information on severe symptoms, go to "What Are the Signs and Symptoms of COPD?")
Call your doctor if you notice that your symptoms are worsening or if you have signs of an infection, such as a fever. Your doctor may change or adjust your treatments to relieve and treat symptoms.
Keep phone numbers handy for your doctor, hospital, and someone who can take you for medical care. You also should have on hand directions to the doctor's office and hospital and a list of all the medicines you're taking.
Living with COPD may cause fear, anxiety, depression, and stress. Talk about how you feel with your health care team. Talking to a professional counselor also might help. If you're very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Joining a patient support group may help you adjust to living with COPD. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has uncovered some of the causes of chronic lung diseases, as well as ways to prevent and treat these diseases.
Many more questions remain about chronic lung diseases, including COPD. The NHLBI continues to support research aimed at learning more about these diseases. For example, NHLBI-supported research on COPD includes studies that explore:
How certain medicines and other therapies can help treat COPD and improve quality of life for people who have the disease
Whether genetic factors increase the risk of lung damage that can lead to COPD
Whether a self-managed physical activity program is cost effective and can help people who have COPD function better
How a coping skills training program can improve quality of life for people who have COPD and their caregivers
Whether the physical properties of mucus play a role in the worsening of COPD, especially chronic bronchitis
How bacteria and toxins found in the lungs, mouth, and digestive system contribute to COPD and other lung diseases
Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you may gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to COPD, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
http://clinicalresearch.nih.gov
www.clinicaltrials.gov
www.nhlbi.nih.gov/studies/index.htm
www.researchmatch.org
A heart attack happens when the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart can't get oxygen. If blood flow isn't restored quickly, the section of heart muscle begins to die.
Heart attacks are a leading killer of both men and women in the United States. The good news is that excellent treatments are available for heart attacks. These treatments can save lives and prevent disabilities.
Heart attack treatment works best when it's given right after symptoms occur. If you think you or someone else is having a heart attack (even if you're not fully sure), call9–1–1 right away.
Heart attacks most often occur as a result of coronary heart disease (CHD), also called coronary artery disease. CHD is a condition in which a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart.
When plaque builds up in the arteries, the condition is called atherosclerosis (ath-er-o-skler-O-sis). The buildup of plaque occurs over many years.
Eventually, an area of plaque can rupture (break open) inside of an artery. This causes a blood clot to form on the plaque's surface. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.
If the blockage isn't treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.
Figure A shows a heart with dead heart muscle caused by a heart attack. Figure B is a cross-section of a coronary artery with plaque buildup and a blood clot.
A less common cause of heart attack is a severe spasm (tightening) of a coronary artery. The spasm cuts off blood flow through the artery. Spasms can occur in coronary arteries that aren't affected by atherosclerosis.
Heart attacks can be associated with or lead to severe health problems, such as heart failure and life-threatening arrhythmias (ah-RITH-me-ahs).
Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. Arrhythmias are irregular heartbeats. Ventricular fibrillation is a life-threatening arrhythmia that can cause death if not treated right away.
Acting fast at the first sign of heart attack symptoms can save your life and limit damage to your heart. Treatment works best when it's given right after symptoms occur.
Many people aren't sure what's wrong when they are having symptoms of a heart attack. Some of the most common warning symptoms of a heart attack for both men and women are:
Chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion.
Upper body discomfort. You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach (above the belly button).
Shortness of breath. This may be your only symptom, or it may occur before or along with chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity.
Other possible symptoms of a heart attack include:
Breaking out in a cold sweat
Feeling unusually tired for no reason, sometimes for days (especially if you are a woman)
Nausea (feeling sick to the stomach) and vomiting
Light-headedness or sudden dizziness
Any sudden, new symptom or a change in the pattern of symptoms you already have (for example, if your symptoms become stronger or last longer than usual)
Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies, or other common symptoms such as chest discomfort. The symptoms of a heart attack can vary from person to person. Some people can have few symptoms and are surprised to learn they've had a heart attack. If you've already had a heart attack, your symptoms may not be the same for another one.
Quick Action Can Save Your Life: Call 9–1–1
If you think you or someone else may be having heart attack symptoms or a heart attack, don't ignore it or feel embarrassed to call for help. Call 9–1–1 for emergency medical care. Acting fast can save your life.
Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. Take a nitroglycerin pill if your doctor has prescribed this type of treatment.
Each year, close to 1 million people in the United States have heart attacks, and many of them die. CHD, which often results in heart attacks, is the leading killer of both men and women in the United States.
Many more people could survive or recover better from heart attacks if they got help faster. Of the people who die from heart attacks, about half die within an hour of the first symptoms and before they reach the hospital.
Myocardial infarction (MI)
Acute myocardial infarction (AMI)
Acute coronary syndrome
Coronary thrombosis
Coronary occlusion
A heart attack happens if the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart can't get oxygen. Most heart attacks occur as a result of coronary heart disease (CHD).
CHD is a condition in which a waxy substance called plaque builds up inside of the coronary arteries. These arteries supply oxygen-rich blood to your heart.
When plaque builds up in the arteries, the condition is called atherosclerosis. The buildup of plaque occurs over many years.
Eventually, an area of plaque can rupture (break open) inside of an artery. This causes a blood clot to form on the plaque's surface. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.
If the blockage isn't treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.
A less common cause of heart attack is a severe spasm (tightening) of a coronary artery. The spasm cuts off blood flow through the artery. Spasms can occur in coronary arteries that aren't affected by atherosclerosis.
What causes a coronary artery to spasm isn't always clear. A spasm may be related to:
Taking certain drugs, such as cocaine
Emotional stress or pain
Exposure to extreme cold
Cigarette smoking
The animation below shows how plaque buildup or a coronary artery spasm can lead to a heart attack. Click the "start" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.
Certain risk factors make it more likely that you'll develop coronary heart disease (CHD) and have a heart attack. You can control many of these risk factors.
The major risk factors for a heart attack that you can control include:
Smoking
High blood pressure
High blood cholesterol
Overweight and obesity
An unhealthy diet (for example, a diet high in saturated fat, trans fat, cholesterol, and sodium)
Lack of routine physical activity
High blood sugar due to insulin resistance or diabetes
Some of these risk factors—such as obesity, high blood pressure, and high blood sugar—tend to occur together. When they do, it's called metabolic syndrome.
In general, a person who has metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as someone who doesn't have metabolic syndrome.
For more information about the risk factors that are part of metabolic syndrome, go to the Health Topics Metabolic Syndrome article.
Risk factors that you can't control include:
Age. The risk of heart disease increases for men after age 45 and for women after age 55 (or after menopause).
Family history of early heart disease. Your risk increases if your father or a brother was diagnosed with heart disease before 55 years of age, or if your mother or a sister was diagnosed with heart disease before 65 years of age.
Preeclampsia (pre-e-KLAMP-se-ah). This condition can develop during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine. Preeclampsia is linked to an increased lifetime risk of heart disease, including CHD, heart attack, heart failure, and high blood pressure.
Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies. In one study, for example, one-third of the patients who had heart attacks had no chest pain. These patients were more likely to be older, female, or diabetic.
The symptoms of a heart attack can vary from person to person. Some people can have few symptoms and are surprised to learn they've had a heart attack. If you've already had a heart attack, your symptoms may not be the same for another one. It is important for you to know the most common symptoms of a heart attack and also remember these facts:
Heart attacks can start slowly and cause only mild pain or discomfort. Symptoms can be mild or more intense and sudden. Symptoms also may come and go over several hours.
People who have high blood sugar (diabetes) may have no symptoms or very mild ones.
The most common symptom, in both men and women, is chest pain or discomfort.
Women are somewhat more likely to have shortness of breath, nausea and vomiting, unusual tiredness (sometimes for days), and pain in the back, shoulders, and jaw.
Some people don't have symptoms at all. Heart attacks that occur without any symptoms or with very mild symptoms are called silent heart attacks.
The most common warning symptoms of a heart attack for both men and women are:
Chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion. The feeling can be mild or severe.
Upper body discomfort. You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach (above the belly button).
Shortness of breath. This may be your only symptom, or it may occur before or along with chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity.
The symptoms of angina (an-JI-nuh or AN-juh-nuh) can be similar to the symptoms of a heart attack. Angina is chest pain that occurs in people who have coronary heart disease, usually when they're active. Angina pain usually lasts for only a few minutes and goes away with rest.
Chest pain or discomfort that doesn't go away or changes from its usual pattern (for example, occurs more often or while you're resting) can be a sign of a heart attack.
All chest pain should be checked by a doctor.
Pay attention to these other possible symptoms of a heart attack:
Breaking out in a cold sweat
Feeling unusually tired for no reason, sometimes for days (especially if you are a woman)
Nausea (feeling sick to the stomach) and vomiting
Light-headedness or sudden dizziness
Any sudden, new symptoms or a change in the pattern of symptoms you already have (for example, if your symptoms become stronger or last longer than usual)
Not everyone having a heart attack has typical symptoms. If you've already had a heart attack, your symptoms may not be the same for another one. However, some people may have a pattern of symptoms that recur.
The more signs and symptoms you have, the more likely it is that you're having a heart attack.
The signs and symptoms of a heart attack can develop suddenly. However, they also can develop slowly—sometimes within hours, days, or weeks of a heart attack.
Any time you think you might be having heart attack symptoms or a heart attack, don't ignore it or feel embarrassed to call for help. Call 9–1–1 for emergency medical care, even if you are not sure whether you're having a heart attack. Here's why:
Acting fast can save your life.
An ambulance is the best and safest way to get to the hospital. Emergency medical services (EMS) personnel can check how you are doing and start life-saving medicines and other treatments right away. People who arrive by ambulance often receive faster treatment at the hospital.
The 9–1–1 operator or EMS technician can give you advice. You might be told to crush or chew an aspirin if you're not allergic, unless there is a medical reason for you not to take one. Aspirin taken during a heart attack can limit the damage to your heart and save your life.
Every minute matters. Never delay calling 9–1–1 to take aspirin or do anything else you think might help.
Your doctor will diagnose a heart attack based on your signs and symptoms, your medical and family histories, and test results.
An EKG is a simple, painless test that detects and records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through each part of the heart.
An EKG can show signs of heart damage due to coronary heart disease (CHD) and signs of a previous or current heart attack.
During a heart attack, heart muscle cells die and release proteins into the bloodstream. Blood tests can measure the amount of these proteins in the bloodstream. Higher than normal levels of these proteins suggest a heart attack.
Commonly used blood tests include troponin tests, CK or CK–MB tests, and serum myoglobin tests. Blood tests often are repeated to check for changes over time.
Coronary angiography (an-jee-OG-ra-fee) is a test that uses dye and special x rays to show the insides of your coronary arteries. This test often is done during a heart attack to help find blockages in the coronary arteries.
To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization (KATH-e-ter-ih-ZA-shun).
A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream.
Special x rays are taken while the dye is flowing through the coronary arteries. The dye lets your doctor study the flow of blood through the heart and blood vessels.
If your doctor finds a blockage, he or she may recommend a procedure calledpercutaneous (per-ku-TA-ne-us) coronary intervention (PCI), sometimes referred to as coronary angioplasty (AN-jee-oh-plas-tee). This procedure can help restore blood flow through a blocked artery. Sometimes a small mesh tube called a stent is placed in the artery to help prevent blockages after the procedure.
Early treatment for a heart attack can prevent or limit damage to the heart muscle. Acting fast, at the first symptoms of a heart attack, can save your life. Medical personnel can begin diagnosis and treatment even before you get to the hospital.
Certain treatments usually are started right away if a heart attack is suspected, even before the diagnosis is confirmed. These include:
Oxygen therapy
Aspirin to thin your blood and prevent further blood clotting
Nitroglycerin to reduce your heart's workload and improve blood flow through the coronary arteries
Treatment for chest pain
Once the diagnosis of a heart attack is confirmed or strongly suspected, doctors start treatments to try to promptly restore blood flow to the heart. The two main treatments are "clot-busting" medicines and percutaneous coronary intervention (PCI), sometimes referred to as coronary angioplasty, a procedure used to open blocked coronary arteries.
Clot-Busting Medicines
Thrombolytic medicines, also called "clot busters," are used to dissolve blood clots that are blocking the coronary arteries. To work best, these medicines must be given within several hours of the start of heart attack symptoms. Ideally, the medicine should be given as soon as possible.
Percutaneous Coronary Intervention
Percutaneous (per-ku-TA-ne-us) coronary intervention (PCI) is a nonsurgical procedure that opens blocked or narrowed coronary arteries. This procedure also is called coronary angioplasty.
A thin, flexible tube with a balloon or other device on the end is threaded through a blood vessel, usually in the groin (upper thigh), to the narrowed or blocked coronary artery.
Once in place, the balloon is inflated to compress the plaque against the wall of the artery. This restores blood flow through the artery.
During the procedure, the doctor may put a small mesh tube called a stent in the artery. The stent helps prevent blockages in the artery in the months or years after the procedure.
For more information, go to the Health Topics PCI article.
Other Treatments for Heart Attack
Medicines
Beta blockers. Beta blockers decrease your heart's workload. These medicines also are used to relieve chest pain and discomfort and to help prevent repeat heart attacks. Beta blockers also are used to treat arrhythmias (irregular heartbeats).
ACE inhibitors. ACE inhibitors lower blood pressure and reduce strain on your heart. They also help slow down further weakening of the heart muscle.
Anticoagulants. Anticoagulants, or "blood thinners," prevent blood clots from forming in your arteries. These medicines also keep existing clots from getting larger.
Anticlotting medicines. Anticlotting medicines stop platelets from clumping together and forming unwanted blood clots. Examples of anticlotting medicines include aspirin and clopidogrel.
You also may be given medicines to relieve pain and anxiety, treat arrhythmias (which often occur during a heart attack), or lower your cholesterol (these medicines are called statins).
