diff --git "a/data/raw/medquad_cardiac.csv" "b/data/raw/medquad_cardiac.csv" new file mode 100644--- /dev/null +++ "b/data/raw/medquad_cardiac.csv" @@ -0,0 +1,8151 @@ +qtype,Question,Answer +information,What is (are) Periventricular Leukomalacia ?,"Periventricular leukomalacia (PVL) is characterized by the death of the white matter of the brain due to softening of the brain tissue. It can affect fetuses or newborns; premature babies are at the greatest risk of the disorder. PVL is caused by a lack of oxygen or blood flow to the periventricular area of the brain, which results in the death or loss of brain tissue. The periventricular area-the area around the spaces in the brain called ventricles-contains nerve fibers that carry messages from the brain to the body's muscles. Although babies with PVL generally have no outward signs or symptoms of the disorder, they are at risk for motor disorders, delayed mental development, coordination problems, and vision and hearing impairments. PVL may be accompanied by a hemorrhage or bleeding in the periventricular-intraventricular area (the area around and inside the ventricles), and can lead to cerebral palsy. The disorder is diagnosed by ultrasound of the head." +treatment,What are the treatments for Periventricular Leukomalacia ?,There is no specific treatment for PVL. Treatment is symptomatic and supportive. Children with PVL should receive regular medical screenings to determine appropriate interventions. +outlook,What is the outlook for Periventricular Leukomalacia ?,"The prognosis for individuals with PVL depends upon the severity of the brain damage. Some children exhibit fairly mild symptoms, while others have significant deficits and disabilities." +information,What is (are) Stroke ?,"A stroke occurs when the blood supply to part of the brain is suddenly interrupted or when a blood vessel in the brain bursts, spilling blood into the spaces surrounding brain cells. Brain cells die when they no longer receive oxygen and nutrients from the blood or there is sudden bleeding into or around the brain. The symptoms of a stroke include sudden numbness or weakness, especially on one side of the body; sudden confusion or trouble speaking or understanding speech; sudden trouble seeing in one or both eyes; sudden trouble with walking, dizziness, or loss of balance or coordination; or sudden severe headache with no known cause. There are two forms of stroke: ischemic - blockage of a blood vessel supplying the brain, and hemorrhagic - bleeding into or around the brain." +treatment,What are the treatments for Stroke ?,"Generally there are three treatment stages for stroke: prevention, therapy immediately after the stroke, and post-stroke rehabilitation. Therapies to prevent a first or recurrent stroke are based on treating an individual's underlying risk factors for stroke, such as hypertension, atrial fibrillation, and diabetes. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot causing an ischemic stroke or by stopping the bleeding of a hemorrhagic stroke. Post-stroke rehabilitation helps individuals overcome disabilities that result from stroke damage. Medication or drug therapy is the most common treatment for stroke. The most popular classes of drugs used to prevent or treat stroke are antithrombotics (antiplatelet agents and anticoagulants) and thrombolytics." +outlook,What is the outlook for Stroke ?,"Although stroke is a disease of the brain, it can affect the entire body. 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. Stroke may cause problems with thinking, awareness, attention, learning, judgment, and memory. Stroke survivors often have problems understanding or forming speech. A stroke can lead to emotional problems. Stroke patients may have difficulty controlling their emotions or may express inappropriate emotions. Many stroke patients experience depression. Stroke survivors may also have numbness or strange sensations. The pain is often worse in the hands and feet and is made worse by movement and temperature changes, especially cold temperatures. + +Recurrent stroke is frequent; about 25 percent of people who recover from their first stroke will have another stroke within 5 years." +information,What is (are) Spinal Cord Infarction ?,"Spinal cord infarction is a stroke either within the spinal cord or the arteries that supply it. It is caused by arteriosclerosis or a thickening or closing of the major arteries to the spinal cord. Frequently spinal cord infarction is caused by a specific form of arteriosclerosis called atheromatosis, in which a deposit or accumulation of lipid-containing matter forms within the arteries. Symptoms, which generally appear within minutes or a few hours of the infarction, may include intermittent sharp or burning back pain, aching pain down through the legs, weakness in the legs, paralysis, loss of deep tendon reflexes, loss of pain and temperature sensation, and incontinence." +information,What is (are) Atrial Fibrillation and Stroke ?,"Atrial fibrillation (AF) describes the rapid, irregular beating of the left atrium (upper chamber) of the heart. These rapid contractions of the heart are weaker than normal contractions, resulting in slow flow of blood in the atrium. The blood pools and becomes sluggish and can result in the formation of blood clots. If a clot leaves the heart and travels to the brain, it can cause a stroke by blocking the flow of blood through cerebral arteries. Some people with AF have no symptoms, but others may experience a fluttering feeling in the area of the chest above the heart, chest pain, lightheadness or fainting, shortness of breath, and fatigue. AF is diagnosed by an electrocardiogram (ECG), a device that records the hearts electrical activity. Other tests are often performed to rule out contributing causes, such as high blood pressure, an overactive thyroid gland, heart failure, faulty heart valves, lung disease, and stimulant or alcohol abuse. Some people will have no identifiable cause for their AF." +treatment,What are the treatments for Atrial Fibrillation and Stroke ?,"Within a few hours after onset of a stroke, treatment with drugs or devices that dissolve or break up the clot can restore blood flow to the brain and lead to a better recovery. To prevent strokes related to AF, doctors often prescribe medications to prevent formation of clots in the heart, which can travel to the brain and cause stroke. Immediately after a stroke, doctors may temporarily administer heparin by injection, while starting an oral medication for long-term protection from clots. The most commonly used drug has been warfarin. People taking warfarin must be closely monitored to make sure their blood is thin enough to prevent clots, but not so thin as to promote bleeding. Since some foods, vitamin supplements, and medications can affect warfarin action, keeping the blood just thin enough can be tricky. More recently, a number of new blood thinners, including dabigatran, rivaroxaban, and apixaban, have been shown to be as effective as warfarin in stroke prevention. These newer medications do not require regular blood test monitoring and may have less tendency to cause bleeding due to making the blood too thin. Some individuals with AF may have a lower risk of stroke and may be treated with aspirin, either alone or with another antiplatelet agency like clopidogrel. Other treatments for AF include medications such as beta blockers or calcium channel blockers to slow the heartbeat, and anti-arrhythmic drugs or electrical cardioversion (which delivers an electrical shock to the heart) to normalize the heartbeat." +outlook,What is the outlook for Atrial Fibrillation and Stroke ?,"AF, which affects as many as 2.2 million Americans, increases an individuals risk of stroke by 4 to 6 times on average. The risk increases with age. In people over 80 years old, AF is the direct cause of 1 in 4 strokes. Treating individuals with warfarin or new blood thinners reduces the rate of stroke for those who have AF by approximately one-half to two- thirds. People with AF can have multiple strokes, including silent strokes (strokes that don't show physical symptoms but show up on a brain scan) that, over time, can cause dementia, so prevention is important." +outlook,What is the outlook for Pompe Disease ?,"Without enzyme replacement therapy, the hearts of babies with infantile onset Pompe disease progressively thicken and enlarge. These babies die before the age of one year from either cardiorespiratory failure or respiratory infection. For individuals with late onset Pompe disease, the prognosis is dependent upon the age of onset. In general, the later the age of onset, the slower the progression of the disease. Ultimately, the prognosis is dependent upon the extent of respiratory muscle involvement." +information,What is (are) High Blood Pressure and Kidney Disease ?,"Blood pressure is the force of blood pushing against blood vessel walls as the heart pumps out blood, and high blood pressure, also called hypertension, is an increase in the amount of force that blood places on blood vessels as it moves through the body. Factors that can increase this force include higher blood volume due to extra fluid in the blood and blood vessels that are narrow, stiff, or clogged. + +Blood pressure test results are written with two numbers separated by a slash. For example, a health care provider will write a blood pressure result as 120/80. A health care provider will say this blood pressure result as 120 over 80. The top number is called the systolic pressure and represents the pressure as the heart beats and pushes blood through the blood vessels. The bottom number is called the diastolic pressure and represents the pressure as blood vessels relax between heartbeats. + +Most people without chronic health conditions have a normal blood pressure if it stays below 120/80. Prehypertension is a systolic pressure of 120 to 139 or a diastolic pressure of 80 to 89. High blood pressure is a systolic pressure of 140 or above or a diastolic pressure of 90 or above.1 + +People should talk with their health care provider about their individual blood pressure goals and how often they should have their blood pressure checked." +information,What is (are) High Blood Pressure and Kidney Disease ?,"The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine. When the bladder empties, urine flows out of the body through a tube called the urethra, located at the bottom of the bladder. In men the urethra is long, while in women it is short. + +Kidneys work at the microscopic level. The kidney is not one large filter. Each kidney is made up of about a million filtering units called nephrons. Each nephron filters a small amount of blood. The nephron includes a filter, called the glomerulus, and a tubule. The nephrons work through a two-step process. The glomerulus lets fluid and waste products pass through it; however, it prevents blood cells and large molecules, mostly proteins, from passing. The filtered fluid then passes through the tubule, which sends needed minerals back to the bloodstream and removes wastes. The final product becomes urine." +symptoms,What are the symptoms of High Blood Pressure and Kidney Disease ?,"Most people with high blood pressure do not have symptoms. In rare cases, high blood pressure can cause headaches. + +Kidney disease also does not have symptoms in the early stages. A person may have swelling called edema, which happens when the kidneys cannot get rid of extra fluid and salt. Edema can occur in the legs, feet, or ankles and less often in the hands or face. Once kidney function decreases further, symptoms can include + +- appetite loss - nausea - vomiting - drowsiness or feeling tired - trouble concentrating - sleep problems - increased or decreased urination - generalized itching or numbness - dry skin - headaches - weight loss - darkened skin - muscle cramps - shortness of breath - chest pain" +exams and tests,How to diagnose High Blood Pressure and Kidney Disease ?,"A health care provider diagnoses high blood pressure when multiple blood pressure testsoften repeated over several visits to a health care providers officeshow that a systolic blood pressure is consistently above 140 or a diastolic blood pressure is consistently above 90. Health care providers measure blood pressure with a blood pressure cuff. People can also buy blood pressure cuffs at discount chain stores and drugstores to monitor their blood pressure at home. + +Kidney disease is diagnosed with urine and blood tests. + +Urine Tests + +Dipstick test for albumin. A dipstick test performed on a urine sample can detect the presence of albumin in the urine. Albumin is a protein in the blood that can pass into the urine when the kidneys are damaged. A patient collects the urine sample in a special container in a health care providers office or a commercial facility. The office or facility tests the sample onsite or sends it to a lab for analysis. For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the urine. Patches on the dipstick change color when blood or protein is present in urine. + +Urine albumin-to-creatinine ratio. A health care provider uses the albumin and creatinine measurement to determine the ratio between the albumin and creatinine in the urine. Creatinine is a waste product in the blood that is filtered in the kidneys and excreted in the urine. A urine albumin-to-creatinine ratio above 30 mg/g may be a sign of kidney disease. + +Blood Test + +A blood test involves having blood drawn at a health care providers office or a commercial facility and sending the sample to a lab for analysis. A health care provider may order a blood test to estimate how much blood the kidneys filter each minute, called the estimated glomerular filtration rate (eGFR). The results of the test indicate the following: + +- eGFR of 60 or above is in the normal range - eGFR below 60 may indicate kidney damage - eGFR of 15 or below may indicate kidney failure + + + +Get Screened for Kidney Disease Kidney disease, when found early, can be treated to prevent more serious disease and other complications. The National Kidney Foundation recommends people with high blood pressure receive the following regular screenings: - blood pressure tests - urine albumin - eGFR Health care providers will help determine how often people with high blood pressure should be screened." +prevention,How to prevent High Blood Pressure and Kidney Disease ?,"The best way to slow or prevent kidney disease from high blood pressure is to take steps to lower blood pressure. These steps include a combination of medication and lifestyle changes, such as + +- healthy eating - physical activity - maintaining a healthy weight - quitting smoking - managing stress + +No matter what the cause of the kidney disease, high blood pressure can increase damage to the kidneys. People with kidney disease should keep their blood pressure below 140/90.4 + +Medication + +Medications that lower blood pressure can also significantly slow the progression of kidney disease. Two types of blood pressure-lowering medications, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have been shown effective in slowing the progression of kidney disease. Many people require two or more medications to control their blood pressure. In addition to an ACE inhibitor or an ARB, a health care provider may prescribe a diuretica medication that helps the kidneys remove fluid from the blood. A person may also need beta blockers, calcium channel blockers, and other blood pressure medications." +considerations,What to do for High Blood Pressure and Kidney Disease ?,"Following a healthy eating plan can help lower blood pressure. A health care provider may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan. DASH focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and lower in sodium, which often comes from salt. The DASH eating plan + +- is low in fat and cholesterol - features fat-free or low-fat milk and dairy products, fish, poultry, and nuts - suggests less red meat, sweets, added sugars, and sugar-containing beverages - is rich in nutrients, protein, and fiber + +Read more about DASH at www.nhlbi.nih.gov/health/resources/heart/hbp-dash-index.htm. + +A dietitian may also recommend this type of diet for people who have already developed kidney disease. A diet low in sodium and liquid intake can help reduce edema and lower blood pressure. Reducing saturated fat and cholesterol can help control high levels of lipids, or fats, in the blood. + +Health care providers may recommend that people with kidney disease eat moderate or reduced amounts of protein, though the benefits of reducing protein in a persons diet is still being researched. Proteins break down into waste products that the kidneys filter from the blood. Eating more protein than the body needs may burden the kidneys and cause kidney function to decline faster. However, protein intake that is too low may lead to malnutrition, a condition that occurs when the body does not get enough nutrients. People with kidney disease who are on a restricted protein diet should be monitored with blood tests that can show low nutrient levels. + +In addition, consuming too much alcohol raises blood pressure, so people should limit alcoholic drinkstwo per day for men and one per day for women. + +A health care provider can help people change their diet to meet their individual needs. + +Physical Activity + +Regular physical activity can lower blood pressure and reduce the chances of other health problems. A health care provider can provide information about how much and what kinds of activity are safe. Most people should try to get at least 30 to 60 minutes of activity most or all days of the week. A person can do all physical activity at once or break up activities into shorter periods of at least 10 minutes each. Moderate activities include brisk walking, dancing, bowling, riding a bike, working in a garden, and cleaning the house. + +Body Weight + +People who are overweight or obese should aim to reduce their weight by 7 to 10 percent during the first year of treatment for high blood pressure. This amount of weight loss can lower the chance of health problems related to high blood pressure. Overweight is defined as a body mass index (BMI)a measurement of weight in relation to heightof 25 to 29. A BMI of 30 or higher is considered obese. A BMI lower than 25 is the goal for keeping blood pressure under control.5 + +Smoking + +People who smoke should quit. Smoking can damage blood vessels, raise the chance of high blood pressure, and worsen health problems related to high blood pressure. People with high blood pressure should talk with their health care provider about programs and products they can use to quit smoking. + +Stress + +Learning how to manage stress, relax, and cope with problems can improve emotional and physical health. Some activities that may help reduce stress include + +- exercising - practicing yoga or tai chi - listening to music - focusing on something calm or peaceful - meditating" +considerations,What to do for High Blood Pressure and Kidney Disease ?,"- Blood pressure is the force of blood pushing against blood vessel walls as the heart pumps out blood, and high blood pressure, also called hypertension, is an increase in the amount of force that blood places on blood vessels as it moves through the body. - High blood pressure can damage blood vessels in the kidneys, reducing their ability to work properly. When the force of blood flow is high, blood vessels stretch so blood flows more easily. Eventually, this stretching scars and weakens blood vessels throughout the body, including those in the kidneys. - High blood pressure is the second leading cause of kidney failure in the United States after diabetes. - A health care provider diagnoses high blood pressure when multiple blood pressure testsoften repeated over several visits to a health care providers officeshow that a systolic blood pressure is consistently above 140 or a diastolic blood pressure is consistently above 90. - Kidney disease is diagnosed with urine and blood tests. - The best way to slow or prevent kidney damage from high blood pressure is to take steps to lower blood pressure. These steps include a combination of medication and lifestyle changes, such as - healthy eating - physical activity - maintaining a healthy weight - quitting smoking - managing stress - No matter what the cause of the kidney disease, high blood pressure can increase damage to the kidneys. People with kidney disease should keep their blood pressure below 140/90." +complications,What are the complications of Anemia in Chronic Kidney Disease ?,"Heart problems are a complication of anemia and may include + +- an irregular heartbeat or an unusually fast heartbeat, especially when exercising. - the harmful enlargement of muscles in the heart. - heart failure, which does not mean the heart suddenly stops working. Instead, heart failure is a long-lasting condition in which the heart cant pump enough blood to meet the bodys needs." +prevention,How to prevent Kidney Disease of Diabetes ?,"Blood Pressure Medicines + +Scientists have made great progress in developing methods that slow the onset and progression of kidney disease in people with diabetes. Drugs used to lower blood pressure can slow the progression of kidney disease significantly. Two types of drugs, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have proven effective in slowing the progression of kidney disease. Many people require two or more drugs to control their blood pressure. In addition to an ACE inhibitor or an ARB, a diuretic can also be useful. Beta blockers, calcium channel blockers, and other blood pressure drugs may also be needed. + +An example of an effective ACE inhibitor is lisinopril (Prinivil, Zestril), which doctors commonly prescribe for treating kidney disease of diabetes. The benefits of lisinopril extend beyond its ability to lower blood pressure: it may directly protect the kidneys' glomeruli. ACE inhibitors have lowered proteinuria and slowed deterioration even in people with diabetes who did not have high blood pressure. + +An example of an effective ARB is losartan (Cozaar), which has also been shown to protect kidney function and lower the risk of cardiovascular events. + +Patients with even mild hypertension or persistent microalbuminuria should consult a health care provider about the use of antihypertensive medicines. + +Moderate-protein Diets + +In people with diabetes, excessive consumption of protein may be harmful. Experts recommend that people with kidney disease of diabetes consume the recommended dietary allowance for protein, but avoid high-protein diets. For people with greatly reduced kidney function, a diet containing reduced amounts of protein may help delay the onset of kidney failure. Anyone following a reduced-protein diet should work with a dietitian to ensure adequate nutrition. + +Intensive Management of Blood Glucose + +Antihypertensive drugs and low-protein diets can slow CKD. A third treatment, known as intensive management of blood glucose or glycemic control, has shown great promise for people with diabetes, especially for those in the early stages of CKD. + +The human body normally converts food to glucose, the simple sugar that is the main source of energy for the body's cells. To enter cells, glucose needs the help of insulin, a hormone produced by the pancreas. When a person does not make enough insulin, or the body does not respond to the insulin that is present, the body cannot process glucose, and it builds up in the bloodstream. High levels of glucose in the blood lead to a diagnosis of diabetes. + +Intensive management of blood glucose is a treatment regimen that aims to keep blood glucose levels close to normal. The regimen includes testing blood glucose frequently, administering insulin throughout the day on the basis of food intake and physical activity, following a diet and activity plan, and consulting a health care team regularly. Some people use an insulin pump to supply insulin throughout the day. + +A number of studies have pointed to the beneficial effects of intensive management of blood glucose. In the Diabetes Control and Complications Trial supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), researchers found a 50 percent decrease in both development and progression of early diabetic kidney disease in participants who followed an intensive regimen for controlling blood glucose levels. The intensively managed patients had average blood glucose levels of 150 milligrams per deciliterabout 80 milligrams per deciliter lower than the levels observed in the conventionally managed patients. The United Kingdom Prospective Diabetes Study, conducted from 1976 to 1997, showed conclusively that, in people with improved blood glucose control, the risk of early kidney disease was reduced by a third. Additional studies conducted over the past decades have clearly established that any program resulting in sustained lowering of blood glucose levels will be beneficial to patients in the early stages of CKD." +prevention,How to prevent Kidney Disease of Diabetes ?,"Blood Pressure Medicines + +Scientists have made great progress in developing methods that slow the onset and progression of kidney disease in people with diabetes. Drugs used to lower blood pressure can slow the progression of kidney disease significantly. Two types of drugs, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have proven effective in slowing the progression of kidney disease. Many people require two or more drugs to control their blood pressure. In addition to an ACE inhibitor or an ARB, a diuretic can also be useful. Beta blockers, calcium channel blockers, and other blood pressure drugs may also be needed. + +An example of an effective ACE inhibitor is lisinopril (Prinivil, Zestril), which doctors commonly prescribe for treating kidney disease of diabetes. The benefits of lisinopril extend beyond its ability to lower blood pressure: it may directly protect the kidneys' glomeruli. ACE inhibitors have lowered proteinuria and slowed deterioration even in people with diabetes who did not have high blood pressure. + +An example of an effective ARB is losartan (Cozaar), which has also been shown to protect kidney function and lower the risk of cardiovascular events. + +Patients with even mild hypertension or persistent microalbuminuria should consult a health care provider about the use of antihypertensive medicines. + +Moderate-protein Diets + +In people with diabetes, excessive consumption of protein may be harmful. Experts recommend that people with kidney disease of diabetes consume the recommended dietary allowance for protein, but avoid high-protein diets. For people with greatly reduced kidney function, a diet containing reduced amounts of protein may help delay the onset of kidney failure. Anyone following a reduced-protein diet should work with a dietitian to ensure adequate nutrition. + +Intensive Management of Blood Glucose + +Antihypertensive drugs and low-protein diets can slow CKD. A third treatment, known as intensive management of blood glucose or glycemic control, has shown great promise for people with diabetes, especially for those in the early stages of CKD. + +The human body normally converts food to glucose, the simple sugar that is the main source of energy for the body's cells. To enter cells, glucose needs the help of insulin, a hormone produced by the pancreas. When a person does not make enough insulin, or the body does not respond to the insulin that is present, the body cannot process glucose, and it builds up in the bloodstream. High levels of glucose in the blood lead to a diagnosis of diabetes. + +Intensive management of blood glucose is a treatment regimen that aims to keep blood glucose levels close to normal. The regimen includes testing blood glucose frequently, administering insulin throughout the day on the basis of food intake and physical activity, following a diet and activity plan, and consulting a health care team regularly. Some people use an insulin pump to supply insulin throughout the day. + +A number of studies have pointed to the beneficial effects of intensive management of blood glucose. In the Diabetes Control and Complications Trial supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), researchers found a 50 percent decrease in both development and progression of early diabetic kidney disease in participants who followed an intensive regimen for controlling blood glucose levels. The intensively managed patients had average blood glucose levels of 150 milligrams per deciliterabout 80 milligrams per deciliter lower than the levels observed in the conventionally managed patients. The United Kingdom Prospective Diabetes Study, conducted from 1976 to 1997, showed conclusively that, in people with improved blood glucose control, the risk of early kidney disease was reduced by a third. Additional studies conducted over the past decades have clearly established that any program resulting in sustained lowering of blood glucose levels will be beneficial to patients in the early stages of CKD." +information,What is (are) Prevent diabetes problems: Keep your kidneys healthy ?,"Blood pressure is the force of blood flow inside your blood vessels. Blood pressure is written with two numbers separated by a slash. For example, a blood pressure result of 130/80 is said as 130 over 80. The first number is the pressure in your blood vessels as your heart beats and pushes blood through your blood vessels. The second number is the pressure as your blood vessels relax between heartbeats. + +High blood pressure forces your heart to work harder to pump blood. High blood pressure can strain your heart, damage your blood vessels, and increase your risk of heart attack, stroke, eye problems, and kidney problems." +susceptibility,Who is at risk for Proteinuria? ?,"People with diabetes, hypertension, or certain family backgrounds are at risk for proteinuria. In the United States, diabetes is the leading cause of ESRD.1 In both type 1 and type 2 diabetes, albumin in the urine is one of the first signs of deteriorating kidney function. As kidney function declines, the amount of albumin in the urine increases. + +Another risk factor for developing proteinuria is hypertension, or high blood pressure. Proteinuria in a person with high blood pressure is an indicator of declining kidney function. If the hypertension is not controlled, the person can progress to full kidney failure. + +African Americans are more likely than Caucasians to have high blood pressure and to develop kidney problems from it, even when their blood pressure is only mildly elevated. In fact, African Americans are six times more likely than Caucasians to develop hypertension-related kidney failure.2 + +Other groups at risk for proteinuria are American Indians, Hispanics/Latinos, Pacific Islander Americans, older adults, and overweight people. These at-risk groups and people who have a family history of kidney disease should have their urine tested regularly." +prevention,How to prevent Prevent diabetes problems: Keep your heart and blood vessels healthy ?,"You can do a lot to prevent heart disease and stroke. + +- Keep your blood glucose under control. You can see if your blood glucose is under control by having an A1C test at least twice a year. The A1C test tells you your average blood glucose for the past 2 to 3 months. The target for most people with diabetes is below 7. In some people with heart disease or other special circumstances, their doctor may recommend slightly higher levels of A1C. - Keep your blood pressure under control. Have it checked at every doctor visit. The target for most people with diabetes is below 140/80, unless their doctor sets a different target. - Keep your cholesterol under control. Have it checked at least once a year. The targets for most people with diabetes are - LDLbadcholesterol: below 100 - HDLgoodcholesterol: above 40 in men and above 50 in women - triglyceridesanother type of fat in the blood: below 150 - Make sure the foods you eat are ""heart-healthy."" Include foods high in fiber, such as oat bran, oatmeal, whole-grain breads and cereals, fruits, and vegetables. Cut back on foods high in saturated fat or cholesterol, such as meats, butter, dairy products with fat, eggs, shortening, lard, and foods with palm oil or coconut oil. Limit foods with trans fat, such as snack foods and commercial baked goods. - If you smoke, quit. Your doctor can tell you about ways to help you quit smoking. - Ask your doctor whether you should take an aspirin every day. Studies have shown that taking a low dose of aspirin every day can help reduce your risk of heart disease and stroke. - Take your medicines as directed." +symptoms,What are the symptoms of Prevent diabetes problems: Keep your heart and blood vessels healthy ?,"A stroke happens when part of your brain is not getting enough blood and stops working. Depending on the part of the brain that is damaged, a stroke can cause + +- sudden weakness or numbness of your face, arm, or leg on one side of your body - sudden confusion, trouble talking, or trouble understanding - sudden dizziness, loss of balance, or trouble walking - sudden trouble seeing in one or both eyes or sudden double vision - sudden severe headache + +Sometimes, one or more of these warning signs may happen and then disappear. You might be having a ""mini-stroke,"" also called a TIA or a transient ischemic attack. If you have any of these warning signs, call 911 right away. Getting care for a TIA may reduce or prevent a stroke. Getting prompt treatment for a stroke can reduce the damage to the brain and improve chances for recovery." +causes,What causes What I need to know about Kidney Failure and How Its Treated ?,"Diabetes and high blood pressure are the most common causes of kidney failure. Other factors include heart and blood vessel disease and a family history of kidney failure. African Americans, Hispanics/Latinos, and American Indians are more likely to have kidney failure." +information,"What is (are) Diabetes, Heart Disease, and Stroke ?","Diabetes is a disorder of metabolismthe way our bodies use digested food for energy. Most of the food we eat is broken down into glucose, the form of sugar in the blood. Glucose is the body's main source of fuel. + +After digestion, glucose enters the bloodstream. Then glucose goes to cells throughout the body where it is used for energy. However, a hormone called insulin must be present to allow glucose to enter the cells. Insulin is a hormone produced by the pancreas, a large gland behind the stomach. + +In people who do not have diabetes, the pancreas automatically produces the right amount of insulin to move glucose from blood into the cells. However, diabetes develops when the pancreas does not make enough insulin, or the cells in the muscles, liver, and fat do not use insulin properly, or both. As a result, the amount of glucose in the blood increases while the cells are starved of energy. + +Over time, high blood glucose levels damage nerves and blood vessels, leading to complications such as heart disease and stroke, the leading causes of death among people with diabetes. Uncontrolled diabetes can eventually lead to other health problems as well, such as vision loss, kidney failure, and amputations." +information,"What is (are) Diabetes, Heart Disease, and Stroke ?","Prediabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. Prediabetes is also called impaired fasting glucose or impaired glucose tolerance. Many people with prediabetes develop type 2 diabetes within 10 years. In addition, they are at risk for heart disease and stroke. With modest weight loss and moderate physical activity, people with prediabetes can delay or prevent type 2 diabetes and lower their risk of heart disease and stroke." +information,"What is (are) Diabetes, Heart Disease, and Stroke ?","If you have diabetes, you are at least twice as likely as someone who does not have diabetes to have heart disease or a stroke. People with diabetes also tend to develop heart disease or have strokes at an earlier age than other people. If you are middle-aged and have type 2 diabetes, some studies suggest that your chance of having a heart attack is as high as someone without diabetes who has already had one heart attack. Women who have not gone through menopause usually have less risk of heart disease than men of the same age. But women of all ages with diabetes have an increased risk of heart disease because diabetes cancels out the protective effects of being a woman in her child-bearing years. + +People with diabetes who have already had one heart attack run an even greater risk of having a second one. In addition, heart attacks in people with diabetes are more serious and more likely to result in death. High blood glucose levels over time can lead to increased deposits of fatty materials on the insides of the blood vessel walls. These deposits may affect blood flow, increasing the chance of clogging and hardening of blood vessels (atherosclerosis)." +information,"What is (are) Diabetes, Heart Disease, and Stroke ?","If you have diabetes, you are at least twice as likely as someone who does not have diabetes to have heart disease or a stroke. People with diabetes also tend to develop heart disease or have strokes at an earlier age than other people. If you are middle-aged and have type 2 diabetes, some studies suggest that your chance of having a heart attack is as high as someone without diabetes who has already had one heart attack. Women who have not gone through menopause usually have less risk of heart disease than men of the same age. But women of all ages with diabetes have an increased risk of heart disease because diabetes cancels out the protective effects of being a woman in her child-bearing years. + +People with diabetes who have already had one heart attack run an even greater risk of having a second one. In addition, heart attacks in people with diabetes are more serious and more likely to result in death. High blood glucose levels over time can lead to increased deposits of fatty materials on the insides of the blood vessel walls. These deposits may affect blood flow, increasing the chance of clogging and hardening of blood vessels (atherosclerosis)." +susceptibility,"Who is at risk for Diabetes, Heart Disease, and Stroke? ?","Diabetes itself is a risk factor for heart disease and stroke. Also, many people with diabetes have other conditions that increase their chance of developing heart disease and stroke. These conditions are called risk factors. One risk factor for heart disease and stroke is having a family history of heart disease. If one or more members of your family had a heart attack at an early age (before age 55 for men or 65 for women), you may be at increased risk. + +You can't change whether heart disease runs in your family, but you can take steps to control the other risk factors for heart disease listed here: + +- Having central obesity. Central obesity means carrying extra weight around the waist, as opposed to the hips. A waist measurement of more than 40 inches for men and more than 35 inches for women means you have central obesity. Your risk of heart disease is higher because abdominal fat can increase the production of LDL (bad) cholesterol, the type of blood fat that can be deposited on the inside of blood vessel walls. - Having abnormal blood fat (cholesterol) levels. - LDL cholesterol can build up inside your blood vessels, leading to narrowing and hardening of your arteriesthe blood vessels that carry blood from the heart to the rest of the body. Arteries can then become blocked. Therefore, high levels of LDL cholesterol raise your risk of getting heart disease. - Triglycerides are another type of blood fat that can raise your risk of heart disease when the levels are high. - HDL (good) cholesterol removes deposits from inside your blood vessels and takes them to the liver for removal. Low levels of HDL cholesterol increase your risk for heart disease. - Having high blood pressure. If you have high blood pressure, also called hypertension, your heart must work harder to pump blood. High blood pressure can strain the heart, damage blood vessels, and increase your risk of heart attack, stroke, eye problems, and kidney problems. - Smoking. Smoking doubles your risk of getting heart disease. Stopping smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels. Smoking also increases the risk of other long-term complications, such as eye problems. In addition, smoking can damage the blood vessels in your legs and increase the risk of amputation." +information,"What is (are) Diabetes, Heart Disease, and Stroke ?","Metabolic syndrome is a grouping of traits and medical conditions that puts people at risk for both heart disease and type 2 diabetes. It is defined by the National Cholesterol Education Program as having any three of the following five traits and medical conditions: + +Traits and Medical Conditions Definition Elevated waist circumference Waist measurement of - 40 inches or more in men - 35 inches or more in women Elevated levels of triglycerides - 150 mg/dL or higher or Taking medication for elevated triglyceride levels Low levels of HDL (good) cholesterol - Below 40 mg/dL in men - Below 50 mg/dL in women or Taking medication for low HDL cholesterol levels Elevated blood pressure levels - 130 mm Hg or higher for systolic blood pressure or - 85 mm Hg or higher for diastolic blood pressure or Taking medication for elevated blood pressure levels Elevated fasting blood glucose levels - 100 mg/dL or higher or Taking medication for elevated blood glucose levels" +prevention,"How to prevent Diabetes, Heart Disease, and Stroke ?","Even if you are at high risk for heart disease and stroke, you can help keep your heart and blood vessels healthy. You can do so by taking the following steps: + +- Make sure that your diet is ""heart-healthy."" Meet with a registered dietitian to plan a diet that meets these goals: - Include at least 14 grams of fiber daily for every 1,000 calories consumed. Foods high in fiber may help lower blood cholesterol. Oat bran, oatmeal, whole-grain breads and cereals, dried beans and peas (such as kidney beans, pinto beans, and black-eyed peas), fruits, and vegetables are all good sources of fiber. Increase the amount of fiber in your diet gradually to avoid digestive problems. - Cut down on saturated fat. It raises your blood cholesterol level. Saturated fat is found in meats, poultry skin, butter, dairy products with fat, shortening, lard, and tropical oils such as palm and coconut oil. Your dietitian can figure out how many grams of saturated fat should be your daily maximum amount. - Keep the cholesterol in your diet to less than 300 milligrams a day. Cholesterol is found in meat, dairy products, and eggs. - Keep the amount of trans fat in your diet to a minimum. It's a type of fat in foods that raises blood cholesterol. Limit your intake of crackers, cookies, snack foods, commercially prepared baked goods, cake mixes, microwave popcorn, fried foods, salad dressings, and other foods made with partially hydrogenated oil. In addition, some kinds of vegetable shortening and margarines have trans fat. Check for trans fat in the Nutrition Facts section on the food package. - If you smoke, quit. Your doctor can help you find ways to quit smoking. - Ask your doctor whether you should take aspirin. Studies have shown that taking a low dose of aspirin every day can help reduce the risk of heart disease and stroke. However, aspirin