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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Heart disease is an umbrella term that includes many different conditions that affect your heart and its blood vessels. Another word for heart disease is cardiovascular disease, although this usually refers to heart problems that stem from narrowed blood vessels. Other forms of heart disease include abnormal heart rhythms (arrhythmias), heart muscle problems (cardiomyopathy), coronary artery disease, heart valve problems, heart infections, and heart issues you’re born with (congenital heart defects).
According to the Centers for Disease Control and Prevention (CDC), approximately one in four deaths every year (that’s about 610,000 people) in the United States are due to heart disease (CDC, 2019). It is the leading cause of death for both men and women. Understanding heart disease is essential for your health because many forms of heart disease can be prevented or treated with healthy lifestyle choices, especially in the early stages of the disease. The risk factors for heart disease include the following:
- Age: As we age, our arteries harden and are more likely to narrow or experience blockages.
- Gender: Men are more likely to get heart disease, especially after age 45. After age 55, the risk for women approaches that of men.
- Genetics: People with a family history of heart disease are at higher risk. This is especially true if your father or brother was diagnosed with heart disease before age 55 or if your mother or sister developed it before age 65 (NIH, n.d.)
- Smoking: Smoking, even inhaling secondhand smoke, can damage your blood vessels increases the risk of developing heart disease.
- High blood pressure: Poorly controlled high blood pressure makes your heart work harder and contributes to the hardening of your arteries, thereby increasing your risk of heart disease.
- High cholesterol: High levels of cholesterol in the blood increases your risk of forming plaques and developing atherosclerosis in your arteries.
- Diabetes: Diabetes increases your risk of heart disease. According to the American Heart Association (AHA), approximately 68% of people with diabetes who are over 65 years old die from some form of heart disease (AHA, 2016). In that same group, 16% die from stroke.
- Obesity or being overweight: People who have excess body fat, especially around their waist, have a higher risk of both heart disease and other risk factors for heart disease, like high blood pressure and diabetes.
- Sedentary lifestyle: People who don’t exercise have a higher risk of developing heart disease, as well as some of its risk factors, like obesity.
- Stress: Stress may damage your arteries and put you at risk for heart disease.
- Diet: Eating a poor diet that is high in sugar, fat, salt, and cholesterol increases your risk of obesity and heart disease.
- Sleep apnea: In this condition, you repeatedly stop and start breathing while you sleep, causing drops in your blood oxygen levels. These sudden drops can increase your blood pressure, putting a strain on the cardiovascular system, which may lead to heart disease.
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Types of heart disease
Arrhythmias are a type of heart disease where the heart rate or rhythm is abnormal. The heart may beat too fast (tachycardia), too slow (bradycardia), skip a beat, have extra beats, or beat with an unusual rhythm. While arrhythmias are common and not dangerous for most people, they can have life-threatening consequences in some cases. Arrhythmias occur because of a problem with the normal flow of electrical impulses that trigger the heart to contract (squeeze) and relax. When these impulses are disrupted, the heart can no longer pump efficiently to push blood throughout the body. Symptoms of arrhythmias include:
- Fluttering or quivering heartbeat (palpitations)
- A racing heartbeat or a slow heartbeat
- Chest pain or pressure
- Shortness of breath
- Weakness, dizziness, and lightheadedness
- Fainting (syncope)
- Collapse and sudden cardiac arrest (in extreme cases)
Several factors can cause arrhythmias; they can occur suddenly due to physical exertion, stress, medication, or problems with the electrical signaling pathways in the heart. They can also be due to heart tissue damage, like from a heart attack; sometimes, the cause of an arrhythmia is unclear. Known causes of arrhythmias include:
- A heart attack or scarring from a prior heart attack
- Coronary artery disease (plaque build-up in the arteries that feed the heart)
- Conditions that affect your heart’s overall structure, like cardiomyopathy
- High blood pressure
- Thyroid problems
- Low blood sugar (hypoglycemia)
- Abnormal levels of electrolytes like potassium, magnesium, sodium, or calcium in your blood
- Certain over-the-counter medicines, such as allergy and cold medications
- Drinking too much alcohol or caffeine
- Drug abuse, especially amphetamines and cocaine