Medical Procedures
Coronary artery bypass grafting (CABG) also may be used to treat a heart attack. During CABG, a surgeon removes a healthy artery or vein from your body. The artery or vein is then connected, or grafted, to the blocked coronary artery.
The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This provides a new route for blood to flow to the heart muscle.
For more information, go to the Health Topics Coronary Artery Bypass Graftingarticle.
Treatment After You Leave the Hospital
Most people spend several days in the hospital after a heart attack. When you leave the hospital, treatment doesn't stop. At home, your treatment may include daily medicines and cardiac rehabilitation (rehab). Your doctor may want you to have a flu shot and pneumococcal vaccine each year.
Your doctor also may recommend lifestyle changes, including following a heart healthy diet, being physically active, maintaining a healthy weight, and quitting smoking. Taking these steps can lower your chances of having another heart attack.
Cardiac Rehabilitation
Your doctor may recommend cardiac rehab to help you recover from a heart attack and to help prevent another heart attack. Almost everyone who has had a heart attack can benefit from rehab.
Cardiac rehab is a medically supervised program that may help improve the health and well-being of people who have heart problems.
The cardiac rehab team may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians or nutritionists, and psychologists or other mental health specialists.
Rehab has two parts:
Exercise training. This part helps you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your personal abilities, needs, and interests.
Education, counseling, and training. This part of rehab helps you understand your heart condition and find ways to reduce your risk of future heart problems. The rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and deal with your fears about the future.
Lowering your risk factors for coronary heart disease (CHD) can help you prevent a heart attack. (For more information about risk factors, go to "Who Is at Risk for a Heart Attack?")
Even if you already have CHD, you can still take steps to lower your risk for a heart attack. These steps involve following a heart healthy lifestyle and getting ongoing care.
Following a healthy diet is an important part of a heart healthy lifestyle. A healthy diet includes a variety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish, beans, and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugars.
For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute's (NHLBI's) Aim for a Healthy Weight Web site, "Your Guide to a Healthy Heart," and "Your Guide to Lowering Your Blood Pressure With DASH." All of these resources provide general information about healthy eating.
If you're overweight or obese, work with your doctor to create a reasonable weight-loss plan that involves diet and physical activity. Controlling your weight helps you control risk factors for CHD and heart attack.
Be as physically active as you can. Physical activity can improve your fitness level and your health. Talk with your doctor about what types of activity are safe for you.
For more information about physical activity, go to the Health Topics Physical Activity and Your Heart article and the NHLBI's "Your Guide to Physical Activity and Your Heart."
If you smoke, quit. Smoking can raise your risk of CHD and heart attack. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke. For more information about quitting smoking, go to the Health Topics Smoking and Your Heart article.
Treating conditions that make a heart attack more likely also can help lower your risk for a heart attack. These conditions may include:
High blood cholesterol. Your doctor may prescribe medicine to lower your cholesterol if diet and exercise aren't enough.
High blood pressure. You doctor may prescribe medicine to keep your blood pressure under control.
Diabetes (high blood sugar). If you have diabetes, try to control your blood sugar level through diet and physical activity (as your doctor recommends). If needed, take medicine as prescribed.
Make sure that you have an emergency action plan in case you or someone in your family has a heart attack. This is very important if you're at high risk for a heart attack or have already had a heart attack.
Write down a list of medicines you are taking, medicines you are allergic to, your health care provider's phone numbers (both during and after office hours), and contact information for a friend or relative. Keep the list in a handy place to share in a medical emergency (for example, fill out this wallet card).
Talk with your doctor about the signs and symptoms of a heart attack, when you should call 9–1–1, and steps you can take while waiting for medical help to arrive.
Many people survive heart attacks and live active, full lives. If you get help quickly, treatment can limit damage to your heart muscle. Less heart damage improves your chances for a better quality of life after a heart attack.
After a heart attack, you'll need treatment for coronary heart disease (CHD). This will help prevent another heart attack. Your doctor may recommend:
Lifestyle changes, such as following a healthy diet, being physically active, maintaining a healthy weight, and quitting smoking
Medicines to control chest pain or discomfort, high blood cholesterol, high blood pressure, and your heart's workload
A cardiac rehabilitation program
If you find it hard to get your medicines or take them, talk with your doctor. Don't stop taking medicines that can help you prevent another heart attack.
After a heart attack, most people who don't have chest pain or discomfort or other problems can safely return to most of their normal activities within a few weeks. Most can begin walking right away.
Sexual activity also can begin within a few weeks for most patients. Talk with your doctor about a safe schedule for returning to your normal routine.
If allowed by State law, driving usually can begin within a week for most patients who don't have chest pain or discomfort or other problems. Each State has rules about driving a motor vehicle following a serious illness. People who have complications shouldn't drive until their symptoms have been stable for a few weeks.
After a heart attack, many people worry about having another heart attack. Sometimes they feel depressed and have trouble adjusting to new lifestyle changes.
Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you're very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Joining a patient support group may help you adjust to life after a heart attack. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
Once you've had a heart attack, you're at higher risk for another one. Knowing the difference between angina and a heart attack is important. Angina is chest pain that occurs in people who have CHD.
The pain from angina usually occurs after physical exertion and goes away in a few minutes when you rest or take medicine as directed.
The pain from a heart attack usually is more severe than the pain from angina. Heart attack pain doesn't go away when you rest or take medicine.
If you don't know whether your chest pain is angina or a heart attack, call 9–1–1.
The symptoms of a second heart attack may not be the same as those of a first heart attack. Don't take a chance if you're in doubt. Always call 9–1–1 right away if you or someone else has heart attack symptoms.
Unfortunately, most heart attack victims wait 2 hours or more after their symptoms start before they seek medical help. This delay can result in lasting heart damage or death.
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has uncovered some of the causes of heart diseases and conditions, as well as ways to prevent or treat them.
Many more questions remain about heart diseases and conditions, including heart attacks. The NHLBI continues to support research aimed at learning more about heart attacks. For example, NHLBI-supported research includes studies that explore:
How new therapies can help treat heart attacks and improve quality of life for people who have had heart attacks
The benefits of using certain tests, such as cardiac MRI, to evaluate people who have had heart attacks
The factors that may play a role in causing heart attacks in women younger than 55 years of age
Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to heart attacks, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
http://clinicalresearch.nih.gov
www.clinicaltrials.gov
www.nhlbi.nih.gov/studies/index.htm
www.researchmatch.org
Source: National Heart, Lung, & Blood Institue, NIH
Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. In some cases, the heart can't fill with enough blood. In other cases, the heart can't pump blood to the rest of the body with enough force. Some people have both problems.
The term "heart failure" doesn't mean that your heart has stopped or is about to stop working. However, heart failure is a serious condition that requires medical care.
Heart failure develops over time as the heart's pumping action grows weaker. The condition can affect the right side of the heart only, or it can affect both sides of the heart. Most cases involve both sides of the heart.
Right-side heart failure occurs if the heart can't pump enough blood to the lungs to pick up oxygen. Left-side heart failure occurs if the heart can't pump enough oxygen-rich blood to the rest of the body.
Right-side heart failure may cause fluid to build up in the feet, ankles, legs, liver, abdomen, and the veins in the neck. Right-side and left-side heart failure also may cause shortness of breath and fatigue (tiredness).
The leading causes of heart failure are diseases that damage the heart. Examples include coronary heart disease (CHD), high blood pressure, and diabetes.
Heart failure is a very common condition. About 5.1 million people in the United States have heart failure.
Both children and adults can have the condition, although the symptoms and treatments differ. This article focuses on heart failure in adults.
Currently, heart failure has no cure. However, treatments—such as medicines and lifestyle changes—can help people who have the condition live longer and more active lives. Researchers continue to study new ways to treat heart failure and its complications.
Congestive heart failure.
Left-side heart failure. This is when the heart can't pump enough oxygen-rich blood to the body.
Right-side heart failure. This is when the heart can't fill with enough blood.
Cor pulmonale. This term refers to right-side heart failure caused by high blood pressure in the pulmonary arteries and right ventricle (lower right heart chamber).
Conditions that damage or overwork the heart muscle can cause heart failure. Over time, the heart weakens. It isn't able to fill with and/or pump blood as well as it should.
As the heart weakens, certain proteins and substances might be released into the blood. These substances have a toxic effect on the heart and blood flow, and they worsen heart failure.
The most common causes of heart failure are coronary heart disease (CHD), high blood pressure, and diabetes. Treating these problems can prevent or improve heart failure.
CHD is a condition in which a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle.
Plaque narrows the arteries and reduces blood flow to your heart muscle. The buildup of plaque also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow.
CHD can lead to chest pain or discomfort called angina (an-JI-nuh or AN-juh-nuh), a heart attack, heart damage, or even death.
Blood pressure is the force of blood pushing against the walls of the arteries. If this pressure rises and stays high over time, it can weaken your heart and lead to plaque buildup.
Blood pressure is considered high if it stays at or above 140/90 mmHg over time. (The mmHg is millimeters of mercury—the units used to measure blood pressure.) If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher.
Diabetes is a disease in which the body's blood glucose (sugar) level is too high. The body normally breaks down food into glucose and then carries it to cells throughout the body. The cells use a hormone called insulin to turn the glucose into energy.
In diabetes, the body doesn't make enough insulin or doesn't use its insulin properly. Over time, high blood sugar levels can damage and weaken the heart muscle and the blood vessels around the heart, leading to heart failure.
Other diseases and conditions also can lead to heart failure, such as:
Cardiomyopathy (KAR-de-o-mi-OP-ah-thee), or heart muscle disease. Cardiomyopathy may be present at birth or caused by injury or infection.
Heart valve disease. Problems with the heart valves may be present at birth or caused by infection, heart attack, or damage from heart disease.
Arrhythmias (ah-RITH-me-ahs), or irregular heartbeats. These heart problems may be present at birth or caused by heart disease or heart defects.
Congenital (kon-JEN-ih-tal) heart defects. These problems with the heart's structure are present at birth.
Other factors also can injure the heart muscle and lead to heart failure. Examples include:
Treatments for cancer, such as radiation and chemotherapy
Thyroid disorders (having either too much or too little thyroid hormone in the body)
Alcohol abuse or cocaine and other illegal drug use
HIV/AIDS
Too much vitamin E
Heart damage from obstructive sleep apnea may worsen heart failure. Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.
Sleep apnea can deprive your heart of oxygen and increase its workload. Treating this sleep disorder might improve heart failure.
About 5.8 million people in the United States have heart failure. The number of people who have this condition is growing.
Heart failure is more common in:
People who are 65 years old or older. Aging can weaken the heart muscle. Older people also may have had diseases for many years that led to heart failure. Heart failure is a leading cause of hospital stays among people on Medicare.
African Americans. African Americans are more likely to have heart failure than people of other races. They're also more likely to have symptoms at a younger age, have more hospital visits due to heart failure, and die from heart failure.
People who are overweight. Excess weight puts strain on the heart. Being overweight also increases your risk of heart disease and type 2 diabetes. These diseases can lead to heart failure.
People who have had a heart attack.
Men. Men have a higher rate of heart failure than women.
Children who have congenital heart defects also can develop heart failure. These defects occur if the heart, heart valves, or blood vessels near the heart don't form correctly while a baby is in the womb.
Congenital heart defects can make the heart work harder. This weakens the heart muscle, which can lead to heart failure.
Children don't have the same symptoms of heart failure or get the same treatments as adults. This article focuses on heart failure in adults.
The most common signs and symptoms of heart failure are:
Shortness of breath or trouble breathing
Fatigue (tiredness)
Swelling in the ankles, feet, legs, abdomen, and veins in the neck
All of these symptoms are the result of fluid buildup in your body. When symptoms start, you may feel tired and short of breath after routine physical effort, like climbing stairs.
As your heart grows weaker, symptoms get worse. You may begin to feel tired and short of breath after getting dressed or walking across the room. Some people have shortness of breath while lying flat.
Fluid buildup from heart failure also causes weight gain, frequent urination, and a cough that's worse at night and when you're lying down. This cough may be a sign of acute pulmonary edema (e-DE-ma). This is a condition in which too much fluid builds up in your lungs. The condition requires emergency treatment.
The image shows the major signs and symptoms of heart failure.
Your doctor will diagnose heart failure based on your medical and family histories, a physical exam, and test results. The signs and symptoms of heart failure also are common in other conditions. Thus, your doctor will:
Find out whether you have a disease or condition that can cause heart failure, such as coronary heart disease (CHD), high blood pressure, or diabetes
Rule out other causes of your symptoms
Find any damage to your heart and check how well your heart pumps blood
Early diagnosis and treatment can help people who have heart failure live longer, more active lives.
Your doctor will ask whether you or others in your family have or have had a disease or condition that can cause heart failure.
Your doctor also will ask about your symptoms. He or she will want to know which symptoms you have, when they occur, how long you've had them, and how severe they are. Your answers will help show whether and how much your symptoms limit your daily routine.
During the physical exam, your doctor will:
Listen to your heart for sounds that aren't normal
Listen to your lungs for the sounds of extra fluid buildup
Look for swelling in your ankles, feet, legs, abdomen, and the veins in your neck
No single test can diagnose heart failure. If you have signs and symptoms of heart failure, your doctor may recommend one or more tests.
Your doctor also may refer you to a cardiologist. A cardiologist is a doctor who specializes in diagnosing and treating heart diseases and conditions.
An EKG is a simple, painless test that detects and records the heart's electrical activity. The test shows how fast your heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through your heart.
An EKG may show whether the walls in your heart's pumping chambers are thicker than normal. Thicker walls can make it harder for your heart to pump blood. An EKG also can show signs of a previous or current heart attack.
A chest x ray takes pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. This test can show whether your heart is enlarged, you have fluid in your lungs, or you have lung disease.