is not safe for everyone. Your doctor can tell you whether taking aspirin is right for you and exactly how much to take. - Get prompt treatment for transient ischemic attacks (TIAs). Early treatment for TIAs, sometimes called mini-strokes, may help prevent or delay a future stroke. Signs of a TIA are sudden weakness, loss of balance, numbness, confusion, blindness in one or both eyes, double vision, difficulty speaking, or a severe headache." +treatment,"What are the treatments for Diabetes, Heart Disease, and Stroke ?","You can keep track of the ABCs of diabetes to make sure your treatment is working. Talk with your health care provider about the best targets for you. + +A stands for A1C (a test that measures blood glucose control). Have an A1C test at least twice a year. It shows your average blood glucose level over the past 3 months. Talk with your doctor about whether you should check your blood glucose at home and how to do it. + +A1C target Below 7 percent, unless your doctor sets a different target + + + +Blood glucose targets Before meals 90 to 130 mg/dL 1 to 2 hours after the start of a meal Less than 180 mg/dL + +B is for blood pressure. Have it checked at every office visit. + +Blood pressure target Below 140/80 mm Hg, unless your doctor sets a different target + +C is for cholesterol. Have it checked at least once a year. + +Blood fat (cholesterol) targets LDL (bad) cholesterol Under 100 mg/dL Triglycerides Under 150 mg/dL HDL (good) cholesterol For men: above 40 mg/dL For women: above 50 mg/dL + +Control of the ABCs of diabetes can reduce your risk for heart disease and stroke. If your blood glucose, blood pressure, and cholesterol levels aren't on target, ask your doctor what changes in diet, activity, and medications can help you reach these goals." +information,"What is (are) Diabetes, Heart Disease, and Stroke ?","Two major types of heart and blood vessel disease, also called cardiovascular disease, are common in people with diabetes: coronary artery disease (CAD) and cerebral vascular disease. People with diabetes are also at risk for heart failure. Narrowing or blockage of the blood vessels in the legs, a condition called peripheral arterial disease, can also occur in people with diabetes. + +Coronary Artery Disease + +Coronary artery disease, also called ischemic heart disease, is caused by a hardening or thickening of the walls of the blood vessels that go to your heart. Your blood supplies oxygen and other materials your heart needs for normal functioning. If the blood vessels to your heart become narrowed or blocked by fatty deposits, the blood supply is reduced or cut off, resulting in a heart attack. + +Cerebral Vascular Disease + +Cerebral vascular disease affects blood flow to the brain, leading to strokes and TIAs. It is caused by narrowing, blocking, or hardening of the blood vessels that go to the brain or by high blood pressure. + +Stroke + +A stroke results when the blood supply to the brain is suddenly cut off, which can occur when a blood vessel in the brain or neck is blocked or bursts. Brain cells are then deprived of oxygen and die. A stroke can result in problems with speech or vision or can cause weakness or paralysis. Most strokes are caused by fatty deposits or blood clotsjelly-like clumps of blood cellsthat narrow or block one of the blood vessels in the brain or neck. A blood clot may stay where it formed or can travel within the body. People with diabetes are at increased risk for strokes caused by blood clots. + +A stroke may also be caused by a bleeding blood vessel in the brain. Called an aneurysm, a break in a blood vessel can occur as a result of high blood pressure or a weak spot in a blood vessel wall. + +TIAs + +TIAs are caused by a temporary blockage of a blood vessel to the brain. This blockage leads to a brief, sudden change in brain function, such as temporary numbness or weakness on one side of the body. Sudden changes in brain function also can lead to loss of balance, confusion, blindness in one or both eyes, double vision, difficulty speaking, or a severe headache. However, most symptoms disappear quickly and permanent damage is unlikely. If symptoms do not resolve in a few minutes, rather than a TIA, the event could be a stroke. The occurrence of a TIA means that a person is at risk for a stroke sometime in the future. See page 3 for more information on risk factors for stroke. + +Heart Failure + +Heart failure is a chronic condition in which the heart cannot pump blood properlyit does not mean that the heart suddenly stops working. Heart failure develops over a period of years, and symptoms can get worse over time. People with diabetes have at least twice the risk of heart failure as other people. One type of heart failure is congestive heart failure, in which fluid builds up inside body tissues. If the buildup is in the lungs, breathing becomes difficult. + +Blockage of the blood vessels and high blood glucose levels also can damage heart muscle and cause irregular heart beats. People with damage to heart muscle, a condition called cardiomyopathy, may have no symptoms in the early stages, but later they may experience weakness, shortness of breath, a severe cough, fatigue, and swelling of the legs and feet. Diabetes can also interfere with pain signals normally carried by the nerves, explaining why a person with diabetes may not experience the typical warning signs of a heart attack. + +Peripheral Arterial Disease + +Another condition related to heart disease and common in people with diabetes is peripheral arterial disease (PAD). With this condition, the blood vessels in the legs are narrowed or blocked by fatty deposits, decreasing blood flow to the legs and feet. PAD increases the chances of a heart attack or stroke occurring. Poor circulation in the legs and feet also raises the risk of amputation. Sometimes people with PAD develop pain in the calf or other parts of the leg when walking, which is relieved by resting for a few minutes." +treatment,"What are the treatments for Diabetes, Heart Disease, and Stroke ?","Treatment for heart disease includes meal planning to ensure a heart-healthy diet and physical activity. In addition, you may need medications to treat heart damage or to lower your blood glucose, blood pressure, and cholesterol. If you are not already taking a low dose of aspirin every day, your doctor may suggest it. You also may need surgery or some other medical procedure. + +For additional information about heart and blood vessel disease, high blood pressure, and high cholesterol, call the National Heart, Lung, and Blood Institute Health Information Center at 3015928573 or see www.nhlbi.nih.gov on the Internet." +treatment,"What are the treatments for Diabetes, Heart Disease, and Stroke ?","At the first sign of a stroke, you should get medical care right away. If blood vessels to your brain are blocked by blood clots, the doctor can give you a ""clot-busting"" drug. The drug must be given soon after a stroke to be effective. Subsequent treatment for stroke includes medications and physical therapy, as well as surgery to repair the damage. Meal planning and physical activity may be part of your ongoing care. In addition, you may need medications to lower your blood glucose, blood pressure, and cholesterol and to prevent blood clots. + +For additional information about strokes, call the National Institute of Neurological Disorders and Stroke at 18003529424 or see www.ninds.nih.gov on the Internet." +considerations,"What to do for Diabetes, Heart Disease, and Stroke ?","- If you have diabetes, you are at least twice as likely as other people to have heart disease or a stroke. - Controlling the ABCs of diabetesA1C (blood glucose), blood pressure, and cholesterol-can cut your risk of heart disease and stroke. - Choosing foods wisely, quitting smoking, and taking medications (if needed) can all help lower your risk of heart disease and stroke. - If you have any warning signs of a heart attack or a stroke, get medical care immediatelydon't delay. Early treatment of heart attack and stroke in a hospital emergency room can reduce damage to the heart and the brain." +considerations,"What to do for Diabetes, Heart Disease, and Stroke ?","- If you have diabetes, you are at least twice as likely as other people to have heart disease or a stroke. - Controlling the ABCs of diabetesA1C (blood glucose), blood pressure, and cholesterol-can cut your risk of heart disease and stroke. - Choosing foods wisely, quitting smoking, and taking medications (if needed) can all help lower your risk of heart disease and stroke. - If you have any warning signs of a heart attack or a stroke, get medical care immediatelydon't delay. Early treatment of heart attack and stroke in a hospital emergency room can reduce damage to the heart and the brain." +information,What is (are) Nutrition for Early Chronic Kidney Disease in Adults ?,"As blood pressure rises, the risk of damage to the arteries, heart, brain, and kidneys increases. Controlling blood pressure through healthy food choices and regular physical activity can delay or prevent the development of CKD. + +Blood pressure is expressed as two numbers. The top number represents the force of the blood pushing against the artery walls when the heart beats. The lower number represents the pressure between beats. Normal blood pressure is below 120/80 millimeters of mercury (mmHg). People with CKD should try to keep their blood pressure below 140/90 mmHg. + +Following a meal plan can help control blood pressure and protect the kidneys. The National Heart, Lung, and Blood Institute supported research that compared a typical American diet with the Dietary Approaches to Stop Hypertension (DASH) eating plan, which is lower in saturated fat, cholesterol, and total fat and emphasizes eating fruits, vegetables, and low-fat dairy foods. People who followed the DASH eating plan were able to reduce their blood pressure much more than those who ate a typical diet. The DASH eating plan also includes whole grain products, fish, poultry, and nuts. Limiting sodium, or salt, is another important feature of the plan. A dietitian can help find low-salt or salt-free alternatives to foods that are high in salt." +considerations,What to do for Nutrition for Early Chronic Kidney Disease in Adults ?,"- Controlling blood glucose and blood pressure through healthy food choices is an important step toward slowing or stopping the progression of chronic kidney disease (CKD). - The kidneys remove wastes and extra water from the blood and make urine. - Millions of Americans are at risk for developing CKD because they have diabetes, high blood pressure, or both. - People with either type 1 or type 2 diabetes must choose foods carefully to control their blood glucose. Following a meal plan to keep blood glucose at a healthy level may prevent CKD from developing. - Controlling blood pressure through healthy food choices and regular physical activity can delay or prevent the development of CKD. People with CKD should try to keep their blood pressure below 140/90 mmHg. - Medical nutrition therapy (MNT) is the use of counseling by a registered dietitian to help promote a medical or health goal. - Dietitians who specialize in helping people with CKD are called renal dietitians. - Learning how to read and understand lab reports lets a person see how different foods can affect the kidneys. Patients can ask their doctor for copies of their lab reports and ask to have them explained, noting any results out of the normal range." +information,What is (are) High Blood Cholesterol ?,"The coronary arteries bring blood to your heart. If plaque builds up in these arteries, the blood may not be able to bring enough oxygen to the heart muscle. This is called coronary heart disease." +prevention,How to prevent Kidney Disease ?,"Risk Factors Diabetes and high blood pressure are the two leading causes of kidney disease. Both diabetes and high blood pressure damage the small blood vessels in your kidneys and can cause kidney disease -- without you feeling it. Other risk factors for kidney disease include: - cardiovascular (heart) disease - family history -- if you have a mother, father, sister, or brother who has had kidney failure, then you are at increased risk. cardiovascular (heart) disease family history -- if you have a mother, father, sister, or brother who has had kidney failure, then you are at increased risk. Additionally, African Americans, Hispanics, and Native Americans are at high risk for developing kidney failure. This is in part due to high rates of diabetes and high blood pressure in these communities. If you have ANY of these risk factors, talk to your health care provider about getting tested for kidney disease. If you have kidney disease, you may not feel any different. It is very important to get tested if you are at risk. (Watch the video to learn more about reducing your risk for kidney disease. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) Prevention If you are at risk for kidney disease, the most important steps you can take to keep your kidneys healthy are to - get your blood and urine checked for kidney disease. - manage your diabetes, high blood pressure, and heart disease. get your blood and urine checked for kidney disease. manage your diabetes, high blood pressure, and heart disease. Manage your diabetes and high blood pressure, and keep your kidneys healthy by - eating healthy foods: fresh fruits, fresh or frozen vegetables, whole grains, and low-fat dairy foods - cutting back on salt - limiting your alcohol intake - being more physically active - losing weight if you are overweight - taking your medicines the way your provider tells you to - keeping your cholesterol levels in the target range - taking steps to quit, if you smoke - seeing your doctor regularly. eating healthy foods: fresh fruits, fresh or frozen vegetables, whole grains, and low-fat dairy foods cutting back on salt limiting your alcohol intake being more physically active losing weight if you are overweight taking your medicines the way your provider tells you to keeping your cholesterol levels in the target range taking steps to quit, if you smoke seeing your doctor regularly. By following these steps and keeping risk factors under control -- especially your blood pressure -- you may be able to delay or even prevent kidney failure. Talk to your health care provider to find out the steps that are right for you. Learn about preventing high blood pressure. Learn about preventing type 2 diabetes." +susceptibility,Who is at risk for Kidney Disease? ?,"Diabetes and high blood pressure are the two leading risk factors for kidney disease. Both diabetes and high blood pressure damage the small blood vessels in your kidneys and can cause kidney disease -- without you feeling it. There are several other risk factors for kidney disease. Cardiovascular (heart) disease is a risk factor. So is family history: if you have a mother, father, sister, or brother who has had kidney disease, then you are at increased risk. African Americans, Hispanics, and Native Americans tend to have a greater risk for kidney failure. This is mostly due to higher rates of diabetes and high blood pressure in these communities, although there may be other reasons. (Watch the video to learn more about the connection between heart disease and kidney disease. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)" +research,what research (or clinical trials) is being done for Peripheral Arterial Disease (P.A.D.) ?,"The National Heart, Lung, and Blood Institute (NHLBI) supports research aimed at learning more about peripheral arterial disease (P.A.D.). For example, NHLBI-supported research on P.A.D. includes studies that - explore whether group walking sessions increase physical activity in people who have P.A.D. - compare how effective certain exercise programs are at reducing leg pain in people who have P.A.D. - examine how inflammation and insulin resistance affect people who have P.A.D. explore whether group walking sessions increase physical activity in people who have P.A.D. compare how effective certain exercise programs are at reducing leg pain in people who have P.A.D. examine how inflammation and insulin resistance affect people who have P.A.D. 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. Carefully conducted clinical trials are the fastest and safest way to find treatments that work in people and ways to improve health. For more information about clinical trials related to P.A.D., 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://www.nih.gov/health/clinicaltrials/ - http://www.clinicaltrials.gov/ - http://www.nhlbi.nih.gov/studies/index.htm - https://www.researchmatch.org/ - http://www.cleverstudy.org/ http://www.nih.gov/health/clinicaltrials/ http://www.clinicaltrials.gov/ http://www.nhlbi.nih.gov/studies/index.htm https://www.researchmatch.org/ http://www.cleverstudy.org/" +information,What is (are) High Blood Pressure ?,"High blood pressure is a common disease in which blood flows through blood vessels (arteries) at higher than normal pressures. What Is Blood Pressure? Blood pressure is the force of blood pushing against the walls of the blood vessels as the heart pumps blood. If your blood pressure rises and stays high over time, its called high blood pressure. High blood pressure is dangerous because it makes the heart work too hard, and the high force of the blood flow can harm arteries and organs such as the heart, kidneys, brain, and eyes. Types of High Blood Pressure There are two main types of high blood pressure: primary and secondary high blood pressure. - Primary, or essential, high blood pressure is the most common type of high blood pressure. This type of high blood pressure tends to develop over years as a person ages. - Secondary high blood pressure is caused by another medical condition or use of certain medicines. This type usually resolves after the cause is treated or removed. Primary, or essential, high blood pressure is the most common type of high blood pressure. This type of high blood pressure tends to develop over years as a person ages. Secondary high blood pressure is caused by another medical condition or use of certain medicines. This type usually resolves after the cause is treated or removed. Measuring Blood Pressure Blood pressure is always given as two numbers, the systolic and diastolic pressures. Both are important. - Systolic Pressure is the pressure of blood against the artery walls when the heart beats. - Diastolic Pressure is the pressure of blood against the artery walls when the heart is at rest between beats. Systolic Pressure is the pressure of blood against the artery walls when the heart beats. Diastolic Pressure is the pressure of blood against the artery walls when the heart is at rest between beats. Usually these numbers are written one above or before the other -- for example, 120/80 mmHg. The top, or first, number is the systolic and the bottom, or second number, is the diastolic. If your blood pressure is 120/80, you say that it is ""120 over 80."" Normal Blood Pressure Normal blood pressure for adults is defined as a systolic pressure below 120 mmHg and a diastolic pressure below 80 mmHg. It is normal for blood pressures to change when you sleep, wake up, or are excited or nervous. When you are active, it is normal for your blood pressure to increase. However, once the activity stops, your blood pressure returns to your normal baseline range. Blood pressure normally rises with age and body size. Newborn babies often have very low blood pressure numbers that are considered normal for babies, while older teens have numbers similar to adults. Abnormal Blood Pressure Abnormal blood pressure is higher than 120/80 mmHg. If either your systolic or diastolic blood pressure is higher than normal (120/80) but not high enough to be considered high blood pressure (140/90), you have pre-hypertension. Pre-hypertension is a top number between 120 and 139 or a bottom number between 80 and 89 mmHg. For example, blood pressure readings of 138/82, 128/70, or 115/86 are all in the ""pre-hypertension"" range. (Click the table on the right to see the stages of high blood pressure in adults.) A systolic blood pressure of 140 mmHg or higher, or a diastolic blood pressure of 90 mmHg or higher, is considered high blood pressure, or hypertension. Hypertension is the medical term for high blood pressure. If you have diabetes or chronic kidney disease, your recommended blood pressure levels are a systolic blood pressure of 130 mmHg or lower, and a diastolic blood pressure of 80 mmHg or lower. Usually Has No Symptoms High blood pressure is often called ""the silent killer"" because it usually has no symptoms. Occasionally, headaches may occur. Some people may not find out they have high blood pressure until they have trouble with their heart, kidneys, or eyes. When high blood pressure is not diagnosed and treated, it can lead to other life-threatening conditions, including heart attack, heart failure, stroke, and kidney failure. It can also lead to vision changes or blindness. Possible Complications Over Time Over time, high blood pressure can cause - your heart to work too hard and become larger or weaker, which can lead to heart failure. - small bulges (aneurysms) to worsen in your blood vessels. Common locations for aneurysms are the aorta, which is the main artery from the heart; the arteries in your brain, legs, and intestines; and the artery leading to your spleen. - blood vessels in your kidneys to narrow, which can cause kidney failure. - blood vessels in your eyes to burst or bleed, which can cause vision changes and can result in blindness. - arteries throughout your body to ""harden"" faster, especially those in your heart, brain, kidneys, and legs. This can cause a heart attack, stroke, or kidney failure. your heart to work too hard and become larger or weaker, which can lead to heart failure. small bulges (aneurysms) to worsen in your blood vessels. Common locations for aneurysms are the aorta, which is the main artery from the heart; the arteries in your brain, legs, and intestines; and the artery leading to your spleen. blood vessels in your kidneys to narrow, which can cause kidney failure. blood vessels in your eyes to burst or bleed, which can cause vision changes and can result in blindness. arteries throughout your body to ""harden"" faster, especially those in your heart, brain, kidneys, and legs. This can cause a heart attack, stroke, or kidney failure." +causes,What causes High Blood Pressure ?,"Changes in Body Functions Researchers continue to study how various changes in normal body functions cause high blood pressure. The key functions affected in high blood pressure include - kidney fluid and salt balances - the renin-angiotensin-aldosterone system - the sympathetic nervous system activity - blood vessel structure and function. kidney fluid and salt balances the renin-angiotensin-aldosterone system the sympathetic nervous system activity blood vessel structure and function. Kidney Fluid and Salt Balances The kidneys normally regulate the bodys salt balance by retaining sodium and water and eliminating potassium. Imbalances in this kidney function can expand blood volumes, which can cause high blood pressure. Renin-Angiotensin-Aldosterone System The renin-angiotensin-aldosterone system makes angiotensin and aldosterone hormones. Angiotensin narrows or constricts blood vessels, which can lead to an increase in blood pressure. Aldosterone controls how the kidneys balance fluid and salt levels. Increased aldosterone levels or activity may change this kidney function, leading to increased blood volumes and high blood pressure. Sympathetic Nervous System Activity The sympathetic nervous system has important functions in blood pressure regulation, including heart rate, blood pressure, and breathing rate. Researchers are investigating whether imbalances in this system cause high blood pressure. Blood Vessel Structure and Function Changes in the structure and function of small and large arteries may contribute to high blood pressure. The angiotensin pathway and the immune system may stiffen small and large arteries, which can affect blood pressure. Genetic Causes High blood pressure often runs in families. Years of research have identified many genes and other mutations associated with high blood pressure. However, known genetic factors only account for 2 to 3 percent of all cases. Emerging research suggests that certain DNA changes before birth also may cause the development of high blood pressure later in life. Unhealthy Lifestyle Habits Unhealthy lifestyle habits can cause high blood pressure, including - high sodium intake and sodium sensitivity - drinking too much alcohol - lack of physical activity. high sodium intake and sodium sensitivity drinking too much alcohol lack of physical activity. Overweight and Obesity Research studies show that being overweight or obese can increase the resistance in the blood vessels, causing the heart to work harder and leading to high blood pressure. Medicines Prescription medicines such as asthma or hormone therapies (including birth control pills and estrogen) and over-the-counter medicines such as cold relief medicines may cause high blood pressure. This happens because medicines can - change the way your body controls fluid and salt balances - cause your blood vessels to constrict - impact the renin-angiotensin-aldosterone system, leading to high blood pressure. change the way your body controls fluid and salt balances cause your blood vessels to constrict impact the renin-angiotensin-aldosterone system, leading to high blood pressure. Other Causes Other causes of high blood pressure include medical conditions such as chronic kidney disease, sleep apnea, thyroid problems, or certain tumors. These conditions can change the way your body controls fluids, sodium, and hormones in your blood, which leads to secondary high blood pressure." +susceptibility,Who is at risk for High Blood Pressure? ?,"Not a Normal Part of Aging Nearly 1 in 3 American adults have high blood pressure. Many people get high blood pressure as they get older. However, getting high blood pressure is not a normal part of aging. There are things you can do to help keep your blood pressure normal, such as eating a healthy diet and getting more exercise. Risk Factors Anyone can develop high blood pressure. However, these factors can increase your risk for developing high blood pressure. - age - race or ethnicity - being overweight - gender - lifestyle habits - a family history of high blood pressure. age race or ethnicity being overweight gender lifestyle habits a family history of high blood pressure. Age Blood pressure tends to rise with age. In fact, about 65 percent of Americans age 60 or older have high blood pressure. Race/Ethnicity High blood pressure is more common in African American adults than in Caucasian or Hispanic American adults. Compared with these ethnic groups, African Americans - tend to get high blood pressure earlier in life - often have higher blood pressure numbers - are less likely to achieve target blood pressure goals with treatment. tend to get high blood pressure earlier in life often have higher blood pressure numbers are less likely to achieve target blood pressure goals with treatment. Overweight You are more likely to develop prehypertension or high blood pressure if youre overweight or obese. The terms overweight and obese refer to body weight thats greater than what is considered healthy for a certain height. Gender Before age 55, men are more likely than women to develop high blood pressure. After age 55, women are more likely than men to develop high blood pressure. Lifestyle Habits Unhealthy lifestyle habits can raise your risk for high blood pressure, and they include - eating too much sodium or too little potassium - lack of physical activity - drinking too much alcohol - smoking - stress. eating too much sodium or too little potassium lack of physical activity drinking too much alcohol smoking stress. Family History A family history of high blood pressure raises the risk of developing prehypertension or high blood pressure. Some people have a high sensitivity to sodium and salt, which may increase their risk for high blood pressure and may run in families. Genetic causes of this condition are why family history is a risk factor for this condition." +prevention,How to prevent High Blood Pressure ?,"Steps You Can Take You can take steps to prevent high blood pressure by adopting these healthy lifestyle habits. - Follow a healthy eating plan. - Be physically active. - Maintain a healthy weight. - If you drink alcoholic beverages, do so in moderation. - Quit smoking. - Learn to cope with and manage stress. Follow a healthy eating plan. Be physically active. Maintain a healthy weight. If you drink alcoholic beverages, do so in moderation. Quit smoking. Learn to cope with and manage stress. Follow a Healthy Eating Plan Follow a healthy eating plan that emphasizes fruits, vegetables, fat-free or low-fat milk and milk products, and whole grains, and that is low in saturated fat, cholesterol, and total fat. Eating this way is even more effective when you also reduce your sodium (salt) intake and calories. One such eating plan is called DASH. DASH stands for Dietary Approaches to Stop Hypertension. This is the name of a study sponsored by the National Institutes of Health that showed that this kind of eating plan can help you prevent and control high blood pressure. The study also showed that combining this kind of eating plan with cutting back on salt in your diet is even more effective at lowering your blood pressure. To learn more about DASH, see Lowering Your Blood Pressure with DASH. Lower Your Salt Intake In general, the lower your salt intake, the lower your blood pressure. Older adults should limit their sodium intake to 2,300 milligrams (mg) daily. The key to reducing the amount of salt we eat is making wise food choices. Only a small amount of the salt that we eat comes from the salt shaker, and only small amounts occur naturally in food. Most of the salt that we eat comes from processed foods -- for example, canned or processed meat, baked goods, certain cereals, soy sauce, and foods that contain seasoned salts, monosodium glutamate (MSG), and baking soda. Food from fast food restaurants, frozen foods, and canned foods also tend to be higher in sodium. See tips to reduce salt in your diet. Read Food Labels Be sure to read food labels to choose products lower in salt. Look for foods and seasonings that are labeled as low-salt or ""no added salt."" Look for the sodium content in milligrams and the Percent Daily Value. Aim for foods that are less than 5 percent of the Daily Value of sodium. Foods with 20 percent or more Daily Value of sodium are considered high. To learn more about reading nutrition labels, see Reading the Label. Be Physically Active Regular physical activity can lower high blood pressure and reduce your risk for other health problems. Everyone should try to participate in moderate-intensity aerobic exercise at least 2 hours and 30 minutes per week, or vigorous-intensity aerobic exercise for 1 hour and 15 minutes per week. Aerobic exercise, such as brisk walking, is any exercise in which your heart beats harder and you use more oxygen than usual. The more active you are, the more you will benefit. Participate in aerobic exercise for at least 10 minutes at a time, spread throughout the week. (Watch the video to learn how exercise maintains healthy aging. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) Most people dont need to see a doctor before they start a moderate-level physical activity. You should check first with your doctor if you - have heart trouble or have had a heart attack - are over age 50 and are not used to moderate-level physical activity - have a family history of heart disease at an early age, or if you have any other serious health problem. have heart trouble or have had a heart attack are over age 50 and are not used to moderate-level physical activity have a family history of heart disease at an early age, or if you have any other serious health problem. See examples of exercises for older adults at Exercises to Try. For more on exercise and physical activity for older adults, visit Go4Life, the exercise and physical activity campaign from the National Institute on Aging. Maintain a Healthy Weight Maintaining a healthy weight can help you control high blood pressure and reduce your risk for other health problems. Blood pressure rises as body weight increases. Losing even 10 pounds can lower blood pressure -- and it has the greatest effect for those who are overweight and already have hypertension. A useful measure of overweight and obesity is body mass index (BMI). BMI measures your weight in relation to your height. See the BMI calculator to determine your body mass index or talk to your health care provider. A BMI - below 18.5 is a sign that you are underweight. - between 18.5 and 24.9 is in the healthy range. - between 25 and 29.9 is considered overweight. - of 30 or more is considered obese. below 18.5 is a sign that you are underweight. between 18.5 and 24.9 is in the healthy range. between 25 and 29.9 is considered overweight. of 30 or more is considered obese. A general goal to aim for is a BMI below 25. Your health care provider can help you set an appropriate BMI goal. Measuring waist circumference helps screen for possible health risks. If most of your fat is around your waist rather than at your hips, youre at a higher risk for heart disease and type 2 diabetes. This risk may be high with a waist size that is greater than 35 inches for women or greater than 40 inches for men. To learn how to measure your waist, visit Assessing Your Weight and Health Risk. For more information about losing weight or maintaining your weight, see Aim for a Healthy Weight. If You Drink Drinking too much alcohol can raise your blood pressure. Alcohol also adds extra calories, which may cause weight gain. Men should have no more than two drinks a day, and women should have no more than one drink a day. If you drink and would like tips on how to cut back, watch the video ""How To Cut Back on Your Drinking."" (To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) See how drinking alcohol can affect you as you age. Don't Smoke Smoking injures blood vessel walls and speeds up the process of hardening of the arteries. It increases your chances of stroke, heart disease, peripheral arterial disease, and several forms of cancer. If you smoke, quit. If you don't smoke, don't start. Once you quit, your risk of having a heart attack is reduced after the first year. So you have a lot to gain by quitting. See how to start a smoking quit plan geared to older adults." +symptoms,What are the symptoms of High Blood Pressure ?,"High blood pressure is often called the ""silent killer"" because you can have it for years without knowing it. The only way to find out if you have high blood pressure is to have your blood pressure measured. Complications When blood pressure stays high over time, it can damage the body and cause complications. Here are some of the common complications, along with their signs and symptoms. - Aneurysms. These occur when an abnormal bulge forms in the wall of an artery. Aneurysms develop and grow for years without causing signs or symptoms until they rupture, grow large enough to press on nearby body parts, or block blood flow. The signs and symptoms that develop depend on the location of the aneurysm. - Chronic Kidney Disease. This disease occurs when blood vessels narrow in the kidneys, possibly causing kidney failure. - Cognitive Changes Research shows that over time, higher blood pressure numbers can lead to cognitive changes. Signs and symptoms include memory loss, difficulty finding words, and losing focus during conversations. - Eye Damage. This condition occurs when blood vessels in the eyes burst or bleed. Signs and symptoms include vision changes or blindness. - Heart Attack. This occurs when the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart doesnt get oxygen. The most common warning symptoms of a heart attack are chest pain or discomfort, upper body discomfort, and shortness of breath. - Heart Failure. This condition occurs when the heart cant pump enough blood to meet the bodys needs. Common signs and symptoms of heart failure include shortness of breath or trouble breathing; feeling tired; and swelling in the ankles, feet, legs, abdomen, and veins in the neck. - Peripheral Arterial Disease. This is a disease in which plaque builds up in leg arteries and affects blood flow in the legs. When people have symptoms, the most common are pain, cramping, numbness, aching, or heaviness in the legs, feet, and buttocks after walking or climbing stairs. - Stroke. A stroke occurs when the flow of oxygen-rich blood to a portion of the brain is blocked. The symptoms of a stroke include sudden onset of weakness; paralysis or numbness of the face, arms, or legs; trouble speaking or understanding speech; and trouble seeing. Aneurysms. These occur when an abnormal bulge forms in the wall of an artery. Aneurysms develop and grow for years without causing signs or symptoms until they rupture, grow large enough to press on nearby body parts, or block blood flow. The signs and symptoms that develop depend on the location of the aneurysm. Chronic Kidney Disease. This disease occurs when blood vessels narrow in the kidneys, possibly causing kidney failure. Cognitive Changes Research shows that over time, higher blood pressure numbers can lead to cognitive changes. Signs and symptoms include memory loss, difficulty finding words, and losing focus during conversations. Eye Damage. This condition occurs when blood vessels in the eyes burst or bleed. Signs and symptoms include vision changes or blindness. Heart Attack. This occurs when the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart doesnt get oxygen. The most common warning symptoms of a heart attack are chest pain or discomfort, upper body discomfort, and shortness of breath. Heart Failure. This condition occurs when the heart cant pump enough blood to meet the bodys needs. Common signs and symptoms of heart failure include shortness of breath or trouble breathing; feeling tired; and swelling in the ankles, feet, legs, abdomen, and veins in the neck. Peripheral Arterial Disease. This is a disease in which plaque builds up in leg arteries and affects blood flow in the legs. When people have symptoms, the most common are pain, cramping, numbness, aching, or heaviness in the legs, feet, and buttocks after walking or climbing stairs. Stroke. A stroke occurs when the flow of oxygen-rich blood to a portion of the brain is blocked. The symptoms of a stroke include sudden onset of weakness; paralysis or numbness of the face, arms, or legs; trouble speaking or understanding speech; and trouble seeing. How Blood Pressure Is Checked Your health care provider usually takes 23 readings at several medical appointments to diagnose high blood pressure. Based on the results of your blood pressure test, your health care provider will diagnose prehypertension or high blood pressure if your systolic or diastolic readings are consistently higher than 120/80 mmHg. Once your health care provider determines the severity of your blood pressure, he or she can order additional tests to determine if your blood pressure is due to other conditions or medicines or if you have primary high blood pressure. Health care providers can use this information to develop your treatment plan. Some people have white coat hypertension. This happens when blood pressure readings are only high when taken in a health care providers office compared with readings taken in any other location. Researchers believe stress, which can occur during the medical appointment, causes white coat hypertension. Preparing for the Test A blood pressure test is easy and painless and can be done in a health care providers office or clinic. To prepare for the test - dont drink coffee or smoke cigarettes for 30 minutes prior to the test - go to the bathroom before the test. A full bladder can change the reading - sit for 5 minutes before the test. dont drink coffee or smoke cigarettes for 30 minutes prior to the test go to the bathroom before the test. A full bladder can change the reading sit for 5 minutes before the test. To track blood pressure readings over a period of time, the health care provider may ask you to come into the office on different days and at different times to take your blood pressure. The health care provider also may ask you to check readings at home or at other locations that have blood pressure equipment and to keep a written log of all your results. Whenever you have an appointment with the health care provider, be sure to bring your log of blood pressure readings. Ask the doctor or nurse to tell you your blood pressure reading in numbers and to explain what the numbers mean. Write down your numbers or ask the doctor or nurse to write them down for you. Write Down Your Readings Ask the doctor or nurse to tell you your blood pressure reading in numbers and to explain what the numbers mean. Write down your numbers or ask the doctor or nurse to write them down for you. (The wallet card on the right can be printed out and used to record your blood pressure numbers.) Checking Your Own Blood Pressure You can also check your blood pressure at home with a home blood pressure measurement device or monitor. It is important that the blood pressure cuff fits you properly and that you understand how to use the monitor. A cuff that is too small, for example, can give you a reading that is higher than your actual blood pressure. Your doctor, nurse, or pharmacist can help you check the cuff size and teach you how to use it correctly. You may also ask for their help in choosing the right blood pressure monitor for you. Blood pressure monitors can be bought at discount chain stores and drug stores. When you are taking your blood pressure at home, sit with your back supported and your feet flat on the floor. Rest your arm on a table at the level of your heart. After a Diagnosis If you're diagnosed with high blood pressure, your doctor will prescribe treatment. Your blood pressure will be tested again to see how the treatment affects it. Once your blood pressure is under control, you'll still need treatment. ""Under control"" means that your blood pressure numbers are in the normal range. Your doctor will likely recommend routine blood pressure tests. He or she can tell you how often you should be tested. The sooner you find out about high blood pressure and treat it, the better. Early treatment may help you avoid problems such as heart attack, stroke and kidney failure. See tips for talking with your doctor after you receive a medical diagnosis." +information,What is (are) High Blood Pressure ?,"Blood pressure is the force of blood pushing against the walls of the blood vessels as the heart pumps blood. If your blood pressure rises and stays high over time, its called high blood pressure. High blood pressure is dangerous because it makes the heart work too hard, and the high force of the blood flow can harm arteries and organs such as the heart, kidneys, brain, and eyes." +information,What is (are) High Blood Pressure ?,"Normal blood pressure for adults is defined as a systolic pressure below 120 mmHg and a diastolic pressure below 80 mmHg. It is normal for blood pressures to change when you sleep, wake up, or are excited or nervous. When you are active, it is normal for your blood pressure to increase. However, once the activity stops, your blood pressure returns to your normal baseline range. Blood pressure normally rises with age and body size. Newborn babies often have very low blood pressure numbers that are considered normal for babies, while older teens have numbers similar to adults." +information,What is (are) High Blood Pressure ?,"High blood pressure is a common disease in which blood flows through blood vessels (arteries) at higher than normal pressures. There are two main types of high blood pressure: primary and secondary high blood pressure. Primary, or essential, high blood pressure is the most common type of high blood pressure. This type of high blood pressure tends to develop over years as a person ages. Secondary high blood pressure is caused by another medical condition or use of certain medicines. This type usually resolves after the cause is treated or removed." +information,What is (are) High Blood Pressure ?,"Abnormal blood pressure is higher than 120/80 mmHg. If either your systolic or diastolic blood pressure is higher than normal (120/80) but not high enough to be considered high blood pressure (140/90), you have pre-hypertension. Pre-hypertension is a top number between 120 and 139 or a bottom number between 80 and 89 mmHg. For example, blood pressure readings of 138/82, 128/70, or 115/86 are all in the ""pre-hypertension"" range. (Click the table on the right to see the stages of high blood pressure in adults.) The ranges in the table are blood pressure guides for adults who do not have any short-term serious illnesses. People with diabetes or chronic kidney disease should keep their blood pressure below 130/80 mmHg." +prevention,How to prevent High Blood Pressure ?,"You can take steps to help prevent high blood pressure by adopting these healthy lifestyle habits. - Follow a healthy eating plan like DASH (Dietary Approaches to Stop Hypertension), which emphasizes fruits, vegetables, fat-free and low-fat milk and milk products, and whole grains, fish, poultry, beans, seeds, and nuts, and choose and prepare foods with less sodium (salt). See how the DASH diet (Dietary Approaches to Stop Hypertension) can help with blood pressure control. Follow a healthy eating plan like DASH (Dietary Approaches to Stop Hypertension), which emphasizes fruits, vegetables, fat-free and low-fat milk and milk products, and whole grains, fish, poultry, beans, seeds, and nuts, and choose and prepare foods with less sodium (salt). See how the DASH diet (Dietary Approaches to Stop Hypertension) can help with blood pressure control. - Be physically active for at least 2 and one-half hours a week. Check out Exercises to Try for older adults, or visit Go4Life, the exercise and physical activity campaign from the National Institute on Aging. (Watch the video to learn how exercise helps maintain healthy aging. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) Be physically active for at least 2 and one-half hours a week. Check out Exercises to Try for older adults, or visit Go4Life, the exercise and physical activity campaign from the National Institute on Aging. (Watch the video to learn how exercise helps maintain healthy aging. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) - Maintain a healthy weight and lose weight if you are overweight or obese. Body mass index (BMI) and waist circumference are measures used to determine if someone is overweight or obese. See the BMI calculator to determine your body mass index. Maintain a healthy weight and lose weight if you are overweight or obese. Body mass index (BMI) and waist circumference are measures used to determine if someone is overweight or obese. See the BMI calculator to determine your body mass index. - If you drink alcoholic beverages, do so in moderation: no more than one drink a day for women, no more than two drinks a day for men. If you drink alcoholic beverages, do so in moderation: no more than one drink a day for women, no more than two drinks a day for men. - Quit smoking, or don't start smoking. To get help quitting, call 1 (800) QUIT-NOW or check out Quitting Smoking for Older Adults. Quit smoking, or don't start smoking. To get help quitting, call 1 (800) QUIT-NOW or check out Quitting Smoking for Older Adults. - Learn to manage stress. Learn about relaxation techniques that may relieve tension. Learn to manage stress. Learn about relaxation techniques that may relieve tension." +exams and tests,How to diagnose High Blood Pressure ?,"If you are diagnosed with high blood pressure, here are questions to ask your doctor. - Your Blood Pressure Numbers - What is my blood pressure reading in numbers? - What is my goal blood pressure? - Is my blood pressure under adequate control? - Is my systolic pressure too high (over 140)? Your Blood Pressure Numbers - What is my blood pressure reading in numbers? - What is my goal blood pressure? - Is my blood pressure under adequate control? - Is my systolic pressure too high (over 140)? - What is my blood pressure reading in numbers? - What is my goal blood pressure? - Is my blood pressure under adequate control? - Is my systolic pressure too high (over 140)? What is my blood pressure reading in numbers? What is my goal blood pressure? Is my blood pressure under adequate control? Is my systolic pressure too high (over 140)? - Healthy Lifestyle Habits - What would be a healthy weight for me? - Is there a diet to help me lose weight (if I need to) and lower my blood pressure? - Is there a recommended healthy eating plan I should follow to help lower my blood pressure (if I dont need to lose weight)? - Is it safe for me to start doing regular physical activity? Healthy Lifestyle Habits - What would be a healthy weight for me? - Is there a diet to help me lose weight (if I need to) and lower my blood pressure? - Is there a recommended healthy eating plan I should follow to help lower my blood pressure (if I dont need to lose weight)? - Is it safe for me to start doing regular physical activity? - What would be a healthy weight for me? - Is there a diet to help me lose weight (if I need to) and lower my blood pressure? - Is there a recommended healthy eating plan I should follow to help lower my blood pressure (if I dont need to lose weight)? - Is it safe for me to start doing regular physical activity? What would be a healthy weight for me? Is there a diet to help me lose weight (if I need to) and lower my blood pressure? Is there a recommended healthy eating plan I should follow to help lower my blood pressure (if I dont need to lose weight)? Is it safe for me to start doing regular physical activity? - Medications - What is the name of my blood pressure medication? - Is that the brand name or the generic name? - What are the possible side effects of my medication? (Be sure the doctor knows about any allergies you have and any other medications you are taking, including over-the-counter drugs, vitamins, and dietary supplements.) - What time of day should I take my blood pressure medicine? - Are there any foods, beverages, or dietary supplements I should avoid when taking this medicine? - What should I do if I forget to take my blood pressure medicine at the recommended time? Should I take it as soon as I remember or should I wait until the next dosage is due? Medications - What is the name of my blood pressure medication? - Is that the brand name or the generic name? - What are the possible side effects of my medication? (Be sure the doctor knows about any allergies you have and any other medications you are taking, including over-the-counter drugs, vitamins, and dietary supplements.) - What time of day should I take my blood pressure medicine? - Are there any foods, beverages, or dietary supplements I should avoid when taking this medicine? - What should I do if I forget to take my blood pressure medicine at the recommended time? Should I take it as soon as I remember or should I wait until the next dosage is due? - What is the name of my blood pressure medication? - Is that the brand name or the generic name? - What are the possible side effects of my medication? (Be sure the doctor knows about any allergies you have and any other medications you are taking, including over-the-counter drugs, vitamins, and dietary supplements.) - What time of day should I take my blood pressure medicine? - Are there any foods, beverages, or dietary supplements I should avoid when taking this medicine? - What should I do if I forget to take my blood pressure medicine at the recommended time? Should I take it as soon as I remember or should I wait until the next dosage is due? What is the name of my blood pressure medication? Is that the brand name or the generic name? What are the possible side effects of my medication? (Be sure the doctor knows about any allergies you have and any other medications you are taking, including over-the-counter drugs, vitamins, and dietary supplements.) What time of day should I take my blood pressure medicine? Are there any foods, beverages, or dietary supplements I should avoid when taking this medicine? What should I do if I forget to take my blood pressure medicine at the recommended time? Should I take it as soon as I remember or should I wait until the next dosage is due?" +treatment,What are the treatments for High Blood Pressure ?,"High blood pressure is treated with lifestyle changes and medicines. Treatment can help control blood pressure, but it will not cure high blood pressure, even if your blood pressure readings appear normal. If you stop treatment, your blood pressure and risk for related health problems will rise. For a healthy future, follow your treatment plan closely. Work with your health care team for lifelong blood pressure control." +treatment,What are the treatments for High Blood Pressure ?,"In most cases, the goal is probably to keep your blood pressure below 140/90 mmHg (130/80 if you have diabetes or chronic kidney disease). Normal blood pressure is less than 120/80. Ask your doctor what your blood pressure goal should be. If you have high blood pressure, you will need to treat it and control it for life. This means making lifestyle changes, and, in some cases, taking prescribed medicines, and getting ongoing medical care." +treatment,What are the treatments for High Blood Pressure ?,"Today, many different types of medicines are available to control high blood pressure. These medicines work in different ways. Some lower blood pressure by removing extra fluid and salt from your body. Others affect blood pressure by slowing down the heartbeat, or by relaxing and widening blood vessels. Often, two or more drugs work better than one. Here are the types of medicines used to treat high blood pressure. - Diuretics (water or fluid Pills) flush excess sodium from your body, which reduces the amount of fluid in your blood and helps to lower your blood pressure. Diuretics are often used with other high blood pressure medicines, sometimes in one combined pill. - Beta Blockers help your heart beat slower and with less force. As a result, your heart pumps less blood through your blood vessels, which can help to lower your blood pressure. - Angiotensin-Converting Enzyme (ACE) Inhibitors. Angiotensin-II is a hormone that narrows blood vessels, increasing blood pressure. ACE converts Angiotensin I to Angiotensin II. ACE inhibitors block this process, which stops the production of Angiotensin II, lowering blood pressure. - Angiotensin II Receptor Blockers (ARBs) block angiotensin II hormone from binding with receptors in the blood vessels. When angiotensin II is blocked, the blood vessels do not constrict or narrow, which can lower your blood pressure. - Calcium Channel Blockers keep calcium from entering the muscle cells of your heart and blood vessels. This allows blood vessels to relax, which can lower your blood pressure. - Alpha Blockers reduce nerve impulses that tighten blood vessels. This allows blood to flow more freely, causing blood pressure to go down. - Alpha-Beta Blockers reduce nerve impulses the same way alpha blockers do. However, like beta blockers, they also slow the heartbeat. As a result, blood pressure goes down. - Central Acting Agents act in the brain to decrease nerve signals that narrow blood vessels, which can lower blood pressure. - Vasodilators relax the muscles in blood vessel walls, which can lower blood pressure. Diuretics (water or fluid Pills) flush excess sodium from your body, which reduces the amount of fluid in your blood and helps to lower your blood pressure. Diuretics are often used with other high blood pressure medicines, sometimes in one combined pill. Beta Blockers help your heart beat slower and with less force. As a result, your heart pumps less blood through your blood vessels, which can help to lower your blood pressure. Angiotensin-Converting Enzyme (ACE) Inhibitors. Angiotensin-II is a hormone that narrows blood vessels, increasing blood pressure. ACE converts Angiotensin I to Angiotensin II. ACE inhibitors block this process, which stops the production of Angiotensin II, lowering blood pressure. Angiotensin II Receptor Blockers (ARBs) block angiotensin II hormone from binding with receptors in the blood vessels. When angiotensin II is blocked, the blood vessels do not constrict or narrow, which can lower your blood pressure. Calcium Channel Blockers keep calcium from entering the muscle cells of your heart and blood vessels. This allows blood vessels to relax, which can lower your blood pressure. Alpha Blockers reduce nerve impulses that tighten blood vessels. This allows blood to flow more freely, causing blood pressure to go down. Alpha-Beta Blockers reduce nerve impulses the same way alpha blockers do. However, like beta blockers, they also slow the heartbeat. As a result, blood pressure goes down. Central Acting Agents act in the brain to decrease nerve signals that narrow blood vessels, which can lower blood pressure. Vasodilators relax the muscles in blood vessel walls, which can lower blood pressure." +prevention,How to prevent High Blood Pressure ?,"Two key measures are used to determine if someone is overweight or obese. These are body mass index, or BMI, and waist circumference. Body mass index (BMI) is a measure of weight in relation to height, and provides an estimate of your total body fat. As your BMI goes up, so do your chances of getting high blood pressure, heart disease, and other health problems. A BMI - below 18.5 is a sign that you are underweight. - between 18.5 and 24.9 is in the healthy range. - between 25 and 29.9 is considered overweight. - of 30 or more is considered obese. below 18.5 is a sign that you are underweight. between 18.5 and 24.9 is in the healthy range. between 25 and 29.9 is considered overweight. of 30 or more is considered obese. See the Body Mass Index Table, available from the National Heart, Lung, and Blood Institute (NHLBI). Body mass index (BMI) applies to both men and women, but it does have some limits. - It may overestimate body fat in in someone who is very muscular or who has swelling from fluid retention (called edema) - It may underestimate body fat in older persons and others who have lost muscle mass. It may overestimate body fat in in someone who is very muscular or who has swelling from fluid retention (called edema) It may underestimate body fat in older persons and others who have lost muscle mass. Thats why waist measurement is often checked as well. Another reason is that too much body fat in the stomach area also increases disease risk. A waist measurement of more than 35 inches in women and more than 40 inches in men is considered high." +information,What is (are) High Blood Pressure ?,"Blood pressure rises as body weight increases. Losing even 10 pounds can lower blood pressure -- and it has the greatest effect for those who are overweight and already have hypertension. If you are overweight or obese, work with your health care provider to develop a plan to help you lower your weight and maintain a healthy weight. Aim to reduce your weight by 7 to 10 percent over six months, which can lower your risk for health problems. For example, if you are overweight at 200 pounds, try to lose 14 to 20 pounds over six months. After that, you may have to continue to lose weight to get to a healthy weight." +information,What is (are) High Blood Pressure ?,"""DASH"" stands for ""Dietary Approaches to Stop Hypertension."" This is the name of a clinical study that tested the effects of nutrients in food on blood pressure. Study results indicated that you can reduce high blood pressure by following an eating plan that emphasizes fruits, vegetables, and fat-free or low-fat milk and milk products, and that is low in saturated fat, cholesterol, total fat, and added sugars. The DASH eating plan also includes whole grains, poultry, fish, and nuts, and has reduced amounts of red meats, sweets, added sugars, and beverages containing sugars. A second study, called ""DASH-Sodium,"" showed that eating less salt also lowered blood pressure in people following either the DASH eating plan or the typical American diet. But those following DASH, especially those with high blood pressure, benefited the most. For more information on using the DASH eating plan, see Your Guide to Lowering Your Blood Pressure with DASH." +information,What is (are) High Blood Pressure ?,"Only a small amount of the salt that we eat comes from the salt shaker, and only small amounts occur naturally in food. Most of the salt that we eat comes from processed foods -- for example, canned or processed meat, baked goods, and certain cereals, and foods with soy sauce, seasoned salts, monosodium glutamate (MSG), and baking soda. Food from fast food restaurants, frozen foods, and canned foods also tend to be higher in sodium." +information,What is (are) High Blood Pressure ?,"Older adults should limit their sodium (salt) intake to 1,500 mg a day. That's about 2/3 of a teaspoon of salt. Here are tips to reduce salt in your diet. - Buy fresh, plain frozen, or canned with no salt added vegetables. Choose foods packed in water instead of broth or salt. - Use fresh poultry, fish, and lean meat, rather than canned or processed types. - Use herbs, spices, and salt-free seasoning blends in cooking and at the table. - Cook rice, pasta, and hot cereal without salt. Cut back on instant or flavored rice, pasta, and cereal mixes, which usually have added salt. - Choose convenience foods that are low in sodium. Cut back on frozen dinners, pizza, packaged mixes, canned soups or broths, and salad dressingsthese often have a lot of sodium. - Rinse canned foods, such as tuna, to remove some sodium. - When available, buy low- or reduced-sodium or no-salt-added versions of foods. - Choose ready-to-eat breakfast cereals that are low in sodium. Buy fresh, plain frozen, or canned with no salt added vegetables. Choose foods packed in water instead of broth or salt. Use fresh poultry, fish, and lean meat, rather than canned or processed types. Use herbs, spices, and salt-free seasoning blends in cooking and at the table. Cook rice, pasta, and hot cereal without salt. Cut back on instant or flavored rice, pasta, and cereal mixes, which usually have added salt. Choose convenience foods that are low in sodium. Cut back on frozen dinners, pizza, packaged mixes, canned soups or broths, and salad dressingsthese often have a lot of sodium. Rinse canned foods, such as tuna, to remove some sodium. When available, buy low- or reduced-sodium or no-salt-added versions of foods. Choose ready-to-eat breakfast cereals that are low in sodium." +information,What is (are) Heart Failure ?,"In heart failure, the heart cannot pump enough blood to meet the body's needs. In some cases, the heart cannot 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. Heart failure develops over time as the pumping action of the heart gets weaker. It can affect either the right, the left, or both sides of the heart. Heart failure does not mean that the heart has stopped working or is about to stop working. When heart failure affects the left side of the heart, the heart cannot pump enough oxygen-rich blood to the rest of the body. When heart failure affects the right side, the heart cannot pump enough blood to the lungs, where it picks up oxygen. The Heart's Pumping Action In normal hearts, blood vessels called veins bring oxygen-poor blood from the body to the right side of the heart. It is then pumped through the pulmonary artery to the lungs, picking up oxygen. From there, the blood returns to the left side of the heart. Then it is pumped through a large artery called the aorta that distributes blood throughout the body. When the heart is weakened by heart failure, blood and fluid can back up into the lungs, and fluid builds up in the feet, ankles, and legs. People with heart failure often experience tiredness and shortness of breath. Heart Failure is Serious Heart failure is a serious and common condition. Scientists estimate that 5 million people in the U.S. have heart failure and that number is growing. It contributes to 300,000 deaths each year. Heart failure is most common in those age 65 and older and it is the number one reason older people are hospitalized. Other Names for Heart Failure Heart failure can also be called congestive heart failure, systolic heart failure, diastolic heart failure, left-sided heart failure, or right-sided heart failure." +causes,What causes Heart Failure ?,"Heart failure is caused by other diseases or conditions that damage the heart muscle such as coronary artery disease (including heart attacks), diabetes, and high blood pressure. Treating these problems can prevent or improve heart failure. Coronary Artery Disease Coronary artery disease is a leading cause of death in men and women. It happens when the arteries that supply blood to the heart become hardened and narrowed. High Blood Pressure High 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, which can then lead to heart failure. Diabetes Diabetes is characterized by having too much glucose, or sugar, in the blood for a long time. This can cause heart problems because high blood glucose can damage parts of the body such as the heart and blood vessels. This damage weakens the heart, often leading to heart failure. Other Diseases 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. 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 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. 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. Sleep Apnea 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. Who Is at Risk? Heart failure can happen to almost anyone. It is the number one reason for hospitalization for people over age 65. Heart failure is more common in - people who are 65 years old or older - African-Americans - people who are overweight - people who have had a heart attack - men. people who are 65 years old or older African-Americans people who are overweight people who have had a heart attack men. Aging can weaken the heart muscle. Older people also may have had diseases for many years that led to heart failure. 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. 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. A history of a heart attack puts people at greater risk for heart failure. Men have a higher rate of heart failure than women." +susceptibility,Who is at risk for Heart Failure? ?,"Preventing Heart Failure There are a number of things you can do to reduce the risk for coronary artery disease and heart failure. These things include - keeping your cholesterol levels healthy - keeping your blood pressure at a normal level - managing diabetes - maintaining a healthy weight - quitting smoking - limiting the amount of alcohol you drink - following a heart healthy diet - limiting the amount of sodium (salt) you consume - getting regular exercise - avoiding using illegal drugs. keeping your cholesterol levels healthy keeping your blood pressure at a normal level managing diabetes maintaining a healthy weight quitting smoking limiting the amount of alcohol you drink following a heart healthy diet limiting the amount of sodium (salt) you consume getting regular exercise avoiding using illegal drugs. Keep Your Cholesterol Levels Healthy Keeping your cholesterol levels healthy can help prevent coronary artery disease. Your goal for LDL, or ""bad,"" cholesterol, depends on how many other risk factors you have. Risk factors include - being a cigarette smoker - having high blood pressure - having low HDL cholesterol - being 45 or older if you are a man and 55 or older if you are a woman - having a close relative who had coronary artery disease at an earlier-than-usual age (before age 55 for male relatives and before age 65 for female relatives). being a cigarette smoker having high blood pressure having low HDL cholesterol being 45 or older if you are a man and 55 or older if you are a woman having a close relative who had coronary artery disease at an earlier-than-usual age (before age 55 for male relatives and before age 65 for female relatives). Recommended LDL Cholesterol Goals - If you don't have coronary heart disease or diabetes and have one or no risk factors, your LDL goal is less than 160 mg/dL. - If you don't have coronary heart disease or diabetes and have two or more risk factors, your LDL goal is less than 130 mg/dL. - If you do have coronary heart disease or diabetes, your LDL goal is less than 100 mg/dL. - The goal for HDL, or ""good,"" cholesterol is above 40 in men and above 50 in women. - The goal for triglycerides, another fat in the blood, is below 150. If you don't have coronary heart disease or diabetes and have one or no risk factors, your LDL goal is less than 160 mg/dL. If you don't have coronary heart disease or diabetes and have two or more risk factors, your LDL goal is less than 130 mg/dL. If you do have coronary heart disease or diabetes, your LDL goal is less than 100 mg/dL. The goal for HDL, or ""good,"" cholesterol is above 40 in men and above 50 in women. The goal for triglycerides, another fat in the blood, is below 150. Learn how to control your cholesterol with TLC -- Therapeutic Lifestyle Changes. Keep Blood Pressure at a Normal Level High blood pressure causes the heart to get larger and work harder, which can then lead to heart failure. You should aim for a blood pressure level of 130/80 or below. Talk to your doctor about ways to lower your blood pressure. Get tips on how to control your blood pressure. Manage Diabetes If you have diabetes, its important to manage it properly. Diabetes is characterized by having too much glucose, or sugar, in the blood for a long time. This can cause heart problems because high blood glucose can damage parts of the body such as the heart and blood vessels. This damage weakens the heart, often leading to heart failure. See ways to manage your diabetes every day. Maintain a Healthy Weight 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. See a sensible approach to weight loss. Don't Smoke If you smoke, quit. For free help quitting, call a smoking quit line. See medications to help you quit. Follow a Heart Healthy Diet Heart-healthy foods include those high in fiber, such as oat bran, oatmeal, whole-grain breads and cereals, fruits, and vegetables. You can also maintain a heart-healthy diet by limiting foods that are high in saturated fat, trans-fat, and cholesterol, such as meats, butter, dairy products with fat, eggs, shortening, lard, and foods with palm oil or coconut oil. For more on healthy eating, see Eating Well As You Get Older. Limit the Amount of Alcohol You Drink In general, healthy men and women over age 65 should not drink more than three drinks a day or a total of seven drinks a week. Learn how alcohol affects you as get older. Limit the Amount of Sodium Sodium contributes to high blood pressure and fluid retention. Older adults should limit their intake of sodium to1,500 milligrams daily (about 2/3 tsp. of salt). See ways to cut back on your salt intake. Get Regular Exericse Studies show that people with heart disease, diabetes, and high blood pressure benefit from regular exercise. In fact, inactive people are nearly twice as likely to develop heart disease as those who are more active. Aim for at least 30 minutes a day of exercise. Check with your doctor before starting any exercise program. For information on exercise and older adults, see Benefits of Exercise or visit Go4Life, the exercise and physical activity campaign for older adults from the National Institute on Aging." +symptoms,What are the symptoms of Heart Failure ?,"Common Symptoms The most common symptoms of heart failure include shortness of breath or difficulty breathing, feeling tired, and swelling. Swelling usually occurs in the ankles, feet, legs, and sometimes in the abdomen. Swelling is caused by fluid buildup in the body. The fluid buildup can lead to weight gain as well as a cough. The cough can be worse at night and when lying down. When symptoms first begin, you might feel tired or short of breath after routine physical activities, such as climbing stairs. As heart failure progresses, the symptoms get worse. You may feel tired or short of breath after performing simple activities, like getting dressed." +exams and tests,How to diagnose Heart Failure ?,"Diagnosing Heart Failure There is not one specific test to diagnose heart failure. Because the symptoms are common for other conditions, your doctor will determine if you have heart failure by doing a detailed medical history, an examination, and several tests. The tests will identify whether you have any diseases or conditions that can cause heart failure. They will also rule out any other causes of your symptoms and determine the amount of damage to your heart. During a physical examination, you can expect your doctor to listen to your heart for abnormal sounds and listen to your lungs for a buildup of fluid. Your doctor will also look for swelling in your ankles, feet, legs, abdomen, and in the veins in your neck If your doctor determines that you have signs of heart failure, he or she may order several tests. Diagnostic Tests Tests that are given to determine heart failure include an electrocardiogram (EKG or ECG), a chest x-ray, and a BNP blood test. An EKG or ECG -- electrocardiogram -- measures the rate and regularity of your heartbeat. This test can also show if you have had a heart attack and whether the walls of your heart have thickened. A chest X-ray takes a picture of your heart and lungs. It will show whether your heart is enlarged or your lungs have fluid in them, both signs of heart failure. A BNP blood test measures the level of a hormone in your blood called BNP -- brain natriuretic peptide -- that increases in heart failure. Once these initial tests have been performed, your doctor may decide to send you to a cardiologist, a specialist in the diagnosis and treatment of heart disease. A cardiologist will perform a physical exam and may order other tests. Other Tests Tests that can identify the cause of heart failure include an echocardiogram, a Holter monitor, and an exercise stress test. An echocardiogram is one of the most useful tests for diagnosing heart failure. This test uses sound waves to create a picture of the heart and shows how well the heart is filling with blood. Your doctor uses this test to determine whether any areas of your heart are damaged. A Holter monitor, which is a small box that is attached to patches placed on your chest. The monitor, which is worn for 24 hours, provides a continuous recording of heart rhythm during normal activity. An exercise stress test captures your EKG and blood pressure before, during, or after exercise to see how your heart responds to exercise. This test tells doctors how your heart responds to activity." +treatment,What are the treatments for Heart Failure ?,"There is no cure for heart failure, but it can be controlled by treating the underlying conditions that cause it. Treatment for heart failure will depend on the type and stage of heart failure (the severity of the condition). The goals for treatment of all stages of heart failure are to reduce symptoms, treat the cause (such as heart disease, high blood pressure, or diabetes), stop the disease from worsening, and prolong life. Treatments for Heart Failure Treatments for heart failure include - lifestyle changes - medications - specialized care for those who are in the advanced stages. lifestyle changes medications specialized care for those who are in the advanced stages. Treatment for heart failure will reduce the chances that you will have to go to the hospital and make it easier for you to do the things you like to do. It is very important that you follow your treatment plan by keeping doctor appointments, taking medications, and making lifestyle changes." +information,What is (are) Heart Failure ?,"In heart failure, the heart cannot pump enough blood through the body. Heart failure develops over time as the pumping action of the heart gets weaker. Heart failure does not mean that the heart has stopped working or is about to stop working. When the heart is weakened by heart failure, blood and fluid can back up into the lungs and fluid builds up in the feet, ankles, and legs. People with heart failure often experience tiredness and shortness of breath." +causes,What causes Heart Failure ?,"Heart failure is caused by other diseases and conditions that damage the heart muscle. It is most commonly caused by coronary artery disease, including heart attack. Diabetes and high blood pressure also contribute to heart failure risk. People who have had a heart attack are at high risk of developing heart failure." +symptoms,What are the symptoms of Heart Failure ?,"The most common symptoms of heart failure include shortness of breath or difficulty breathing, feeling tired, and swelling. Swelling is caused by fluid build-up in the body. Fluid buildup can lead to weight gain and frequent urination, as well as coughing." +frequency,How many people are affected by Heart Failure ?,"Approximately 5 million people in the United States have heart failure. It contributes to 300,000 deaths each year. It is the number one cause of hospitalizations for people over the age of 65." +susceptibility,Who is at risk for Heart Failure? ?,"Heart failure is more common in - people who are 65 years old or older - African-Americans - people who are overweight - people who have had a heart attack - men. people who are 65 years old or older African-Americans people who are overweight people who have had a heart attack men. Aging can weaken the heart muscle. Older people also may have had diseases for many years that led to heart failure. 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. 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. A history of a heart attack puts people at greater risk for heart failure. Men have a higher rate of heart failure than women." +prevention,How to prevent Heart Failure ?,"Ways to prevent heart failure include - keeping your cholesterol and blood pressure levels healthy - keeping diabetes in check - maintaining a healthy weight - quitting smoking - following a heart healthy diet - limiting the amount of alcohol you drink - eating a diet low in salt because salt can cause extra fluid to build up in your body and also contribute to high blood pressure. Older adults should limit their sodium (salt) intake to1500 mg a day (about 2/3 tsp of salt). - getting regular exercise. Aim for at least 30 minutes a day of exercise. Check with your doctor before starting any exercise program. For information about exercises that older adults can do safely, see Exercises to Try or visit Go4Life, the exercise and physical activity campaign for older adults from the National Institute on Aging. keeping your cholesterol and blood pressure levels healthy keeping diabetes in check maintaining a healthy weight quitting smoking following a heart healthy diet limiting the amount of alcohol you drink eating a diet low in salt because salt can cause extra fluid to build up in your body and also contribute to high blood pressure. Older adults should limit their sodium (salt) intake to1500 mg a day (about 2/3 tsp of salt). getting regular exercise. Aim for at least 30 minutes a day of exercise. Check with your doctor before starting any exercise program. For information about exercises that older adults can do safely, see Exercises to Try or visit Go4Life, the exercise and physical activity campaign for older adults from the National Institute on Aging." +information,What is (are) Heart Failure ?,"Keeping your cholesterol levels healthy can help prevent coronary artery disease. Your goal for LDL, or ""bad,"" cholesterol depends on how many other risk factors you have. Here are recommended LDL cholesterol goals. - If you don't have coronary heart disease or diabetes and have one or no risk factors, your LDL goal is less than 160 mg/dL. - If you don't have coronary heart disease or diabetes and have two or more risk factors, your LDL goal is less than 130 mg/dL. - If you do have coronary heart disease or diabetes, your LDL goal is less than 100 mg/dL. If you don't have coronary heart disease or diabetes and have one or no risk factors, your LDL goal is less than 160 mg/dL. If you don't have coronary heart disease or diabetes and have two or more risk factors, your LDL goal is less than 130 mg/dL. If you do have coronary heart disease or diabetes, your LDL goal is less than 100 mg/dL. The goal for HDL, or ""good,"" cholesterol is above 40 in men and above 50 in women. The goal for triglycerides, another fat in the blood, is below 150." +exams and tests,How to diagnose Heart Failure ?,"There is not one specific test to diagnose heart failure. Because the symptoms are common for other conditions, your doctor will determine if you have heart failure by doing a detailed medical history, an examination, and several tests. During a physical exam, a doctor will listen for abnormal heart sounds and lung sounds that indicate fluid buildup, as well as look for signs of swelling. If there are signs of heart failure, the doctor may order several tests, including: - an EKG, or electrocardiogram, to measure the rate and regularity of the heartbeat - a chest X-ray to evaluate the heart and lungs - a BNP blood test to measure the level of a hormone called BNP that increases when heart failure is present. an EKG, or electrocardiogram, to measure the rate and regularity of the heartbeat a chest X-ray to evaluate the heart and lungs a BNP blood test to measure the level of a hormone called BNP that increases when heart failure is present." +exams and tests,How to diagnose Heart Failure ?,"Once initial tests have been performed, your doctor may decide to send you to a cardiologist, a specialist in diagnosis and treatment of heart disease. A cardiologist will perform a physical exam and may order other tests. There are several tests that can identify the cause of heart failure. These tests include: - An echocardiogram is one of the most useful tests for diagnosing heart failure. This test uses sound waves to create a picture of the heart and shows how well the heart is filling with blood. Your doctor uses this test to determine whether any areas of your heart are damaged. An echocardiogram is one of the most useful tests for diagnosing heart failure. This test uses sound waves to create a picture of the heart and shows how well the heart is filling with blood. Your doctor uses this test to determine whether any areas of your heart are damaged. - A Holter monitor, which is a small box that is attached to patches placed on your chest. The monitor, which is worn for 24 hours, provides a continuous recording of heart rhythm during normal activity. A Holter monitor, which is a small box that is attached to patches placed on your chest. The monitor, which is worn for 24 hours, provides a continuous recording of heart rhythm during normal activity. - An exercise stress test captures your EKG and blood pressure before, during, or after exercise to see how your heart responds to exercise. This test tells doctors how your heart responds to activity. An exercise stress test captures your EKG and blood pressure before, during, or after exercise to see how your heart responds to exercise. This test tells doctors how your heart responds to activity." +treatment,What are the treatments for Heart Failure ?,Treatment for heart failure includes lifestyle changes medications specialized care for those in advanced stages of the disease. +treatment,What are the treatments for Heart Failure ?,Lifestyle changes to treat heart failure may include - reducing salt and fluid intake - following a heart healthy diet - adopting a plan to lose weight - quitting smoking - engaging in physical activity. reducing salt and fluid intake following a heart healthy diet adopting a plan to lose weight quitting smoking engaging in physical activity. +treatment,What are the treatments for Heart Failure ?,"Many medications are used to manage heart failure. They include diuretics, ACE inhibitors, beta blockers and digoxin. Diuretics are used to reduce fluid buildup. ACE inhibitors work to improve heart failure in many ways, including lowering blood pressure. Beta blockers can also improve heart failure in many ways, including slowing the heart rate. Digoxin affects the hormones that worsen heart failure." +treatment,What are the treatments for Heart Failure ?,"For severe heart failure, patients may require additional oxygen, a mechanical heart pump, or a heart transplant." +information,What is (are) Heart Failure ?,More detailed information on heart failure is available at http://www.nhlbi.nih.gov/health/dci +information,What is (are) Diabetes ?,"Heart disease and stroke are the leading causes of death for people with diabetes. Controlling the ABCs of diabetes -- your blood glucose, your blood pressure, and your cholesterol, as well as stopping smoking -- can help prevent these and other complications from diabetes. - A is for the A1C test - B is for Blood pressure - C is for Cholesterol. A is for the A1C test B is for Blood pressure C is for Cholesterol. - The A1C test (A-one-C) shows you what your blood glucose has been over the last three months. Your health care provider does this test to see what your blood glucose level is most of the time. This test should be done at least twice a year for all people with diabetes and for some people more often as needed. For many people with diabetes, an A1C test result of under 7 percent usually means that their diabetes treatment is working well and their blood glucose is under control. The A1C test (A-one-C) shows you what your blood glucose has been over the last three months. Your health care provider does this test to see what your blood glucose level is most of the time. This test should be done at least twice a year for all people with diabetes and for some people more often as needed. For many people with diabetes, an A1C test result of under 7 percent usually means that their diabetes treatment is working well and their blood glucose is under control. - B is for Blood pressure. The goal for most people is 140/90 but may be different for you. High blood pressure makes your heart work too hard. It can cause heart attack, stroke, and kidney disease. Your blood pressure should be checked at every doctor visit. Talk with your health care provider about your blood pressure goal. B is for Blood pressure. The goal for most people is 140/90 but may be different for you. High blood pressure makes your heart work too hard. It can cause heart attack, stroke, and kidney disease. Your blood pressure should be checked at every doctor visit. Talk with your health care provider about your blood pressure goal. - C is for Cholesterol (ko-LES-ter-ol). The LDL goal for most people is less than 100. Low density lipoprotein, or LDL-cholesterol, is the bad cholesterol that builds up in your blood vessels. It causes the vessels to narrow and harden, which can lead to a heart attack. Your doctor should check your LDL at least once a year. Talk with your health care provider about your cholesterol goal. C is for Cholesterol (ko-LES-ter-ol). The LDL goal for most people is less than 100. Low density lipoprotein, or LDL-cholesterol, is the bad cholesterol that builds up in your blood vessels. It causes the vessels to narrow and harden, which can lead to a heart attack. Your doctor should check your LDL at least once a year. Talk with your health care provider about your cholesterol goal. Ask your health care team - what your A1C, blood pressure, and cholesterol numbers are. - what your ABCs should be. - what you can do to reach your target. what your A1C, blood pressure, and cholesterol numbers are. what your ABCs should be. what you can do to reach your target." +information,What is (are) Heart Attack ?,"Blood Flow to the Heart Is Blocked The heart works 24 hours a day, pumping oxygen and nutrient-rich blood to the body. Blood is supplied to the heart through its coronary arteries. If a blood clot suddenly blocks a coronary artery, it cuts off most or all blood supply to the heart, and a heart attack results. If blood flow isn't restored quickly, the section of heart muscle begins to die. The more time that passes without treatment to restore blood flow, the greater the damage to the heart. Affects Both Men and Women Heart attacks are a leading killer of both men and women in the United States. Each year, more than one million people in the U.S. have a heart attack and about half of them die. Half of those who die do so within one hour of the start of symptoms and before reaching the hospital. The good news is that excellent treatments are available for heart attacks. These treatments can save lives and prevent disabilities. Prompt Treatment Is Important Heart attack treatment works best when it's given right after symptoms occur. Prompt treatment of a heart attack can help prevent or limit damage to the heart and prevent sudden death. Call 9-1-1 Right Away A heart attack is an emergency. Call 9-1-1 for an ambulance right away -- within 5 minutes -- if you think you or someone else may be having a heart attack. You also should call for help if your chest pain doesn't go away as it usually does when you take medicine prescribed for angina (chest pain). Do not drive to the hospital or let someone else drive you. Emergency personnel in the ambulance can begin life-saving treatment on the way to the emergency room. They carry drugs and equipment that can help your medical condition, including - oxygen - aspirin to prevent further blood clotting - heart medications, such as nitroglycerin - pain relief treatments - defibrillators that can restart the heart if it stops beating. oxygen aspirin to prevent further blood clotting heart medications, such as nitroglycerin pain relief treatments defibrillators that can restart the heart if it stops beating. If blood flow in the blocked artery can be restored quickly, permanent heart damage may be prevented. Yet, many people do not seek medical care for 2 hours or more after symptoms start." +symptoms,What are the symptoms of Heart Attack ?,"Symptoms Can Vary Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies. The warning signs and symptoms of a heart attack aren't the same for everyone. Many heart attacks start slowly as mild pain or discomfort. Some people don't have symptoms at all. Heart attacks that occur without any symptoms or very mild symptoms are called silent heart attacks. 