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Cardiomyopathy refers to a group of conditions where the heart muscle weakens and cannot pump blood effectively. Sometimes there are no symptoms in these conditions, especially in the early stage. However, as cardiomyopathy progresses, you may notice signs and symptoms like:
- Shortness of breath (either at rest or with exertion)
- Leg, foot, or ankle swelling
- Abdominal fluid build-up
- Dizziness or lightheadedness
- Coughing, especially when lying down (fluid build-up in the lungs)
- Chest pain or pressure
- Rapid or fluttering heartbeat
There are three main types of cardiomyopathy: dilated, hypertrophic, and restrictive. Dilated cardiomyopathy (DCM) is the most common type of cardiomyopathy, and it occurs most often in middle-aged men. In this condition, part of the heart becomes dilated (enlarged), and the heart can no longer effectively pump blood out to the rest of the body; this makes the heart work harder and can lead to heart failure. Causes of dilated cardiomyopathy include:
- Coronary heart disease
- Heart attack
- High blood pressure
- Other medical conditions like diabetes, thyroid disease, viral hepatitis, and HIV
- Complications during the last months of pregnancy
- Illegal drugs, such as cocaine and amphetamines, and some medications used to treat cancer (chemotherapy drugs)
- Infections, especially viral infections that inflame the heart muscle (endocarditis)
Hypertrophic cardiomyopathy (HCM) is a condition where your heart muscle becomes abnormally thick, especially the ventricles (lower chambers of the heart). The thickened tissues narrow the chambers and make the heart work harder to pump blood to the rest of the body. This type of cardiomyopathy can be severe if it starts during childhood; people with HCM often have a family history of the disease, and there are several gene mutations linked to hypertrophic cardiomyopathy. In some cases, hypertrophic cardiomyopathy develops over time because of high blood pressure, aging changes, diabetes, or thyroid disease. Other times, no cause is found.
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Restrictive cardiomyopathy is the least common type of cardiomyopathy. It occurs when the heart muscle becomes stiff but does not thicken. Stiff heart muscles mean that the heart cannot pump blood effectively; it is unable to relax and fill up with blood. Over time, the heart weakens, and you can develop heart failure and heart valve problems. Restrictive cardiomyopathy sometimes occurs for no reason (idiopathic). Other times, it may be caused by one of the following:
- Amyloidosis: Abnormal proteins build up in the heart, and elsewhere in the body
- Connective tissue disorders
- Hemochromatosis: Too much iron in the body, which can damage the heart
- Sarcoidosis: An autoimmune condition where the body attacks itself
- Cancer treatments, like radiation and chemotherapy
Coronary artery disease
Coronary artery disease (also called CAD, coronary heart disease, cardiovascular disease, or ischemic heart disease) is a condition where the blood flow to your heart is restricted or reduced because of narrowing or blockage of the arteries that feed it. In the early stages, most people don’t experience any symptoms. However, as the blood flow to the heart continues to decrease, you may start to experience symptoms, including:
- Angina: Chest pain or pressure (like a heavy weight on your chest), that can occur at rest, with physical activity, or with emotional stress.
- Shortness of breath, especially with exercise
- Cold sweat
Women, however, can have a different presentation of their coronary heart disease. They may have chest pain but can also experience tightness or pressure in the chest, nausea, abdominal pain, vomiting, fatigue, and dizziness. Coronary artery disease is most often due to atherosclerosis; this is a build-up of plaque along the walls of the coronary arteries. As atherosclerosis progresses and the fatty plaque deposits get thicker, the central channel (lumen) of the blood vessels (where the blood flows) gets narrower. This narrow lumen results in less blood (and oxygen) getting through to the heart cells. Risk factors for developing atherosclerosis (and coronary artery disease) include:
- High cholesterol
- High blood pressure
- Lack of exercise
- Diets high in salt, fat, cholesterol, and sugar
You can learn more about coronary heart disease by clicking here.
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Valvular heart disease
Your heart is made up of four chambers (left atrium, right atrium, left ventricle, right ventricle) and four one-way valves (tricuspid, pulmonary, mitral, and aortic valves) to guide the flow of blood through the heart and prevent blood from moving backward. Valvular heart disease occurs when you have a problem with one or more of these valves. There are three main ways that these valves can malfunction:
- Regurgitation: the valve cannot close with a tight seal, and you get leakage backward; examples include mitral regurgitation and aortic regurgitation.