This test checks the level of a hormone in your blood called BNP. The level of this hormone rises during heart failure.
Echocardiography (echo) uses sound waves to create a moving picture of your heart. The test shows the size and shape of your heart and how well your heart chambers and valves work.
Echo also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and heart muscle damage caused by lack of blood flow.
Echo might be done before and after a stress test (see below). A stress echo can show how well blood is flowing through your heart. The test also can show how well your heart pumps blood when it beats.
A Doppler ultrasound uses sound waves to measure the speed and direction of blood flow. This test often is done with echo to give a more complete picture of blood flow to the heart and lungs.
Doctors often use Doppler ultrasound to help diagnose right-side heart failure.
A Holter monitor records your heart's electrical activity for a full 24- or 48-hour period, while you go about your normal daily routine.
You wear small patches called electrodes on your chest. Wires connect the patches to a small, portable recorder. The recorder can be clipped to a belt, kept in a pocket, or hung around your neck.
A nuclear heart scan shows how well blood is flowing through your heart and how much blood is reaching your heart muscle.
During a nuclear heart scan, a safe, radioactive substance called a tracer is injected into your bloodstream through a vein. The tracer travels to your heart and releases energy. Special cameras outside of your body detect the energy and use it to create pictures of your heart.
A nuclear heart scan can show where the heart muscle is healthy and where it's damaged.
A positron emission tomography (PET) scan is a type of nuclear heart scan. It shows the level of chemical activity in areas of your heart. This test can help your doctor see whether enough blood is flowing to these areas. A PET scan can show blood flow problems that other tests might not detect.
During cardiac catheterization (KATH-eh-ter-ih-ZA-shun), a long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck and threaded to your heart. This allows your doctor to look inside your coronary (heart) arteries.
During this procedure, your doctor can check the pressure and blood flow in your heart chambers, collect blood samples, and use x rays to look at your coronary arteries.
Coronary angiography (an-jee-OG-rah-fee) usually is done with cardiac catheterization. A dye that can be seen on x ray is injected into your bloodstream through the tip of the catheter.
The dye allows your doctor to see the flow of blood to your heart muscle. Angiography also shows how well your heart is pumping.
Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise to make your heart work hard and beat fast.
You may walk or run on a treadmill or pedal a bicycle. If you can't exercise, you may be given medicine to raise your heart rate.
Heart tests, such as nuclear heart scanning and echo, often are done during stress testing.
Cardiac MRI (magnetic resonance imaging) uses radio waves, magnets, and a computer to create pictures of your heart as it's beating. The test produces both still and moving pictures of your heart and major blood vessels.
A cardiac MRI can show whether parts of your heart are damaged. Doctors also have used MRI in research studies to find early signs of heart failure, even before symptoms appear.
Thyroid function tests show how well your thyroid gland is working. These tests include blood tests, imaging tests, and tests to stimulate the thyroid. Having too much or too little thyroid hormone in the blood can lead to heart failure.
Early diagnosis and treatment can help people who have heart failure live longer, more active lives. Treatment for heart failure will depend on the type and stage of heart failure (the severity of the condition).
The goals of treatment for all stages of heart failure include:
Treating the condition's underlying cause, such as coronary heart disease (CHD), high blood pressure, or diabetes
Reducing symptoms
Stopping the heart failure from getting worse
Increasing your lifespan and improving your quality of life
Treatments usually include lifestyle changes, medicines, and ongoing care. If you have severe heart failure, you also may need medical procedures or surgery.
Simple changes can help you feel better and control heart failure. The sooner you make these changes, the better off you'll likely be.
Following a heart healthy diet is an important part of managing heart failure. In fact, not having a proper diet can make heart failure worse. Ask your doctor and health care team to create an eating plan that works for you.
A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, eggs, poultry without skin, seafood, nuts, seeds, beans, and peas.
A healthy diet is low in sodium (salt) and solid fats (saturated fat and trans fatty acids). Too much salt can cause extra fluid to build up in your body, making heart failure worse. Saturated fat and trans fatty acids can cause unhealthy blood cholesterol levels, which are a risk factor for heart disease.
A healthy diet also is low in added sugars and refined grains. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber). Examples of refined grains include white rice and white bread.
A balanced, nutrient-rich diet can help your heart work better. Getting enough potassium is important for people who have heart failure. Some heart failure medicines deplete the potassium in your body. Lack of potassium can cause very rapid heart rhythms that can lead to sudden death.
Potassium is found in foods like white potatoes and sweet potatoes, greens (such as spinach), bananas, many dried fruits, and white beans and soybeans.
Talk with your health care team about getting the correct amount of potassium. Too much potassium also can be harmful.
For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute's "Your Guide to Lowering Your Blood Pressure With DASH" and the U.S. Department of Agriculture's ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating.
It's important for people who have heart failure to drink the correct amounts and types of fluid. Drinking too much fluid can worsen heart failure. Also, if you have heart failure, you shouldn't drink alcohol.
Talk with your doctor about what amounts and types of fluid you should have each day.
Taking steps to control risk factors for CHD, high blood pressure, and diabetes will help control heart failure. For example:
Lose weight if you're overweight or obese. Work with your health care team to lose weight safely.
Be physically active (as your doctor advises) to become more fit and stay as active as possible.
Quit smoking and avoid using illegal drugs. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke. Smoking and drugs can worsen heart failure and harm your health.
Get enough rest.
Your doctor will prescribe medicines based on the type of heart failure you have, how severe it is, and your response to certain medicines. The following medicines are commonly used to treat heart failure:
Diuretics (water or fluid pills) help reduce fluid buildup in your lungs and swelling in your feet and ankles.
ACE inhibitors lower blood pressure and reduce strain on your heart. They also may reduce the risk of a future heart attack.
Aldosterone antagonists trigger the body to get rid of salt and water through urine. This lowers the volume of blood that the heart must pump.
Angiotensin receptor blockers relax your blood vessels and lower blood pressure to decrease your heart's workload.
Beta blockers slow your heart rate and lower your blood pressure to decrease your heart's workload.
Isosorbide dinitrate/hydralazine hydrochloride helps relax your blood vessels so your heart doesn't work as hard to pump blood. Studies have shown that this medicine can reduce the risk of death in African Americans. More studies are needed to find out whether this medicine will benefit other racial groups.
Digoxin makes the heart beat stronger and pump more blood.
You should watch for signs that heart failure is getting worse. For example, weight gain may mean that fluids are building up in your body. Ask your doctor how often you should check your weight and when to report weight changes.
Getting medical care for other related conditions is important. If you have diabetes or high blood pressure, work with your health care team to control these conditions. Have your blood sugar level and blood pressure checked. Talk with your doctor about when you should have tests and how often to take measurements at home.
Try to avoid respiratory infections like the flu and pneumonia. Talk with your doctor or nurse about getting flu and pneumonia vaccines.
Many people who have severe heart failure may need treatment in a hospital from time to time. Your doctor may recommend oxygen therapy (oxygen given through nasal prongs or a mask). Oxygen therapy can be given in a hospital or at home.
As heart failure worsens, lifestyle changes and medicines may no longer control your symptoms. You may need a medical procedure or surgery.
If you have heart damage and severe heart failure symptoms, your doctor might recommend a cardiac resynchronization therapy (CRT) device or an implantable cardioverter defibrillator (ICD).
In heart failure, the right and left sides of the heart may no longer contract at the same time. This disrupts the heart's pumping. To correct this problem, your doctor might implant a CRT device (a type of pacemaker) near your heart.
This device helps both sides of your heart contract at the same time, which can decrease heart failure symptoms.
Some people who have heart failure have very rapid, irregular heartbeats. Without treatment, these heartbeats can cause sudden cardiac arrest. Your doctor might implant an ICD near your heart to solve this problem. An ICD checks your heart rate and uses electrical pulses to correct irregular heart rhythms.
People who have severe heart failure symptoms at rest, despite other treatments, may need:
A mechanical heart pump, such as a left ventricular assist device. This device helps pump blood from the heart to the rest of the body. You may use a heart pump until you have surgery or as a long-term treatment.
Heart transplant. A heart transplant is an operation in which a person's diseased heart is replaced with a healthy heart from a deceased donor. Heart transplants are done as a life-saving measure for end-stage heart failure when medical treatment and less drastic surgery have failed.
Experimental treatments. Studies are under way to find new and better ways to treat heart failure.
Researchers continue to learn more about heart failure and how to treat it. As a result, treatments are getting better.
If you have heart failure, you may want to consider taking part in research studies called clinical trials. These studies offer care from experts and the chance to help advance heart failure knowledge and treatment.
For more information about clinical trials, go to the "Clinical Trials" section of this article.
If you have heart failure, you may also want to take part in a heart failure registry. The registry tracks the course of disease and treatment in large numbers of people. These data help research move forward. You may help yourself and others by taking part. Talk with your health care team to learn more.
ou can take steps to prevent heart failure. The sooner you start, the better your chances of preventing or delaying the condition.
If you have a healthy heart, you can take action to prevent heart disease and heart failure. To reduce your risk of heart disease:
Follow a healthy diet. A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods. A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains.
If you smoke, make an effort to quit. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.
If you're overweight or obese, try to lose weight. Work with your health care team to create a reasonable weight-loss plan.
Be physically active. People gain health benefits from as little as 60 minutes of moderate-intensity aerobic activity per week. The more active you are, the more you will benefit.
Avoid using illegal drugs.
Even if you're at high risk for heart failure, you can take steps to reduce your risk. People at high risk include those who have coronary heart disease, high blood pressure, or diabetes.
Follow all of the steps listed above. Talk with your doctor about what types and amounts of physical activity are safe for you.
Treat and control any conditions that can cause heart failure. Take medicines as your doctor prescribes.
Avoid drinking alcohol.
See your doctor for ongoing care.
If you have heart damage but no signs of heart failure, you can still reduce your risk of developing the condition. In addition to the steps above, take your medicines as prescribed to reduce your heart's workload.
Currently, heart failure has no cure. You'll likely have to take medicine and follow a treatment plan for the rest of your life.
Despite treatment, symptoms may get worse over time. You may not be able to do many of the things that you did before you had heart failure. However, if you take all the steps your doctor recommends, you can stay healthier longer.
Researchers also might find new treatments that can help you in the future.
Treatment can relieve your symptoms and make daily activities easier. It also can reduce the chance that you'll have to go to the hospital. Thus, it's important that you follow your treatment plan.
Take your medicines as your doctor prescribes. If you have side effects from any of your medicines, tell your doctor. He or she might adjust the dose or type of medicine you take to relieve side effects.
Make all of the lifestyle changes that your doctor recommends.
Get advice from your doctor about how active you can and should be. This includes advice on daily activities, work, leisure time, sex, and exercise. Your level of activity will depend on the stage of your heart failure (how severe it is).
Keep all of your medical appointments, including visits to the doctor and appointments to get tests and lab work. Your doctor needs the results of these tests to adjust your medicine doses and help you avoid harmful side effects.
Certain actions can worsen your heart failure, such as:
Forgetting to take your medicines
Not following your diet (for example, eating salty foods)
Drinking alcohol
These actions can lead to a hospital stay. If you have trouble following your diet, talk with your doctor. He or she can help arrange for a dietitian to work with you. Avoid drinking alcohol.
People who have heart failure often have other serious conditions that require ongoing treatment. If you have other serious conditions, you're likely taking medicines for them as well as for heart failure.
Taking more than one medicine raises the risk of side effects and other problems. Make sure your doctors and your pharmacist have a complete list of all of the medicines and over-the-counter products that you're taking.
Tell your doctor right away about any problems with your medicines. Also, talk with your doctor before taking any new medicine prescribed by another doctor or any new over-the-counter medicines or herbal supplements.
Try to avoid respiratory infections like the flu and pneumonia. Ask your doctor or nurse about getting flu and pneumonia vaccines.
If you have heart failure, it's important to know:
When to seek help. Ask your doctor when to make an office visit or get emergency care.
Phone numbers for your doctor and hospital.
Directions to your doctor's office and hospital and people who can take you there.
A list of medicines you're taking.
Living with heart failure may cause fear, anxiety, depression, and stress. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you're very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Joining a patient support group may help you adjust to living with heart failure. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has uncovered some of the causes of heart diseases and conditions, as well as ways to prevent or treat these disorders.
Many more questions remain about heart diseases and conditions, including heart failure. The NHLBI continues to support research aimed at learning more about heart failure, including:
Finding new therapies for treating heart failure and improving quality of life for people who have the condition
Creating a new tool for identifying high- and low-risk heart failure patients in emergency departments
Finding out whether cognitive behavioral therapy can help treat heart failure patients who have depression
Exploring gene therapy as a possible treatment for heart failure
Assessing an educational program that aims to improve heart failure outcomes in adults living in rural areas
Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to heart failure, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
http://clinicalresearch.nih.gov
www.clinicaltrials.gov
www.nhlbi.nih.gov/studies/index.htm
www.researchmatch.org
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
Source: NHLBI, NIH
What Is a Heart Murmur?
A heart murmur is an extra or unusual sound heard during a heartbeat. Murmurs range from very faint to very loud. Sometimes they sound like a whooshing or swishing noise.
Normal heartbeats make a "lub-DUPP" or "lub-DUB" sound. This is the sound of the heart valves closing as blood moves through the heart. Doctors can hear these sounds and heart murmurs using a stethoscope.
The two types of heart murmurs are innocent (harmless) and abnormal.
Innocent heart murmurs aren't caused by heart problems. These murmurs are common in healthy children. Many children will have heart murmurs heard by their doctors at some point in their lives.
People who have abnormal heart murmurs may have signs or symptoms of heart problems. Most abnormal murmurs in children are caused by congenital (kon-JEN-ih-tal) heart defects. These defects are problems with the heart's structure that are present at birth.