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 If you have a second heart attack, your symptoms may not be the same as the first heart attack. Here are common signs and symptoms of a heart attack. Chest Pain or Discomfort The most common symptom of heart attack is chest pain or discomfort. 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. Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. It can be mild or severe. Heart attack pain can sometimes feel like indigestion or heartburn. All chest pain should be checked by a doctor. Other Upper Body Discomfort Discomfort can also occur in other areas of the upper body, including pain or numbness in one or both arms, the back, neck, jaw or stomach. Shortness of Breath Shortness of breath often happens along with, or before chest discomfort. Other Symptoms Other symptoms may include - breaking out in a cold sweat - having nausea and vomiting - feeling light-headed or dizzy - fainting - sleep problems - fatigue - lack of energy. breaking out in a cold sweat having nausea and vomiting feeling light-headed or dizzy fainting sleep problems fatigue lack of energy. Angina or a Heart Attack? Angina is chest pain or discomfort that occurs if an area of your heart muscle doesn't get enough oxygen-rich blood. Angina occurs in people who have coronary heart disease, usually when they're active. Angina symptoms can be very similar to heart attack symptoms. Angina pain usually lasts for only a few minutes and goes away with rest. If you think you may be having a heart attack, or if your angina pain does not go away as usual when you take your angina medication as directed, call 9-1-1 for help. You can begin to receive life saving treatment in the ambulance on the way to the emergency room." +causes,What causes Heart Attack ?,"Most heart attacks are caused by a blood clot that blocks one of the coronary arteries, the blood vessels that bring blood and oxygen to the heart muscle. When blood cannot reach part of your heart, that area starves for oxygen. If the blockage continues long enough, cells in the affected area die. The Most Common Cause Coronary heart disease (CHD)is the most common underlying cause of a heart attack. CHD, also called coronary artery disease, is the hardening and narrowing of the coronary arteries caused by the buildup of plaque inside the walls of the arteries. 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. Over time, 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. Other Causes Heart attack also can occur due to problems with the very small, microscopic blood vessels of the heart. This condition is called microvascular disease. It's believed to be more common in women than in men. A less common cause of heart attacks is a severe spasm or tightening of the coronary artery that cuts off blood flow to the heart. These spasms can occur in persons with or without coronary artery disease. What causes a coronary artery to spasm isn't always clear. A spasm may be related to emotional stress or pain, exposure to extreme cold, cigarette smoking, or by taking certain drugs like cocaine. Risk Factors You Cannot Change Certain factors make it more likely that you will develop coronary artery disease and have a heart attack. These risk factors include some things you cannot change. If you are a man over age 45 or a woman over age 55, you are at greater risk. Having a family history of early heart disease, diagnosed in a father or brother before age 55 or in a mother or sister before age 65, is another risk factor. You are also at risk if you have a personal history of angina or previous heart attack, or if you have had a heart procedure such as percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). Risk Factors You Can Change Importantly, there are many risk factors that you can change. These include - smoking - being overweight or obese - physical inactivity - high blood pressure - high blood cholesterol - high blood sugar due to insulin resistance or diabetes - an unhealthy diet (for example, a diet high in saturated fat, trans fat, cholesterol, and sodium). smoking being overweight or obese physical inactivity high blood pressure high blood cholesterol high blood sugar due to insulin resistance or diabetes an unhealthy diet (for example, a diet high in saturated fat, trans fat, cholesterol, and sodium). Metabolic Syndrome Some of these risk factorssuch as obesity, high blood pressure, and high blood sugartend to occur together. When they do, it's called metabolic syndrome. In general, a person with metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as someone without metabolic syndrome." +susceptibility,Who is at risk for Heart Attack? ?,"Lowering your risk factors for coronary heart disease (CHD) can help you prevent a heart attack. Even if you already have CHD or have already had a heart attack, you can still take steps to lower your risk. These steps involve following a heart healthy lifestyle and getting ongoing care for conditions that raise your risk. Heart Healthy Lifestyle Changes You can make these lifestyle changes to lower your risk of having a heart attack. - If you smoke, quit. - Maintain a healthy weight. - Be as physically active as you can. - Follow a heart healthy diet. If you smoke, quit. Maintain a healthy weight. Be as physically active as you can. Follow a heart healthy diet. 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. Maintain a healthy weight. 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 coronary heart disease (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. Follow a heart healthy diet. Following a healthy diet is an important part of a heart healthy lifestyle. Eat a healthy diet to prevent or reduce high blood pressure and high blood cholesterol, and to maintain a healthy weight. 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 Healthy Eating 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. In addition, a variety of heart healthy recipes to help you plan meals is available at Aim for a Healthy Weight. All of these resources provide general information about healthy eating. Treatment for Related Conditions Get treatment for related conditions that make having a heart attack more likely. - If you have high blood cholesterol, follow your doctor's advice about lowering it. Take medications to lower your cholesterol as directed if diet and exercise aren't enough. - If you have high blood pressure, follow your doctor's advice about keeping it under control. Take blood pressure medications as directed. - If you have diabetes, sometimes called high blood sugar, try to control your blood sugar level through diet and physical activity (as your doctor recommends). If needed, take medicine as prescribed. If you have high blood cholesterol, follow your doctor's advice about lowering it. Take medications to lower your cholesterol as directed if diet and exercise aren't enough. If you have high blood pressure, follow your doctor's advice about keeping it under control. Take blood pressure medications as directed. If you have diabetes, sometimes called high blood sugar, try to control your blood sugar level through diet and physical activity (as your doctor recommends). If needed, take medicine as prescribed." +exams and tests,How to diagnose Heart Attack ?,"If You Have Symptoms, Call 9-1-1 Diagnosis and treatment of a heart attack can begin when emergency personnel arrive after you call 9-1-1. Do not put off calling 9-1-1 because you are not sure that you are having a heart attack. Call within 5 minutes of the start of symptoms. At the hospital emergency room, doctors will work fast to find out if you are having or have had a heart attack. They will consider your symptoms, medical and family history, and test results. Initial tests will be quickly followed by treatment if you are having a heart attack. Diagnostic Tests - an electrocardiogram - blood tests - nuclear heart scan - cardiac catheterization - and coronary angiography. an electrocardiogram blood tests nuclear heart scan cardiac catheterization and coronary angiography. The electrocardiogram, also known as ECG or EKG, is used to measure the rate and regularity of your heartbeat. Blood tests are also used in diagnosing a heart attack. When cells in the heart die, they release enzymes into the blood. They are called markers or biomarkers. Measuring the amount of these markers in the blood can show how much damage was done to your heart. Doctors often repeat these tests to check for changes. The nuclear heart scan uses radioactive tracers to outline the heart chambers and major blood vessels leading to and from the heart. A nuclear heart scan shows any damage to your heart muscle as well as how well blood flows to and from the heart. In cardiac catheterization, a thin, flexible tube is passed through an artery in your groin or arm to reach the coronary arteries. This test allows your doctor to - determine blood pressure and flow in the heart's chambers - collect blood samples from the heart, and - examine the arteries of the heart by x-ray. determine blood pressure and flow in the heart's chambers collect blood samples from the heart, and examine the arteries of the heart by x-ray. Coronary angiography is usually done with the cardiac catheterization. A dye that can be seen on an x-ray is injected through the catheter into the coronary arteries. It shows where there are blockages and how severe they are." +treatment,What are the treatments for Heart Attack ?,"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. Act Fast The signs and symptoms of a heart attack can develop suddenly. However, they also can develop slowlysometimes within hours, days, or weeks of a heart attack. Know the warning signs of a heart attack so you can act fast to get treatment for yourself or someone else. The sooner you get emergency help, the less damage your heart will sustain. Call 911 for an ambulance right away if you think you or someone else may be having a heart attack. You also should call for help if your chest pain doesn't go away as it usually does when you take medicine prescribed for angina. Treatment May Start Right Away Treatment for a heart attack may begin in the ambulance or in the emergency department and continue in a special area of the hospital called a coronary care unit. 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. Restoring Blood Flow to the Heart The coronary care unit is specially equipped with monitors that continuously monitor your vital signs. These include - an EKG which detects any heart rhythm problems - a blood pressure monitor, and - pulse oximetry, which measures the amount of oxygen in the blood. an EKG which detects any heart rhythm problems a blood pressure monitor, and pulse oximetry, which measures the amount of oxygen in the blood. In the hospital, if you have had or are having a heart attack, doctors will work quickly to restore blood flow to your heart and continuously monitor your vital signs to detect and treat complications. Restoring blood flow to the heart can prevent or limit damage to the heart muscle and help prevent another heart attack. Doctors may use clot-busting drugs called thrombolytics and procedures such as angioplasty. - Clot-busters or thrombolytic drugs are used to dissolve blood clots that are blocking blood flow to the heart. When given soon after a heart attack begins, these drugs can limit or prevent permanent damage to the heart. To be most effective, these drugs must be given within one hour after the start of heart attack symptoms. - Angioplasty procedures are used to open blocked or narrowed coronary arteries. A stent, which is a tiny metal mesh tube, may be placed in the artery to help keep it open. Some stents are coated with medicines that help prevent the artery from becoming blocked again. - Coronary artery bypass surgery uses arteries or veins from other areas in your body to bypass your blocked coronary arteries. Clot-busters or thrombolytic drugs are used to dissolve blood clots that are blocking blood flow to the heart. When given soon after a heart attack begins, these drugs can limit or prevent permanent damage to the heart. To be most effective, these drugs must be given within one hour after the start of heart attack symptoms. Angioplasty procedures are used to open blocked or narrowed coronary arteries. A stent, which is a tiny metal mesh tube, may be placed in the artery to help keep it open. Some stents are coated with medicines that help prevent the artery from becoming blocked again. Coronary artery bypass surgery uses arteries or veins from other areas in your body to bypass your blocked coronary arteries. Drug Treatments Many medications are used to treat heart attacks. They include beta blockers, ACE inhibitors, nitrates, anticoagulants, antiplatelet medications, and medications to relieve pain and anxiety. - Beta blockers slow your heart rate and reduce your heart's need for blood and oxygen. As a result, your heart beats with less force, and your blood pressure falls. Beta blockers are also used to relieve angina and prevent second heart attacks and correct an irregular heartbeat. - Angiotensin-converting enzyme or ACE inhibitors lower your blood pressure and reduce the strain on your heart. They are used in some patients after a heart attack to help prevent further weakening of the heart and increase the chances of survival. - Nitrates, such as nitroglycerin, relax blood vessels and relieve chest pain. Anticoagulants, such as heparin and warfarin, thin the blood and prevent clots from forming in your arteries. - >Antiplatelet medications, such as aspirin and clopidogrel, stop platelets from clumping together to form clots. They are given to people who have had a heart attack, have angina, or have had an angioplasty. - Glycoprotein llb-llla inhibitors are potent antiplatelet medications given intravenously to prevent clots from forming in your arteries. Beta blockers slow your heart rate and reduce your heart's need for blood and oxygen. As a result, your heart beats with less force, and your blood pressure falls. Beta blockers are also used to relieve angina and prevent second heart attacks and correct an irregular heartbeat. Angiotensin-converting enzyme or ACE inhibitors lower your blood pressure and reduce the strain on your heart. They are used in some patients after a heart attack to help prevent further weakening of the heart and increase the chances of survival. Nitrates, such as nitroglycerin, relax blood vessels and relieve chest pain. Anticoagulants, such as heparin and warfarin, thin the blood and prevent clots from forming in your arteries. >Antiplatelet medications, such as aspirin and clopidogrel, stop platelets from clumping together to form clots. They are given to people who have had a heart attack, have angina, or have had an angioplasty. Glycoprotein llb-llla inhibitors are potent antiplatelet medications given intravenously to prevent clots from forming in your arteries. Doctors may also prescribe medications to relieve pain and anxiety, or to treat irregular heart rhythms which often occur during a heart attack. Echocardiogram and Stress Tests While you are still in the hospital or after you go home, your doctor may order other tests, such as an echocardiogram. An echocardiogram uses ultrasound to make an image of the heart which can be seen on a video monitor. It shows how well the heart is filling with blood and pumping it to the rest of the body. Your doctor may also order a stress test to see how well your heart works when it has a heavy workload. You run on a treadmill or pedal a bicycle or receive medicine through a vein in your arm to make your heart work harder. EKG and blood pressure readings are taken before, during, and after the test to see how your heart responds. Often, an echocardiogram or nuclear scan of the heart is performed before and after exercise or intravenous medication. The test is stopped if chest pain or a very sharp rise or fall in blood pressure occurs. Monitoring continues for 10 to 15 minutes after the test or until your heart rate returns to baseline." +information,What is (are) Heart Attack ?,"A heart attack occurs when the supply of blood and oxygen to an area of the heart muscle is blocked, usually by a blood clot in a coronary artery. If the blockage is not treated within a few hours, the heart muscle will be permanently damaged and replaced by scar tissue." +causes,What causes Heart Attack ?,"Coronary heart disease, or CHD, is the most common underlying cause of a heart attack. Coronary arteries are the blood vessels that bring blood and oxygen to the heart muscle. Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. When blood cannot reach part of your heart, that area starves for oxygen. If the blockage continues long enough, cells in the affected area die." +symptoms,What are the symptoms of Heart Attack ?,"Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. It can include pain or numbness in one or both arms, the back, neck, jaw, or stomach. Heart attack pain can sometimes feel like indigestion or heartburn. Shortness of breath often happens along with, or before chest discomfort. Other symptoms may include breaking out in a cold sweat, having nausea and vomiting, or feeling light-headed or dizzy. Symptoms vary, and some people have no symptoms. Know the symptoms of a heart attack so you can act fast to get treatment." +symptoms,What are the symptoms of Heart Attack ?,"No. Most heart attack patients do not have all of the symptoms. The important thing to remember is that if you have any of the symptoms and they grow more intense, and last more than 5 minutes, you should call 9-1-1 immediately." +frequency,How many people are affected by Heart Attack ?,"Very common. Each year, more than 1 million people in the U.S. have a heart attack and about half of them die. About one-half of those who die do so within 1 hour of the start of symptoms and before reaching the hospital." +susceptibility,Who is at risk for Heart Attack? ?,"Certain factors increase the risk of developing coronary heart disease and having a heart attack. These risk factors include some things you cannot change. You are at greater risk if you - are a man over age 45 or a woman over age 55. - have a family history of early heart disease -- heart disease in a father or brother before age 55 or in a mother or sister before age 65. - have a personal history of angina or previous heart attack. - have had a heart procedure, such as angioplasty or heart bypass. are a man over age 45 or a woman over age 55. have a family history of early heart disease -- heart disease in a father or brother before age 55 or in a mother or sister before age 65. have a personal history of angina or previous heart attack. have had a heart procedure, such as angioplasty or heart bypass. Importantly, there are many risk factors for heart attack that you CAN change, including - smoking - being obese or overweight - being physically inactive - having high blood pressure, high blood cholesterol or diabetes. smoking being obese or overweight being physically inactive having high blood pressure, high blood cholesterol or diabetes." +susceptibility,Who is at risk for Heart Attack? ?,"You can lower your risk of having a heart attack, even if you have already had a heart attack or have been told that your chances of having a heart attack are high. To prevent a heart attack, you will need to make lifestyle changes. You may also need to get treatment for conditions that raise your risk. Lifestyle changes you can make to lower your risk for heart attack include the following: - If you smoke, quit. - Maintain a healthy weight. Lose weight gradually if you are overweight or obese. If you smoke, quit. Maintain a healthy weight. Lose weight gradually if you are overweight or obese. - Follow a heart healthy diet -- such as one low in salt, saturated fat and trans fat, and calories -- to prevent or reduce high blood pressure and high blood cholesterol and maintain a healthy weight. - Be as physically active as you can. Follow a heart healthy diet -- such as one low in salt, saturated fat and trans fat, and calories -- to prevent or reduce high blood pressure and high blood cholesterol and maintain a healthy weight. Be as physically active as you can. Get treatment for related conditions that might make having a heart attack more likely. - If you have high blood cholesterol, follow your doctor's advice about lowering it. Take medications to lower your cholesterol as directed. - If you have high blood pressure, follow your doctor's advice about keeping it under control. Take blood pressure medications as directed. - If you have diabetes, sometimes called high blood sugar, follow your doctor's advice about keeping blood sugar levels under control. Take your medicines as directed. If you have high blood cholesterol, follow your doctor's advice about lowering it. Take medications to lower your cholesterol as directed. If you have high blood pressure, follow your doctor's advice about keeping it under control. Take blood pressure medications as directed. If you have diabetes, sometimes called high blood sugar, follow your doctor's advice about keeping blood sugar levels under control. Take your medicines as directed." +exams and tests,How to diagnose Heart Attack ?,"Several tests are used to diagnose a heart attack. - An electrocardiogram, also called an EKG, measures the rate and regularity of your heartbeat. - Blood tests identify and measure markers in the blood that can show how much damage was done to your heart. These tests are often repeated at specific time periods to check for changes. - A nuclear heart scan uses radioactive tracers to show damage to heart chambers and major blood vessels. - Cardiac catheterization involves passing a thin flexible tube through an artery in your groin or arm to look at your coronary arteries. It allows your doctor to examine the blood flow in your heart's chambers. - Cardiac angiography is usually performed along with cardiac catheterization, using a dye injected through the cardiac catheter. The dye allows the doctor to see where there may be blockages in the coronary arteries. An electrocardiogram, also called an EKG, measures the rate and regularity of your heartbeat. Blood tests identify and measure markers in the blood that can show how much damage was done to your heart. These tests are often repeated at specific time periods to check for changes. A nuclear heart scan uses radioactive tracers to show damage to heart chambers and major blood vessels. Cardiac catheterization involves passing a thin flexible tube through an artery in your groin or arm to look at your coronary arteries. It allows your doctor to examine the blood flow in your heart's chambers. Cardiac angiography is usually performed along with cardiac catheterization, using a dye injected through the cardiac catheter. The dye allows the doctor to see where there may be blockages in the coronary arteries." +treatment,What are the treatments for Heart Attack ?,"If you are having a heart attack, doctors will work quickly to restore blood flow to the heart and continuously monitor vital signs to detect and treat complications. Restoring blood flow to the heart can prevent or limit damage to the heart muscle and help prevent another heart attack. Doctors may use clot-busting drugs called thrombolytics and procedures, such as angioplasty. Long-term treatment after a heart attack may include cardiac rehabilitation, checkups and tests, lifestyle changes, and medications." +information,What is (are) Heart Attack ?,"Angina is a recurring pain or discomfort in the chest that happens when some part of the heart does not receive enough blood. An episode of angina is not a heart attack. However, people with angina may have a hard time telling the difference between angina and heart attack symptoms. Angina is chest pain or discomfort that occurs when your heart muscle does not get enough blood. Angina may feel like pressure or a squeezing pain in your chest. The pain may also occur in your shoulders, arms, neck, jaw, or back. It may also feel like indigestion. It is usually relieved within a few minutes by resting or by taking prescribed angina medicine." +treatment,What are the treatments for Heart Attack ?,"There are many medicines that are used to treat a heart attack. - Clot-busters or thrombolytic drugs dissolve blood clots that are blocking blood flow to the heart. - Beta blockers decrease the workload on your heart by slowing your heart rate. - Angiotensin-converting enzyme (ACE) inhibitors lower your blood pressure and reduce the strain on your heart. - Nitrates, such as nitroglycerin relax blood vessels and relieve chest pain. - Anticoagulants thin the blood and prevent clots from forming in your arteries. - Antiplatelet medications, such as aspirin and clopidogrel, stop platelets from clumping together to form clots. These medications are given to people who have had a heart attack, have angina, or have had angioplasty. Clot-busters or thrombolytic drugs dissolve blood clots that are blocking blood flow to the heart. Beta blockers decrease the workload on your heart by slowing your heart rate. Angiotensin-converting enzyme (ACE) inhibitors lower your blood pressure and reduce the strain on your heart. Nitrates, such as nitroglycerin relax blood vessels and relieve chest pain. Anticoagulants thin the blood and prevent clots from forming in your arteries. Antiplatelet medications, such as aspirin and clopidogrel, stop platelets from clumping together to form clots. These medications are given to people who have had a heart attack, have angina, or have had angioplasty. Doctors may also prescribe medicines to relieve pain and anxiety, or to treat irregular heart rhythms which often occur during a heart attack." +information,What is (are) Heart Attack ?,"Having a heart attack increases your chances of having another one. Therefore, it is very important that you and your family know how and when to seek medical attention. Talk to your doctor about making an emergency action plan, and discuss it with your family. The emergency action plan should include - warning signs or symptoms of a heart attack - instructions for accessing emergency medical services in your community, including calling 9-1-1 - steps you can take while waiting for medical help to arrive, such as taking aspirin and nitroglycerin - important information to take along with you to the hospital, such as a list of medications that you take or that you are allergic to, and name and number of whom you should contact if you go to the hospital. warning signs or symptoms of a heart attack instructions for accessing emergency medical services in your community, including calling 9-1-1 steps you can take while waiting for medical help to arrive, such as taking aspirin and nitroglycerin important information to take along with you to the hospital, such as a list of medications that you take or that you are allergic to, and name and number of whom you should contact if you go to the hospital." +treatment,What are the treatments for Heart Attack ?,"After a heart attack, many people worry about having another heart attack. They often feel depressed and may have trouble adjusting to a new lifestyle. You should discuss your feelings with your doctor. Your doctor can give you medication for anxiety or depression and may recommend professional counseling. Spend time with family, friends, and even pets. Affection can make you feel better and less lonely. Most people stop feeling depressed after they have fully recovered." +information,What is (are) Heart Attack ?,More detailed information on heart attacks is available at www.nhlbi.nih.gov/health/dci. +information,What is (are) Stroke ?,"Stroke -- A Serious Event 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. What Is 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. Ischemic Stroke 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 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. Hemorrhagic Stroke 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." +symptoms,What are the symptoms of Stroke ?,"Know the Signs 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! Common Signs of Stroke 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. 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. Don't Ignore ""Mini-Strokes"" 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. Why It's Important To Act Fast 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 peoples 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. What Should You Do? 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." +susceptibility,Who is at risk for Stroke? ?,"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. 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. 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. 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. 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 smoking heart disease high blood cholesterol warning signs or history of a stroke diabetes. High Blood Pressure 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. 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. Smoking 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 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. High Blood Cholesterol 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. Warning Signs or History of Stroke 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. Diabetes 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." +prevention,How to prevent 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. Preventing Stroke 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. 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. Diagnosing 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. Measuring Stroke Severity 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. Diagnostic Imaging: CT Scan 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. Diagnostic Imaging: MRI Scan 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. Differences Between CT and MRI Scans 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." +information,What is (are) Stroke ?,"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. Knowing stroke symptoms, calling 911 immediately, and getting to a hospital as quickly as possible are critical." +susceptibility,Who is at risk for Stroke? ?,"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. Studies show the risk of stroke doubles for each decade between the ages of 55 and 85. However, a recent study found that stroke rates are on the rise for people under 55." +information,What is (are) Stroke ?,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 in the brain. 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. +symptoms,What are the symptoms of Stroke ?,"Warning signs are clues your body sends to tell you that your brain is not receiving enough oxygen. These are warning signs of a stroke, or brain attack: - 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. 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. If you observe one or more of these signs, don't wait. Call 911 right away!" +information,What is (are) Stroke ?,"Transient ischemic attacks, or TIAs, occur when the warning signs of stroke last only a few moments and then disappear. These brief episodes are also sometimes called ""mini-strokes."" Although brief, they 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." +susceptibility,Who is at risk for Stroke? ?,"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. Risk factors for stroke include ones that you cannot control and ones that you can control. Some of the risk factors that you cannot control include - Age. Although stroke can occur at any age, the risk of stroke doubles for each decade between the ages of 55 and 85. - Gender. Men have a higher risk for stroke, but more women die from stroke. Men generally do not live as long as women, so men are usually younger when they have their strokes and therefore have a higher rate of survival. - Race. The risk of stroke is higher among African-American and Hispanic Americans. - Family History. Family history of stroke increases your risk. Age. Although stroke can occur at any age, the risk of stroke doubles for each decade between the ages of 55 and 85. Gender. Men have a higher risk for stroke, but more women die from stroke. Men generally do not live as long as women, so men are usually younger when they have their strokes and therefore have a higher rate of survival. Race. The risk of stroke is higher among African-American and Hispanic Americans. Family History. Family history of stroke increases your risk. The risk factors for stroke that you CAN control include - high blood pressure - cigarette smoking - diabetes - high blood cholesterol - heart disease. high blood pressure cigarette smoking diabetes high blood cholesterol heart disease. Experiencing warning signs and having a history of stroke are also risk factors for stroke." +information,What is (are) Stroke ?,"Atherosclerosis, also known as hardening of the arteries, is the most common blood vessel disease. It is caused by the buildup of fatty deposits in the arteries, and is a risk factor for stroke." +prevention,How to prevent Stroke ?,"Yes. Stroke is preventable. 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. Managing your high blood pressure is the most important thing you can do to avoid stroke. See ways to manage high blood pressure. - If you smoke, quit. See resources to help you quit, including , smoking quitlines, an online quit plan, a quit smoking website for older adults, and mobile apps and free text messaging services. If you have high blood pressure, work with your doctor to get it under control. Managing your high blood pressure is the most important thing you can do to avoid stroke. See ways to manage high blood pressure. If you smoke, quit. See resources to help you quit, including , smoking quitlines, an online quit plan, a quit smoking website for older adults, and mobile apps and free text messaging services. - 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. See ways to manage diabetes every day. - If you are overweight, start maintaining a healthy diet and exercising regularly. See a sensible approach to weight loss. See exercises tailored for older adults. 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. See ways to manage diabetes every day. If you are overweight, start maintaining a healthy diet and exercising regularly. See a sensible approach to weight loss. See exercises tailored for older adults. - 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. Learn about lifestyle changes to control cholesterol. 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. Learn about lifestyle changes to control cholesterol." +exams and tests,How to diagnose Stroke ?,"Doctors have several 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 (CT) or magnetic resonance imaging (MRI) will often be done." +information,What is (are) Stroke ?,"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." +information,What is (are) Stroke ?,"The most commonly used imaging procedure is the computed tomography or CT scan, also known as a CAT scan. A CT scan is comprised of a series of cross-sectional images of the head and brain. Because it 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. 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." +information,What is (are) Stroke ?,"Another imaging technique used for 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. An MRI can show this type of damage very soon after the stroke symptoms start. 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). Also, MRI can be more sensitive than CT for detecting other types of neurologic 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. Also, MRI typically takes longer to perform than CT, and therefore may not be the first choice when minutes count." +treatment,What are the treatments for Stroke ?,"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 treatments include medications, surgery, and rehabilitation." +treatment,What are the treatments for Stroke ?,"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. Antithrombotics prevent the formation of blood clots that can become stuck in an artery of the brain and cause strokes. - 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. 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). 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). Thrombolytic drugs halt the stroke by dissolving the blood clot that is blocking blood flow to the brain. Ischemic strokes -- the most common kind -- can be treated with thrombolytic drugs. But a person needs to be at the hospital as soon as possible after 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. 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." +treatment,What are the treatments for Stroke ?,"Surgery Surgery 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. 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. Vascular Interventions 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. 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. - Stenting is another procedure used to prevent stroke. 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. Stenting is another procedure used to prevent stroke. 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. 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." +information,What is (are) Stroke ?,"Brain plasticity is the brain's ability to learn and change, allowing it to adapt to deficits and injury and to take over the functions of damaged cells. 