- Stenosis: The valve is unable to open completely, resulting in a narrow channel for the blood to flow through; this prevents the usual amount of blood from getting through the valve, leading to decreased blood flow. Examples include aortic stenosis and pulmonic stenosis.
- Atresia: A poorly developed heart valve that does not have an opening for blood to flow through; this is a type of congenital heart defect present at birth and is the least common type of valvular heart disease.
The main physical sign of valvular heart disease is an abnormal sounding heartbeat, called a heart murmur. Many people with heart valve disease have no symptoms, especially early on in the course of the condition. Signs and symptoms that people with valvular heart disease may experience include:
- Shortness of breath or difficulty catching your breath, especially when lying down or with exertion (like walking)
- Chest pain
- Feeling like your heart is fluttering, racing, or skipping beats
- Swollen feet, legs, or abdomen
- Lightheadedness or episodes of fainting
You can learn more about valvular heart disease by clicking here.
Congestive heart failure
Congestive heart failure (CHF) is a condition in which the heart is unable to pump enough blood to meet the body’s needs. Congestive heart failure occurs when there is a problem with either: 1) How the heart fills with blood or 2) How the heart pumps blood forward. When the heart has trouble filling with blood, it is called diastolic heart failure or heart failure with preserved ejection fraction. When the heart has trouble pumping blood forward, it is called systolic heart failure or heart failure with reduced ejection fraction. (The ejection fraction is the percentage of blood in the heart that gets pushed forward each time the heart beats.)
CHF can be caused by other heart conditions, including cardiomyopathy, CAD, valvular heart disease, and even arrhythmias. In CHF, there is often fluid build-up in the body, and the symptoms are the same as the symptoms listed above for cardiomyopathy.
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Endocarditis (heart infections)
Endocarditis is an infection of the endocardium, the inner lining of your heart; it is a rare condition but can be life-threatening. In endocarditis, bacteria, viruses, or fungi travel through the blood and infect the lining of the heart. Sometimes these bacteria or fungi clump on one of the heart valves; if that clump breaks off into the bloodstream, it can travel to other parts of the body, like your brain, blocking blood flow and spreading the infection (embolus). Common signs and symptoms of infectious endocarditis include:
- Fever, chills, or other flu-like symptoms
- A heart murmur that is new or changed from before
- Joint and muscle aches
- Night sweats
- Shortness of breath
- Chest pain, especially when you breathe
- Swelling in your feet, legs, or abdomen
- Abdominal pain
- Skin changes, such as painful red or purple bumps on your fingers or toes (Osler’s nodes), painless flat red spots on the palms of your hands or soles of your feet (Janeway lesions), or tiny reddish-purple spots from broken blood vessels on your skin, eyes, or in your mouth (petechiae).
Endocarditis is caused by germs, such as bacteria and fungi, getting into the heart from the bloodstream. There are different pathways the bugs can use to access a person’s blood, including:
- Dental activities: Brushing your teeth, or other activities that could cause your gums to bleed; these activities allow bacteria to enter your bloodstream, especially if you do not have healthy gums. Similarly, dental procedures that cut your gums can also introduce germs into your blood.
- Infections: Bacteria can spread from an infected area, like a skin infection, into the blood circulation.
- Catheters: People who need to have catheters (thin tubes) placed to inject medications or remove fluid are at a higher risk of having bacteria enter their body through the catheter; this is especially true if the catheter is in place for an extended period
- Needles: Needles used for tattoos, body piercing, or intravenous (IV) illegal drug use (like heroin or cocaine) can become contaminated with bacteria and transport it into the bloodstream.