In adults, abnormal heart murmurs most often are caused by acquired heart valve disease. This is heart valve disease that develops as the result of another condition. Infections, diseases, and aging can cause heart valve disease.
A heart murmur isn't a disease, and most murmurs are harmless. Innocent murmurs don't cause symptoms. Having one doesn't require you to limit your physical activity or do anything else special. Although you may have an innocent murmur throughout your life, you won't need treatment for it.
The outlook and treatment for abnormal heart murmurs depend on the type and severity of the heart problem causing them.
The heart is a muscle about the size of your fist. It works like a pump and beats 100,000 times a day.
The heart has two sides, separated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to pick up oxygen. The left side of the heart receives the oxygen-rich blood from the lungs and pumps it to the body.
The heart has four chambers and four valves and is connected to various blood vessels. Veins are blood vessels that carry blood from the body to the heart. Arteries are blood vessels that carry blood away from the heart to the body.
Figure 1 shows the location of the heart in the body. Figure B shows a cross-section of a healthy heart and its inside structures. The blue arrow shows the direction in which oxygen-poor blood flows through the heart to the lungs. The red arrow shows the direction in which oxygen-rich blood flows from the lungs into the heart and then out to the body.
The heart has four chambers or "rooms."
The atria (AY-tree-uh) are the two upper chambers that collect blood as it flows into the heart.
The ventricles (VEN-trih-kuls) are the two lower chambers that pump blood out of the heart to the lungs or other parts of the body.
Four valves control the flow of blood from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart.
The tricuspid (tri-CUSS-pid) valve is in the right side of the heart, between the right atrium and the right ventricle.
The pulmonary (PULL-mun-ary) valve is in the right side of the heart, between the right ventricle and the entrance to the pulmonary artery. The artery carries blood from the heart to the lungs.
The mitral (MI-trul) valve is in the left side of the heart, between the left atrium and the left ventricle.
The aortic (ay-OR-tik) valve is in the left side of the heart, between the left ventricle and the entrance to the aorta. This artery carries blood from the heart to the body.
Valves are like doors that open and close. They open to allow blood to flow through to the next chamber or to one of the arteries. Then they shut to keep blood from flowing backward.
When the heart's valves open and close, they make a "lub-DUB" sound that a doctor can hear using a stethoscope.
The first sound—the "lub"—is made by the mitral and tricuspid valves closing at the beginning of systole (SIS-toe-lee). Systole is when the ventricles contract, or squeeze, and pump blood out of the heart.
The second sound—the "DUB"—is made by the aortic and pulmonary valves closing at the beginning of diastole (di-AS-toe-lee). Diastole is when the ventricles relax and fill with blood pumped into them by the atria.
The arteries are major blood vessels connected to your heart.
The pulmonary artery carries blood from the right side of the heart to the lungs to pick up a fresh supply of oxygen.
The aorta is the main artery that carries oxygen-rich blood from the left side of the heart to the body.
The coronary arteries are the other important arteries attached to the heart. They carry oxygen-rich blood from the aorta to the heart muscle, which must have its own blood supply to function.
The veins also are major blood vessels connected to your heart.
The pulmonary veins carry oxygen-rich blood from the lungs to the left side of the heart so it can be pumped to the body.
The superior and inferior vena cavae are large veins that carry oxygen-poor blood from the body back to the heart.
For more information about how a healthy heart works, go to the Health Topics How the Heart Works article. This article contains animations that show how your heart pumps blood and how your heart's electrical system works.
Benign heart murmurs.
Flow murmurs.
Functional heart murmurs.
Mammary souffle (SOO-fl). (This type of heart murmur is heard in some pregnant women because of increased blood flow to the breasts.)
Normal heart murmurs.
Physiologic heart murmurs.
Still's murmurs.
Venous hums.
Pathologic heart murmurs.
Why some people have innocent heart murmurs and others do not isn't known. Innocent murmurs are simply sounds made by blood flowing through the heart's chambers and valves, or through blood vessels near the heart.
Extra blood flow through the heart also may cause innocent heart murmurs. After childhood, the most common cause of extra blood flow through the heart is pregnancy. This is because during pregnancy, women's bodies make extra blood. Most heart murmurs that occur in pregnant women are innocent.
Congenital heart defects or acquired heart valve disease often are the cause of abnormal heart murmurs.
Congenital heart defects are the most common cause of abnormal heart murmurs in children. These defects are problems with the heart's structure that are present at birth. They change the normal flow of blood through the heart.
Congenital heart defects can involve the interior walls of the heart, the valves inside the heart, or the arteries and veins that carry blood to and from the heart. Some babies are born with more than one heart defect.
Heart valve problems, septal defects (also called holes in the heart), and diseases of the heart muscle such as hypertrophic cardiomyopathy are common heart defects that cause abnormal heart murmurs.
Examples of valve problems are narrow valves that limit blood flow or leaky valves that don't close properly. Septal defects are holes in the wall that separates the right and left sides of the heart. This wall is called the septum.
A hole in the septum between the heart's two upper chambers is called an atrial septal defect. A hole in the septum between the heart's two lower chambers is called a ventricular septal defect.
Hypertrophic (hi-per-TROF-ik) cardiomyopathy (kar-de-o-mi-OP-ah-thee) (HCM) occurs if heart muscle cells enlarge and cause the walls of the ventricles (usually the left ventricle) to thicken. The thickening may block blood flow out of the ventricle. If a blockage occurs, the ventricle must work hard to pump blood to the body. HCM also can affect the heart’s mitral valve, causing blood to leak backward through the valve.
Figure A shows the structure and blood flow inside a normal heart. Figure B shows a heart with leaking and narrowed valves. Figure C shows a heart with a ventricular septal defect.
Acquired heart valve disease often is the cause of abnormal heart murmurs in adults. This is heart valve disease that develops as the result of another condition.
Many conditions can cause heart valve disease. Examples include heart conditions and other disorders, age-related changes, rheumatic (ru-MAT-ik) fever, and infections.
Heart conditions and other disorders. Certain conditions can stretch and distort the heart valves, such as:
Damage and scar tissue from a heart attack or injury to the heart.
Advanced high blood pressure and heart failure. These conditions can enlarge the heart or its main arteries.
Age-related changes. As you get older, calcium deposits or other deposits may form on your heart valves. These deposits stiffen and thicken the valve flaps and limit blood flow. This stiffening and thickening of the valve is called sclerosis (skle-RO-sis).
Rheumatic fever. The bacteria that cause strep throat, scarlet fever, and, in some cases, impetigo (im-peh-TI-go) also can cause rheumatic fever. This serious illness can develop if you have an untreated or not fully treated streptococcal (strep) infection.
Rheumatic fever can damage and scar the heart valves. The symptoms of this heart valve damage often don't occur until many years after recovery from rheumatic fever.
Today, most people who have strep infections are treated with antibiotics before rheumatic fever develops. It's very important to take all of the antibiotics your doctor prescribes for strep throat, even if you feel better before the medicine is gone.
Infections. Common germs that enter the bloodstream and get carried to the heart can sometimes infect the inner surface of the heart, including the heart valves. This rare but sometimes life-threatening infection is called infective endocarditis (EN-do-kar-DI-tis), or IE.
IE is more likely to develop in people who already have abnormal blood flow through a heart valve because of heart valve disease. The abnormal blood flow causes blood clots to form on the surface of the valve. The blood clots make it easier for germs to attach to and infect the valve.
IE can worsen existing heart valve disease.
Some heart murmurs occur because of an illness outside of the heart. The heart is normal, but an illness or condition can cause blood flow that's faster than normal. Examples of this type of illness include fever, anemia (uh-NEE-me-eh), and hyperthyroidism.
Anemia is a condition in which the body has a lower than normal number of red blood cells. Hyperthyroidism is a condition in which the body has too much thyroid hormone.
People who have innocent (harmless) heart murmurs don't have any signs or symptoms other than the murmur itself. This is because innocent heart murmurs aren't caused by heart problems.
People who have abnormal heart murmurs may have signs or symptoms of the heart problems causing the murmurs. These signs and symptoms may include:
Poor eating and failure to grow normally (in infants)
Shortness of breath, which may occur only with physical exertion
Excessive sweating with minimal or no exertion
Chest pain
Dizziness or fainting
A bluish color on the skin, especially on the fingertips and lips
Chronic cough
Swelling or sudden weight gain
Enlarged liver
Enlarged neck veins
Signs and symptoms depend on the problem causing the heart murmur and its severity.
Doctors use a stethoscope to listen to heart sounds and hear heart murmurs. They may detect heart murmurs during routine checkups or while checking for another condition.
If a congenital heart defect causes a murmur, it's often heard at birth or during infancy. Abnormal heart murmurs caused by other heart problems can be heard in patients of any age.
Primary care doctors usually refer people who have abnormal heart murmurs to cardiologists or pediatric cardiologists for further care and testing.
Cardiologists are doctors who specialize in diagnosing and treating heart problems in adults. Pediatric cardiologists specialize in diagnosing and treating heart problems in children.
Your doctor will carefully listen to your heart or your child's heart with a stethoscope to find out whether a murmur is innocent or abnormal. He or she will listen to the loudness, location, and timing of the murmur. This will help your doctor diagnose the cause of the murmur.
Your doctor also may:
Ask about your medical and family histories.
Do a complete physical exam. He or she will look for signs of illness or physical problems. For example, your doctor may look for a bluish color on your skin. In infants, doctors may look for delayed growth and feeding problems.
Ask about your symptoms, such as chest pain, shortness of breath (especially with physical exertion), dizziness, or fainting.
When evaluating a heart murmur, your doctor will pay attention to many things, such as:
How faint or loud the sound is. Your doctor will grade the murmur on a scale of 1 to 6 (1 is very faint and 6 is very loud).
When the sound occurs in the cycle of the heartbeat.
Where the sound is heard in the chest and whether it also can be heard in the neck or back.
Whether the sound has a high, medium, or low pitch.
How long the sound lasts.
How breathing, physical activity, or a change in body position affects the sound.
If your doctor thinks you or your child has an abnormal heart murmur, he or she may recommend one or more of the following tests.
A chest x ray is a painless test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. This test is done to find the cause of symptoms, such as shortness of breath and chest pain.
An EKG (electrocardiogram) is a simple test that detects and records the heart's electrical activity. An EKG shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through each part of the heart.
This test is used to detect and locate the source of heart problems. The results from an EKG also may be used to rule out certain heart problems.
Echocardiography (EK-o-kar-de-OG-ra-fee), or echo, is a painless test that uses sound waves to create pictures of your heart. The test shows the size and shape of your heart and how well your heart's chambers and valves are working.
Echo also can show areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.
There are several types of echo, including a stress echo. This test is done both before and after a stress test. During this test, you exercise to make your heart work hard and beat fast. If you can’t exercise, you may be given medicine to make your heart work hard and beat fast. Echo is used to take pictures of your heart before you exercise and as soon as you finish.
Stress echo shows whether you have decreased blood flow to your heart (a sign of coronary heart disease).
A heart murmur isn't a disease. It's an extra or unusual sound heard during the heartbeat. Thus, murmurs themselves don't require treatment. However, if an underlying condition is causing a heart murmur, your doctor may recommend treatment for that condition.
Healthy children who have innocent (harmless) heart murmurs don't need treatment. Their heart murmurs aren't caused by heart problems or other conditions.
Pregnant women who have innocent heart murmurs due to extra blood volume also don't need treatment. Their heart murmurs should go away after pregnancy.
If you or your child has an abnormal heart murmur, your doctor will recommend treatment for the disease or condition causing the murmur.
Some medical conditions, such as anemia or hyperthyroidism, can cause heart murmurs that aren't related to heart disease. Treating these conditions should make the heart murmur go away.
If a congenital heart defect is causing a heart murmur, treatment will depend on the type and severity of the defect. Treatment may include medicines or surgery. For more information about treatments for congenital heart defects, go to the Health Topics Congenital Heart Defects article.
If acquired heart valve disease is causing a heart murmur, treatment usually will depend on the type, amount, and severity of the disease.
Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines can treat symptoms and help delay complications. Eventually, though, you may need surgery to repair or replace a faulty heart valve.
For more information about treatments for heart valve disease, go to the Health Topics Heart Valve Disease article.
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to heart murmurs or other heart diseases or conditions, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
http://clinicalresearch.nih.gov
www.clinicaltrials.gov
www.nhlbi.nih.gov/studies/index.htm
www.researchmatch.org
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
Source: NHLBI, NIH
What Are Palpitations?
Palpitations (pal-pi-TA-shuns) are feelings that your heart is skipping a beat, fluttering, or beating too hard or too fast. You may have these feelings in your chest, throat, or neck. They can occur during activity or even when you're sitting still or lying down.
Many things can trigger palpitations, including:
Strong emotions
Vigorous physical activity
Medicines such as diet pills and decongestants
Caffeine, alcohol, nicotine, and illegal drugs
Certain medical conditions, such as thyroid disease or anemia
(uh-NEE-me-uh)
These factors can make the heart beat faster or stronger than usual, or they can cause premature (extra) heartbeats. In these situations, the heart is still working normally. Thus, these palpitations usually are harmless.
Some palpitations are symptoms of arrhythmias (ah-RITH-me-ahs). Arrhythmias are problems with the rate or rhythm of the heartbeat.
Some arrhythmias are signs of heart conditions, such as heart attack, heart failure, heart valve disease, or heart muscle disease. However, less than half of the people who have palpitations have arrhythmias.
You can take steps to reduce or prevent palpitations. Try to avoid things that trigger them (such as stress and stimulants) and treat related medical conditions.
Palpitations are very common. They usually aren't serious or harmful, but they can be bothersome. If you have them, your doctor can decide whether you need treatment or ongoing care.
Many things can cause palpitations. You may have these feelings even when your heart is beating normally or somewhat faster than normal.