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 torewire the connections between its nerve cells allows it to compensate for lost functions." +information,What is (are) Stroke ?,"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." +susceptibility,Who is at risk for Smoking and Your Heart? ?,"The chemicals in tobacco smoke harm your heart and blood vessels in many ways. For example, they: + +Contribute to inflammation, which may trigger plaque buildup in your arteries. + +Damage blood vessel walls, making them stiff and less elastic (stretchy). This damage narrows the blood vessels and contributes to the damage caused by unhealthy cholesterol levels. + +Disturb normal heart rhythms. + +Increase your blood pressure and heart rate, making your heart work harder thannormal. + +Lower your HDL (good) cholesterol and raise your LDL (bad) cholesterol. Smoking also increases your triglyceride level. Triglycerides are a type of fat found in theblood. + +Thicken your blood and make it harder for your blood to carry oxygen. + +Smoking and Heart Disease Risk + +Smoking is a major risk factor for coronary heart disease, a condition in which plaque builds up inside the coronary arteries. These arteries supply your heart muscle with oxygen-rich blood. + +When plaque builds up in the arteries, the condition is called atherosclerosis. + +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. + +Over time, smoking contributes to atherosclerosis and increases your risk of having and dying from heart disease, heart failure, or a heartattack. + +Compared with nonsmokers, people who smoke are more likely to have heart disease and suffer from a heart attack. The risk of having or dying from a heart attack is even higher among people who smoke and already have heart disease. + +For some people, such as women who use birth control pills and people who have diabetes, smoking poses an even greater risk to the heart and blood vessels. + +Smoking is a major risk factor for heart disease. When combined with other risk factorssuch as unhealthy blood cholesterol levels, high blood pressure, and overweight or obesitysmoking further raises the risk of heart disease. + +Smoking and the Risk of Peripheral Artery Disease + +Peripheral artery disease (P.A.D.) is a disease in which plaque builds up in the arteries that carry blood to your head, organs, and limbs. Smoking is a major risk factor for P.A.D. + +P.A.D. usually affects the arteries that carry blood to your legs. Blocked blood flow in the leg arteries can cause cramping, pain, weakness, and numbness in your hips, thighs, and calf muscles. + +Blocked blood flow also can raise your risk of getting an infection in the affected limb. Your body might have a hard time fighting the infection. + +If severe enough, blocked blood flow can cause gangrene (tissue death). In very serious cases, this can lead to leg amputation. + +If you have P.A.D., your risk of heart disease and heart attack is higher than the risk for people who dont have P.A.D. + +Smoking even one or two cigarettes a day can interfere with P.A.D. treatments. People who smoke and people who have diabetes are at highest risk for P.A.D. complications, including gangrene in the leg from decreased blood flow. + +Secondhand Smoke Risks + +Secondhand smoke is the smoke that comes from the burning end of a cigarette, cigar, or pipe. Secondhand smoke also refers to smoke thats breathed out by a person who is smoking. + +Secondhand smoke contains many of the same harmful chemicals that people inhale when they smoke. It can damage the heart and blood vessels of people who dont smoke in the same way that active smoking harms people who do smoke. Secondhand smoke greatly increases adults risk of heart attack and death. + +Secondhand smoke also raises the risk of future coronary heart disease in children and teens because it: + +Damages heart tissues + +Lowers HDL cholesterol + +Raises blood pressure + +The risks of secondhand smoke are especially high for premature babies who have respiratory distress syndrome and children who have conditions such asasthma. + +Cigar and Pipe Smoke Risks + +Researchers know less about how cigar and pipe smoke affects the heart and blood vessels than they do about cigarette smoke. + +However, the smoke from cigars and pipes contains the same harmful chemicals as the smoke from cigarettes. Also, studies have shown that people who smoke cigars are at increased risk of heart disease." +information,What is (are) Sudden Cardiac Arrest ?,"Sudden cardiac arrest (SCA) is a condition in which the heart suddenly and unexpectedly stops beating. If this happens, blood stops flowing to the brain and other vital organs. + +SCA usually causes death if it's not treated within minutes. + +Overview + +To understand SCA, it helps to understand how the heart works. The heart has an electrical system that controls the rate and rhythm of the heartbeat. Problems with the heart's electrical system can cause irregular heartbeats called arrhythmias. + +There are many types of arrhythmias. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. Some arrhythmias can cause the heart to stop pumping blood to the bodythese arrhythmias cause SCA. + +SCA is not the same as a heart attack. A heart attack occurs if blood flow to part of the heart muscle is blocked. During a heart attack, the heart usually doesn't suddenly stop beating. SCA, however, may happen after or during recovery from a heart attack. + +People who have heart disease are at higher risk for SCA. However, SCA can happen in people who appear healthy and have no known heart disease or other risk factors for SCA. + +Outlook + +Most people who have SCA die from itoften within minutes. Rapid treatment of SCA with a defibrillator can be lifesaving. A defibrillator is a device that sends an electric shock to the heart to try to restore its normal rhythm. + +Automated external defibrillators (AEDs) can be used by bystanders to save the lives of people who are having SCA. These portable devices often are found in public places, such as shopping malls, golf courses, businesses, airports, airplanes, casinos, convention centers, hotels, sports venues, and schools." +causes,What causes Sudden Cardiac Arrest ?,"Ventricular fibrillation (v-fib) causes most sudden cardiac arrests (SCAs). V-fib is a type of arrhythmia. + +During v-fib, the ventricles (the heart's lower chambers) don't beat normally. Instead, they quiver very rapidly and irregularly. When this happens, the heart pumps little or no blood to the body. V-fib is fatal if not treated within a few minutes. + +Other problems with the heart's electrical system also can cause SCA. For example, SCA can occur if the rate of the heart's electrical signals becomes very slow and stops. SCA also can occur if the heart muscle doesn't respond to the heart's electrical signals. + +Certain diseases and conditions can cause the electrical problems that lead to SCA. Examples include coronary heart disease (CHD), also called coronary artery disease; severe physical stress; certain inherited disorders; and structural changes in the heart. + +Several research studies are under way to try to find the exact causes of SCA and how to prevent them. + +Coronary Heart Disease + +CHD is a disease in which a waxy substance called plaque (plak) builds up in 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. Eventually, an area of plaque can rupture (break open). This may cause a blood clot to form on the plaque's surface. + +A blood clot can partly or fully block the flow of oxygen-rich blood to the portion of heart muscle fed by the artery. This causes a heart attack. + +During a heart attack, some heart muscle cells die and are replaced with scar tissue. The scar tissue damages the heart's electrical system. As a result, electrical signals may spread abnormally throughout the heart. These changes to the heart increase the risk of dangerous arrhythmias and SCA. + +CHD seems to cause most cases of SCA in adults. Many of these adults, however, have no signs or symptoms of CHD before having SCA. + +Physical Stress + +Certain types of physical stress can cause your heart's electrical system to fail. Examples include: + +Intense physical activity. The hormone adrenaline is released during intense physical activity. This hormone can trigger SCA in people who have heart problems. + +Very low blood levels of potassium or magnesium. These minerals play an important role in your heart's electrical signaling. + +Major blood loss. + +Severe lack of oxygen. + +Inherited Disorders + +A tendency to have arrhythmias runs in some families. This tendency is inherited, which means it's passed from parents to children through the genes. Members of these families may be at higher risk for SCA. + +An example of an inherited disorder that makes you more likely to have arrhythmias is long QT syndrome (LQTS). LQTS is a disorder of the heart's electrical activity. Problems with tiny pores on the surface of heart muscle cells cause the disorder. LQTS can cause sudden, uncontrollable, dangerous heart rhythms. + +People who inherit structural heart problems also may be at higher risk for SCA. These types of problems often are the cause of SCA in children. + +Structural Changes in the Heart + +Changes in the heart's normal size or structure may affect its electrical system. Examples of such changes include an enlarged heart due to high blood pressure or advanced heart disease. Heart infections also may cause structural changes in the heart." +susceptibility,Who is at risk for Sudden Cardiac Arrest? ?,"The risk of sudden cardiac arrest (SCA) increases: + +With age + +If you are a man. Men are more likely than women to have SCA. + +Some studies show that blacksparticularly those with underlying conditions such as diabetes, high blood pressure, heart failure, and chronic kidney disease or certain cardiac findings on tests such as an electrocardiogramhave a higher risk forSCA. + +Major Risk Factor + +The major risk factor for SCA is coronary heart disease. Most people who have SCA have some degree of coronary heart disease; however, many people may not know that they have coronary heart disease until SCA occurs. Usually their coronary heart disease is silentthat is, it has no signs or symptoms. Because of this, doctors and nurses have not detected it. + +Many people who have SCA also have silent, or undiagnosed, heart attacks before sudden cardiac arrest happens. These people have no clear signs of heart attack, and they dont even realize that theyve had one. Read more about coronary heart disease risk factors. + +Other Risk Factors + +Other risk factors for SCA include: + +A personal history of arrhythmias + +A personal or family history of SCA or inherited disorders that make you prone toarrhythmias + +Drug or alcohol abuse + +Heart attack + +Heart failure" +symptoms,What are the symptoms of Sudden Cardiac Arrest ?,"Usually, the first sign of sudden cardiac arrest (SCA) is loss of consciousness (fainting). At the same time, no heartbeat (or pulse) can be felt. + +Some people may have a racing heartbeat or feel dizzy or light-headed just before they faint. Within an hour before SCA, some people have chest pain, shortness of breath, nausea (feeling sick to the stomach), or vomiting." +exams and tests,How to diagnose Sudden Cardiac Arrest ?,"Sudden cardiac arrest (SCA) happens without warning and requires emergency treatment. Doctors rarely diagnose SCA with medical tests as it's happening. Instead, SCA often is diagnosed after it happens. Doctors do this by ruling out other causes of a person's sudden collapse. + +Specialists Involved + +If you're at high risk for SCA, your doctor may refer you to a cardiologist. This is a doctor who specializes in diagnosing and treating heart diseases and conditions. Your cardiologist will work with you to decide whether you need treatment to prevent SCA. + +Some cardiologists specialize in problems with the heart's electrical system. These specialists are called cardiac electrophysiologists. + +Diagnostic Tests and Procedures + +Doctors use several tests to help detect the factors that put people at risk for SCA. + +EKG (Electrocardiogram) + +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 evidence of heart damage due to coronary heart disease (CHD). The test also can show signs of a previous or current heart attack. + +Echocardiography + +Echocardiography, 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 chambers and valves are working. + +Echo 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. + +There are several types of echo, including stress echo. This test is done both before and after a cardiac stress test. During this test, you exercise (or are given medicine if you're unable to exercise) to make your heart work hard and beat fast. + +Stress echo shows whether you have decreased blood flow to your heart (a sign of CHD). + +MUGA Test or Cardiac MRI + +A MUGA (multiple gated acquisition) test shows how well your heart is pumping blood. For this test, a small amount of radioactive substance is injected into a vein and travels to your heart. + +The substance releases energy, which special cameras outside of your body can detect. The cameras use the energy to create pictures of many parts of your heart. + +Cardiac MRI (magnetic resonance imaging) is a safe procedure that uses radio waves and magnets to create detailed pictures of your heart. The test creates still and moving pictures of your heart and major blood vessels. + +Doctors use cardiac MRI to get pictures of the beating heart and to look at the structure and function of the heart. + +Cardiac Catheterization + +Cardiac catheterization is a procedure used to diagnose and treat certain heart conditions. 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. Through the catheter, your doctor can do diagnostic tests and treatments on your heart. + +Sometimes dye is put into the catheter. The dye will flow through your bloodstream to your heart. The dye makes your coronary (heart) arteries visible on x-ray pictures. The dye can show whether plaque has narrowed or blocked any of your coronary arteries. + +Electrophysiology Study + +For an electrophysiology study, doctors use cardiac catheterization to record how your heart's electrical system responds to certain medicines and electrical stimulation. This helps your doctor find where the heart's electrical system is damaged. + +Blood Tests + +Your doctor may recommend blood tests to check the levels of potassium, magnesium, and other chemicals in your blood. These chemicals play an important role in your heart's electrical signaling." +treatment,What are the treatments for Sudden Cardiac Arrest ?,"Emergency Treatment + +Sudden cardiac arrest (SCA) is an emergency. A person having SCA needs to be treated with a defibrillator right away. This device sends an electric shock to the heart. The electric shock can restore a normal rhythm to a heart that's stopped beating. + +To work well, defibrillation must be done within minutes of SCA. With every minute that passes, the chances of surviving SCA drop rapidly. + +Police, emergency medical technicians, and other first responders usually are trained and equipped to use a defibrillator. Call 911 right away if someone has signs or symptoms of SCA. The sooner you call for help, the sooner lifesaving treatment can begin. + +Automated External Defibrillators + +Automated external defibrillators (AEDs) are special defibrillators that untrained bystanders can use. These portable devices often are found in public places, such as shopping malls, golf courses, businesses, airports, airplanes, casinos, convention centers, hotels, sports venues, and schools. + +AEDs are programmed to give an electric shock if they detect a dangerous arrhythmia, such as ventricular fibrillation. This prevents giving a shock to someone who may have fainted but isn't having SCA. + +You should give cardiopulmonary resuscitation (CPR) to a person having SCA until defibrillation can be done. + +People who are at risk for SCA may want to consider having an AED at home. A 2008 study by the National Heart, Lung, and Blood Institute and the National Institutes of Health found that AEDs in the home are safe and effective. + +Some people feel that placing these devices in homes will save many lives because many SCAs occur at home.Others note that no evidence supports the idea that home-use AEDs save more lives. These people fear that people who have AEDs in their homes will delay calling for help during an emergency. They're also concerned that people who have home-use AEDs will not properly maintain the devices or forget where they are. + +When considering a home-use AED, talk with your doctor. He or she can help you decide whether having an AED in your home will benefit you. + +Treatment in a Hospital + +If you survive SCA, you'll likely be admitted to a hospital for ongoing care and treatment. In the hospital, your medical team will closely watch your heart. They may give you medicines to try to reduce the risk of another SCA. + +While in the hospital, your medical team will try to find out what caused your SCA. If you're diagnosed with coronary heart disease, you may havepercutaneous coronary intervention, also known as coronary angioplasty,or coronary artery bypass grafting. These procedures help restore blood flow through narrowed or blocked coronary arteries. + +Often, people who have SCA get a device called an implantable cardioverter defibrillator (ICD). This small device is surgically placed under the skin in your chest or abdomen. An ICD uses electric pulses or shocks to help control dangerous arrhythmias. (For more information, go to ""How Can Death Due to Sudden Cardiac Arrest Be Prevented?"")" +prevention,How to prevent Sudden Cardiac Arrest ?,"Ways to prevent death due to sudden cardiac arrest (SCA) differ depending on whether: + +You've already had SCA + +You've never had SCA but are at high risk for the condition + +You've never had SCA and have no known risk factors for the condition + +For People Who Have Survived Sudden Cardiac Arrest + +If you've already had SCA, you're at high risk of having it again. Research shows that an implantable cardioverter defibrillator (ICD) reduces the chances of dying from a second SCA.An ICD is surgically placed under the skin in your chest or abdomen. The device has wires with electrodes on the ends that connect to your heart's chambers. The ICD monitors your heartbeat. + +If the ICD detects a dangerous heart rhythm, it gives an electric shock to restore the heart's normal rhythm. Your doctor may give you medicine to limit irregular heartbeats that can trigger the ICD. + +Implantable Cardioverter Defibrillator + + + +An ICD isn't the same as a pacemaker. The devices are similar, but they have some differences. Pacemakers give off low-energy electrical pulses. They're often used to treat less dangerous heart rhythms, such as those that occur in the upper chambers of the heart. Most new ICDs work as both pacemakers and ICDs. + +For People at High Risk for a First Sudden Cardiac Arrest + +If you have severe coronary heart disease (CHD), you're at increased risk for SCA. This is especially true if you've recently had a heart attack. + +Your doctor may prescribe a type of medicine called a beta blocker to help lower your risk for SCA. Your doctor also may discuss beginning statin treatment if you have an elevated risk for developing heart disease or having a stroke. Doctors usually prescribe statins for people who have: + +Diabetes + +Heart disease or had a prior stroke + +High LDL cholesterol levels + +Your doctor also may prescribe other medications to: + +Decrease your chance of having a heart attack or dying suddenly. + +Lower blood pressure. + +Prevent blood clots, which can lead to heart attack or stroke. + +Prevent or delay the need for a procedure or surgery, such as angioplasty or coronary artery bypass grafting. + +Reduce your hearts workload and relieve coronary heart disease symptoms. + +Take all medicines regularly, as your doctor prescribes. Dont change the amount of your medicine or skip a dose unless your doctor tells you to. You should still follow a heart-healthy lifestyle, even if you take medicines to treat your coronary heart disease. + +Other treatments for coronary heart diseasesuch as percutaneous coronary intervention, also known as coronary angioplasty, or coronary artery bypass graftingalso may lower your risk for SCA. Your doctor also may recommend an ICD if youre at high risk for SCA. + +For People Who Have No Known Risk Factors for Sudden Cardiac Arrest + +CHD seems to be the cause of most SCAs in adults. CHD also is a major risk factor for angina (chest pain or discomfort) and heart attack, and it contributes to other heart problems. + +Following a healthy lifestyle can help you lower your risk for CHD, SCA, and other heart problems. A heart-healthy lifestyle includes: + +Heart-healthy eating + +Maintaining a healthy weight + +Managing stress + +Physical activity + +Quitting smoking + +Heart-Healthy Eating + +Heart-healthy eating is an important part of a heart-healthy lifestyle. Your doctor may recommend heart-healthy eating, which should include: + +Fat-free or low-fat dairy products, such as skim milk + +Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week + +Fruits, such as apples, bananas, oranges, pears, and prunes + +Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans + +Vegetables, such as broccoli, cabbage, and carrots + +Whole grains, such as oatmeal, brown rice, and corn tortillas + +When following a heart-healthy diet, you should avoid eating: + +A lot of red meat + +Palm and coconut oils + +Sugary foods and beverages + +Two nutrients in your diet make blood cholesterol levels rise: + +Saturated fatfound mostly in foods that come from animals + +Trans fat (trans fatty acids)found in foods made with hydrogenated oils and fats, such as stick margarine; baked goods, such as cookies, cakes, and pies; crackers; frostings; and coffee creamers. Some trans fats also occur naturally in animal fats and meats. + +Saturated fat raises your blood cholesterol more than anything else in your diet. When you follow a heart-healthy eating plan, only 5percent to 6percent of your daily calories should come from saturated fat. Food labels list the amounts of saturated fat. To help you stay on track, here are some examples: + +If you eat: + +Try to eat no more than: + +1,200 calories a day + +8 grams of saturated fat a day + +1,500 calories a day + +10 grams of saturated fat a day + +1,800 calories a day + +12 grams of saturated fat a day + +2,000 calories a day + +13 grams of saturated fat a day + +2,500 calories a day + +17 grams of saturated fat a day + +Not all fats are bad. Monounsaturated and polyunsaturated fats actually help lower blood cholesterol levels. Some sources of monounsaturated and polyunsaturated fats are: + +Avocados + +Corn, sunflower, and soybean oils + +Nuts and seeds, such as walnuts + +Olive, canola, peanut, safflower, and sesame oils + +Peanut butter + +Salmon and trout + +Tofu + +Sodium + +You should try to limit the amount of sodium that you eat. This means choosing and preparing foods that are lower in salt and sodium. Try to use low-sodium and no added salt foods and seasonings at the table or while cooking. Food labels tell you what you need to know about choosing foods that are lower in sodium. Try to eat no more than 2,300milligrams of sodium a day. If you have high blood pressure, you may need to restrict your sodium intake even more. + +Dietary Approaches to Stop Hypertension + +Your doctor may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium and salt. + +The DASH eating plan is a good heart-healthy eating plan, even for those who dont have high blood pressure. Read more about DASH. + +Limiting Alcohol + +Try to limit alcohol intake. Too much alcohol can raise your blood pressure and triglyceride levels, a type of fat found in the blood. Alcohol also adds extra calories, which may cause weight gain. + +Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is: + +12 ounces of beer + +5 ounces of wine + +1 ounces of liquor + +Maintaining a Healthy Weight + +Maintaining a healthy weight is important for overall health and can lower your risk for sudden cardiac arrest. Aim for a Healthy Weight by following a heart-healthy eating plan and keeping physically active. + +Knowing your body mass index (BMI) helps you find out if youre a healthy weight in relation to your height and gives an estimate of your total body fat. To figure out your BMI, check out the National Heart, Lung, and Blood Institutes online BMI calculator or talk to your doctor. A BMI: + +Below 18.5 is a sign that you are underweight. + +Between 18.5 and 24.9 is in the normal range + +Between 25.0 and 29.9 is considered overweight + +Of 30.0 or higher is considered obese + +A general goal to aim for is a BMI of less than 25. Your doctor or health care provider can help you set an appropriate BMI goal. + +Measuring waist circumference helps screen for possible health risks. If most of your fat is around your waist rather than at your hips, youre at a higher risk for heart disease and type2 diabetes. This risk may be higher with a waist size that is greater than 35 inches for women or greater than 40 inches for men. To learn how to measure your waist, visit Assessing Your Weight and Health Risk. + +If youre overweight or obese, try to lose weight. A loss of just 3percent to 5percent of your current weight can lower your triglycerides, blood glucose, and the risk of developing type2 diabetes. Greater amounts of weight loss can improve blood pressure readings, lower LDL cholesterol, and increase HDL cholesterol. + +Managing Stress + +Managing and coping with stress. Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Consider healthy stress-reducing activities, such as: + +A stress management program + +Meditation + +Physical activity + +Relaxation therapy + +Talking things out with friends or family + +Physical Activity + +Regular physical activity can lower your risk for coronary heart disease, sudden cardiac arrest, and other health problems. Everyone should try to participate in moderate-intensity aerobic exercise at least 2hours and 30minutes per week or vigorous aerobic exercise for 1hour and 15minutes per week. Aerobic exercise, such as brisk walking, is any exercise in which your heart beats faster and you use more oxygen than usual. The more active you are, the more you will benefit. Participate in aerobic exercise for at least 10minutes at a time spread throughout the week. + +Talk with your doctor before you start a new exercise plan. Ask your doctor how much and what kinds of physical activity are safe for you. + +Read more about physical activity at: + +Physical Activity and Your Heart + +U.S. Department of Health and Human Services, 2008 Physical Activity Guidelines for Americans + +Quitting Smoking + +People who smoke are more likely to have a heart attack than are people who dont smoke. The risk of having a heart attack increases with the number of cigarettes smoked each day. Smoking also raises your risk for stroke and lung diseases, such as chronic obstructive pulmonary disease (COPD) and lung cancer. + +Quitting smoking can greatly reduce your risk for heart and lung diseases. Ask your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke. 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. Read more about how to quit smoking." +information,What is (are) Holes in the Heart ?,"Holes in the heart are simple congenital (kon-JEN-ih-tal) heart defects. Congenital heart defects are problems with the heart's structure that are present at birth. These defects change the normal flow of blood through the heart. + +The heart has two sides, separated by an inner wall called the septum. With each heartbeat, the right side of the heart receives oxygen-poor blood from the body and pumps it to the lungs. The left side of the heart receives oxygen-rich blood from the lungs and pumps it to the body. + +The septum prevents mixing of blood between the two sides of the heart. However, some babies are born with holes in the upper or lower septum. + +A hole in the septum between the heart's two upper chambers is called an atrial septal defect (ASD). A hole in the septum between the heart's two lower chambers is called a ventricular septal defect (VSD). + +ASDs and VSDs allow blood to pass from the left side of the heart to the right side. Thus, oxygen-rich blood mixes with oxygen-poor blood. As a result, some oxygen-rich blood is pumped to the lungs instead of the body. + +Over the past few decades, the diagnosis and treatment of ASDs and VSDs have greatly improved. Children who have simple congenital heart defects can survive to adulthood. They can live normal, active lives because their heart defects close on their own or have been repaired." +causes,What causes Holes in the Heart ?,"Mothers of children who are born with atrial septal defects (ASDs), ventricular septal defects (VSDs), or other heart defects may think they did something wrong during their pregnancies. However, most of the time, doctors don't know why congenital heart defects occur. + +Heredity may play a role in some heart defects. For example, a parent who has a congenital heart defect is slightly more likely than other people to have a child who has the problem. Very rarely, more than one child in a family is born with a heart defect. + +Children who have genetic disorders, such as Down syndrome, often have congenital heart defects. Half of all babies who have Down syndrome have congenital heart defects. + +Smoking during pregnancy also has been linked to several congenital heart defects, including septal defects. + +Scientists continue to search for the causes of congenital heart defects." +symptoms,What are the symptoms of Holes in the Heart ?,"Atrial Septal Defect + +Many babies who are born with atrial septal defects (ASDs) have no signs or symptoms. However, as they grow, these children may be small for their age. + +When signs and symptoms do occur, a heart murmur is the most common. A heart murmur is an extra or unusual sound heard during a heartbeat. + +Often, a heart murmur is the only sign of an ASD. However, not all murmurs are signs of congenital heart defects. Many healthy children have heart murmurs. Doctors can listen to heart murmurs and tell whether they're harmless or signs of heart problems. + +If a large ASD isn't repaired, the extra blood flow to the right side of the heart can damage the heart and lungs and cause heart failure. This generally doesn't occur until adulthood. Signs and symptoms of heart failure include: + +Fatigue (tiredness) + +Tiring easily during physical activity + +Shortness of breath + +A buildup of blood and fluid in the lungs + +Swelling in the ankles, feet, legs, abdomen, and veins in the neck + +Ventricular Septal Defect + +Babies born with ventricular septal defects (VSDs) usually have heart murmurs. Murmurs may be the first and only sign of a VSD. Heart murmurs often are present right after birth in many infants. However, the murmurs may not be heard until the babies are 6 to 8 weeks old. + +Most newborns who have VSDs don't have heart-related symptoms. However, babies who have medium or large VSDs can develop heart failure. Signs and symptoms of heart failure usually occur during the baby's first 2 months of life. + +The signs and symptoms of heart failure due to VSD are similar to those listed above for ASD, but they occur in infancy. + +A major sign of heart failure in infancy is poor feeding and growth. VSD signs and symptoms are rare after infancy. This is because the defects either decrease in size on their own or they're repaired." +exams and tests,How to diagnose Holes in the Heart ?,"Doctors usually diagnose holes in the heart based on a physical exam and the results from tests and procedures. The exam findings for an atrial septal defect (ASD) often aren't obvious. Thus, the diagnosis sometimes isn't made until later in childhood or even in adulthood. + +Ventricular septal defects (VSDs) cause a very distinct heart murmur. Because of this, a diagnosis usually is made in infancy. + +Specialists Involved + +Doctors who specialize in diagnosing and treating heart problems are called cardiologists. Pediatric cardiologists take care of babies and children who have heart problems. Cardiac surgeons repair heart defects using surgery. + +Physical Exam + +During a physical exam, your child's doctor will listen to your child's heart and lungs with a stethoscope. The doctor also will look for signs of a heart defect, such as a heart murmur or signs of heart failure. + +Diagnostic Tests and Procedures + +Your child's doctor may recommend several tests to diagnose an ASD or VSD. These tests also will help the doctor figure out the location and size of the defect. + +Echocardiography + +Echocardiography (echo) is a painless test that uses sound waves to create a moving picture of the heart. The sound waves (called ultrasound) bounce off the structures of the heart. A computer converts the sound waves into pictures on a screen. + +Echo allows the doctor to clearly see any problem with the way the heart is formed or the way it's working. + +Echo is an important test for both diagnosing a hole in the heart and following the problem over time. Echo can show problems with the heart's structure and how the heart is reacting to the problems. This test will help your child's cardiologist decide whether and when treatment is needed. + +EKG (Electrocardiogram) + +An EKG is a simple, painless test that records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through the heart. + +An EKG can detect whether one of the heart's chambers is enlarged, which can help diagnose a heart problem. + +Chest X Ray + +A chest x ray is a painless test that creates pictures of the structures in the chest, such as the heart, lungs, and blood vessels. + +This test can show whether the heart is enlarged. A chest x ray also can show whether the lungs have extra blood flow or extra fluid, a sign of heart failure. + +Pulse Oximetry + +Pulse oximetry shows the level of oxygen in the blood. A small sensor is attached to a finger or ear. The sensor uses light to estimate how much oxygen is in the blood. + +Cardiac Catheterization + +During cardiac catheterization (KATH-e-ter-i-ZA-shun), a thin, flexible tube called a catheter is put into a vein in the arm, groin (upper thigh), or neck. The tube is threaded to the heart. + +Special dye is injected through the catheter into a blood vessel or one of the heart's chambers. The dye allows the doctor to see the flow of blood through the heart and blood vessels on an x-ray image. + +The doctor also can use cardiac catheterization to measure the pressure inside the heart chambers and blood vessels. This can help the doctor figure out whether blood is mixing between the two sides of the heart. + +Doctors also use cardiac catheterization to repair some heart defects. For more information, go to ""How Are Holes in the Heart Treated?""" +treatment,What are the treatments for Holes in the Heart ?,"Many holes in the heart don't need treatment, but some do. Those that do often are repaired during infancy or early childhood. Sometimes adults are treated for holes in the heart if problems develop. + +The treatment your child receives depends on the type, location, and size of the hole. Other factors include your child's age, size, and general health. + +Treating an Atrial Septal Defect + +If a child has an atrial septal defect (ASD), routine checkups are done to see whether it closes on its own. About half of all ASDs close on their own over time, and about 20 percent close within the first year of life. + +Your child's doctor will let you know how often your child should have checkups. For an ASD, frequent checkups aren't needed. + +If an ASD requires treatment, catheter or surgical procedures are used to close the hole. Doctors often decide to close ASDs in children who still have medium- or large-sized holes by the time they're 2 to 5 years old. + +Catheter Procedure + +Until the early 1990s, surgery was the usual method for closing all ASDs. Now, thanks to medical advances, doctors can use catheter procedures to close secundum ASDs. These are the most common type of ASD. + +Before a catheter procedure, your child is given medicine so he or she will sleep and not feel any pain. Then, the doctor inserts a catheter (a thin, flexible tube) into a vein in the groin (upper thigh). He or she threads the tube to the heart's septum. A device made up of two small disks or an umbrella-like device is attached to the catheter. + +When the catheter reaches the septum, the device is pushed out of the catheter. The device is placed so that it plugs the hole between the atria. It's secured in place and the catheter is withdrawn from the body. + +Within 6 months, normal tissue grows in and over the device. The closure device does not need to be replaced as the child grows. + +Doctors often use echocardiography (echo), transesophageal (tranz-ih-sof-uh-JEE-ul) echo (TEE), and coronary angiography (an-jee-OG-rah-fee) to guide them in threading the catheter to the heart and closing the defect. TEE is a special type of echo that takes pictures of the heart through the esophagus. The esophagus is the passage leading from the mouth to the stomach. + +Catheter procedures are much easier on patients than surgery. They involve only a needle puncture in the skin where the catheter is inserted. This means that recovery is faster and easier. + +The outlook for children having this procedure is excellent. Closures are successful in more than 9 out of 10 patients, with no major leakage. Rarely, a defect is too large for catheter closure and surgery is needed. + +Surgery + +Open-heart surgery generally is done to repair primum or sinus venosus ASDs. Before the surgery, your child is given medicine so he or she will sleep and not feel any pain. + +Then, the cardiac surgeon makes an incision (cut) in the chest to reach the ASD. He or she repairs the defect with a special patch that covers the hole. A heart-lung bypass machine is used during the surgery so the surgeon can open the heart. The machine takes over the heart's pumping action and moves blood away from the heart. + +The outlook for children who have ASD surgery is excellent. On average, children spend 3 to 4 days in the hospital before going home. Complications, such as bleeding and infection, are very rare. + +In some children, the outer lining of the heart may become inflamed. This condition is called pericarditis (PER-i-kar-DI-tis). The inflammation causes fluid to collect around the heart in the weeks after surgery. Medicine usually can treat this condition. + +While in the hospital, your child will be given medicine as needed to reduce pain or anxiety. The doctors and nurses at the hospital will teach you how to care for your child at home. + +They will talk about preventing blows to the chest as the incision heals, limiting activity while your child recovers, bathing, scheduling ongoing care, and deciding when your child can go back to his or her regular activities. + +Treating a Ventricular Septal Defect + +Doctors may choose to monitor children who have ventricular septal defects (VSDs) but no symptoms of heart failure. This means regular checkups and tests to see whether the defect closes on its own or gets smaller. + +More than half of VSDs eventually close, usually by the time children are in preschool. Your child's doctor will let you know how often your child needs checkups. Checkups may range from once a month to once every 1 or 2 years. + +If treatment for a VSD is required, options include extra nutrition and surgery to close the VSD. Doctors also can use catheter procedures to close some VSDs. They may use this approach if surgery isn't possible or doesn't work. More research is needed to find out the risks and benefits of using catheter procedures to treat VSDs. + +Extra Nutrition + +Some infants who have VSDs don't grow and develop or gain weight as they should. These infants usually: + +Have large VSDs + +Are born too early + +Tire easily during feeding + +Doctors usually recommend extra nutrition or special feedings for these infants. These feedings are high-calorie formulas or breast milk supplements that give babies extra nourishment. + +Some infants need tube feeding. A small tube is inserted into the mouth and moved down into the stomach. Food is given through the tube. + +Tube feeding can add to or take the place of bottle feeding. This treatment often is short-term because a VSD that causes symptoms will likely require surgery. + +Surgery + +Most doctors recommend surgery to close large VSDs that are causing symptoms, affecting the aortic valve, or haven't closed by the time children are 1 year old. Surgery may be needed earlier if: + +A child doesn't gain weight + +Medicines are needed to control the symptoms of heart failure + +Rarely, medium-sized VSDs that are causing enlarged heart chambers are treated with surgery after infancy. However, most VSDs that require surgery are repaired in the first year of life. Doctors use open-heart surgery and patches to close VSDs." +information,What is (are) Congenital Heart Defects ?,"Congenital (kon-JEN-ih-tal) heart defects are problems with the heart's structure that are present at birth. These defects can involve: + +The interior walls of the heart + +The valves inside the heart + +The arteries and veins that carry blood to the heart or the body + +Congenital heart defects change the normal flow of blood through the heart. + +There are many types of congenital heart defects. They range from simple defects with no symptoms to complex defects with severe, life-threatening symptoms. + +Congenital heart defects are the most common type of birth defect. They affect 8 out of every 1,000 newborns. Each year, more than 35,000 babies in the United States are born with congenital heart defects. + +Many of these defects are simple conditions. They need no treatment or are easily fixed. Some babies are born with complex congenital heart defects. These defects require special medical care soon after birth. + +The diagnosis and treatment of complex heart defects has greatly improved over the past few decades. As a result, almost all children who have complex heart defects survive to adulthood and can live active, productive lives. + +Most people who have complex heart defects continue to need special heart care throughout their lives. They may need to pay special attention to how their condition affects issues such as health insurance, employment, birth control and pregnancy, and other health issues. + +In the United States, more than 1 million adults are living with congenital heart defects." +causes,What causes Congenital Heart Defects ?,"If your child has a congenital heart defect, you may think you did something wrong during your pregnancy to cause the problem. However, doctors often don't know why congenital heart defects occur. + +Heredity may play a role in some heart defects. For example, a parent who has a congenital heart defect may be more likely than other people to have a child with the defect. Rarely, more than one child in a family is born with a heart defect. + +Children who have genetic disorders, such as Down syndrome, often have congenital heart defects. In fact, half of all babies who have Down syndrome have congenital heart defects. + +Smoking during pregnancy also has been linked to several congenital heart defects, including septal defects. + +Researchers continue to search for the causes of congenital heart defects." +symptoms,What are the symptoms of Congenital Heart Defects ?,"Many congenital heart defects cause few or no signs and symptoms. A doctor may not even detect signs of a heart defect during a physical exam. + +Some heart defects do cause signs and symptoms. They depend on the number, type, and severity of the defects. Severe defects can cause signs and symptoms, usually in newborns. These signs and symptoms may include: + +Rapid breathing + +Cyanosis (a bluish tint to the skin, lips, and fingernails) + +Fatigue (tiredness) + +Poor blood circulation + +Congenital heart defects don't cause chest pain or other painful symptoms. + +Heart defects can cause heart murmurs (extra or unusual sounds heard during a heartbeat). Doctors can hear heart murmurs using a stethoscope. However, not all murmurs are signs of congenital heart defects. Many healthy children have heart murmurs. + +Normal growth and development depend on a normal workload for the heart and normal flow of oxygen-rich blood to all parts of the body. Babies who have congenital heart defects may have cyanosis and tire easily while feeding. As a result, they may not gain weight or grow as they should. + +Older children who have congenital heart defects may get tired easily or short of breath during physical activity. + +Many types of congenital heart defects cause the heart to work harder than it should. With severe defects, this can lead to heart failure. Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. Symptoms of heart failure include: + +Shortness of breath or trouble breathing + +Fatigue with physical activity + +A buildup of blood and fluid in the lungs + +Swelling in the ankles, feet, legs, abdomen, and veins in the neck" +exams and tests,How to diagnose Congenital Heart Defects ?,"Severe congenital heart defects generally are diagnosed during pregnancy or soon after birth. Less severe defects often aren't diagnosed until children are older. + +Minor defects often have no signs or symptoms. Doctors may diagnose them based on results from a physical exam and tests done for another reason. + +Specialists Involved + +Pediatric cardiologists are doctors who specialize in the care of babies and children who have heart problems. Cardiac surgeons are specialists who repair heart defects using surgery. + +Physical Exam + +During a physical exam, the doctor will: + +Listen to your child's heart and lungs with a stethoscope + +Look for signs of a heart defect, such as cyanosis (a bluish tint to the skin, lips, or fingernails), shortness of breath, rapid breathing, delayed growth, or signs of heart failure + +Diagnostic Tests + +Echocardiography + +Echocardiography (echo) is a painless test that uses sound waves to create a moving picture of the heart. During the test, the sound waves (called ultrasound) bounce off the structures of the heart. A computer converts the sound waves into pictures on a screen. + +Echo allows the doctor to clearly see any problem with the way the heart is formed or the way it's working. + +Echo is an important test for both diagnosing a heart problem and following the problem over time. The test can show problems with the heart's structure and how the heart is reacting to those problems. Echo will help your child's cardiologist decide if and when treatment is needed. + +During pregnancy, if your doctor suspects that your baby has a congenital heart defect, fetal echo can be done. This test uses sound waves to create a picture of the baby's heart while the baby is still in the womb. + +Fetal echo usually is done at about 18 to 22 weeks of pregnancy. If your child is diagnosed with a congenital heart defect before birth, your doctor can plan treatment before the baby is born. + +EKG (Electrocardiogram) + +An EKG is a simple, painless test that 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 the heart. + +An EKG can detect if one of the heart's chambers is enlarged, which can help diagnose a heart problem. + +Chest X Ray + +A chest x ray is a painless test that creates pictures of the structures in the chest, such as the heart and lungs. This test can show whether the heart is enlarged. It also can show whether the lungs have extra blood flow or extra fluid, a sign of heart failure. + +Pulse Oximetry + +For this test, a small sensor is attached to a finger or toe (like an adhesive bandage). The sensor gives an estimate of how much oxygen is in the blood. + +Cardiac Catheterization + +During cardiac catheterization (KATH-e-ter-ih-ZA-shun), a thin, flexible tube called a catheter is put into a vein in the arm, groin (upper thigh), or neck. The tube is threaded to the heart. + +Special dye is injected through the catheter into a blood vessel or one of the hearts chambers. The dye allows the doctor to see blood flowing through the heart and blood vessels on an x-ray image. + +The doctor also can use cardiac catheterization to measure the pressure and oxygen level inside the heart chambers and blood vessels. This can help the doctor figure out whether blood is mixing between the two sides of the heart. + +Cardiac catheterization also is used to repair some heart defects." +treatment,What are the treatments for Congenital Heart Defects ?,"Although many children who have congenital heart defects don't need treatment, some do. Doctors repair congenital heart defects with catheter procedures or surgery. + +Sometimes doctors combine catheter and surgical procedures to repair complex heart defects, which may involve several kinds of defects. + +The treatment your child receives depends on the type and severity of his or her heart defect. Other factors include your child's age, size, and general health. + +Some children who have complex congenital heart defects may need several catheter or surgical procedures over a period of years, or they may need to take medicines for years. + +Catheter Procedures + +Catheter procedures are much easier on patients than surgery. They involve only a needle puncture in the skin where the catheter (thin, flexible tube) is inserted into a vein or an artery. + +Doctors don't have to surgically open the chest or operate directly on the heart to repair the defect(s). This means that recovery may be easier and quicker. + +The use of catheter procedures has increased a lot in the past 20 years. They have become the preferred way to repair many simple heart defects, such as atrial septal defect (ASD) and pulmonary valve stenosis. + +For ASD repair, the doctor inserts a catheter into a vein in the groin (upper thigh). He or she threads the tube to the heart's septum. A device made up of two small disks or an umbrella-like device is attached to the catheter. + +When the catheter reaches the septum, the device is pushed out of the catheter. The device is placed so that it plugs the hole between the atria. Its secured in place and the catheter is withdrawn from the body. + +Within 6 months, normal tissue grows in and over the device. The closure device does not need to be replaced as the child grows. + +For pulmonary valve stenosis, the doctor inserts a catheter into a vein and threads it to the hearts pulmonary valve. A tiny balloon at the end of the catheter is quickly inflated to push apart the leaflets, or ""doors,"" of the valve. + +Then, the balloon is deflated and the catheter and ballon are withdrawn. This procedure can be used to repair any narrowed valve in the heart. + +To help guide the catheter, doctors often use echocardiography (echo), transesophageal (tranz-ih-sof-uh-JEE-ul) echo (TEE), and coronary angiography (an-jee-OG-rah-fee). + +TEE is a special type of echo that takes pictures of the heart through the esophagus. The esophagus is the passage leading from the mouth to the stomach. Doctors also use TEE to examine complex heart defects. + +Surgery + +A child may need open-heart surgery if his or her heart defect can't be fixed using a catheter procedure. Sometimes one surgery can repair the defect completely. If that's not possible, the child may need more surgeries over months or years to fix the problem. + +Cardiac surgeons may use open-heart surgery to: + +Close holes in the heart with stitches or a patch + +Repair or replace heart valves + +Widen arteries or openings to heart valves + +Repair complex defects, such as problems with the location of blood vessels near the heart or how they are formed + +Rarely, babies are born with multiple defects that are too complex to repair. These babies may need heart transplants. In this procedure, the child's heart is replaced with a healthy heart from a deceased child. The heart has been donated by the deceased childs family." +causes,What causes Heart Disease in Women ?,"Research suggests thatcoronary heart disease(CHD) begins with damage to the lining and inner layers of the coronary (heart) arteries. Several factors contribute to this damage. They include: + +Smoking, including secondhand smoke + +High amounts of certain fats andcholesterol in the blood + +High blood pressure + +High amounts of sugar in the blood due to insulin resistance or diabetes + +Blood vessel inflammation + +Plaque may begin to build up where the arteries are damaged. The buildup of plaque in the coronary arteries may start in childhood. + +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 calledangina. + +If the plaque ruptures, blood cell fragments called platelets (PLATE-lets) stick to the site of the injury. They may clump together to form blood clots. + +Blood clots can further narrow the coronary arteries and worsenangina. If a clot becomes large enough, it can mostly or completely block a coronary artery and cause a heart attack. + +In addition to the factors above, low estrogen levels before or after menopause may play a role in causingcoronary microvascular disease(MVD). Coronary MVD is heart disease that affects the heart's tiny arteries. + +The cause of broken heart syndrome isn't yet known. However, a sudden release of stress hormones may play a role in causing the disorder. Most cases of broken heart syndrome occur in women who have gone through menopause." +susceptibility,Who is at risk for Heart Disease in Women? ?,"Certain traits, conditions, or habits may raise your risk forcoronary heart disease(CHD). These conditions are known as risk factors. Risk factors also increase the chance that existing CHD will worsen. + +Women generally have the same CHD risk factors as men. However, some risk factors may affect women differently than men. For example, diabetes raises the risk of CHD more in women. Also, some risk factors, such as birth control pills and menopause, only affect women. + +There are many known CHD risk factors. Your risk for CHD andheart attackrises with the number of risk factors you have and their severity. Risk factors tend to ""gang up"" and worsen each other's effects. + +Having just one risk factor doubles your risk for CHD. Having two risk factors increases your risk for CHD fourfold. Having three or more risk factors increases your risk for CHD more than tenfold. + +Also, some risk factors, such as smoking and diabetes, put you at greater risk for CHD and heart attack than others. + +More than 75 percent of women aged 40 to 60 have one or more risk factors for CHD. Many risk factors start during childhood; some even develop within the first 10 years of life. You can control most risk factors, but some you can't. + +For more information about CHD risk factors, go to the Health Topics Coronary Heart Disease Risk Factorsarticle. To find out whether you're at risk for CHD, talk with your doctor or health care provider. + +Risk Factors You Can Control + +Smoking + +Smoking is the most powerful risk factor that women can control. Smoking tobacco or long-term exposure to secondhand smoke raises your risk for CHD and heart attack. + +Smoking exposes you to carbon monoxide. This chemical robs your blood of oxygen and triggers a buildup of plaque in your arteries. + +Smoking also increases the risk of blood clots forming in your arteries. Blood clots can block plaque-narrowed arteries and cause a heart attack. The more you smoke, the greater your risk for a heart attack. + +Even women who smoke fewer than two cigarettes a day are at increased risk for CHD. + +High Blood Cholesterol and High Triglyceride Levels + +Cholesterol travels in the bloodstream in small packages called lipoproteins (LI-po-pro-teens). The two major kinds of lipoproteins are low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol. + +LDL cholesterol is sometimes called ""bad"" cholesterol. This is because it carries cholesterol to tissues, including your heart arteries. HDL cholesterol is sometimes called ""good"" cholesterol. This is because it helps remove cholesterol from your arteries. + +A blood test called a lipoprotein panel is used to measure cholesterol levels. This test gives information about your total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides (a type of fat found in the blood). + +Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood. A woman's risk for CHD increases if she has a total cholesterol level greater than 200 mg/dL, an LDL cholesterol level greater than 100 mg/dL, or an HDL cholesterol level less than 50 mg/dL. + +A triglyceride level greater than 150 mg/dL also increases a woman's risk for CHD. A woman's HDL cholesterol and triglyceride levels predict her risk for CHD better than her total cholesterol or LDL cholesterol levels. + +High Blood Pressure + +Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps blood. If this pressure rises and stays high over time, it can damage the body in many ways. + +Women who have blood pressure greater than 120/80 mmHg are at increased risk for CHD. (The mmHg is millimeters of mercurythe units used to measure blood pressure.) + +High blood pressure is defined differently for people who have diabetes or chronic kidney disease. If you have one of these diseases, work with your doctor to set a healthy blood pressure goal. + +Diabetes and Prediabetes + +Diabetes is a disease in which the body's blood sugar level is too high. This is because the body doesn't make enough insulin or doesn't use its insulin properly. + +Insulin is a hormone that helps move blood sugar into cells, where it's used for energy. Over time, a high blood sugar level can lead to increased plaque buildup in your arteries. + +Prediabetes is a condition in which your blood sugar level is higher than normal, but not as high as it is in diabetes. Prediabetes puts you at higher risk for both diabetes and CHD. + +Diabetes and prediabetes raise the risk of CHD more in women than in men. In fact, having diabetes doubles a woman's risk of developing CHD. + +Before menopause, estrogen provides women some protection against CHD. However, in women who have diabetes, the disease counters the protective effects of estrogen. + +Overweight and Obesity + +The terms ""overweight"" and ""obesity"" refer to body weight that's greater than what is considered healthy for a certain height. + +The most useful measure of overweight and obesity is body mass index (BMI). BMI is calculated from your height and weight. In adults, a BMI of 18.5 to 24.9 is considered normal. A BMI of 25 to 29.9 is considered overweight. A BMI of 30 or more is considered obese. + +You can use the National Heart, Lung, and Blood Institute's (NHLBI's) online BMI calculator to figure out your BMI, or your doctor can help you. + +Studies suggest that where extra weight occurs on the body may predict CHD risk better than BMI. Women who carry much of their fat around the waist are at greatest risk for CHD. These women have ""apple-shaped"" figures. + +Women who carry most of their fat on their hips and thighsthat is, those who have ""pear-shaped"" figuresare at lower risk for CHD. + +To fully know how excess weight affects your CHD risk, you should know your BMI and waist measurement. If you have a BMI greater than 24.9 and a waist measurement greater than 35 inches, you're at increased risk for CHD. + +If your waist measurement divided by your hip measurement is greater than 0.9, you're also at increased risk for CHD. + +Studies also suggest that women whose weight goes up and down dramatically (typically due to unhealthy dieting) are at increased risk for CHD. These swings in weight can lower HDL cholesterol levels. + +Metabolic Syndrome + +Metabolic syndromeis the name for a group of risk factors that raises your risk for CHD and other health problems, such as diabetes and stroke. A diagnosis of metabolic syndrome is made if you have at least three of the following risk factors: + +A large waistline. Having extra fat in the waist area is a greater risk factor for CHD than having extra fat in other parts of the body, such as on the hips. + +A higher than normal triglyceride level (or you're on medicine to treat high triglycerides). + +A lower than normal HDL cholesterol level (or you're on medicine to treat low HDL cholesterol). + +Higher than normal blood pressure (or you're on medicine to treat high blood pressure). + +Higher than normal fasting blood sugar (or you're on medicine to treat diabetes) + +Metabolic syndrome is more common in African American women and Mexican American women than in men of the same racial groups. The condition affects White women and men about equally. + +Birth Control Pills + +Women who smoke and take birth control pills are at very high risk for CHD, especially if they're older than 35. For women who take birth control pills but don't smoke, the risk of CHD isn't fully known. + +Lack of Physical Activity + +Inactive people are nearly twice as likely to develop CHD as those who are physically active. A lack of physical activity can worsen other CHD risk factors, such as high blood cholesterol and triglyceride levels, high blood pressure, diabetes and prediabetes, and overweight and obesity. + +Unhealthy Diet + +An unhealthy diet can raise your risk for CHD. For example, foods that are high in saturated and trans fats and cholesterol raise your LDL cholesterol level. A high-sodium (salt) diet can raise your risk for high blood pressure. + +Foods with added sugars will give you extra calories without nutrients, such as vitamins and minerals. This can cause you to gain weight, which raises your risk for CHD. + +Too much alcohol also can cause you to gain weight, and it will raise your blood pressure. + +Stress or Depression + +Stress may play a role in causing CHD. Stress can trigger your arteries to narrow. This can raise your blood pressure and your risk for a heart attack. + +Getting upset or angry also can trigger a heart attack. Stress also may indirectly raise your risk for CHD if it makes you more likely to smoke or overeat foods high in fat and sugar. + +People who are depressed are two to three times more likely to develop CHD than people who are not. Depression is twice as common in women as in men. + +Anemia + +Anemia (uh-NEE-me-eh) is a condition in which your blood has a lower than normal number of red blood cells. + +The condition also can occur if your red blood cells don't contain enough hemoglobin (HEE-muh-glow-bin). Hemoglobin is an iron-rich protein that carries oxygen from your lungs to the rest of your organs. + +If you have anemia, your organs don't get enough oxygen-rich blood. This causes your heart to work harder, which may raise your risk for CHD. + +Anemia has many causes. For more information, go to the Health Topics Anemiaarticle. + +Sleep Apnea + +Sleep apneais a common disorder that causes pauses in breathing or shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an hour. + +Typically, normal breathing starts again after the pause, sometimes with a loud snort or choking sound. Major signs of sleep apnea are snoring and daytime sleepiness. + +When you stop breathing, the lack of oxygen triggers your body's stress hormones. This causes blood pressure to rise and makes the blood more likely to clot. + +Untreated sleep apnea can raise your risk for high blood pressure, diabetes, and even a heart attack or stroke. + +Women are more likely to develop sleep apnea after menopause. + +Risk Factors You Can't Control + +Age and Menopause + +As you get older, your risk for CHD and heart attack rises. This is due in part to the slow buildup of plaque inside your heart arteries, which can start during childhood. + +Before age 55, women have a lower risk for CHD than men. Estrogen provides women with some protection against CHD before menopause. After age 55, however, the risk of CHD increases in both women and men. + +You may have gone through early menopause, either naturally or because you had your ovaries removed. If so, you're twice as likely to develop CHD as women of the same age who aren't yet menopausal. + +Another reason why women are at increased risk for CHD after age 55 is that middle age is when you tend to develop other CHD risk factors. + +Women who have gone through menopause also are at increased risk for broken heart syndrome. (For more information, go to the section on emerging risk factors below.) + +Family History + +Family history plays a role in CHD risk. Your risk increases if your father or a brother was diagnosed with CHD before 55 years of age, or if your mother or a sister was diagnosed with CHD before 65 years of age. + +Also, a family history of strokeespecially a mother's stroke historycan help predict the risk of heart attack in women. + +Having a family history of CHD or stroke doesn't mean that you'll develop heart disease. This is especially true if your affected family member smoked or had other risk factors that were not well treated. + +Making lifestyle changes and taking medicines to treat risk factors often can lessen genetic influences and prevent or delay heart problems. + +Preeclampsia + +Preeclampsia (pre-e-KLAMP-se-ah) is a condition that develops during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine. + +These signs usually occur during the second half of pregnancy and go away after delivery. However, your risk of developing high blood pressure later in life increases after having preeclampsia. + +Preeclampsia also is linked to an increased lifetime risk of heart disease, including CHD, heart attack, and heart failure. (Likewise, having heart disease risk factors, such as diabetes or obesity, increases your risk for preeclampsia.) + +If you had preeclampsia during pregnancy, you're twice as likely to develop heart disease as women who haven't had the condition. You're also more likely to develop heart disease earlier in life. + +Preeclampsia is a heart disease risk factor that you can't control. However, if you've had the condition, you should take extra care to try and control other heart disease risk factors. + +The more severe your preeclampsia was, the greater your risk for heart disease. Let your doctor know that you had preeclampsia so he or she can assess your heart disease risk and how to reduce it. + +Emerging Risk Factors + +Research suggests that inflammation plays a role in causing CHD. Inflammation is the body's response to injury or infection. Damage to the arteries' inner walls seems to trigger inflammation and help plaque grow. + +High blood levels of a protein called C-reactive protein (CRP) are a sign of inflammation in the body. Research suggests that women who have high blood levels of CRP are at increased risk for heart attack. + +Also, some inflammatory diseases, such as lupus and rheumatoid arthritis, may increase the risk for CHD. + +Some studies suggest that women who have migraine headaches may be at greater risk for CHD. This is especially true for women who have migraines with auras (visual disturbances), such as flashes of light or zig-zag lines. + +Low bone density and low intake of folate and vitamin B6 also may raise a woman's risk for CHD. + +More research is needed to find out whether calcium supplements with or without vitamin D affect CHD risk. You may want to talk with your doctor to find out whether these types of supplements are right for you. + +Researchers are just starting to learn about broken heart syndrome risk factors. Most women who have this disorder are White and have gone through menopause. + +Many of these women have other heart disease risk factors, such as high blood pressure, high blood cholesterol, diabetes, and smoking. However, these risk factors tend to be less common in women who have broken heart syndrome than in women who have CHD." +symptoms,What are the symptoms of Heart Disease in Women ?,"The signs and symptoms ofcoronary heart disease(CHD) may differ between women and men. Some women who have CHD have no signs or symptoms. This is called silent CHD. + +Silent CHD may not be diagnosed until a woman has signs and symptoms of aheart attack, heart failure, or an arrhythmia(irregular heartbeat). + +Other women who have CHD will have signs and symptoms of the disease. + +Heart Disease Signs and Symptoms + + + +A common symptom of CHD isangina.Angina is chest pain or discomfort that occurs when your heart muscle doesn't get enough oxygen-rich blood. + +In men, angina often feels like pressure or squeezing in the chest. This feeling may extend to the arms. Women can also have these angina symptoms. But women also tend to describe a sharp, burning chest pain. Women are more likely to have pain in the neck, jaw, throat, abdomen, or back. + +In men, angina tends to worsen with physical activity and go away with rest. Women are more likely than men to have angina while they're resting or sleeping. + +In women who havecoronary microvascular disease, angina often occurs during routine daily activities, such as shopping or cooking, rather than while exercising. Mental stress also is more likely to trigger angina pain in women than in men. + +The severity of angina varies. The pain may get worse or occur more often as the buildup of plaque continues to narrow the coronary (heart) arteries. + +Signs and Symptoms Coronary Heart Disease Complications + +Heart Attack + +The most common heart attack symptom in men and women is chest pain or discomfort. However, only half of women who have heart attacks have chest pain. + +Women are more likely than men to report back or neck pain, indigestion, heartburn, nausea (feeling sick to the stomach), vomiting, extreme fatigue (tiredness), or problems breathing. + +Heart attacks also can cause upper body discomfort in one or both arms, the back, neck, jaw, or upper part of the stomach. Other heart attack symptoms are light-headedness and dizziness, which occur more often in women than men. + +Men are more likely than women to break out in a cold sweat and to report pain in the left arm during a heart attack. + +Heart Failure + +Heart failure is a condition in which your heart can't pump enough blood to meet your body's needs. Heart failure doesn't mean that your heart has stopped or is about to stop working. It means that your heart can't cope with the demands of everyday activities. + +Heart failure causes shortness of breath and fatigue that tends to increase with physical exertion. Heart failure also can cause swelling in the feet, ankles, legs, abdomen, and veins in the neck. + +Arrhythmia + +An arrhythmia 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. + +Some people describe arrhythmias as fluttering or thumping feelings or skipped beats in their chests. These feelings are calledpalpitations. + +Some arrhythmias can cause your heart to suddenly stop beating. This condition is calledsudden cardiac arrest(SCA). SCA causes loss of consciousness and death if it's not treated right away. + +Signs and Symptoms of Broken Heart Syndrome + +The most common signs and symptoms of broken heart syndrome are chest pain and shortness of breath. In this disorder, these symptoms tend to occur suddenly in people who have no history of heart disease. + +Arrhythmias orcardiogenic shockalso may occur. Cardiogenic shock is a condition in which a suddenly weakened heart isn't able to pump enough blood to meet the body's needs. + +Some of the signs and symptoms of broken heart syndrome differ from those of heart attack. For example, in people who have broken heart syndrome: + +Symptoms occur suddenly after having extreme emotional or physical stress. + +EKG (electrocardiogram) results don't look the same as the EKG results for a person having a heart attack. (An EKG is a test that records the heart's electrical activity.) + +Blood tests show no signs or mild signs of heart damage. + +Tests show no signs of blockages in the coronary arteries. + +Tests show ballooning and unusual movement of the lower left heart chamber (left ventricle). + +Recovery time is quick, usually within days or weeks (compared with the recovery time of a month or more for a heart attack)." +exams and tests,How to diagnose Heart Disease in Women ?,"Your doctor will diagnosecoronary heart disease(CHD) based on your medical and family histories, your risk factors, a physical exam, and the results from tests and procedures. + +No single test can diagnose CHD. If your doctor thinks you have CHD, he or she may recommend one or more of the following tests. + +EKG (Electrocardiogram) + +An EKGis 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 the heart. + +An EKG can show signs of heart damage due to CHD and signs of a previous or current heart attack. + +Stress Testing + +Duringstress 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 medicines to increase your heart rate. + +When your heart is working hard and beating fast, it needs more blood and oxygen. Plaque-narrowed coronary (heart) arteries can't supply enough oxygen-rich blood to meet your heart's needs. + +A stress test can show possible signs and symptoms of CHD, such as: + +Abnormal changes in your heart rate or blood pressure + +Shortness of breath or chest pain + +Abnormal changes in your heart rhythm or your heart's electrical activity + +If you can't exercise for as long as what is considered normal for someone your age, your heart may not be getting enough oxygen-rich blood. However, other factors also can prevent you from exercising long enough (for example, lung diseases,anemia, or poor general fitness). + +As part of some stress tests, pictures are taken of your heart while you exercise and while you rest. These imaging stress tests can show how well blood is flowing in your heart and how well your heart pumps blood when it beats. + +Echocardiography + +Echocardiography (echo) uses sound waves to create a moving picture of your heart. The test provides information about the size and shape of your heart and how well your heart 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. + +Chest X Ray + +Achest x raycreates pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels. + +A chest x ray can reveal signs ofheart failure, as well as lung disorders and other causes of symptoms not related to CHD. + +Blood Tests + +Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels may be a sign that you're at risk for CHD. Blood tests also help detectanemia,a risk factor for CHD. + +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. High levels of these proteins are a sign of a recent heart attack. + +Coronary Angiography and Cardiac Catheterization + +Your doctor may recommendcoronary angiography(an-jee-OG-rah-fee) if other tests or factors suggest you have CHD. This test uses dye and special x rays to look inside your coronary arteries. + +To get the dye into your coronary arteries, your doctor will use a procedure calledcardiac 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 your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels. + +Coronary angiography detects blockages in the large coronary arteries. However, the test doesn't detectcoronary microvascular disease(MVD). This is because coronary MVD doesn't cause blockages in the large coronary arteries. + +Even if the results of your coronary angiography are normal, you may still have chest pain or other CHD symptoms. If so, talk with your doctor about whether you might have coronary MVD. + +Your doctor may ask you to fill out a questionnaire called the Duke Activity Status Index. This questionnaire measures how easily you can do routine tasks. It gives your doctor information about how well blood is flowing through your coronary arteries. + +Your doctor also may recommend other tests that measure blood flow in the heart, such as acardiac MRI (magnetic resonance imaging) stress test. + +Cardiac MRI uses radio waves, magnets, and a computer to create pictures of your heart as it beats. The test produces both still and moving pictures of your heart and major blood vessels. + +Other tests done during cardiac catheterization can check blood flow in the heart's small arteries and the thickness of the artery walls. + +Tests Used To Diagnose Broken Heart Syndrome + +If your doctor thinks you have broken heart syndrome, he or she may recommend coronary angiography. Other tests are also used to diagnose this disorder, including blood tests, EKG, echo, and cardiac MRI." +treatment,What are the treatments for Heart Disease in Women ?,"Treatment forcoronary heart disease (CHD) usually is the same for both women and men. Treatment may include lifestyle changes, medicines, medical and surgical procedures, andcardiac rehabilitation(rehab). + +The goals of treatment are to: + +Relieve symptoms. + +Reduce risk factors in an effort to slow, stop, or reverse the buildup of plaque. + +Lower the risk of blood clots forming. (Blood clots can cause aheart attack.) + +Widen or bypass plaque-clogged coronary (heart) arteries. + +Prevent CHD complications. + +Lifestyle Changes + +Making lifestyle changes can help prevent or treat CHD. These changes may be the only treatment that some people need. + +Quit Smoking + +If you smoke or use tobacco, try to quit. Smoking can raise your risk for CHD and heart attack and worsen other CHD risk factors. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke. + +If you find it hard to quit smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit 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 (NHLBI's) ""Your Guide to a Healthy Heart."" + +Follow a Healthy Diet + +A healthy diet is an important part of a healthy lifestyle. A healthy diet includes a variety of vegetables and fruits. These foods can be fresh, canned, frozen, or dried. A good rule is to try to fill half of your plate with vegetables and fruits. + +A healthy diet 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. + +Choose and prepare foods with little sodium (salt). Too much salt can raise your risk for high blood pressure. Studies show that following the Dietary Approaches to Stop Hypertension (DASH) eating plan can lower blood pressure. + +Try to avoid foods and drinks that are high in added sugars. For example, drink water instead of sugary drinks, like soda. + +Also, try to limit the amount of solid fats and refined grains that you eat. 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). + +If you drink alcohol, do so in moderation. Research suggests that regularly drinking small to moderate amounts of alcohol may lower the risk of CHD. Women should have no more than one alcoholic drink a day. + +One drink a day can lower your CHD risk by raising your HDL cholesterol level. One drink is a glass of wine, beer, or a small amount of hard liquor. + +If you don't drink, this isn't a recommendation to start using alcohol. Also, you shouldn't drink if you're pregnant, if you're planning to become pregnant, or if you have another health condition that could make alcohol use harmful. + +Too much alcohol can cause you to gain weight and raise your blood pressure and triglyceride level. In women, even one drink a day may raise the risk of certain types of cancer. + +For more information about following a healthy diet, go to the NHLBI'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. + +Be Physically Active + +Regular physical activity can lower many CHD risk factors, including high LDL cholesterol,high blood pressure, and excess weight. + +Physical activity also can lower your risk for diabetes and raise your HDL cholesterol level. (HDL cholesterol helps remove cholesterol from your arteries.) + +Talk with your doctor before you start a new exercise plan. Ask him or her how much and what kinds of physical activity are safe for you. + +People gain health benefits from as little as 60 minutes of moderate-intensity aerobic activity per week. Walking is an excellent heart healthy exercise. The more active you are, the more you will benefit. + +For more information about physical activity, go to the U.S. Department of Health and Human Services' ""2008 Physical Activity Guidelines for Americans,"" the Health Topics Physical Activity and Your Heart article, and the NHLBI's ""Your Guide to Physical Activity and Your Heart."" + +Maintain a Healthy Weight + +Overweight and obesity are risk factors for CHD. If you're overweight or obese, try to lose weight. Cut back your calorie intake and do more physical activity. Eat smaller portions and choose lower calorie foods. Your health care provider may refer you to a dietitian to help you manage your weight. + +A BMI of less than 25 and a waist circumference of 35 inches or less is the goal for preventing and treating CHD. BMI measures your weight in relation to your height and gives an estimate of your total body fat. You can use the NHLBI's online BMI calculator to figure out your BMI, or your doctor can help you. + +To measure your waist, stand and place a tape measure around your middle, just above your hipbones. Measure your waist just after you breathe out. Make sure the tape is snug but doesn't squeeze the flesh. + +For more information about losing weight or maintaining a healthy weight, go to the NHLBI's Aim for a Healthy Weight Web site. + +Stress and Depression + +Research shows that getting upset or angry can trigger a heart attack. Also, some of the ways people cope with stresssuch as drinking, smoking, or overeatingaren't heart healthy. + +Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. + +Having supportive people in your life with whom you can share your feelings or concerns can help relieve stress. Physical activity, yoga, and relaxation therapy also can help relieve stress. You may want to consider taking part in a stress management program. + +Depression can double or triple your risk for CHD. Depression also makes it hard to maintain a heart healthy lifestyle. + +Talk with your doctor if you have symptoms of depression, such as feeling hopeless or not taking interest in daily activities. He or she may recommend counseling or prescribe medicines to help you manage the condition. + +Medicines + +You may need medicines to treat CHD if lifestyle changes aren't enough. Medicines can help: + +Reduce your heart's workload and relieve CHD symptoms + +Decrease your chance of having a heart attack or dying suddenly + +Lower your LDL cholesterol, blood pressure, and other CHD risk factors + +Prevent blood clots + +Prevent or delay the need for a procedure or surgery, such asangioplasty (AN-jee-oh-plas-tee) or coronary artery bypass grafting (CABG) + +Women who havecoronary microvascular disease and anemiamay benefit from taking medicine to treat the anemia. + +Women who have broken heart syndrome also may need medicines. Doctors may prescribe medicines to relieve fluid buildup, treat blood pressure problems, prevent blood clots, and manage stress hormones. Most people who have broken heart syndrome make a full recovery within weeks. + +Take all of your medicines as prescribed. If you have side effects or other problems related to your medicines, tell your doctor. He or she may be able to provide other options. + +Menopausal Hormone Therapy + +Recent studies have shown that menopausal hormone therapy (MHT) doesn't prevent CHD. Some studies have even shown that MHT increases women's risk for CHD, stroke, and breast cancer. + +However, these studies tested MHT on women who had been postmenopausal for at least several years. During that time, they could have already developed CHD. + +Research is ongoing to see whether MHT helps prevent CHD when taken right when menopause starts. While questions remain, current findings suggest MHT shouldn't routinely be used to prevent or treat CHD. + +Ask your doctor about other ways to prevent or treat CHD, including lifestyle changes and medicines. For more information about MHT, go to the NHLBI's Postmenopausal Hormone Therapy Web site. + +Procedures and Surgery + +You may need a procedure or surgery to treat CHD. Both angioplasty and CABG are used as treatments. You and your doctor can discuss which treatment is right for you. + +Percutaneous Coronary Intervention + +Percutaneous coronary intervention (PCI), commonly known as angioplasty (AN-jee-oh-plas-tee), is a nonsurgical procedure that opens blocked or narrowed coronary arteries. + +A thin, flexible tube with a balloon or other device on the end is threaded through a blood vessel 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. + +PCI can improve blood flow to your heart and relieve chest pain. A small mesh tube called a stent usually is placed in the artery to help keep it open after the procedure. + +For more information, go to the Health Topics PCI article. + +Coronary Artery Bypass Grafting + +CABG is a type of surgery. During CABG, a surgeon removes arteries or veins from other areas in your body and uses them to bypass (that is, go around) narrowed or blocked coronary arteries. + +CABG can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. + +For more information, go to the Health Topics Coronary Artery Bypass Grafting article. + +Cardiac Rehabilitation + +Your doctor may prescribe cardiac rehab foranginaor after angioplasty, CABG, or a heart attack. Almost everyone who has CHD can benefit from cardiac rehab. + +Cardiac rehab is a medically supervised program that can 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. + +Cardiac rehab has two parts: + +Exercise training. This part of rehab 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 lower your risk for future heart problems. The rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and with your fears about the future. + +For more information, go to the Health Topics Cardiac Rehabilitation article." +prevention,How to prevent Heart Disease in Women ?,"Taking action to control your risk factors can help prevent or delaycoronary heart disease(CHD). Your risk for CHD increases with the number of CHD risk factors you have. + +One step you can take is to adopt a heart healthy lifestyle. A heart healthy lifestyle should be part of a lifelong approach to healthy living. + +For example, if you smoke, try to quit. Smoking can raise your risk for CHD andheart attackand worsen other CHD risk factors. 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 and the National Heart, Lung, and Blood Institute's (NHLBI's) ""Your Guide to a Healthy Heart."" + +Following a healthy diet also is an important part of a healthy lifestyle. 