Congenital heart defects
There are several types of congenital heart defects, an umbrella term for abnormalities of the structure of the heart that are present at birth. Some of these defects do not need treatment because they do not cause symptoms; however, they may cause complications as an adult. Other types require surgery, sometimes very soon after birth, because of life-threatening consequences. Types of congenital heart defects consist of holes in the heart, blocked blood flow, abnormal blood vessels, heart valve problems, and a poorly developed heart; babies can also be born with a combination of defects. Not all congenital heart defects cause symptoms, but for those that do, common symptoms include:
- Gray or blue skin color (cyanosis)
- Lack of energy
- Heart murmurs (abnormal heart sounds)
- Rapid breathing
- Shortness of breath when feeding
- Swelling in the abdomen, legs, or around the eyes
- Older children may notice that they become tired quickly, get short of breath, or faint during exercise
Congenital heart defects occur because of a problem with heart development in the fetus; heart development typically begins in the first six weeks of pregnancy. Researchers do not definitively know the reason why some people develop congenital heart defects. Genetics can play a role, and medications, certain medical conditions, and smoking may also be involved.
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How to diagnose heart disease
The diagnosis of heart disease begins with a physical exam and talking to your provider about your symptoms and family history. In addition to checking your blood to look at your cholesterol, sugar, electrolytes, or other abnormalities, your provider may also order one or more of the following tests:
- Electrocardiogram (ECG or EKG): This is a simple test that looks at the electrical activity of the heart and can be performed in your provider’s office.
- Holter monitors or event monitors: These are portable ECGs that provide information about how your heart is functioning during daily activities.
- Stress test: While exercising on a treadmill (or after taking medications to make your heart beat faster to simulate exercise), pictures are taken of your heart to see how it functions under stress.
- Echocardiogram: Echocardiograms use sound waves (ultrasound) to create a picture of your heart and look at its structure and function.
- Cardiac angiography (catheterization): In this minimally invasive procedure, a thin tube is inserted into a blood vessel in your groin or arm and guided into your heart. Then a special dye is injected into your blood vessels to visualize how the blood flows through the blood vessels and heart valves.
- Cardiac CT or MRI scan: A CT or MRI scan is taken of your heart to detect or evaluate any abnormalities.
Treatment of heart disease
The different treatments for heart disease vary depending on the type (or types) of heart disease involved. Therapies can include any combination of the following: lifestyle modifications, medications, and procedures or surgery.
Lifestyle modifications can help not only treat heart disease but also decrease your risk factors for heart disease and improve your overall heart health. Changes you can make include:
- Eating heart-healthy with a diet low in sodium and saturated fat and rich in fruits and vegetables
- Maintaining a healthy weight
- Minimizing stress
- Exercising for at least 30 minutes several times a week
- Quit smoking
For some people, lifestyle changes are not enough to treat their heart disease; in these cases, the healthcare provider may prescribe medications such as:
If the combination of medication and lifestyle changes are not enough, or your heart disease is severe, you may need surgery to address your condition. Your surgical options depend on your specific heart problem.
Preventing heart disease
Some types of heart disease cannot be avoided, especially congenital heart defects that you are born with. For many of the others, however, you can prevent heart disease by making healthy lifestyle changes. Heart disease can start as early as childhood but not present itself until well into adulthood, so it is never too early to start thinking about your heart health. Things you can do to reduce your risk of developing heart disease:
- Quit smoking
- Maintain a healthy weight
- Eat a heart-healthy diet full of fruits and vegetables and low in sugar, fat, salt, and cholesterol
- Exercise several times a week
- Regularly check and control your blood pressure, blood sugar, and cholesterol levels; if you are being treated for hypertension, diabetes, or high cholesterol be sure to take your medications as prescribed
- Manage stress
If you have any questions about your risks of heart disease, talk to your health care provider. Together, you can develop a plan to keep your heart healthy for years to come.
- American Heart Association (AHA). (2016, June 30). Understand Your Risks to Prevent a Heart Attack. Retrieved Dec. 4, 2019 from https://www.heart.org/en/health-topics/heart-attack/understand-your-risks-to-prevent-a-heart-attack
- Centers for Disease Control and Prevention (CDC). (2019, December 2). Heart Disease Facts. Retrieved Dec. 4, 2019 from https://www.cdc.gov/heartdisease/facts.htm
- National Institutes of Health (NIH). (n.d.). National Heart, Lung, and Blood Institute – Ischemic Heart Disease. Retrieved Dec. 4, 2019 from https://www.nhlbi.nih.gov/health-topics/ischemic-heart-disease
Dr. Mike is a licensed physician and the Director, Medical Content & Education at Ro.