Most palpitations are harmless and often go away on their own. However, some palpitations are signs of a heart problem. Sometimes the cause of palpitations can't be found.
If you start having palpitations, see your doctor to have them checked.
You may feel your heart pounding or racing during anxiety, fear, or stress. You also may have these feelings if you're having a panic attack.
Intense activity can make your heart feel like it’s beating too hard or too fast, even though it's working normally. Intense activity also can cause occasional premature (extra) heartbeats.
Some medical conditions can cause palpitations. These conditions can make the heart beat faster or stronger than usual. They also can cause premature (extra) heartbeats.
Examples of these medical conditions include:
An overactive thyroid
A low blood sugar level
Anemia
Some types of low blood pressure
Fever
Dehydration (not enough fluid in the body)
The hormonal changes that happen during pregnancy, menstruation, and the perimenopausal period may cause palpitations. The palpitations will likely improve or go away as these conditions go away or change.
Some palpitations that occur during pregnancy may be due to anemia.
Many medicines can trigger palpitations because they can make the heart beat faster or stronger than usual. Medicines also can cause premature (extra) heartbeats.
Examples of these medicines include:
Inhaled asthma medicines.
Medicines to treat an underactive thyroid. Taking too much of these medicines can cause an overactive thyroid and lead to palpitations.
Medicines to prevent arrhythmias. Medicines used to treat irregular heart rhythms can sometimes cause other irregular heart rhythms.
Over-the-counter medicines that act as stimulants also may cause palpitations. These include decongestants (found in cough and cold medicines) and some herbal and nutritional supplements.
Caffeine, nicotine (found in tobacco), alcohol, and illegal drugs (such as cocaine and amphetamines) also can cause palpitations.
Some palpitations are symptoms of arrhythmias. Arrhythmias are problems with the rate or rhythm of the heartbeat. However, less than half of the people who have palpitations have arrhythmias.
During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. An arrhythmia happens if some part of the heart's electrical system doesn't work as it should.
Palpitations are more likely to be related to an arrhythmia if you:
Have had a heart attack or are at risk for one.
Have coronary heart disease (CHD) or risk factors for CHD.
Have other heart problems, such as heart failure, heart valve disease, or heart muscle disease.
Have abnormal electrolyte levels. Electrolytes are minerals, such as potassium and sodium, found in blood and body fluids. They're vital for normal health and functioning of the body.
Some people may be more likely than others to have palpitations. People at increased risk include those who:
Have anxiety or panic attacks, or people who are highly stressed
Take certain medicines or stimulants
Have certain medical conditions that aren't related to heart problems, such as an overactive thyroid
Have certain heart problems, such as arrhythmias (irregular heartbeats), a previous heart attack, heart failure, heart valve disease, or heart muscle disease
Women who are pregnant, menstruating, or perimenopausal also may be at higher risk for palpitations because of hormonal changes. Some palpitations that occur during pregnancy may be due to anemia.
For more information about these risk factors, go to "What Causes Palpitations?"
Symptoms of palpitations include feelings that your heart is:
Skipping a beat
Fluttering
Beating too hard or too fast
You may have these feelings in your chest, throat, or neck. They can occur during activity or even when you're sitting still or lying down.
Palpitations often are harmless, and your heart is working normally. However, these feelings can be a sign of a more serious problem if you also:
Feel dizzy or confused
Are light-headed, think you may faint, or do faint
Have trouble breathing
Have pain, pressure, or tightness in your chest, jaw, or arms
Feel short of breath
Have unusual sweating
Your doctor may have already told you that your palpitations are harmless. Even so, see your doctor again if your palpitations:
Start to occur more often or are more noticeable or bothersome
Occur with other symptoms, such as those listed above
Your doctor will want to check whether your palpitations are the symptom of a heart problem, such as an arrhythmia (irregular heartbeat).
First, your doctor will want to find out whether your palpitations are harmless or related to a heart problem. He or she will ask about your symptoms and medical history, do a physical exam, and recommend several basic tests.
This information may point to a heart problem as the cause of your palpitations. If so, your doctor may recommend more tests. These tests will help show what the problem is, so your doctor can decide how to treat it.
The cause of palpitations may be hard to diagnose, especially if symptoms don't occur regularly.
Several types of doctors may work with you to diagnose and treat your palpitations. These include a:
Primary care doctor
Cardiologist (a doctor who specializes in diagnosing and treating heart diseases and conditions)
Electrophysiologist (a cardiologist who specializes in the heart's electrical system)
Your doctor will ask questions about your palpitations, such as:
When did they begin?
How long do they last?
How often do they occur?
Do they start and stop suddenly?
Does your heartbeat feel steady or irregular during the palpitations?
Do other symptoms occur with the palpitations?
Do your palpitations have a pattern? For example, do they occur when you exercise or drink coffee? Do they happen at a certain time of day?
Your doctor also may ask about your use of caffeine, alcohol, supplements, and illegal drugs.
Your doctor will take your pulse to find out how fast your heart is beating and whether its rhythm is normal. He or she also will use a stethoscope to listen to your heartbeat.
Your doctor may look for signs of conditions that can cause palpitations, such as an overactive thyroid.
Often, the first test that's done is an EKG (electrocardiogram). This simple test records your heart's electrical activity.
An EKG shows how fast your heart is beating and its rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through your heart.
Even if your EKG results are normal, you may still have a medical condition that's causing palpitations. If your doctor suspects this is the case, you may have blood tests to gather more information about your heart's structure, function, and electrical system.
A standard EKG only records the heartbeat for a few seconds. It won't detect heart rhythm problems that don't happen during the test. To diagnose problems that come and go, your doctor may have you wear a Holter or event monitor.
A Holter monitor records the heart’s electrical activity for a full 24- or 48-hour period. You wear patches called electrodes on your chest. Wires connect the patches to a small, portable recorder. The recorder can be clipped to a belt, kept in a pocket, or hung around your neck.
During the 24- or 48-hour period, you do your usual daily activities. You use a notebook to record any symptoms you have and the time they occur. You then return both the recorder and the notebook to your doctor to read the results. Your doctor can see how your heart was beating at the time you had symptoms.
An event monitor is similar to a Holter monitor. You wear an event monitor while doing your normal activities. However, an event monitor only records your heart's electrical activity at certain times while you're wearing it.
For many event monitors, you push a button to start the monitor when you feel symptoms. Other event monitors start automatically when they sense abnormal heart rhythms.
You can wear an event monitor for weeks or until symptoms occur.
Figure A shows how a Holter or event monitor attaches to a patient. In this example, the monitor is clipped to the patient's belt and electrodes are attached to his chest. Figure B shows an electrocardiogram strip, which maps the data from the Holter or event monitor.
Echocardiography uses sound waves to create a moving picture of your heart. The picture shows the size and shape of your heart and how well your heart chambers and valves are working.
The test also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.
Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can’t exercise, you may be given medicine to make your heart work hard and beat fast.
Treatment for palpitations depends on their cause. Most palpitations are harmless and often go away on their own. In these cases, no treatment is needed.
Your palpitations may be harmless but bothersome. If so, your doctor may suggest avoiding things that trigger them. For examples, your doctor may advise you to:
Reduce anxiety and stress. Anxiety and stress (including panic attacks) are a common cause of harmless palpitations. Relaxation exercises, yoga or tai chi, biofeedback or guided imagery, or aromatherapy may help you relax.
Avoid or limit stimulants, such as caffeine, nicotine, or alcohol.
Avoid illegal drugs, such as cocaine and amphetamines.
Avoid medicines that act as stimulants, such as cough and cold medicines and some herbal and nutritional supplements.
Work with your doctor to control medical conditions that can cause palpitations, such as an overactive thyroid. If you're taking medicine that's causing palpitations, your doctor will try to find a different medicine for you.
If your palpitations are caused by an arrhythmia (irregular heartbeat), your doctor may recommend medicines or procedures to treat the problem. For more information, go to the Health Topics Arrhythmia article.
You can take steps to prevent palpitations. Try to avoid things that trigger them. For example:
Reduce anxiety and stress. Anxiety and stress (including panic attacks) are a common cause of harmless palpitations. Relaxation exercises, yoga or tai chi, biofeedback or guided imagery, or aromatherapy may help you relax.
Avoid or limit stimulants, such as caffeine, nicotine, or alcohol.
Avoid illegal drugs, such as cocaine and amphetamines.
Avoid medicines that act as stimulants, such as cough and cold medicines and some herbal and nutritional supplements.
Also, work with your doctor to treat medical conditions that can cause palpitations.
Most palpitations are harmless and often go away on their own. Treatment usually isn’t needed in these cases. Your doctor may advise you to avoid triggers for palpitations. (For more information, go to "How Are Palpitations Treated?")
Your doctor may have already told you that your palpitations are harmless. Even so, see your doctor again if they get worse, start to occur more often, become more noticeable or bothersome, or occur with other symptoms.
Your doctor will tell you about other signs and symptoms to be aware of and when to seek emergency care.
A medical condition or heart problem might be the cause of your palpitations. If so, your doctor will give you advice and treatment for your condition.
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they’re widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don’t directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You’ll learn about treatments and tests you may receive, and the benefits and risks they may pose. You’ll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you’ll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to palpitations, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
http://clinicalresearch.nih.gov
www.clinicaltrials.gov
www.nhlbi.nih.gov/studies/index.htm
www.researchmatch.org
For more information about clinical trials for children, visit the NHLBI’s Children and Clinical Studies Web page.
Source: NHLBI, NIH
Heart valve disease occurs if one or more of your heart valves don't work well. The heart has four valves: the tricuspid (tri-CUSS-pid), pulmonary (PULL-mun-ary), mitral (MI-trul), and aortic (ay-OR-tik) valves.
These valves have tissue flaps that open and close with each heartbeat. The flaps make sure blood flows in the right direction through your heart's four chambers and to the rest of your body.
Figure A shows the location of the heart in the body. Figure B shows a cross-section of a healthy heart and its inside structures. The blue arrow shows the direction in which oxygen-poor blood flows through the heart to the lungs. The red arrow shows the direction in which oxygen-rich blood flows from the lungs into the heart and then out to the body.
Birth defects, age-related changes, infections, or other conditions can cause one or more of your heart valves to not open fully or to let blood leak back into the heart chambers. This can make your heart work harder and affect its ability to pump blood.
At the start of each heartbeat, blood returning from the body and lungs fills the atria (the heart's two upper chambers). The mitral and tricuspid valves are located at the bottom of these chambers. As the blood builds up in the atria, these valves open to allow blood to flow into the ventricles (the heart's two lower chambers).
After a brief delay, as the ventricles begin to contract, the mitral and tricuspid valves shut tightly. This prevents blood from flowing back into the atria.
As the ventricles contract, they pump blood through the pulmonary and aortic valves. The pulmonary valve opens to allow blood to flow from the right ventricle into the pulmonary artery. This artery carries blood to the lungs to get oxygen.
At the same time, the aortic valve opens to allow blood to flow from the left ventricle into the aorta. The aorta carries oxygen-rich blood to the body. As the ventricles relax, the pulmonary and aortic valves shut tightly. This prevents blood from flowing back into the ventricles.
For more information about how the heart pumps blood and detailed animations, go to the Health Topics How the Heart Works article.
Heart valves can have three basic kinds of problems: regurgitation (re-GUR-jih-TA-shun), stenosis (ste-NO-sis), and atresia (a-TRE-ze-ah).
Regurgitation, or backflow, occurs if a valve doesn't close tightly. Blood leaks back into the chambers rather than flowing forward through the heart or into an artery.
In the United States, backflow most often is due to prolapse. "Prolapse" is when the flaps of the valve flop or bulge back into an upper heart chamber during a heartbeat. Prolapse mainly affects the mitral valve.
Stenosis occurs if the flaps of a valve thicken, stiffen, or fuse together. This prevents the heart valve from fully opening. As a result, not enough blood flows through the valve. Some valves can have both stenosis and backflow problems.
Atresia occurs if a heart valve lacks an opening for blood to pass through.
Some people are born with heart valve disease, while others acquire it later in life. Heart valve disease that develops before birth is called congenital (kon-JEN-ih-tal) heart valve disease. Congenital heart valve disease can occur alone or with other congenital heart defects.
Congenital heart valve disease often involves pulmonary or aortic valves that don't form properly. These valves may not have enough tissue flaps, they may be the wrong size or shape, or they may lack an opening through which blood can flow properly.
Acquired heart valve disease usually involves aortic or mitral valves. Although the valves are normal at first, problems develop over time.
Both congenital and acquired heart valve disease can cause stenosis or backflow.
Many people have heart valve defects or disease but don't have symptoms. For some people, the condition mostly stays the same throughout their lives and doesn't cause any problems.
For other people, heart valve disease slowly worsens until symptoms develop. If not treated, advanced heart valve disease can cause heart failure, stroke, blood clots, or death due to sudden cardiac arrest (SCA).
Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines can relieve many of its symptoms and complications.
These treatments also can lower your risk of developing a life-threatening condition, such as stroke or SCA. Eventually, you may need to have your faulty heart valve repaired or replaced.
Some types of congenital heart valve disease are so severe that the valve is repaired or replaced during infancy, childhood, or even before birth. Other types may not cause problems until middle-age or older, if at all.
Aortic regurgitation
Aortic stenosis
Aortic sclerosis
Aortic valve disease
Bicuspid aortic valve
Congenital heart defect
Congenital valve disease
Mitral regurgitation
Mitral stenosis
Mitral valve disease
Mitral valve prolapse
Pulmonic regurgitation
Pulmonic stenosis
Pulmonic valve disease
Tricuspid regurgitation
Tricuspid stenosis
Tricuspid valve disease
Heart conditions and other disorders, age-related changes, rheumatic fever, or infections can cause acquired heart valve disease. These factors change the shape or flexibility of once-normal valves.