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). + +The NHLBI's Therapeutic Lifestyle Changes (TLC) and Dietary Approaches to Stop Hypertension (DASH) are two programs that promote healthy eating. + +If you'reoverweight or obese, work with your doctor to create a reasonable weight-loss plan. Controlling your weight helps you control CHD risk factors. + +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."" + +Know your family history of CHD. If you or someone in your family has CHD, be sure to tell your doctor. + +If lifestyle changes aren't enough, you also may need medicines to control your CHD risk factors. Take all of your medicines as prescribed. + +For more information about lifestyle changes and medicines, go to ""How Is Heart Disease Treated?""" +information,What is (are) Coronary Heart Disease ?,"Espaol + +Coronary heart disease (CHD) is a disease in which a waxy substance called plaque builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle. + +When plaque builds up in the arteries, the condition is called atherosclerosis. The buildup of plaque occurs over many years. + +Atherosclerosis + + + +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. + +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. Over time, ruptured plaque also hardens and narrows the coronary arteries. + +Overview + +If the flow of oxygen-rich blood to your heart muscle is reduced or blocked, angina or a heart attack can occur. + +Angina is chest pain or discomfort. It may feel like pressure or squeezing in your chest. The pain also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. + +A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle is cut off. If blood flow isnt restored quickly, the section of heart muscle begins to die. Without quick treatment, a heart attack can lead to serious health problems or death. + +Over time, CHD can weaken the heart muscle and lead to heart failure and arrhythmias. Heart failure is a condition in which your heart can't pump enough blood to meet your bodys needs. Arrhythmias are problems with the rate or rhythm of the heartbeat. + +Outlook + +Lifestyle changes, medicines, and medical procedures can help prevent or treat coronary heart disease. These treatments may reduce the risk of related health problems." +causes,What causes Coronary Heart Disease ?,"Research suggests that coronary heart disease (CHD) starts when certain factors damage the inner layers of the coronary arteries. These factors include: + +Smoking + +High levels of certain fats and cholesterol in the blood + +High blood pressure + +High levels of sugar in the blood due to insulin resistance or diabetes + +Blood vessel inflammation + +Plaque might begin to build up where the arteries are damaged. The buildup of plaque in the coronary arteries may start in childhood. + +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 angina (chest pain or discomfort). + +If the plaque ruptures, blood cell fragments called platelets (PLATE-lets) stick to the site of the injury. They may clump together to form blood clots. + +Blood clots can further narrow the coronary arteries and worsen angina. If a clot becomes large enough, it can mostly or completely block a coronary artery and cause a heart attack." +susceptibility,Who is at risk for Coronary Heart Disease? ?,"In the United States, coronary heart disease (CHD) is a leading cause of death for both men and women. Each year, about 370,000 Americans die from coronary heart disease. + +Certain traits, conditions, or habits may raise your risk for CHD. The more risk factors you have, the more likely you are to develop the disease. + +You can control many risk factors, which may help prevent or delay CHD. + +Major Risk Factors + +Unhealthy blood cholesterol levels. This includes high LDL cholesterol (sometimes called bad cholesterol) and low HDL cholesterol (sometimes called good cholesterol). + +High blood pressure. Blood pressure is considered high if it stays at or above 140/90 mmHg over time. If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher. (The mmHg is millimeters of mercurythe units used to measure blood pressure.) + +Smoking. Smoking can damage and tighten blood vessels, lead to unhealthy cholesterol levels, and raise blood pressure. Smoking also can limit how much oxygen reaches the body's tissues. + +Insulin resistance. This condition occurs if the body can't use its own insulin properly. Insulin is a hormone that helps move blood sugar into cells where it's used for energy. Insulin resistance may lead to diabetes. + +Diabetes. With this disease, the body's blood sugar level is too high because the body doesn't make enough insulin or doesn't use its insulin properly. + +Overweight or obesity. The terms overweight and obesity refer to body weight thats greater than what is considered healthy for a certain height. + +Metabolic syndrome. Metabolic syndrome is the name for a group of risk factors that raises your risk for CHD and other health problems, such as diabetes and stroke. + +Lack of physical activity. Being physically inactive can worsen other risk factors for CHD, such as unhealthy blood cholesterol levels, high blood pressure, diabetes, and overweight or obesity. + +Unhealthy diet. An unhealthy diet can raise your risk for CHD. Foods that are high in saturated and trans fats, cholesterol, sodium, and sugar can worsen other risk factors for CHD. + +Older age. Genetic or lifestyle factors cause plaque to build up in your arteries as you age. In men, the risk for coronary heart disease increases starting at age 45. In women, the risk for coronary heart disease increases starting at age 55. + +A family history of early coronary heart disease is a risk factor for developing coronary heart disease, specifically if a father or brother is diagnosed before age 55, or a mother or sister is diagnosed before age 65. + +Although older age and a family history of early heart disease are risk factors, it doesn't mean that youll develop CHD if you have one or both. Controlling other risk factors often can lessen genetic influences and help prevent CHD, even in older adults. + +Emerging Risk Factors + +Researchers continue to study other possible risk factors for CHD. + +High levels of a protein called C-reactive protein (CRP) in the blood may raise the risk of CHD and heart attack. High levels of CRP are a sign of inflammation in the body. + +Inflammation is the body's response to injury or infection. Damage to the arteries' inner walls may trigger inflammation and help plaque grow. + +Research is under way to find out whether reducing inflammation and lowering CRP levels also can reduce the risk of CHD and heart attack. + +High levels of triglycerides in the blood also may raise the risk of CHD, especially in women. Triglycerides are a type of fat. + +Other Risks Related to Coronary Heart Disease + +Other conditions and factors also may contribute to CHD, including: + +Sleep apnea. Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. Untreated sleep apnea can increase your risk for high blood pressure, diabetes, and even a heart attack or stroke. + +Stress. Research shows that the most commonly reported ""trigger"" for a heart attack is an emotionally upsetting event, especially one involving anger. + +Alcohol. Heavy drinking can damage the heart muscle and worsen other CHD risk factors. Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. + +Preeclampsia. This condition can occur 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. + +For more detailed information, go to the Health Topics Coronary Heart Disease Risk Factors article." +symptoms,What are the symptoms of Coronary Heart Disease ?,"A common symptom of coronary heart disease (CHD) is angina. Angina is chest pain or discomfort that occurs if an area of your heart muscle doesn't get enough oxygen-rich blood. + +Angina may feel like pressure or squeezing in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. The pain tends to get worse with activity and go away with rest. Emotional stress also can trigger the pain. + +Another common symptom of CHD is shortness of breath. This symptom occurs if CHD causes heart failure. When you have heart failure, your heart can't pump enough blood to meet your bodys needs. Fluid builds up in your lungs, making it hard to breathe. + +The severity of these symptoms varies. They may get more severe as the buildup of plaque continues to narrow the coronary arteries. + +Signs and Symptoms of Heart Problems Related to Coronary Heart Disease + +Some people who have CHD have no signs or symptomsa condition called silent CHD. The disease might not be diagnosed until a person has signs or symptoms of a heart attack, heart failure, or an arrhythmia (an irregular heartbeat). + +Heart Attack + +A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle is cut off. This can happen if an area of plaque in a coronary artery ruptures (breaks open). + +Blood cell fragments called platelets stick to the site of the injury and may clump together to form blood clots. If a clot becomes large enough, it can mostly or completely block blood flow through a coronary artery. + +If the blockage isnt 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. + +Heart With Muscle Damage and a Blocked Artery + + + + + +The most common heart attack symptom is chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest that often lasts for more than a few minutes or goes away and comes back. + +The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. The feeling can be mild or severe. Heart attack pain sometimes feels like indigestion or heartburn. + +The symptoms of angina can be similar to the symptoms of a heart attack. Angina pain usually lasts for only a few minutes and goes away with rest. + +Chest pain or discomfort that doesnt go away or changes from its usual pattern (for example, occurs more often or while youre resting) might be a sign of a heart attack. If you dont know whether your chest pain is angina or a heart attack, call 911. + +All chest pain should be checked by a doctor. + +Other common signs and symptoms of a heart attack include: + +Upper body discomfort in one or both arms, the back, neck, jaw, or upper part of the stomach + +Shortness of breath, which may occur with or before chest discomfort + +Nausea (feeling sick to your stomach), vomiting, light-headedness or fainting, or breaking out in a cold sweat + +Sleep problems, fatigue (tiredness), or lack of energy + +For more information, go to the Health Topics Heart Attack article. + +Heart Failure + +Heart failure is a condition in which your heart can't pump enough blood to meet your bodys needs. Heart failure doesn't mean that your heart has stopped or is about to stop working. + +The most common signs and symptoms of heart failure are shortness of breath or trouble breathing; fatigue; and swelling in the ankles, feet, legs, stomach, 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. + +For more information, go to the Health Topics Heart Failure article. + +Arrhythmia + +An arrhythmia is a problem with the rate or rhythm of the heartbeat. When you have an arrhythmia, you may notice that your heart is skipping beats or beating too fast. + +Some people describe arrhythmias as a fluttering feeling in the chest. These feelings are called palpitations (pal-pih-TA-shuns). + +Some arrhythmias can cause your heart to suddenly stop beating. This condition is called sudden cardiac arrest (SCA). SCA usually causes death if it's not treated within minutes. + +For more information, go to the Health Topics Arrhythmia article." +exams and tests,How to diagnose Coronary Heart Disease ?,"Your doctor will diagnose coronary heart disease (CHD) based on your medical and family histories, your risk factors for CHD, a physical exam, and the results from tests and procedures. + +No single test can diagnose CHD. If your doctor thinks you have CHD, he or she may recommend one or more of the following tests. + +EKG (Electrocardiogram) + +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 the heart. + +An EKG can show signs of heart damage due to CHD and signs of a previous or current heart attack. + +Stress Testing + +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 raise your heart rate. + +When your heart is working hard and beating fast, it needs more blood and oxygen. Plaque-narrowed arteries can't supply enough oxygen-rich blood to meet your heart's needs. + +A stress test can show possible signs and symptoms of CHD, such as: + +Abnormal changes in your heart rate or blood pressure + +Shortness of breath or chest pain + +Abnormal changes in your heart rhythm or your heart's electrical activity + +If you can't exercise for as long as what is considered normal for someone your age, your heart may not be getting enough oxygen-rich blood. However, other factors also can prevent you from exercising long enough (for example, lung diseases, anemia, or poor general fitness). + +As part of some stress tests, pictures are taken of your heart while you exercise and while you rest. These imaging stress tests can show how well blood is flowing in your heart and how well your heart pumps blood when it beats. + +Echocardiography + +Echocardiography(echo) 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. + +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. + +Chest X Ray + +A chest x ray takes pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels. + +A chest x ray can reveal signs of heart failure, as well as lung disorders and other causes of symptoms not related to CHD. + +Blood Tests + +Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels might be a sign that you're at risk for CHD. + +Coronary Angiography and Cardiac Catheterization + +Your doctor may recommend coronary angiography (an-jee-OG-rah-fee) if other tests or factors show that you're likely to have CHD. This test 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 your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels. + +Cardiac catheterization usually is done in a hospital. You're awake during the procedure. It usually causes little or no pain, although you may feel some soreness in the blood vessel where your doctor inserts the catheter." +treatment,What are the treatments for Coronary Heart Disease ?,"Treatments for coronary heart disease include heart-healthy lifestyle changes, medicines, medical procedures and surgery, and cardiac rehabilitation. Treatment goals may include: + +Lowering the risk of blood clots forming (blood clots can cause a heart attack) + +Preventing complications of coronary heart disease + +Reducing risk factors in an effort to slow, stop, or reverse the buildup of plaque + +Relieving symptoms + +Widening or bypassing clogged arteries + + + +Heart-Healthy Lifestyle Changes + +Your doctor may recommend heart-healthy lifestyle changes if you have coronary heart disease. Heart-healthy lifestyle changes include: + +Heart-healthy eating + +Maintaining a healthy weight + +Managing stress + +Physical activity + +Quitting smoking + + + +Heart-Healthy Eating + +Your doctor may recommend heart-healthy eating, which should include: + +Fat-free or low-fat dairy products, such as fat-free milk + +Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week + +Fruits, such as apples, bananas, oranges, pears, and prunes + +Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans + +Vegetables, such as broccoli, cabbage, and carrots + +Whole grains, such as oatmeal, brown rice, and corn tortillas + +When following a heart-healthy diet, you should avoid eating: + +A lot of red meat + +Palm and coconut oils + +Sugary foods and beverages + +Two nutrients in your diet make blood cholesterol levels rise: + +Saturated fatfound mostly in foods that come from animals + +Trans fat (trans fatty acids)found in foods made with hydrogenated oils and fats, such as stick margarine; baked goods, such as cookies, cakes, and pies; crackers; frostings; and coffee creamers. Some trans fats also occur naturally in animal fats andmeats. + +Saturated fat raises your blood cholesterol more than anything else in your diet. When you follow a heart-healthy eating plan, only 5 percent to 6 percent of your daily calories should come from saturated fat. Food labels list the amounts of saturated fat. To help you stay on track, here are some examples: + +1,200 calories a day + +8 grams of saturated fat a day + +1,500 calories a day + +10 grams of saturated fat a day + +1,800 calories a day + +12 grams of saturated fat a day + +2,000 calories a day + +13 grams of saturated fat a day + +2,500 calories a day + +17 grams of saturated fat a day + +Not all fats are bad. Monounsaturated and polyunsaturated fats actually help lower blood cholesterol levels. + +Some sources of monounsaturated and polyunsaturated fats are: + +Avocados + +Corn, sunflower, and soybean oils + +Nuts and seeds, such as walnuts + +Olive, canola, peanut, safflower, and sesame oils + +Peanut butter + +Salmon and trout + +Tofu + +Sodium + +You should try to limit the amount of sodium that you eat. This means choosing and preparing foods that are lower in salt and sodium. Try to use low-sodium and no added salt foods and seasonings at the table or while cooking. Food labels tell you what you need to know about choosing foods that are lower in sodium. Try to eat no more than 2,300 milligrams of sodium a day. If you have high blood pressure, you may need to restrict your sodium intake even more. + +Dietary Approaches to Stop Hypertension + +Your doctor may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium and salt. The DASH eating plan is a good heart-healthy eating plan, even for those who dont have high blood pressure. Read more about DASH. + +Alcohol + +Try to limit alcohol intake. Too much alcohol canraise your blood pressure and triglyceride levels, a type of fat found in the blood. Alcohol also adds extra calories, which may cause weight gain. + +Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is: + +12 ounces of beer + +5 ounces of wine + +1 ounces of liquor + + + +Maintaining a Healthy Weight + +Maintaining a healthy weight is important for overall health and can lower your risk for coronary heart disease. Aim for a Healthy Weight by following a heart-healthy eating plan and keeping physically active. + +Knowing your body mass index (BMI) helps you find out if youre a healthy weight in relation to your height and gives an estimate of your total body fat. To figure out your BMI, check out the National Heart, Lung, and Blood Institutes (NHLBI) online BMI calculator or talk to your doctor. A BMI: + +Below 18.5 is a sign that you are underweight. + +Between 18.5 and 24.9 is in the normal range. + +Between 25 and 29.9 is considered overweight. + +Of 30 or more is considered obese. + +A general goal to aim for is a BMI of less than 25. Your doctor or health care provider can help you set an appropriate BMI goal. + +Measuring waist circumference helps screen for possible health risks. If most of your fat is around your waist rather than at your hips, youre at a higher risk for heart disease and type 2 diabetes. This risk may be high with a waist size that is greater than 35 inches for women or greater than 40 inches for men. To learn how to measure your waist, visit Assessing Your Weight and Health Risk. + +If youre overweight or obese, try to lose weight. A loss of just 3 percent to 5 percent of your current weight can lower your triglycerides, blood glucose, and the risk of developing type 2 diabetes. Greater amounts of weight loss can improve blood pressure readings, lower LDL cholesterol, and increase HDL cholesterol. + +Managing Stress + +Research shows that the most commonly reported trigger for a heart attack is an emotionally upsetting eventparticularly one involving anger. Also, some of the ways people cope with stresssuch as drinking, smoking, or overeatingarent healthy. + +Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Consider healthy stress-reducing activities, such as: + +A stress management program + +Meditation + +Physical activity + +Relaxation therapy + +Talking things out with friends or family + +Physical Activity + +Routine physical activity can lower many coronary heart disease risk factors, including LDL (bad) cholesterol, high blood pressure, and excess weight. Physical activity also can lower your risk for diabetes and raise your HDL cholesterol level. HDL is the good cholesterol that helps prevent coronary heart disease. + +Everyone should try to participate in moderate-intensity aerobic exercise at least 2hours and 30minutes per week, or vigorous aerobic exercise for 1hour and 15minutes per week. Aerobic exercise, such as brisk walking, is any exercise in which your heart beats faster and you use more oxygen than usual. The more active you are, the more you will benefit. Participate in aerobic exercise for at least 10 minutes at a time spread throughout the week. + +Read more about physical activity at: + +Physical Activity and Your Heart + +U.S. Department of Health and Human Services 2008 Physical Activity Guidelines forAmericans + +Talk with your doctor before you start a new exercise plan. Ask your doctor how much and what kinds of physical activity are safe for you. + +Quitting Smoking + +If you smoke, quit. Smoking can raise your risk for coronary heart disease and heart attack and worsen other coronary heart disease risk factors. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke. + +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. Read more about quitting smoking at Smoking and Your Heart. + + + +Medicines + +Sometimes lifestyle changes arent enough to control your blood cholesterol levels. For example, you may need statin medications to control or lower your cholesterol. By lowering your cholesterol level, you can decrease your chance of having a heart attack or stroke. Doctors usually prescribe statins for people who have: + +Coronary heart disease, peripheral artery disease, or had a stroke + +Diabetes + +High LDL cholesterol levels + +Doctors may discuss beginning statin treatment with those who have an elevated risk for developing heart disease or having a stroke. + +Your doctor also may prescribe other medications to: + +Decrease your chance of having a heart attack or dying suddenly. + +Lower your blood pressure. + +Prevent blood clots, which can lead to heart attack or stroke. + +Prevent or delay the need for a stent or percutaneous coronary intervention (PCI) or surgery, such as coronary artery bypass grafting (CABG). + +Reduce your hearts workload and relieve coronary heart disease symptoms. + +Take all medicines regularly, as your doctor prescribes. Dont change the amount of your medicine or skip a dose unless your doctor tells you to. You should still follow a heart healthy lifestyle, even if you take medicines to treat your coronary heart disease. + + + +Medical Procedures and Surgery + +You may need a procedure or surgery to treat coronary heart disease. Both PCIand CABG are used to treat blocked coronary arteries. You and your doctor can discuss which treatment is right for you. + +Percutaneous Coronary Intervention + +Percutaneous coronary intervention, commonly known as angioplasty, is a nonsurgical procedure that opens blocked or narrowed coronary arteries. A thin, flexible tube with a balloon or other device on the end is threaded through a blood vessel 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 angioplasty. Read more about this procedure at PCI. + +Coronary Artery Bypass Grafting + +CABG is a type of surgery in which arteries or veins from other areas in your body are used to bypass (that is, go around) your narrowed coronary arteries. CABG can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. + +Read more about this surgery at CABG. + +Cardiac Rehabilitation + +Your doctor may prescribe cardiac rehabilitation (rehab) for angina or after CABG, angioplasty, or a heart attack. Nearly everyone who has coronary heart disease can benefit from cardiac 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: + +Education, counseling, and training. This part of rehab helps you understand your heart condition and find ways to reduce your risk for future heart problems. The rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and how to deal with your fears about the future. + +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. + +Read more about this therapy at Cardiac Rehabilitation." +prevention,How to prevent Coronary Heart Disease ?,"You can prevent and control coronary heart disease (CHD)by taking action to control your risk factors with heart-healthy lifestyle changes and medicines. Examples of risk factors you can control include high blood cholesterol, high blood pressure, and overweight and obesity. Only a few risk factorssuch as age, gender, and family historycant be controlled. + +Your risk for CHD increases with the number of risk factors you have. To reduce your risk of CHD and heart attack, try to control each risk factor you have by adopting the following heart-healthy lifestyles: + +Heart-healthy eating + +Maintaining a healthy weight + +Managing stress + +Physical activity + +Quitting smoking + +Know your family history of health problems related to CHD. If you or someone in your family has CHD, be sure to tell your doctor. If lifestyle changes aren't enough, you also may need medicines to control your CHD risk factors." +information,What is (are) Arrhythmia ?,"Espaol + +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. + +A heartbeat that is too fast is called tachycardia (TAK-ih-KAR-de-ah). A heartbeat that is too slow is called bradycardia (bray-de-KAR-de-ah). + +Most arrhythmias are harmless, but some can be serious or even life threatening. During an arrhythmia, 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. + +Understanding the Heart's Electrical System + +To understand arrhythmias, it helps to understand the heart's internal electrical system. The heart's electrical system controls the rate and rhythm of the heartbeat. + +With each heartbeat, an electrical signal spreads from the top of the heart to the bottom. As the signal travels, it causes the heart to contract and pump blood. + +Each electrical signal begins in a group of cells called the sinus node or sinoatrial (SA) node. The SA node is located in the heart's upper right chamber, the right atrium (AY-tree-um). In a healthy adult heart at rest, the SA node fires off an electrical signal to begin a new heartbeat 60 to 100 times a minute. + +From the SA node, the electrical signal travels through special pathways in the right and left atria. This causes the atria to contract and pump blood into the heart's two lower chambers, the ventricles (VEN-trih-kuls). + +The electrical signal then moves down to a group of cells called the atrioventricular (AV) node, located between the atria and the ventricles. Here, the signal slows down just a little, allowing the ventricles time to finish filling with blood. + +The electrical signal then leaves the AV node and travels along a pathway called the bundle of His. This pathway divides into a right bundle branch and a left bundle branch. The signal goes down these branches to the ventricles, causing them to contract and pump blood to the lungs and the rest of the body. + +The ventricles then relax, and the heartbeat process starts all over again in the SA node. (For more information about the heart's electrical system, including detailed animations, go to the Health Topics How the Heart Works article.) + +A problem with any part of this process can cause an arrhythmia. For example, in atrial fibrillation (A-tre-al fi-bri-LA-shun), a common type of arrhythmia, electrical signals travel through the atria in a fast and disorganized way. This causes the atria to quiver instead of contract. + +Outlook + +There are many types of arrhythmia. Most arrhythmias are harmless, but some are not. The outlook for a person who has an arrhythmia depends on the type and severity of the arrhythmia. + +Even serious arrhythmias often can be successfully treated. Most people who have arrhythmias are able to live normal, healthy lives." +causes,What causes Arrhythmia ?,"An arrhythmia can occur if the electrical signals that control the heartbeat are delayed or blocked. This can happen if the special nerve cells that produce electrical signals don't work properly. It also can happen if the electrical signals don't travel normally through the heart. + +An arrhythmia also can occur if another part of the heart starts to produce electrical signals. This adds to the signals from the special nerve cells and disrupts the normal heartbeat. + +Smoking, heavy alcohol use, use of some drugs (such as cocaine or amphetamines), use of some prescription or over-the-counter medicines, or too much caffeine or nicotine can lead to arrhythmias in some people. + +Strong emotional stress or anger can make the heart work harder, raise blood pressure, and release stress hormones. Sometimes these reactions can lead to arrhythmias. + +A heart attack or other condition that damages the heart's electrical system also can cause arrhythmias. Examples of such conditions include high blood pressure, coronary heart disease, heart failure, an overactive or underactive thyroid gland (too much or too little thyroid hormone produced), and rheumatic heart disease. + +Congenital (kon-JEN-ih-tal) heart defects can cause some arrhythmias, such as Wolff-Parkinson-White syndrome. The term ""congenital means the defect is present at birth. + +Sometimes the cause of arrhythmias is unknown." +susceptibility,Who is at risk for Arrhythmia? ?,"Arrhythmias are very common in older adults. Atrial fibrillation (a common type of arrhythmia that can cause problems) affects millions of people, and the number is rising. + +Most serious arrhythmias affect people older than 60. This is because older adults are more likely to have heart disease and other health problems that can lead to arrhythmias. + +Older adults also tend to be more sensitive to the side effects of medicines, some of which can cause arrhythmias. Some medicines used to treat arrhythmias can even cause arrhythmias as a side effect. + +Some types of arrhythmia happen more often in children and young adults. Paroxysmal supraventricular tachycardia (PSVT), including Wolff-Parkinson-White syndrome, is more common in young people. PSVT is a fast heart rate that begins and ends suddenly. + +Major Risk Factors + +Arrhythmias are more common in people who have diseases or conditions that weaken the heart, such as: + +Heart attack + +Heart failure or cardiomyopathy, which weakens the heart and changes the way electrical signals move through the heart + +Heart tissue that's too thick or stiff or that hasn't formed normally + +Leaking or narrowed heart valves, which make the heart work too hard and can lead to heart failure + +Congenital heart defects (defects present at birth) that affect the heart's structure or function + +Other conditions also can raise the risk for arrhythmias, such as: + +High blood pressure + +Infections that damage the heart muscle or the sac around the heart + +Diabetes, which increases the risk of high blood pressure and coronary heart disease + +Sleep apnea, which can stress the heart because the heart doesn't get enough oxygen + +An overactive or underactive thyroid gland (too much or too little thyroid hormone in the body) + +Several other risk factors also can raise your risk for arrhythmias. Examples include heart surgery, certain drugs (such as cocaine or amphetamines), or an imbalance of chemicals or other substances (such as potassium) in the bloodstream." +symptoms,What are the symptoms of Arrhythmia ?,"Many arrhythmias cause no signs or symptoms. When signs or symptoms are present, the most common ones are: + +Palpitations (feelings that your heart is skipping a beat, fluttering, or beating too hard or fast) + +A slow heartbeat + +An irregular heartbeat + +Feeling pauses between heartbeats + +More serious signs and symptoms include: + +Anxiety + +Weakness, dizziness, and light-headedness + +Fainting or nearly fainting + +Sweating + +Shortness of breath + +Chest pain" +exams and tests,How to diagnose Arrhythmia ?,"Arrhythmias can be hard to diagnose, especially the types that only cause symptoms every once in a while. Doctors diagnose arrhythmias based on medical and family histories, a physical exam, and the results from tests and procedures. + +Specialists Involved + +Doctors who specialize in the diagnosis and treatment of heart diseases include: + +Cardiologists. These doctors diagnose and treat adults who have heart problems. + +Pediatric cardiologists. These doctors diagnose and treat babies, children, and youth who have heart problems. + +Electrophysiologists. These doctors are cardiologists or pediatric cardiologists who specialize in arrhythmias. + +Medical and Family Histories + +To diagnose an arrhythmia, your doctor may ask you to describe your symptoms. He or she may ask whether you feel fluttering in your chest and whether you feel dizzy or light-headed. + +Your doctor also may ask whether you have other health problems, such as a history of heart disease, high blood pressure, diabetes, or thyroid problems. He or she may ask about your family's medical history, including whether anyone in your family: + +Has a history of arrhythmias + +Has ever had heart disease or high blood pressure + +Has died suddenly + +Has other illnesses or health problems + +Your doctor will likely want to know what medicines you're taking, including over-the-counter medicines and supplements. + +Your doctor may ask about your health habits, such as physical activity, smoking, or using alcohol or drugs (for example, cocaine). He or she also may want to know whether you've had emotional stress or anger. + +Physical Exam + +During a physical exam, your doctor may: + +Listen to the rate and rhythm of your heartbeat + +Listen to your heart for a heart murmur (an extra or unusual sound heard during your heartbeat) + +Check your pulse to find out how fast your heart is beating + +Check for swelling in your legs or feet, which could be a sign of an enlarged heart or heart failure + +Look for signs of other diseases, such as thyroid disease, that could be causing the problem + +Diagnostic Tests and Procedures + +EKG (Electrocardiogram) + +An EKG is a simple, painless test that detects and records the heart's electrical activity. It's the most common test used to diagnose arrhythmias. + +An EKG shows how fast the heart is beating and its rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through the heart. + +A standard EKG only records the heartbeat for a few seconds. It won't detect arrhythmias that don't happen during the test. + +To diagnose arrhythmias that come and go, your doctor may have you wear a portable EKG monitor. The two most common types of portable EKGs are Holter and event monitors. + +Holter and Event Monitors + +A Holter monitor records the heart's electrical signals for a full 24- or 48-hour period. You wear one while you do your normal daily activities. This allows the monitor to record your heart for a longer time than a standard EKG. + +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. + +Some event monitors are able to send data about your heart's electrical activity to a central monitoring station. Technicians at the station review the information and send it to your doctor. You also can use the device to report any symptoms you're having. + +You can wear an event monitor for weeks or until symptoms occur. + +Other Tests + +Other tests also are used to help diagnose arrhythmias. + +Blood tests. Blood tests check the level of substances in the blood, such as potassium and thyroid hormone. Abnormal levels of these substances can increase your chances of having an arrhythmia. + +Chest x ray. A chest x ray is a painless test that creates pictures of the structures in your chest, such as your heart and lungs. This test can show whether your heart is enlarged. + +Echocardiography. This test uses sound waves to create a moving picture of your heart. Echocardiography (echo) provides information about 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. + +There are several types of echo, including stress echo. This test is done both before and after a stress test (see below). A stress echo usually is done to find out whether you have decreased blood flow to your heart, a sign of coronary heart disease (CHD). + +A transesophageal (tranz-ih-sof-uh-JEE-ul) echo, or TEE, is a special type of echo that takes pictures of the heart through the esophagus. The esophagus is the passage leading from your mouth to your stomach. + +Stress test. 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. + +The heart tests done during stress testing may include nuclear heart scanning, echo, and positron emission tomography (PET) scanning of the heart. + +Electrophysiology study (EPS). This test is used to assess serious arrhythmias. During an EPS, a thin, flexible wire is passed through a vein in your groin (upper thigh) or arm to your heart. The wire records your heart's electrical signals. + +Your doctor can use the wire to electrically stimulate your heart and trigger an arrhythmia. This allows your doctor to see whether an antiarrhythmia medicine can stop the problem. + +Catheter ablation, a procedure used to treat some arrhythmias, may be done during an EPS. + +Tilt table testing. This test sometimes is used to help find the cause of fainting spells. You lie on a table that moves from a lying down to an upright position. The change in position may cause you to faint. + +Your doctor watches your symptoms, heart rate, EKG reading, and blood pressure throughout the test. He or she may give you medicine and then check your response to the medicine. + +Coronary angiography. Coronary angiography uses dye and special x rays to show the inside of your 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 your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels. This helps your doctor find blockages that can cause a heart attack. + +Implantable loop recorder. This device detects abnormal heart rhythms. Minor surgery is used to place this device under the skin in the chest area. + +An implantable loop recorder helps doctors figure out why a person may be having palpitations or fainting spells, especially if these symptoms don't happen very often. The device can be used for as long as 12 to 24 months." +treatment,What are the treatments for Arrhythmia ?,"Common arrhythmia treatments include medicines, medical procedures, and surgery. Your doctor may recommend treatment if your arrhythmia causes serious symptoms, such as dizziness, chest pain, or fainting. + +Your doctor also may recommend treatment if the arrhythmia increases your risk for problems such as heart failure, stroke, or sudden cardiac arrest. + +Medicines + +Medicines can slow down a heart that's beating too fast. They also can change an abnormal heart rhythm to a normal, steady rhythm. Medicines that do this are called antiarrhythmics. + +Some of the medicines used to slow a fast heart rate are beta blockers (such as metoprolol and atenolol), calcium channel blockers (such as diltiazem and verapamil), and digoxin (digitalis). These medicines often are used to treat atrial fibrillation (AF). + +Some of the medicines used to restore a normal heart rhythm are amiodarone, sotalol, flecainide, propafenone, dofetilide, ibutilide, quinidine, procainamide, and disopyramide. These medicines often have side effects. Some side effects can make an arrhythmia worse or even cause a different kind of arrhythmia. + +Currently, no medicine can reliably speed up a slow heart rate. Abnormally slow heart rates are treated with pacemakers. + +People who have AF and some other arrhythmias may be treated with blood-thinning medicines. These medicines reduce the risk of blood clots forming. Warfarin (Coumadin), dabigatran, heparin, and aspirin are examples of blood-thinning medicines. + +Medicines also can control an underlying medical condition that might be causing an arrhythmia, such as heart disease or a thyroid condition. + +Medical Procedures + +Some arrhythmias are treated with pacemakers. A pacemaker is a small device that's placed under the skin of your chest or abdomen to help control abnormal heart rhythms. + +Pacemakers have sensors that detect the heart's electrical activity. When the device senses an abnormal heart rhythm, it sends electrical pulses to prompt the heart to beat at a normal rate. + +Some arrhythmias are treated with a jolt of electricity to the heart. This type of treatment is called cardioversion or defibrillation, depending on which type of arrhythmia is being treated. + +Some people who are at risk for ventricular fibrillation are treated with a device called an implantable cardioverter defibrillator (ICD). Like a pacemaker, an ICD is a small device that's placed under the skin in the chest. This device uses electrical pulses or shocks to help control life-threatening arrhythmias. + +An ICD continuously monitors the heartbeat. If it senses a dangerous ventricular arrhythmia, it sends an electric shock to the heart to restore a normal heartbeat. + +A procedure called catheter ablation is used to treat some arrhythmias if medicines don't work. During this procedure, a thin, flexible tube is put into a blood vessel in your arm, groin (upper thigh), or neck. Then, the tube is guided to your heart. + +A special machine sends energy through the tube to your heart. The energy finds and destroys small areas of heart tissue where abnormal heart rhythms may start. Catheter ablation usually is done in a hospital as part of an electrophysiology study. + +Your doctor may recommend transesophageal echocardiography before catheter ablation to make sure no blood clots are present in the atria (the heart's upper chambers). + +Surgery + +Doctors treat some arrhythmias with surgery. This may occur if surgery is already being done for another reason, such as repair of a heart valve. + +One type of surgery for AF is called maze surgery. During this surgery, a surgeon makes small cuts or burns in the atria. These cuts or burns prevent the spread of disorganized electrical signals. + +If coronary heart disease is the cause of your arrhythmia, your doctor may recommend coronary artery bypass grafting. This surgery improves blood flow to the heart muscle. + +Other Treatments + +Vagal maneuvers are another type of treatment for arrhythmia. These simple exercises sometimes can stop or slow down certain types of supraventricular arrhythmias. They do this by affecting the vagus nerve, which helps control the heart rate. + +Some vagal maneuvers include: + +Gagging + +Holding your breath and bearing down (Valsalva maneuver) + +Immersing your face in ice-cold water + +Coughing + +Putting your fingers on your eyelids and pressing down gently + +Vagal maneuvers aren't an appropriate treatment for everyone. Discuss with your doctor whether vagal maneuvers are an option for you." +causes,What causes Varicose Veins ?,"Weak or damaged valves in the veins can cause varicose veins. After your arteries and capillaries deliver oxygen-rich blood to your body, your veins return the blood to your heart. The veins in your legs must work against gravity to do this. + +One-way valves inside the veins open to let blood flow through, and then they shut to keep blood from flowing backward. If the valves are weak or damaged, blood can back up and pool in your veins. This causes the veins to swell. + +Weak vein walls may cause weak valves. Normally, the walls of the veins are elastic (stretchy). If these walls become weak, they lose their normal elasticity. They become like an overstretched rubber band. This makes the walls of the veins longer and wider, and it causes the flaps of the valves to separate. + +When the valve flaps separate, blood can flow backward through the valves. The backflow of blood fills the veins and stretches the walls even more. As a result, the veins get bigger, swell, and often twist as they try to squeeze into their normal space. These are varicose veins. + +Normal Vein and Varicose Vein + + + +Figure A shows a normal vein with a working valve and normal blood flow. Figure B shows a varicose vein with a deformed valve, abnormal blood flow, and thin, stretched walls. The middle image shows where varicose veins might appear in a leg. + +Older age or a family history of varicose veins may raise your risk for weak vein walls. You also may be at higher risk if you have increased pressure in your veins due to overweight or obesity or pregnancy." +information,What is (are) Mitral Valve Prolapse ?,"Mitral valve prolapse (MVP) is a condition in which the hearts mitral valve doesnt work well. The flaps of the valve are floppy and may not close tightly. These flaps normally help seal or open the valve. + +Much of the time, MVP doesnt cause any problems. Rarely, blood can leak the wrong way through the floppy valve. This can lead topalpitations, shortness of breath, chest pain, and other symptoms. (Palpitations are feelings that your heart is skipping a beat, fluttering, or beating too hard or too fast.) + +Normal Mitral Valve + +The mitral valve controls blood flow between the upper and lower chambers of the left side of the heart. The upper chamber is called the left atrium. The lower chamber is called the left ventricle. + +The mitral valve allows blood to flow from the left atrium into the left ventricle, but not back the other way. The heart also has a right atrium and ventricle, separated by the tricuspid valve. + +With each heartbeat, the atria contract and push blood into the ventricles. The flaps of the mitral and tricuspid valves open to let blood through. Then, the ventricles contract to pump the blood out of the heart. + +When the ventricles contract, the flaps of the mitral and tricuspid valves close. They form a tight seal that prevents blood from flowing back into the atria. + +For more information, go to the Health TopicsHow the Heart Worksarticle. This article contains animations that show how your heart pumps blood and how your hearts electrical system works. + +Mitral Valve Prolapse + +In MVP, when the left ventricle contracts, one or both flaps of the mitral valve flop or bulge back (prolapse) into the left atrium. This can prevent the valve from forming a tight seal. As a result, blood may leak from the ventricle back into the atrium. The backflow of blood is called regurgitation. + +MVP doesnt always cause backflow. In fact, most people who have MVP dont have backflow and never have any related symptoms or problems. When backflow occurs, it can get worse over time and itcan change the hearts size and raise pressure in the left