The cause of congenital heart valve disease isn't known. It occurs before birth as the heart is forming. Congenital heart valve disease can occur alone or with other types of congenital heart defects.
Certain conditions can stretch and distort the heart valves, such as:
Damage and scar tissue due to a heart attack or injury to the heart.
Advanced high blood pressure and heart failure. These conditions can enlarge the heart or the main arteries.
Atherosclerosis (ath-er-o-skler-O-sis) in the aorta. Atherosclerosis is a condition in which a waxy substance called plaque (plak) builds up inside the arteries. The aorta is the main artery that carries oxygen-rich blood to the body.
Men older than 65 and women older than 75 are prone to developing calcium and other types of deposits on their heart valves. These deposits stiffen and thicken the valve flaps and limit blood flow through the valve (stenosis).
The aortic valve is especially prone to this problem. The deposits look similar to the plaque deposits seen in people who have atherosclerosis. Some of the same processes may cause both atherosclerosis and heart valve disease.
Untreated strep throat or other infections with strep bacteria that progress to rheumatic fever can cause heart valve disease.
When the body tries to fight the strep infection, one or more heart valves may be damaged or scarred in the process. The aortic and mitral valves most often are affected. Symptoms of heart valve damage often don't appear until many years after recovery from rheumatic fever.
Today, most people who have strep infections are treated with antibiotics before rheumatic fever occurs. If you have strep throat, take all of the antibiotics your doctor prescribes, even if you feel better before the medicine is gone.
Heart valve disease caused by rheumatic fever mainly affects older adults who had strep infections before antibiotics were available. It also affects people from developing countries, where rheumatic fever is more common.
Common germs that enter the bloodstream and get carried to the heart can sometimes infect the inner surface of the heart, including the heart valves. This rare but serious infection is called infective endocarditis (EN-do-kar-DI-tis), or IE.
The germs can enter the bloodstream through needles, syringes, or other medical devices and through breaks in the skin or gums. Often, the body's defenses fight off the germs and no infection occurs. Sometimes these defenses fail, which leads to IE.
IE can develop in people who already have abnormal blood flow through a heart valve as the result of congenital or acquired heart valve disease. The abnormal blood flow causes blood clots to form on the surface of the valve. The blood clots make it easier for germs to attach to and infect the valve.
IE can worsen existing heart valve disease.
Many other conditions and factors are linked to heart valve disease. However, the role they play in causing heart valve disease often isn't clear.
Autoimmune disorders. Autoimmune disorders, such as lupus, can affect the aortic and mitral valves.
Carcinoid syndrome. Tumors in the digestive tract that spread to the liver or lymph nodes can affect the tricuspid and pulmonary valves.
Metabolic disorders. Relatively uncommon diseases (such as Fabry disease) and other metabolic disorders (such as high blood cholesterol) can affect the heart valves.
Diet medicines. The use of fenfluramine and phentermine ("fen-phen") has sometimes been linked to heart valve problems. These problems typically stabilize or improve after the medicine is stopped.
Radiation therapy. Radiation therapy to the chest area can cause heart valve disease. This therapy is used to treat cancer. Heart valve disease due to radiation therapy may not cause symptoms until years after the therapy.
Marfan syndrome. Congenital disorders, such as Marfan syndrome and other connective tissue disorders, can affect the heart valves.
Older age is a risk factor for heart valve disease. As you age, your heart valves thicken and become stiffer. Also, people are living longer now than in the past. As a result, heart valve disease has become an increasing problem.
People who have a history of infective endocarditis (IE), rheumatic fever, heart attack, or heart failure—or previous heart valve disease—also are at higher risk for heart valve disease. In addition, having risk factors for IE, such as intravenous drug use, increases the risk of heart valve disease.
You're also at higher risk for heart valve disease if you have risk factors for coronary heart disease. These risk factors include high blood cholesterol, high blood pressure, smoking, insulin resistance, diabetes, overweight or obesity, lack of physical activity, and a family history of early heart disease.
Some people are born with an aortic valve that has two flaps instead of three. Sometimes an aortic valve may have three flaps, but two flaps are fused together and act as one flap. This is called a bicuspid or bicommissural aortic valve. People who have this congenital condition are more likely to develop aortic heart valve disease.
The main sign of heart valve disease is an unusual heartbeat sound called a heart murmur. Your doctor can hear a heart murmur with a stethoscope.
However, many people have heart murmurs without having heart valve disease or any other heart problems. Others may have heart murmurs due to heart valve disease, but have no other signs or symptoms.
Heart valve disease often worsens over time, so signs and symptoms may occur years after a heart murmur is first heard. Many people who have heart valve disease don't have any symptoms until they're middle-aged or older.
Other common signs and symptoms of heart valve disease relate to heart failure, which heart valve disease can cause. These signs and symptoms include:
Unusual fatigue (tiredness)
Shortness of breath, especially when you exert yourself or when you're lying down
Swelling in your ankles, feet, legs, abdomen, and veins in the neck
Heart valve disease can cause chest pain that may happen only when you exert yourself. You also may notice a fluttering, racing, or irregular heartbeat. Some types of heart valve disease, such as aortic or mitral valve stenosis, can cause dizziness or fainting.
Your primary care doctor may detect a heart murmur or other signs of heart valve disease. However, a cardiologist usually will diagnose the condition. A cardiologist is a doctor who specializes in diagnosing and treating heart problems.
To diagnose heart valve disease, your doctor will ask about your signs and symptoms. He or she also will do a physical exam and look at the results from tests and procedures.
Your doctor will listen to your heart with a stethoscope. He or she will want to find out whether you have a heart murmur that's likely caused by a heart valve problem.
Your doctor also will listen to your lungs as you breathe to check for fluid buildup. He or she will check for swollen ankles and other signs that your body is retaining water.
Echocardiography (echo) is the main test for diagnosing heart valve disease. But an EKG (electrocardiogram) or chest x ray commonly is used to reveal certain signs of the condition. If these signs are present, echo usually is done to confirm the diagnosis.
Your doctor also may recommend other tests and procedures if you're diagnosed with heart valve disease. For example, you may have cardiac catheterization, (KATH-eh-ter-ih-ZA-shun), stress testing, or cardiac MRI (magnetic resonance imaging). These tests and procedures help your doctor assess how severe your condition is so he or she can plan your treatment.
This simple test detects and records the heart's electrical activity. An EKG can detect an irregular heartbeat and signs of a previous heart attack. It also can show whether your heart chambers are enlarged.
An EKG usually is done in a doctor's office.
This test can show whether certain sections of your heart are enlarged, whether you have fluid in your lungs, or whether calcium deposits are present in your heart.
A chest x ray helps your doctor learn which type of valve defect you have, how severe it is, and whether you have any other heart problems.
Echo uses sound waves to create a moving picture of your heart as it beats. A device called a transducer is placed on the surface of your chest.
The transducer sends sound waves through your chest wall to your heart. Echoes from the sound waves are converted into pictures of your heart on a computer screen.
Echo can show:
The size and shape of your heart valves and chambers
How well your heart is pumping blood
Whether a valve is narrow or has backflow
Your doctor may recommend transesophageal (tranz-ih-sof-uh-JEE-ul) echo, or TEE, to get a better image of your heart.
During TEE, the transducer is attached to the end of a flexible tube. The tube is guided down your throat and into your esophagus (the passage leading from your mouth to your stomach). From there, your doctor can get detailed pictures of your heart.
You'll likely be given medicine to help you relax during this procedure.
For this procedure, a long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck and threaded to your heart. Your doctor uses x-ray images to guide the catheter.
Through the catheter, your doctor does diagnostic tests and imaging that show whether backflow is occurring through a valve and how fully the valve opens. You'll be given medicine to help you relax, but you will be awake during the procedure.
Your doctor may recommend cardiac catheterization if your signs and symptoms of heart valve disease aren't in line with your echo results.
The procedure also can help your doctor assess whether your symptoms are due to specific valve problems or coronary heart disease. All of this information helps your doctor decide the best way to treat you.
During stress testing, you exercise to make your heart work hard and beat fast while heart tests and imaging are done. If you can't exercise, you may be given medicine to raise your heart rate.
A stress test can show whether you have signs and symptoms of heart valve disease when your heart is working hard. It can help your doctor assess the severity of your heart valve disease.
Cardiac MRI uses a powerful magnet and radio waves to make detailed images of your heart. A cardiac MRI image can confirm information about valve defects or provide more detailed information.
This information can help your doctor plan your treatment. An MRI also may be done before heart valve surgery to help your surgeon plan for the surgery.
Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines often can successfully treat symptoms and delay problems for many years. Eventually, though, you may need surgery to repair or replace a faulty heart valve.
The goals of treating heart valve disease might include:
Preventing, treating, or relieving the symptoms of other related heart conditions.
Protecting heart valves from further damage.
Repairing or replacing faulty valves when they cause severe symptoms or become life threatening. Replacement valves can be man-made or biological.
To relieve the symptoms of heart conditions related to heart valve disease, your doctor may advise you to quit smoking and follow a healthy diet.
A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas.
A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).
For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute's "Your Guide to Lowering Your Blood Pressure With DASH" and the U.S. Department of Agriculture's ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating.
Your doctor may ask you to limit physical activities that make you short of breath and tired. He or she also may ask that you limit competitive athletic activity, even if the activity doesn't leave you unusually short of breath or tired.
Your doctor may prescribe medicines to:
Treat heart failure. Heart failure medicines widen blood vessels and rid the body of excess fluid.
Lower high blood pressure or high blood cholesterol.
Treat coronary heart disease (CHD). CHD medicines can reduce your heart's workload and relieve symptoms.
Prevent arrhythmias (irregular heartbeats).
Thin the blood and prevent clots (if you have a man-made replacement valve). These medicines also are prescribed for mitral stenosis or other valve defects that raise the risk of blood clots.
If you've had previous heart valve disease and now have a man-made valve, you may be at risk for a heart infection called infective endocarditis (IE). This infection can worsen your heart valve disease.
One of the most common causes of IE is poor dental hygiene. To prevent this serious infection, floss and brush your teeth and regularly see a dentist. Gum infections and tooth decay can increase the risk of IE.
Let your doctors and dentists know if you have a man-made valve or if you've had IE before. They may give you antibiotics before dental procedures (such as dental cleanings) that could allow bacteria to enter your bloodstream. Talk to your doctor about whether you need to take antibiotics before such procedures.
Your doctor may recommend repairing or replacing your heart valve(s), even if your heart valve disease isn't causing symptoms. Repairing or replacing a valve can prevent lasting damage to your heart and sudden death.
Having heart valve repair or replacement depends on many factors, including:
The severity of your valve disease.
Your age and general health.
Whether you need heart surgery for other conditions, such as bypass surgery to treat CHD. Bypass surgery and valve surgery can be done at the same time.
When possible, heart valve repair is preferred over heart valve replacement. Valve repair preserves the strength and function of the heart muscle. People who have valve repair also have a lower risk of IE after the surgery, and they don't need to take blood-thinning medicines for the rest of their lives.
However, heart valve repair surgery is harder to do than valve replacement. Also, not all valves can be repaired. Mitral valves often can be repaired. Aortic and pulmonary valves often have to be replaced.
Heart surgeons can repair heart valves by:
Separating fused valve flaps
Removing or reshaping tissue so the valve can close tighter
Adding tissue to patch holes or tears or to increase the support at the base of the valve
Sometimes cardiologists repair heart valves using cardiac catheterization. Although catheter procedures are less invasive than surgery, they may not work as well for some patients.
Work with your doctor to decide whether repair is appropriate. If so, your doctor can advise you on the best procedure for doing it.
Balloon valvuloplasty. Heart valves that don't fully open (stenosis) can be repaired with surgery or with a less invasive catheter procedure called balloon valvuloplasty (VAL-vyu-lo-plas-tee). This procedure also is called balloon valvotomy (val-VOT-o-me).
During the procedure, a catheter (thin tube) with a balloon at its tip is threaded through a blood vessel to the faulty valve in your heart. The balloon is inflated to help widen the opening of the valve. Your doctor then deflates the balloon and removes both it and the tube.
You're awake during the procedure, which usually requires an overnight stay in a hospital.
Balloon valvuloplasty relieves many of the symptoms of heart valve disease, but it may not cure it. The condition can worsen over time. You still may need medicines to treat symptoms or surgery to repair or replace the faulty valve.
Balloon valvuloplasty has a shorter recovery time than surgery. The procedure may work as well as surgery for some patients who have mitral valve stenosis. Thus, for these people, balloon valvuloplasty often is preferred over surgical repair or replacement.
Balloon valvuloplasty doesn't work as well as surgery for adults who have aortic valve stenosis.
Doctors often use balloon valvuloplasty to repair valve stenosis in infants and children.
Sometimes heart valves can't be repaired and must be replaced. This surgery involves removing the faulty valve and replacing it with a man-made or biological valve.
Biological valves are made from pig, cow, or human heart tissue and may have man-made parts as well. These valves are specially treated, so you won't need medicines to stop your body from rejecting the valve.
Man-made valves last longer than biological valves and usually don't have to be replaced. Biological valves usually have to be replaced after about 10 years, although newer ones may last 15 years or longer.
Unlike biological valves, however, man-made valves require you to take blood-thinning medicines for the rest of your life. These medicines prevent blood clots from forming on the valve. Blood clots can cause a heart attack or stroke. Man-made valves also raise your risk of IE.
You and your doctor will decide together whether you should have a man-made or biological replacement valve.
If you're a woman of childbearing age or if you're athletic, you may prefer a biological valve so you don't have to take blood-thinning medicines. If you're elderly, you also may prefer a biological valve, as it will likely last for the rest of your life.
Some newer forms of heart valve repair and replacement surgery are less invasive than traditional surgery. These procedures use smaller incisions (cuts) to reach the heart valves. Hospital stays for these newer types of surgery usually are 3–5 days, compared with 5-day stays for traditional heart valve surgery.
New surgeries tend to cause less pain and have a lower risk of infection. Recovery time also tends to be shorter—2–4 weeks versus 6–8 weeks for traditional surgery.
Some cardiologists and surgeons are exploring catheter procedures that involve threading clips or other devices through blood vessels to faulty heart valves. The clips or devices are used to reshape the valves and stop the backflow of blood.
People who receive these clips recover more easily than people who have surgery. However, the clips may not treat backflow as well as surgery. Researchers are still studying this treatment method.
Doctor also may use catheters to replace faulty aortic valves. This procedure is called transcatheter aortic valve implantation (TAVI).
For this procedure, the catheter usually is inserted into an artery in the groin (upper thigh) and threaded to the heart. At the end of the catheter is a deflated balloon with a folded replacement valve around it.
Once the replacement valve is properly placed, the balloon is used to expand the new valve so it fits securely within the old valve. The balloon is then deflated, and the balloon and catheter are removed.
A replacement valve also can be inserted in an existing replacement valve that is failing. This is called a valve-in-valve procedure.
Catheter procedures may be an option for patients who have conditions that make open-heart surgery too risky. Only a few medical centers have experience with these fairly new procedures.
Doctors also treat faulty aortic valves with a procedure called the Ross operation. During this operation, your doctor removes your faulty aortic valve and replaces it with your pulmonary valve. Your pulmonary valve is then replaced with a pulmonary valve from a deceased human donor.
This is more involved surgery than typical valve replacement, and it has a greater risk of complications.
The Ross operation may be especially useful for children because the surgically replaced valves continue to grow with the child. Also, lifelong treatment with blood-thinning medicines isn't required.
But in some patients, one or both valves fail to work well within a few years of the surgery. Experts continue to debate and study the usefulness of this procedure.
Serious risks from all types of heart valve surgery vary according to your age, health, the type of valve defect(s) you have, and the surgical procedures used.
To prevent heart valve disease caused by rheumatic fever, see your doctor if you have signs of a strep infection. These signs include a painful sore throat, fever, and white spots on your tonsils.
If you do have a strep infection, be sure to take all medicines prescribed to treat it. Prompt treatment of strep infections can prevent rheumatic fever, which damages the heart valves.
It's possible that exercise, a healthy diet, and medicines that lower cholesterol might prevent aortic stenosis (thickening and stiffening of the aortic valve). Researchers continue to study this possibility.
A healthy diet, physical activity, other lifestyle changes, and medicines aimed at preventing a heart attack, high blood pressure, or heart failure also may help prevent heart valve disease.
If you've had previous heart valve disease and now have a man-made valve, you're at risk for a heart infection called infective endocarditis (IE).
One of the most common causes of IE is poor dental hygiene. Thus, to prevent this serious infection, floss and brush your teeth and regularly see a dentist. Gum infections and tooth decay can increase the risk of IE.
Let your doctors and dentists know if you have a man-made valve or if you've had IE before. They may give you antibiotics before dental procedures (such as dental cleanings) that could allow bacteria to enter your bloodstream. Talk to your doctor about whether you need to take antibiotics before such procedures.
Heart valve disease is a lifelong condition. However, many people have heart valve defects or disease but don't have symptoms. For some people, the condition mostly stays the same throughout their lives and doesn't cause any problems.
For other people, the condition slowly worsens until symptoms develop. If not treated, advanced heart valve disease can cause heart failure or other life-threatening conditions.
Eventually, you may need to have your faulty heart valve(s) repaired or replaced. After repair or replacement, you'll still need certain medicines and regular checkups with your doctor.
If you have heart valve disease, see your doctor regularly for checkups and for echocardiography or other tests. This will allow your doctor to check the progress of your heart valve disease.
Call your doctor if your symptoms worsen or you have new symptoms. Also, discuss with your doctor whether lifestyle changes might benefit you. Ask him or her which types of physical activity are safe for you.
Call your doctor if you have symptoms of infective endocarditis (IE). Symptoms of this heart infection include fever, chills, muscle aches, night sweats, problems breathing, fatigue (tiredness), weakness, red spots on the palms and soles, and swelling of the feet, legs, and belly.
Let your doctors and dentists know if you have a man-made valve or if you've had IE before. They may give you antibiotics before dental procedures (such as dental cleanings) that could allow bacteria to enter your bloodstream. Talk to your doctor about whether you need to take antibiotics before such procedures.
Take all of your medicines as prescribed.
Mild or moderate heart valve disease during pregnancy usually can be managed with medicines or bed rest. With proper care, the disease usually won't pose heightened risks to the mother or fetus.
Doctors can treat most heart valve conditions with medicines that are safe to take during pregnancy. Your doctor can advise you on which medicines are safe for you.
Severe heart valve disease can make pregnancy or labor and delivery risky. If you have severe heart valve disease, consider having your heart valves repaired or replaced before getting pregnant. This treatment also can be done during pregnancy, if needed. However, this surgery poses danger to both the mother and fetus.
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has uncovered some of the causes of heart diseases and conditions, as well as ways to prevent or treat them.
Many more questions remain about heart diseases and conditions, including heart valve disease. Thus, the NHLBI continues to support research to learn more. For example, NHLBI-supported research on heart valve disease includes studies that explore:
New techniques to evaluate mitral valve backflow
Whether mitral valve repair or replacement works better for people who have severe backflow through their mitral valves
Whether coronary artery bypass grafting alone or with mitral valve repair works better for treating people who have moderate mitral valve backflow and coronary heart disease
Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to heart valve disease, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
http://clinicalresearch.nih.gov
www.clinicaltrials.gov
www.nhlbi.nih.gov/studies/index.htm
www.researchmatch.org
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
Source: NHLBI, NIH
What Is Heart Surgery?
Heart surgery is done to correct problems with the heart. Many heart surgeries are done each year in the United States for various heart problems.
Heart surgery is used for both children and adults. This article discusses heart surgery for adults. For more information about heart surgery for children, go to the Health Topics articles about congenital heart defects, holes in the heart, and tetralogy of Fallot.
The most common type of heart surgery for adults is coronary artery bypass grafting (CABG). During CABG, a healthy artery or vein from the body is connected, or grafted, to a blocked coronary (heart) artery.
The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This creates a new path for oxygen-rich blood to flow to the heart muscle. CABG can relieve chest pain and may lower your risk of having a heart attack.
Doctors also use heart surgery to:
Repair or replace heart valves, which control blood flow through the heart
Repair abnormal or damaged structures in the heart
Implant medical devices that help control the heartbeat or support heart function and blood flow
Replace a damaged heart with a healthy heart from a donor
Traditional heart surgery, often called open-heart surgery, is done by opening the chest wall to operate on the heart. The surgeon cuts through the patient's breastbone (or just the upper part of it) to open the chest.
Once the heart is exposed, the patient is connected to a heart-lung bypass machine. The machine takes over the heart's pumping action and moves blood away from the heart. This allows the surgeon to operate on a heart that isn't beating and that doesn't have blood flowing through it.
Another type of heart surgery is called off-pump, or beating heart, surgery. It's like traditional open-heart surgery because the chest bone is opened to access the heart. However, the heart isn't stopped, and a heart-lung bypass machine isn't used. Off-pump heart surgery is limited to CABG.
Surgeons can now make small incisions (cuts) between the ribs to do some types of heart surgery. The breastbone is not opened to reach the heart. This is called minimally invasive heart surgery. This type of heart surgery may or may not use a heart-lung bypass machine.
Newer methods of heart surgery (such as off-pump and minimally invasive) may reduce risks and speed up recovery time. Studies are under way to compare these types of heart surgery with traditional open-heart surgery.
The results of these studies will help doctors decide the best surgery to use for each patient.
The results of heart surgery in adults often are excellent. Heart surgery can reduce symptoms, improve quality of life, and improve the chances of survival.
To understand heart surgery, it's helpful to know how a normal heart works. Go to the Health Topics article on How the Heart Works for more information.
Coronary artery bypass grafting (CABG) is the most common type of heart surgery. CABG improves blood flow to the heart. Surgeons use CABG to treat people who have severe coronary heart disease (CHD).
CHD is a disease in which a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart.
Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina (an-JI-nuh or AN-juh-nuh).
If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries.
During CABG, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This creates a new path for oxygen-rich blood to flow to the heart muscle.
Surgeons can bypass multiple blocked coronary arteries during one surgery.
Figure A shows the location of the heart. Figure B shows how vein and artery bypass grafts are attached to the heart.
CABG isn't the only treatment for CHD. A nonsurgical procedure that opens blocked or narrow coronary arteries is percutaneous (per-ku-TA-ne-us) coronary intervention (PCI), sometimes referred to as angioplasty (AN-jee-oh-plas-tee).
During PCI, a thin, flexible tube with a balloon at its tip is threaded through a blood vessel to the narrow or blocked coronary artery. Once in place, the balloon is inflated to push the plaque against the artery wall. This restores blood flow through the artery.
During PCI, a stent might be placed in the coronary artery to help keep it open. A stent is a small mesh tube that supports the inner artery wall.
If both CABG and PCI are options, your doctor can help you decide which treatment is right for you.
Transmyocardial (tranz-mi-o-KAR-de-al) laser revascularization (re-VAS-kyu-lar-ih-ZA-shun), or TMR, is surgery used to treat angina.
TMR is most often used when no other treatments work. For example, if you've already had one CABG procedure and can't have another one, TMR might be an option. For some people, TMR is combined with CABG.
If TMR is done alone, the procedure may be performed through a small opening in the chest.
During TMR, a surgeon uses lasers to make small channels through the heart muscle and into the heart's lower left chamber (the left ventricle).
It isn't fully known how TMR relieves angina. The surgery may help the heart grow tiny new blood vessels. Oxygen-rich blood may flow through these vessels into the heart muscle, which could relieve angina.
For the heart to work well, blood must flow in only one direction. The heart's valves make this possible. Healthy valves open and close in a precise way as the heart pumps blood.
Each valve has a set of flaps called leaflets. The leaflets open to allow blood to pass from one heart chamber into another or into the arteries. Then the leaflets close tightly to stop blood from flowing backward.
Heart surgery is used to fix leaflets that don't open as wide as they should. This can happen if they become thick or stiff or fuse together. As a result, not enough blood flows through the valve.
Heart surgery also is used to fix leaflets that don't close tightly. This problem can cause blood to leak back into the heart chambers, rather than only moving forward into the arteries as it should.
To fix these problems, surgeons either repair the valve or replace it with a man-made or biological valve. Biological valves are made from pig, cow, or human heart tissue and may have man-made parts as well.
To repair a mitral (MI-trul) or pulmonary (PULL-mun-ary) valve that's too narrow, a cardiologist (heart specialist) will insert a catheter (a thin, flexible tube) through a large blood vessel and guide it to the heart.
The cardiologist will place the end of the catheter inside the narrow valve. He or she will inflate and deflate a small balloon at the tip of the catheter. This widens the valve, allowing more blood to flow through it. This approach is less invasive than open-heart surgery.
Researchers also are testing new ways to use catheters in other types of valve surgeries. For example, catheters might be used to place clips on the mitral valve leaflets to hold them in place.
Catheters also might be used to replace faulty aortic valves. For this procedure, the catheter usually is inserted into an artery in the groin (upper thigh) and threaded to the heart.
In some cases, surgeons might make a small cut in the chest and left ventricle (the lower left heart chamber). They will thread the catheter into the heart through the small opening.
The catheter has a deflated balloon at its tip with a folded replacement valve around it. The balloon is used to expand the new valve so it fits securely within the old valve.
Currently, surgery to replace the valve is the traditional treatment for reasonably healthy people. However, catheter procedures might be a safer option for patients who have conditions that make open-heart surgery very risky.
An arrhythmia (ah-RITH-me-ah) is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.
Many arrhythmias are harmless, but some can be serious or even life threatening. If the heart rate is abnormal, the heart may not be able to pump enough blood to the body. Lack of blood flow can damage the brain, heart, and other organs.
Medicine usually is the first line of treatment for arrhythmias. If medicine doesn't work well, your doctor may recommend surgery. For example, surgery may be used to implant a pacemaker or an implantable cardioverter defibrillator (ICD).
A pacemaker is a small device that's placed under the skin of your chest or abdomen. Wires connect the pacemaker to your heart chambers. The device uses low-energy electrical pulses to control your heart rhythm. Most pacemakers have a sensor that starts the device only if your heart rhythm is abnormal.
An ICD is another small device that's placed under the skin of your chest or abdomen. This device also is connected to your heart with wires. An ICD checks your heartbeat for dangerous arrhythmias. If the device senses one, it sends an electric shock to your heart to restore a normal heart rhythm.
Another arrhythmia treatment is called maze surgery. For this surgery, the surgeon makes new paths for the heart's electrical signals to travel through. This type of surgery is used to treat atrial fibrillation, the most common type of serious arrhythmia.
Simpler, less invasive procedures also are used to treat atrial fibrillation. These procedures use high heat or intense cold to prevent abnormal electrical signals from moving through the heart.
An aneurysm (AN-u-rism) is a balloon-like bulge in the wall of an artery or the heart muscle. This bulge can occur if the artery wall weakens. Pressure from blood moving through the artery or heart causes the weak area to bulge.
Over time, an aneurysm can grow and burst, causing dangerous, often fatal bleeding inside the body. Aneurysms also can develop a split in one or more layers of the artery wall. The split causes bleeding into and along the layers of the artery wall.
Aneurysms in the heart most often occur in the heart's lower left chamber (the left ventricle). Repairing an aneurysm involves surgery to replace the weak section of the artery or heart wall with a patch or graft.
A heart transplant is surgery to remove a person's diseased heart and replace it with a healthy heart from a deceased donor. Most heart transplants are done on patients who have end-stage heart failure.
Heart failure is a condition in which the heart is damaged or weak. As a result, it can't pump enough blood to meet the body's needs. "End-stage" means the condition is so severe that all treatments, other than heart transplant, have failed.
Patients on the waiting list for a donor heart receive ongoing treatment for heart failure and other medical conditions. Ventricular assist devices (VADs) or total artificial hearts (TAHs) might be used to treat these patients.
A VAD is a mechanical pump that is used to support heart function and blood flow in people who have weak hearts.
Your doctor may recommend a VAD if you have heart failure that isn't responding to treatment or if you're waiting for a heart transplant. You can use a VAD for a short time or for months or years, depending on your situation.
A TAH is a device that replaces the two lower chambers of the heart (the ventricles). You may benefit from a TAH if both of your ventricles don't work well due to end-stage heart failure.
Placing either device requires open-heart surgery.
Surgeons can use different approaches to operate on the heart, including open-heart surgery, off-pump heart surgery, and minimally invasive heart surgery.
The surgical approach will depend on the patient's heart problem, general health, and other factors.
Open-heart surgery is any kind of surgery in which a surgeon makes a large incision (cut) in the chest to open the rib cage and operate on the heart. "Open" refers to the chest, not the heart. Depending on the type of surgery, the surgeon also may open the heart.
Once the heart is exposed, the patient is connected to a heart-lung bypass machine. The machine takes over the heart's pumping action and moves blood away from the heart. This allows the surgeon to operate on a heart that isn't beating and that doesn't have blood flowing through it.
Open-heart surgery is used to do CABG, repair or replace heart valves, treat atrial fibrillation, do heart transplants, and place VADs and TAHs.
Surgeons also use off-pump, or beating heart, surgery to do CABG. This approach is like traditional open-heart surgery because the chest bone is opened to access the heart. However, the heart isn't stopped, and a heart-lung bypass machine isn't used.
Off-pump heart surgery isn't right for all patients. Work with your doctor to decide whether this type of surgery is an option for you. Your doctor will carefully consider your heart problem, age, overall health, and other factors that may affect the surgery.
For minimally invasive heart surgery, a surgeon makes small incisions (cuts) in the side of the chest between the ribs. This type of surgery may or may not use a heart-lung bypass machine.
Minimally invasive heart surgery is used to do some bypass and maze surgeries. It's also used to repair or replace heart valves, insert pacemakers or ICDs, or take a vein or artery from the body to use as a bypass graft for CABG.
One type of minimally invasive heart surgery that is becoming more common is robotic-assisted surgery. For this surgery, a surgeon uses a computer to control surgical tools on thin robotic arms.
The tools are inserted through small incisions in the chest. This allows the surgeon to do complex and highly precise surgery. The surgeon always is in total control of the robotic arms; they don't move on their own.
Heart surgery is used to treat many heart problems. For example, it's used to:
Treat heart failure and coronary heart disease (CHD)
Fix heart valves that don't work well
Control abnormal heart rhythms
Place medical devices
Replace a damaged heart with a healthy one
If other treatments—such as lifestyle changes, medicines, and medical procedures—haven't worked or can't be used, heart surgery might be an option.
Your primary care doctor, a cardiologist, and a cardiothoracic (KAR-de-o-tho-RAS-ik) surgeon will work with you to decide whether you need heart surgery.
A cardiologist specializes in diagnosing and treating heart problems. A cardiothoracic surgeon specializes in surgery on the heart and lungs.
These doctors will talk with you and do tests to learn about your general health and your heart problem. They'll discuss the test results with you and help you make decisions about the surgery.
Your doctors will talk with you about:
The kind of heart problem you have and the symptoms it's causing. Your doctor may ask you how long you've had symptoms.
Your past treatment of heart problems, including surgeries, procedures, and medicines.
Your family's history of heart problems.
Your history of other health problems, such as diabetes or high blood pressure.
Your age and general health.
You also may have blood tests, such as a complete blood count, a lipoprotein panel (cholesterol test), and other tests as needed.
Tests are done to find out more about your heart problem and your general health. This helps your doctors decide whether you need heart surgery, what type of surgery you need, and when to do it.
An EKG is a painless, noninvasive test that records the heart's electrical activity. "Noninvasive" means that no surgery is done and no instruments are inserted into your body.
The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through the heart.
An EKG can show signs of heart damage due to CHD and signs of a previous or current heart attack.
Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise to make your heart work hard and beat fast. If you can't exercise, you may be given medicine to raise your heart rate.
As part of the test, your blood pressure is checked and an EKG is done. Other heart tests also might be done.
Echocardiography (echo) is a painless, noninvasive test. This test uses sound waves to create a moving picture of your heart. Echocardiography shows the size and shape of your heart and how well your heart chambers and valves are working.
The test also can show areas of poor blood flow to your heart, areas of heart muscle that aren't working well, and previous injury to your heart muscle caused by poor blood flow.
Coronary angiography (an-jee-OG-rah-fee) is a test that uses dye and special x rays to show the insides of your coronary arteries.
To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization (KATH-eh-ter-ih-ZA-shun).
A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream.
Special x rays are taken while the dye is flowing through the coronary arteries. These
x rays are called angiograms.
The dye lets your doctor study blood flow through the heart and blood vessels. This helps your doctor find blockages that can cause a heart attack.
An aortogram is an angiogram of the aorta. The aorta is the main artery that carries blood from your heart to your body. An aortogram may show the location and size of an aortic aneurysm.
A chest x ray creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels.
This test gives your doctor information about the size and shape of your heart. A chest x ray also shows the position and shape of the large arteries around your heart.
A cardiac computed tomography (to-MOG-rah-fee) scan, or cardiac CT scan, is a painless test that uses an x-ray machine to take clear, detailed pictures of the heart.
Sometimes an iodine-based dye (contrast dye) is injected into one of your veins during the scan. The contrast dye highlights your coronary (heart) arteries on the x-ray pictures. This type of CT scan is called a coronary CT angiography, or CTA.
A cardiac CT scan can show whether plaque is narrowing your coronary arteries or whether you have an aneurysm. A CT scan also can find problems with the heart's function and valves.
Magnetic resonance imaging (MRI) is a safe, noninvasive test that uses magnets, radio waves, and a computer to create pictures of your organs and tissues.
Cardiac MRI creates images of your heart as it is beating. The computer makes both still and moving pictures of your heart and major blood vessels.
Cardiac MRI shows the structure and function of your heart. This test can show the size and location of an aneurysm.
There are many types of heart surgery. One person's experience before surgery can be very different from another's.
Some people carefully plan their surgeries with their doctors. They know exactly when and how their surgeries will happen. Other people need emergency heart surgery. For example, they might be diagnosed with blocked coronary arteries and admitted to the hospital right away for surgery.
If you're having a planned surgery, your doctors and others on your health care team will meet with you to explain what will happen. They'll tell you how to prepare for the surgery. You might be admitted to the hospital the afternoon or morning before your surgery.
You may have some tests before the surgery, such as an EKG (electrocardiogram), chest x ray, or blood tests. An intravenous (IV) line will be placed into a blood vessel in your arm or chest to give you fluids and medicines.
A member of your health care team may shave the area where your surgeon will make the incision (cut). Also, your skin might be washed with special soap to reduce the risk of infection.
Just before the surgery, you'll be moved to the operating room. You'll be given medicine so that you fall asleep and don't feel pain during the surgery.
Heart surgery is done in a hospital, and a team of experts is involved. Cardiothoracic surgeons perform the surgery with other doctors and nurses who help.
How long the surgery takes will depend on the type of surgery you're having. CABG, the most common type of heart surgery, takes about 3–6 hours.
For this type of surgery, you'll be given medicine to help you fall asleep. A doctor will check your heartbeat, blood pressure, oxygen levels, and breathing during the surgery.
A breathing tube will be placed in your lungs through your throat. The tube will connect to a ventilator (a machine that supports breathing).
Your surgeon will make a 6- to 8-inch incision (cut) down the center of your chest wall. Then, he or she will cut your breastbone and open your rib cage to reach your heart.
During the surgery, you'll receive medicine to thin your blood and keep it from clotting. A heart-lung bypass machine will be connected to your heart. The machine will take over your heart's pumping action and move blood away from your heart.
A specialist will oversee the heart-lung bypass machine. The machine will allow the surgeon to operate on a heart that isn't beating and that doesn't have blood flowing through it.
The image shows how a heart-lung bypass machine works during surgery.
You'll be given medicine to stop your heartbeat once you're connected to the heart-lung bypass machine. A tube will be placed in your heart to drain blood to the machine.
The machine will remove carbon dioxide (a waste product) from your blood, add oxygen to your blood, and then pump the blood back into your body. Your surgeon will insert tubes into your chest to drain fluid.
Once the bypass machine starts to work, the surgeon will repair your heart problem. After the surgery is done, he or she will restore blood flow to your heart. Usually, your heart will start beating again on its own. Sometimes mild electric shocks are used to restart the heart.
Once your heart has started beating again, your surgeon will remove the tubes and stop the heart-lung bypass machine. You'll be given medicine to allow your blood to clot again.
The surgeon will use wires to close your breastbone. The wires will stay in your body permanently. After your breastbone heals, it will be as strong as it was before the surgery.
Stitches or staples will be used to close the skin incision. Your breathing tube will be removed when you're able to breathe without it.
Off-pump heart surgery is like traditional open-heart surgery because the chest bone is opened to access the heart. However, the heart isn't stopped, and a heart-lung bypass machine isn't used.
Instead, your surgeon will steady your heart with a mechanical device so he or she can work on it. Your heart will continue to pump blood to your body.
For this type of heart surgery, your surgeon will make small incisions in the side of your chest between the ribs. These cuts can be as small as 2–3 inches. The surgeon will insert surgical tools through these small cuts.
A tool with a small video camera at the tip also will be inserted through an incision. This tool will allow the surgeon to see inside your body.
Some types of minimally invasive heart surgery use a heart-lung bypass machine and others don't.
You may spend a day or more in the hospital's intensive care unit (ICU), depending on the type of heart surgery you have. An intravenous (IV) needle might be inserted in a blood vessel in your arm or chest to give you fluids until you're ready to drink on your own.
Your health care team may give you extra oxygen through a face mask or nasal prongs that fit just inside your nose. They will remove the mask or prongs when you no longer need them.
When you leave the ICU, you'll be moved to another part of the hospital for several days before you go home. While you're in the hospital, doctors and nurses will closely watch your heart rate, blood pressure, breathing, and incision site(s).
People respond differently to heart surgery. Your recovery at home will depend on what kind of heart problem and surgery you had. Your doctor will tell you how to:
Care for your healing incision(s)
Recognize signs of infection or other complications
Cope with the after-effects of surgery
You also will get information about followup appointments, medicines, and situations when you should call your doctor right away.
After-effects of heart surgery are normal. They may include muscle pain, chest pain, or swelling (especially if you have an incision in your leg from coronary artery bypass grafting, or CABG).
Other after-effects may include loss of appetite, problems sleeping, constipation, and mood swings and depression. After-effects usually go away over time.
Recovery time after heart surgery depends on the type of surgery you had, your overall health before the surgery, and any complications from the surgery.
Your doctor will let you know when you can go back to your daily routine, such as working, driving, and physical activity.
Ongoing care after your surgery will include checkups with your doctor. During these visits, you may have blood tests, an EKG (electrocardiogram), echocardiography, or a stress test. These tests will show how your heart is working after the surgery.
After some types of heart surgery, you'll need to take a blood-thinning medicine. Your doctor will do routine tests to make sure you're getting the right amount of medicine.
Your doctor also may recommend lifestyle changes and medicines to help you stay healthy. Lifestyle changes may include quitting smoking, changing your diet, being physically active, and reducing and managing stress.
Your doctor also may refer you to cardiac rehabilitation (rehab). Cardiac rehab is a medically supervised program that helps improve the health and well-being of people who have heart problems.
Cardiac rehab includes exercise training, education on heart healthy living, and counseling to reduce stress and help you recover. Your doctor can tell you where to find a cardiac rehab program near your home.
Heart surgery has risks, even though its results often are excellent. Risks include:
Bleeding.
Infection, fever, swelling, and other signs of inflammation.
A reaction to the medicine used to make you sleep during the surgery.
Arrhythmias (irregular heartbeats).
Damage to tissues in the heart, kidneys, liver, and lungs.
Stroke, which may cause short-term or permanent damage.
Death. (Heart surgery is more likely to be life threatening in people who are very sick before the surgery.)
Memory loss and other issues, such as problems concentrating or thinking clearly, may occur in some people.
These problems are more likely to affect older patients and women. These issues often improve within 6–12 months of surgery.
In general, the risk of complications is higher if heart surgery is done in an emergency situation (for example, during a heart attack). The risk also is higher if you have other diseases or conditions, such as diabetes, kidney disease, lung disease, or peripheral arterial disease (P.A.D.).
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has evaluated various treatments for heart problems, including heart surgery.
The NHLBI continues to support research on heart surgery. For example, the NHLBI is involved in studies that:
Determine which treatments are most effective in patients who have diabetes and blockages in more than one coronary artery
Determine which treatments—including medical therapy alone or with coronary artery bypass grafting (CABG) or surgery to restore the heart to its normal size and shape—will help patients who have heart failure and coronary heart disease live longer
Explore whether a valve procedure should be done at the same time as CABG in some patients who have heart valve defects
Examine whether using off-pump CABG, as opposed to traditional CAGB, might reduce neurological side effects in patients
Study a new ventricular assist device (VAD) for heart failure patients who don't qualify for a heart transplant or a permanent VAD
Examine whether it's better for people who have severe mitral valve leakage to have valve repair or valve replacement surgery
Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to heart surgery, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
http://clinicalresearch.nih.gov
www.clinicaltrials.gov
www.nhlbi.nih.gov/studies/index.htm
www.researchmatch.org
For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.
Source: NHLBI, NIH