atrium and lungs. Backflow also raises the risk of heart valve infections. + +Medicines can treat troublesome MVP symptoms and help prevent complications. Some people will need surgery to repair or replace their mitral valves. + +Mitral Valve Prolapse" +causes,What causes Mitral Valve Prolapse ?,"The exact cause of mitral valve prolapse (MVP) isn't known. Most people who have the condition are born with it. MVP tends to run in families. Also, it's more common in people who are born with connective tissue disorders, such as Marfan syndrome. + +In people who have MVP, the mitral valve may be abnormal in the following ways: + +The valve flaps may be too large and thick. + +The valve flaps may be ""floppy."" The tissue of the flaps and their supporting ""strings"" are too stretchy, and parts of the valve flop or bulge back into the atrium. + +The opening of the valve may stretch. + +These problems can keep the valve from making a tight seal. Some people's valves are abnormal in more than one way." +susceptibility,Who is at risk for Mitral Valve Prolapse? ?,"Mitral valve prolapse (MVP) affects people of all ages and both sexes; however, aging raises the risk of developing the disease. + +Certain conditions have been associated with MVP, including: + +A history of rheumatic fever + +Connective tissue disorders, such as Marfan syndrome or Ehlers-Danlos syndrome + +Graves disease + +Scoliosis and other skeletal problems + +Some types of muscular dystrophy" +symptoms,What are the symptoms of Mitral Valve Prolapse ?,"Most people who have mitral valve prolapse (MVP) aren't affected by the condition. They don't have any symptoms or major mitral valve backflow. + +When MVP does cause signs and symptoms, they may include: + +Palpitations (feelings that your heart is skipping a beat, fluttering, or beating too hard or too fast) + +Shortness of breath + +Cough + +Fatigue (tiredness), dizziness, or anxiety + +Migraine headaches + +Chest discomfort + +MVP symptoms can vary from one person to another. They tend to be mild but can worsen over time, mainly when complications occur. + +Mitral Valve Prolapse Complications + +MVP complications are rare. When present, they're most often caused by the backflow of blood through the mitral valve. + +Mitral valve backflow is most common among men and people who have high blood pressure. People who have severe backflow may need valve surgery to prevent complications. + +Mitral valve backflow causes blood to flow from the left ventricle back into the left atrium. Blood can even back up from the atrium into the lungs, causing shortness of breath. + +The backflow of blood strains the muscles of both the atrium and the ventricle. Over time, the strain can lead to arrhythmias. Backflow also increases the risk of infective endocarditis (IE). IE is an infection of the inner lining of your heart chambers and valves. + +Arrhythmias + +Arrhythmias are problems with the rate or rhythm of the heartbeat. The most common types of arrhythmias are harmless. Other arrhythmias can be serious or even life threatening, such as ventricular arrhythmias. + +If the heart rate is too slow, too fast, or irregular, 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. + +One troublesome arrhythmia that MVP can cause is atrial fibrillation (AF). In AF, the walls of the atria quiver instead of beating normally. As a result, the atria aren't able to pump blood into the ventricles the way they should. + +AF is bothersome but rarely life threatening, unless the atria contract very fast or blood clots form in the atria. Blood clots can occur because some blood ""pools"" in the atria instead of flowing into the ventricles. If a blood clot breaks off and travels through the bloodstream, it can reach the brain and cause a stroke. + +Infection of the Mitral Valve + +A deformed mitral valve flap can attract bacteria in the bloodstream. The bacteria attach to the valve and can cause a serious infection called infective endocarditis (IE). Signs and symptoms of a bacterial infection include fever, chills, body aches, and headaches. + +IE doesn't happen often, but when it does, it's serious. MVP is the most common heart condition that puts people at risk for this infection. + +If you have MVP, you can take steps to prevent IE. Floss and brush your teeth regularly. Gum infections and tooth decay can cause IE." +exams and tests,How to diagnose Mitral Valve Prolapse ?,"Mitral valve prolapse (MVP) most often is detected during a routine physical exam. During the exam, your doctor will listen to your heart with a stethoscope. + +Stretched valve flaps can make a clicking sound as they shut. If the mitral valve is leaking blood back into the left atrium, your doctor may heart a heart murmur or whooshing sound. + +However, these abnormal heart sounds may come and go. Your doctor may not hear them at the time of an exam, even if you have MVP. Thus, you also may have tests and procedures to diagnose MVP. + +Diagnostic Tests and Procedures + +Echocardiography + +Echocardiography (echo) is the most useful test for diagnosing MVP. This painless test uses sound waves to create a moving picture of your heart. + +Echo 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 heart muscle that aren't contracting normally because of poor blood flow or injury to the heart muscle. + +Echo can show prolapse of the mitral valve flaps and backflow of blood through the leaky valve. + +There are several types of echo, including stress echo. Stress echo is done before and after a stress test. During a stress test, you exercise or take medicine (given by your doctor) to make your heart work hard and beat fast. + +You may have stress echo to find out whether you have decreased blood flow to your heart (a sign of coronary heart disease). + +Echo also can be done by placing a tiny probe in your esophagus to get a closer look at the mitral valve. The esophagus is the passage leading from your mouth to your stomach. + +The probe uses sound waves to create pictures of your heart. This form of echo is called transesophageal (tranz-ih-sof-uh-JEE-ul) echocardiography, or TEE. + +Doppler Ultrasound + +A Doppler ultrasound is part of an echo test. A Doppler ultrasound shows the speed and direction of blood flow through the mitral valve. + +Other Tests + +Other tests that can help diagnose MVP include: + +A chest x ray. This test is used to look for fluid in your lungs or to show whether your heart is enlarged. + +An EKG (electrocardiogram). An EKG is a simple test that records your heart's electrical activity. An EKG can show how fast your heart is beating and whether its rhythm is steady or irregular. This test also records the strength and timing of electrical signals as they pass through your heart." +treatment,What are the treatments for Mitral Valve Prolapse ?,"Most people who have mitral valve prolapse (MVP) dont need treatment because they dont have symptoms and complications. + +Even people who do have symptoms may not need treatment. The presence of symptoms doesnt always mean that the backflow of blood through the valve is significant. + +People who have MVP and troublesome mitral valve backflow may be treated with medicines, surgery, or both. + +The goals of treating MVP include: + +Correcting the underlying mitral valve problem, if necessary + +Preventinginfective endocarditis,arrhythmias, and other complications + +Relieving symptoms + +Medicines + +Medicines called beta blockers may be used to treatpalpitationsand chest discomfort in people who have little or no mitral valve backflow. + +If you have significant backflow and symptoms, your doctor may prescribe: + +Blood-thinning medicines to reduce the risk of blood clots forming if you haveatrial fibrillation. + +Digoxin to strengthen your heartbeat. + +Diuretics (fluidpills) to remove excess sodium and fluid in your body and lungs. + +Medicines such as flecainide and procainamide to regulate your heart rhythms. + +Vasodilators to widen your blood vessels and reduce your hearts workload. Examples of vasodilators are isosorbide dinitrate and hydralazine. + +Take all medicines regularly, as your doctor prescribes. Dont change the amount of your medicine or skip a dose unless your doctor tells you to. + +Surgery + +Surgery is done only if the mitral valve is very abnormal and blood is flowing back into the atrium. The main goal of surgery is to improve symptoms and reduce the risk ofheart failure. + +The timing of the surgery is important. If its done too early and your leaking valve is working fairly well, you may be put at needless risk from surgery. If its done too late, you may have heart damage that can't be fixed. + +Surgical Approaches + +Traditionally, heart surgeons repair or replace a mitral valve by making an incision (cut) in the breastbone and exposing the heart. + +A small but growing number of surgeons are using another approach that involves one or more small cuts through the side of the chest wall. This results in less cutting, reduced blood loss, and a shorter hospital stay. However, not all hospitals offer this method. + +Valve Repair and Valve Replacement + +In mitral valve surgery, the valve is repaired or replaced. Valve repair is preferred when possible. Repair is less likely than replacement to weaken the heart. Repair also lowers the risk of infection and decreases the need for lifelong use of blood-thinning medicines. + +If repair isnt an option, the valve can be replaced. Mechanical and biological valves are used as replacement valves. + +Mechanical valves are man-made and can last a lifetime. People who have mechanical valves must take blood-thinning medicines for the rest of their lives. + +Biological valves are taken from cows or pigs or made from human tissue. Many people who have biological valves dont need to take blood-thinning medicines for the rest of their lives. The major drawback of biological valves is that they weaken over time and often last only about 10 years. + +After surgery, youll likely stay in the hospitals intensive care unit for 2 to 3 days. Overall, most people who have mitral valve surgery spend about 1 to 2 weeks in the hospital. Complete recovery takes a few weeks to several months, depending on your health before surgery. + +If youve had valve repair or replacement, you may need antibiotics before dental work and surgery. These procedures can allow bacteria to enter your bloodstream. Antibiotics can help prevent infective endocarditis, a serious heart valve infection. Discuss with your doctor whether you need to take antibiotics before such procedures. + +Transcatheter Valve Therapy + +Interventional cardiologists may be able to repair leaky mitral valves by implanting a device using a catheter (tube) inserted through a large blood vessel. This approach is less invasive and can prevent a person from havingopen-heart surgery. At present, the device is only approved for people with severe mitral regurgitation who cannot undergo surgery." +prevention,How to prevent Mitral Valve Prolapse ?,"You can't prevent mitral valve prolapse (MVP). Most people who have the condition are born with it. + +Complications from MVP, such as arrhythmias (irregular heartbeats) and infective endocarditis (IE), are rare. IE is an infection of the inner lining of your heart chambers and valves. + +People at high risk for IE may be given antibiotics before some types of surgery and dental work. Antibiotics can help prevent IE. Your doctor will tell you whether you need this type of treatment. + +People at high risk for IE may include those who've had valve repair or replacement or who have some types of underlying heart disease." +information,What is (are) Heart Failure ?,"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. + +Overview + +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. + +Outlook + +Heart failure is a very common condition. About 5.7 million people in the United States have heart failure.Both children and adults can have the condition, although the symptoms and treatments differ. The Health Topicfocuses on heart failure in adults. + +Currently, heart failure has no cure. However, treatmentssuch as medicines and lifestyle changescan 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." +causes,What causes Heart Failure ?,"Conditions that damage or overwork the heart muscle can cause heart failure. Over time, the heart weakens. It isnt 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. + +Causes of heart failure include: + +Coronary heart disease + +Diabetes + +High blood pressure + +Other heart conditions or diseases + +Other factors + + + +Coronary Heart Disease + +Coronary heart disease is a condition in which a waxy substance called plaque 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. Coronary heart disease can lead to chest pain or discomfort calledangina, aheart attack, and heart damage. + + + +Diabetes + +Diabetes is a disease in which the bodys 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 doesnt make enough insulin or doesnt 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. + + + +High Blood Pressure + +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 mercurythe 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. + + + +Other Heart Conditions or Diseases + +Other conditions and diseases also can lead to heart failure, such as: + +Arrhythmia. Happens when a problem occurs with the rate or rhythm of the heartbeat. + +Cardiomyopathy.Happens when the heart muscle becomes enlarged, thick, or rigid. + +Congenital heart defects. Problems with the hearts structure are present at birth. + +Heart valve disease. Occurs if one or more of your heart valves doesnt work properly, which can be present at birth or caused by infection, other heart conditions, and age. + + + +Other Factors + +Other factors also can injure the heart muscle and lead to heart failure. Examples include: + +Alcohol abuse or cocaine and other illegal drug use + +HIV/AIDS + +Thyroid disorders (having either too much or too little thyroid hormone in the body) + +Too much vitamin E + +Treatments for cancer, such as radiation and chemotherapy" +susceptibility,Who is at risk for Heart Failure? ?,"About 5.7 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 age 65 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. + +Blacks are more likely to have heart failure than people of other races. Theyre 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 areoverweight. Excess weight puts strain on the heart. Being overweight also increases your risk of heart disease and type 2diabetes. These diseases can lead to heart failure. + +People who have had a heart attack. Damage to the heart muscle from a heart attack and can weaken the heart muscle. + +Children who havecongenital heart defectsalso can develop heart failure. These defects occur if the heart, heart valves, or blood vessels near the heart dont 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 dont have the same symptoms of heart failure or get the same treatments as adults. This Health Topic focuses on heart failure in adults." +symptoms,What are the symptoms of Heart Failure ?,"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. + +Heart Failure Signs and Symptoms" +exams and tests,How to diagnose 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. + +Medical and Family Histories + +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. + +Physical Exam + +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 + +Diagnostic Tests + +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. + +EKG (Electrocardiogram) + +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. + +Chest X Ray + +A chest x raytakes 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. + +BNP Blood Test + +This test checks the level of a hormone in your blood called BNP. The level of this hormone rises during heart failure. + +Echocardiography + +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. + +Doppler Ultrasound + +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. + +Holter Monitor + +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. + +Nuclear Heart Scan + +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. + +Cardiac Catheterization + +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 + +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. + +Stress Test + +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 + +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 + +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." +treatment,What are the treatments for Heart Failure ?,"Early diagnosis and treatment can help people who have heart failure live longer, more active lives. Treatment for heart failure depends on the type and severity of the heart failure. + +The goals of treatment for all stages of heart failure include: + +Treating the conditions underlying cause, such ascoronary heart disease,high blood pressure, ordiabetes + +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. + +Heart-Healthy Lifestyle Changes + +Your doctor may recommend heart-healthy lifestyle changes if you have heart failure. Heart-healthy lifestyle changes include: + +Heart-healthy eating + +Maintaining a healthy weight + +Physical activity + +Quitting smoking + +Heart-Healthy Eating + +Your doctor may recommend a heart-healthy eating plan, which should include: + +Fat-free or low-fat dairy products, such as skim milk + +Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week + +Fruits, such as apples, bananas, oranges, pears, and prunes + +Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans + +Vegetables, such as broccoli, cabbage, and carrots + +Whole grains, such as oatmeal, brown rice, and corn tortillas + +When following a heart-healthy diet, you should avoid eating: + +A lot of red meat + +Palm and coconut oils + +Sugary foods and beverages + +Two nutrients in your diet make blood cholesterol levels rise: + +Saturated fatfound mostly in foods that come from animals + +Trans fat (trans fatty acids)found in foods made with hydrogenated oils and fats, such as stick margarine; baked goods, such as cookies, cakes, and pies; crackers; frostings; and coffee creamers. Some trans fats also occur naturally in animal fats andmeats. + +Saturated fat raises your blood cholesterol more than anything else in your diet. When you follow a heart-healthy eating plan, only 5 percent to 6 percent of your daily calories should come from saturated fat. Food labels list the amounts of saturated fat. To help you stay on track, here are some examples: + +If you eat: + +Try to eat no more than: + +1,200 calories a day + +8 grams of saturated fat a day + +1,500 calories a day + +10 grams of saturated fat a day + +1,800 calories a day + +12 grams of saturated fat a day + +2,000 calories a day + +13 grams of saturated fat a day + +2,500 calories a day + +17 grams of saturated fat a day + +Not all fats are bad. Monounsaturated and polyunsaturated fats actually help lower blood cholesterollevels. + +Some sources of monounsaturated and polyunsaturated fats are: + +Avocados + +Corn, sunflower, and soybean oils + +Nuts and seeds, such as walnuts + +Olive, canola, peanut, safflower, and sesame oils + +Peanut butter + +Salmon and trout + +Tofu + +Sodium + +You should try to limit the amount of sodium that you eat. This means choosing and preparing foods that are lower in salt and sodium. Try to use low-sodium and no added salt foods and seasonings at the table or while cooking. Food labels tell you what you need to know about choosing foods that are lower in sodium. Try to eat no more than 2,300 milligrams of sodium a day. If you have high blood pressure, you may need to restrict your sodium intake even more. + +Dietary Approaches to Stop Hypertension + +Your doctor may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium and salt. + +The DASH eating plan is a good heart-healthy eating plan, even for those who dont have high blood pressure. Read more about DASH. + +Liquid Intake + +Its important for people who have heart failure to take in the correct amounts and types of liquids. Consuming too much liquid can worsen heart failure. Also, if you have heart failure, you shouldnt drink alcohol. Talk with your doctor about what amounts and types of liquids you should have each day. + +Maintaining a Healthy Weight + +Maintaining a healthy weight is important for overall health and can lower your risk for heart failure and coronary heart disease. Aim for a Healthy Weight by following a heart-healthy eating plan and keeping physically active. + +Knowing your body mass index (BMI) helps you find out if youre a healthy weight in relation to your height and gives an estimate of your total body fat. To figure out your BMI, check out the National Heart, Lung, and Blood Institutes (NHLBI) online BMI calculator or talk to your doctor. A BMI: + +Below 18.5 is a sign that you are underweight. + +Between 18.5 and 24.9 is in the normal range. + +Between 25 and 29.9 is considered overweight. + +Of 30 or more is considered obese. + +A general goal to aim for is a BMI below 25. Your doctor or health care provider can help you set an appropriate BMI goal. + +Measuring waist circumference helps screen for possible health risks. If most of your fat is around your waist rather than at your hips, youre at a higher risk for heart disease and type 2 diabetes. This risk may be higher with a waist size that is greater than 35 inches for women or greater than 40 inches for men. To learn how to measure your waist, visit Assessing Your Weight and Health Risk. + +If youre overweight or obese, try to lose weight. A loss of just 3 percent to 5 percent of your current weight can lower your triglycerides, blood glucose, and the risk of developing type 2 diabetes. Greater amounts of weight loss can improve blood pressure readings, lower LDL cholesterol, and increase HDL cholesterol. + +Physical Activity + +Routine physical activity can lower many coronary heart disease risk factors, including LDL (bad) cholesterol, high blood pressure, and excess weight. Physical activity also can lower your risk for diabetes and raise your HDL cholesterol level. HDL is the good cholesterol that helps prevent coronary heart disease. + +Everyone should try to participate in moderate-intensity aerobic exercise at least 2hours and 30minutes per week, or vigorous aerobic exercise for 1hour and 15minutes per week. Aerobic exercise, such as brisk walking, is any exercise in which your heart beats faster and you use more oxygen than usual. The more active you are, the more you will benefit. Participate in aerobic exercise for at least 10minutes at a time spread throughout the week. + +Read more about physical activity at: + +Physical Activity and Your Heart + +U.S. Department of Health and Human Services 2008 Physical Activity Guidelines forAmericans + +Talk with your doctor before you start a new exercise plan. Ask your doctor how much and what kinds of physical activity are safe for you. + +Quitting Smoking + +If you smoke, quit. Smoking can raise your risk for coronary heart disease and heart attack and worsen heart failure. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke. + +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. + +Read more about quitting smoking at Smoking and Your Heart. + +Medicines + +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: + +ACE inhibitors lower blood pressure and reduce strain on your heart. They also may reduce the risk of a futureheart attack. + +Aldosterone antagonists trigger the body to remove excess sodium 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 hearts workload. + +Beta blockers slow your heart rate and lower your blood pressure to decrease your hearts workload. + +Digoxin makes the heart beat stronger and pump more blood. + +Diuretics (fluid pills) help reduce fluid buildup in your lungs and swelling in your feet and ankles. + +Isosorbide dinitrate/hydralazine hydrochloride helps relax your blood vessels so your heart doesnt work as hard to pump blood. Studies have shown that this medicine can reduce the risk of death in blacks. More studies are needed to find out whether this medicine will benefit other racial groups. + +Take all medicines regularly, as your doctor prescribes. Dont change the amount of your medicine or skip a dose unless your doctor tells you to. You should still follow a heart healthy lifestyle, even if you take medicines to treat your heart failure. + +Ongoing Care + +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 andpneumonia. 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, which can be given in a hospital or at home. + +Medical Procedures and Surgery + +As heart failure worsens, lifestyle changes and medicines may no longer control your symptoms. You may need a medical procedure or surgery. + +In heart failure, the right and left sides of the heart may no longer contract at the same time. This disrupts the hearts pumping. To correct this problem, your doctor might implant a cardiac resynchronization therapy device (a type ofpacemaker) 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 causesudden cardiac arrest. Your doctor might implant an implantable cardioverter defibrillator (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 aleft 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 persons 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." +prevention,How to prevent Heart Failure ?,"You can take steps to prevent heart failure. The sooner you start, the better your chances of preventing or delaying the condition. + +For People Who Have Healthy Hearts + +If you have a healthy heart, you can take action to prevent heart disease and heart failure. To reduce your risk of heart disease: + +Avoid using illegal drugs. + +Be physically active. The more active you are, the more you will benefit. + +Follow a heart-healthy eating plan. + +If yousmoke, 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. + +Maintain a healthy weight. Work with your health care team to create a reasonable weight-loss plan. + +For People Who Are at High Risk for Heart Failure + +Even if youre 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, ordiabetes. + +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. + +For People Who Have Heart Damage but No Signs of Heart Failure + +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 hearts workload." +information,What is (are) Broken Heart Syndrome ?,"Broken heart syndrome is a condition in which extreme stress can lead to heart muscle failure. The failure is severe, but often short-term. + +Most people who experience broken heart syndrome think they may be having a heart attack, a more common medical emergency caused by a blocked coronary (heart) artery. The two conditions have similar symptoms, including chest pain and shortness of breath. However, theres no evidence of blocked coronary arteries in broken heart syndrome, and most people have a full and quick recovery. + +Overview + +Broken heart syndrome is a recently recognized heart problem. It was originally reported in the Asian population in 1990 and named takotsubo cardiomyopathy (KAR-de-o-mi-OP-ah-thee). In this condition, the heart is so weak that it assumes a bulging shape (tako tsubo is the term for an octopus trap, whose shape resembles the bulging appearance of the heart during this condition). Cases have since been reported worldwide, and the first reports of broken heart syndrome in the United States appeared in 1998. The condition also is commonly called stress-induced cardiomyopathy. + +The cause of broken heart syndrome is not fully known. In most cases, symptoms are triggered by extreme emotional or physical stress, such as intense grief, anger, or surprise. Researchers think that the stress releases hormones that stun the heart and affect its ability to pump blood to the body. (The term stunned is often used to indicate that the injury to the heart muscle is only temporary.) + +People who have broken heart syndrome often have sudden intense chest pain and shortness of breath. These symptoms begin just a few minutes to hours after exposure to the unexpected stress. Many seek emergency care, concerned they are having a heart attack. Often, patients who have broken heart syndrome have previously been healthy. + +Women are more likely than men to have broken heart syndrome. Researchers are just starting to explore what causes this disorder and how to diagnose and treat it. + +Broken Heart Syndrome Versus Heart Attack + +Symptoms of broken heart syndrome can look like those of a heart attack. + +Most heart attacks are caused by blockages and blood clots forming in the coronary arteries, which supply the heart with blood. If these clots cut off the blood supply to the heart for a long enough period of time, heart muscle cells can die, leaving the heart with permanent damage. Heart attacks most often occur as a result of coronary heart disease (CHD), also called coronary artery disease. + +Broken heart syndrome is quite different. Most people who experience broken heart syndrome have fairly normal coronary arteries, without severe blockages or clots. The heart cells are stunned by stress hormones but not killed. The stunning effects reverse quickly, often within just a few days or weeks. In most cases, there is no lasting damage to the heart. + +Because symptoms are similar to a heart attack, it is important to seek help right away. You, and sometimes emergency care providers, may not be able to tell that you have broken heart syndrome until you have some tests. + +All chest pain should be checked by a doctor. 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 911 for emergency medical care. In the case of a heart attack, acting fast at the first sign of symptoms can save your life and limit damage to your heart. + +Outlook + +Research is ongoing to learn more about broken heart syndrome and its causes. + +The symptoms of broken heart syndrome are treatable, and most people who experience it have a full recovery, usually within days or weeks. The heart muscle is not permanently damaged, and the risk of broken heart syndrome happening again is low." +causes,What causes Broken Heart Syndrome ?,"The cause of broken heart syndrome isnt fully known. However, extreme emotional or physical stress is believed to play a role in causing the temporary disorder. + +Although symptoms are similar to those of a heart attack, what is happening to the heart is quite different. Most heart attacks are caused by near or complete blockage of a coronary artery. In broken heart syndrome, the coronary arteries are not blocked, although blood flow may be reduced. + +Potential Triggers + +In most cases, broken heart syndrome occurs after an intense and upsetting emotional or physical event. Some potential triggers of broken heart syndrome are: + +Emotional stressorsextreme grief, fear, or anger, for example as a result of the unexpected death of a loved one, financial or legal trouble, intense fear, domestic abuse, confrontational argument, car accident, public speaking, or even a surprise party. + +Physical stressorsan asthma attack, serious illness or surgery, or exhausting physical effort. + +Potential Causes + +Researchers think that sudden stress releases hormones that overwhelm or stun the heart. (The term stunned is often used to indicate that the injury to the heart muscle is only temporary.) This can trigger changes in heart muscle cells or coronary blood vessels, or both. The heart becomes so weak that its left ventricle (which is the chamber that pumps blood from your heart to your body) bulges and cannot pump well, while the other parts of the heart work normally or with even more forceful contractions. As a result the heart is unable to pump properly. (For more information about the hearts pumping action and blood flow, go to the Health Topics How the Heart Works article.) + +Researchers are trying to identify the precise way in which the stress hormones affect the heart. Broken heart syndrome may result from a hormone surge, coronary artery spasm, or microvascular dysfunction. + +Hormone Surge + +Intense stress causes large amounts of the fight or flight hormones, such as adrenaline and noradrenaline, to be released into your bloodstream. The hormones are meant to help you cope with the stress. Researchers think that the sudden surge of hormones overwhelms and stuns the heart muscle, producing symptoms similar to those of a heart attack. + +Coronary Artery Spasm + +Some research suggests that the extreme stress causes a temporary, sudden narrowing of one of the coronary arteries as a result of a spasm. The spasm slows or stops blood flow through the artery and starves part of the heart of oxygen-rich blood. + +Microvascular Dysfunction + +Another theory that is gaining traction is that the very small coronary arteries (called microvascular arteries) do not function well due to low hormone levels occurring before or after menopause. The microvascular arteries fail to provide enough oxygen-rich blood to the heart muscle." +susceptibility,Who is at risk for Broken Heart Syndrome? ?,"Broken heart syndrome affects women more often than men. Often, people who experience broken heart syndrome have previously been healthy. Research shows that the traditional risk factors for heart disease may not apply to broken heart syndrome. + +People who might be at increased risk for broken heart syndrome include: + +Women who have gone through menopause, particularly women in their sixties and seventies + +People who often have no previous history of heart disease + +Asian and White populations + +Although these are the characteristics for most cases of broken heart syndrome, the condition can occur in anyone. + +Research is ongoing to learn more about broken heart syndrome and its causes." +symptoms,What are the symptoms of Broken Heart Syndrome ?,"All chest pain should be checked by a doctor. Because symptoms of broken heart syndrome are similar to those of a heart attack, it is important to seek help right away. Your doctor may not be able to diagnose broken heart syndrome until you have some tests. + +Common Signs and Symptoms + +The most common symptoms of broken heart syndrome are sudden, sharp chest pain and shortness of breath. Typically these symptoms begin just minutes to hours after experiencing a severe, and usually unexpected, stress. + +Because the syndrome involves severe heart muscle weakness, some people also may experience signs and symptoms such as fainting, arrhythmias (ah-RITH-me-ahs) (fast or irregular heartbeats), cardiogenic (KAR-de-o-JEN-ik) shock (when the heart cant pump enough blood to meet the bodys needs), low blood pressure, and heart failure. + +Differences From a Heart Attack + +Some of the signs and symptoms of broken heart syndrome differ from those of a heart attack. For example, in people who have broken heart syndrome: + +Symptoms (chest pain and shortness of breath) occur suddenly after having extreme emotional or physical stress. + +EKG(electrocardiogram) results dont look the same as the results for a person having a heart attack. (An EKG is a test that records the hearts electrical activity.) + +Blood tests show no signs or mild signs of heart damage. + +Tests show enlarged and unusual movement of the lower left heart chamber (the left ventricle).\ + +Tests show no signs of blockages in the coronary arteries. + +Recovery time is quick, usually within days or weeks (compared with the recovery time of a month or more for a heart attack). + +Complications + +Broken heart syndrome can be life threatening in some cases. It can lead to serious heart problems such as: + +Heart failure, a condition in which the heart cant pump enough blood to meet the bodys needs + +Heart rhythm problems that cause the heart to beat much faster or slower than normal + +Heart valve problems + +The good news is that most people who have broken heart syndrome make a full recovery within weeks. With medical care, even the most critically ill tend to make a quick and complete recovery." +exams and tests,How to diagnose Broken Heart Syndrome ?,"Because the symptoms are similar, at first your doctor may not be able to tell whether you are experiencing broken heart syndrome or having a heart attack. Therefore, the doctors immediate goals will be: + +To determine whats causing your symptoms + +To determine whether youre having or about to have a heart attack + +Your doctor will diagnose broken heart syndrome based on your signs and symptoms, your medical and family histories, and the results from tests and procedures. + +Specialists Involved + +Your doctor may refer you to a cardiologist. A cardiologist is a doctor who specializes in diagnosing and treating heart diseases and conditions. + +Physical Exam and Medical History + +Your doctor will do a physical exam and ask you to describe your symptoms. He or she may ask questions such as when your symptoms began, where you are feeling pain or discomfort and what it feels like, and whether the pain is constant or varies. + +To learn about your medical history, your doctor may ask about your overall health, risk factors for coronary heart disease (CHD) and other heart disease, and family history. Your doctor will ask whether you've recently experienced any major stresses. + +Diagnostic Tests and Procedures + +No single test can diagnose broken heart syndrome. The tests and procedures for broken heart syndrome are similar to those used to diagnose CHD or heart attack. The diagnosis is made based on the results of the following standards tests to rule out heart attack and imaging studies to help establish broken heart syndrome. + +Standard Tests and Procedures + + + +EKG (Electrocardiogram) + + + +AnEKGis a simple, painless test that detects and records the hearts electrical activity. The test shows how fast your heart is beating and whether its rhythm is steady or irregular. An EKG also records the strength and timing of electrical signals as they pass through each part of the heart. + +The EKG may show abnormalities in your heartbeat, a sign of broken heart syndrome as well as heart damage due to CHD. + + + +Blood Tests + +Blood tests check the levels of certain substances in your blood, such as fats, cholesterol, sugar, and proteins. Blood tests help greatly in diagnosing broken heart syndrome, because certain enzymes (proteins in the blood) may be present in the blood to indicate the condition. + +Imaging Procedures + + + +Echocardiography + +Echocardiography(echo) uses sound waves to create a moving picture of your heart. The test provides information about the size and shape of your heart and how well your heart chambers and valves are working. Echo also can show areas of heart muscle that aren't contracting well because of poor blood flow or previous injury. + +The echo may show slowed blood flow in the left chamber of the heart. + + + +Chest X Ray + +A chest x rayis a painless test that creates pictures of the structures in your chest, such as your heart, lungs, and blood vessels. Your doctor will need a chest x ray to analyze whether your heart has the enlarged shape that is a sign of broken heart syndrome. + +A chest x ray can reveal signs of heart failure, as well as lung disorders and other causes of symptoms not related to broken heart syndrome. + + + +Cardiac MRI + +Cardiac magnetic resonance imaging (MRI) is a common test that uses radio waves, magnets, and a computer to make both still and moving pictures of your heart and major blood vessels. Doctors use cardiac MRI to get pictures of the beating heart and to look at its structure and function. These pictures can help them decide the best way to treat people who have heart problems. + + + +Coronary Angiography and Cardiac Catheterization + +Your doctor may recommend coronary angiography (an-jee-OG-rah-fee) if other tests or factors suggest you have CHD. This test uses dye and special x rays to look inside 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 your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels. + + + +Ventriculogram + +Ventriculogram is another test that can be done during a cardiac catheterization that examines the left ventricle, which is the hearts main pumping chamber. During this test, a dye is injected into the inside of the heart and x ray pictures are taken. The test can show the ventricles size and how well it pumps blood. It also shows how well the blood flows through the aortic and mitral values." +treatment,What are the treatments for Broken Heart Syndrome ?,"Even though broken heart syndrome may feel like a heart attack, its a very different problem that needs a different type of treatment. + +The good news is that broken heart syndrome is usually treatable, and most people make a full recovery. Most people who experience broken heart syndrome stay in the hospital for a few days to a week. + +Initial treatment is aimed at improving blood flow to the heart, and may be similar to that for a heart attack until the diagnosis is clear. Further treatment can include medicines and lifestyle changes. + +Medicines + +Doctors may prescribe medicines to relieve fluid buildup, treat blood pressure problems, prevent blood clots, and manage stress hormones. Medicines are often discontinued once heart function has returned to normal. + +Your doctor may prescribe the following medicines: + +ACE inhibitors (or angiotensin-converting enzyme inhibitors), to lower blood pressure and reduce strain on your heart + +Beta blockers, to slow your heart rate and lower your blood pressure to decrease your hearts workload + +Diuretics (water or fluid pills), to help reduce fluid buildup in your lungs and swelling in your feet and ankles + +Anti-anxiety medicines, to help manage stress hormones + +Take all of your medicines as prescribed. If you have side effects or other problems related to your medicines, tell your doctor. He or she may be able to provide other options. + +Treatment of Complications + +Broken heart syndrome can be life threatening in some cases. Because the syndrome involves severe heart muscle weakness, patients can experience shock, heart failure, low blood pressure, and potentially life-threatening heart rhythm abnormalities. + +The good news is that this condition improves very quickly, so with proper diagnosis and management, even the most critically ill tend to make a quick and complete recovery. + +Lifestyle Changes + +To stay healthy, its important to find ways to reduce stress and cope with particularly upsetting situations. Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. + +Having supportive people in your life with whom you can share your feelings or concerns can help relieve stress. Physical activity, medicine, and relaxation therapy also can help relieve stress. You may want to consider taking part in a stress management program. + +Treatments Not Helpful for Broken Heart Syndrome + +Several procedures used to treat a heart attack are not helpful in treating broken heart syndrome. These procedurespercutaneous coronary intervention (sometimes referred to as angioplasty), stent placement, and surgerytreat blocked arteries, which is not the cause of broken heart syndrome." +prevention,How to prevent Broken Heart Syndrome ?,"Researchers are still learning about broken heart syndrome, and no treatments have been shown to prevent it. For people who have experienced the condition, the risk of recurrence is low. + +An emotionally upsetting or serious physical event can trigger broken heart syndrome. Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. + +Having supportive people in your life with whom you can share your feelings or concerns can help relieve stress. Physical activity, medicine, and relaxation therapy also can help relieve stress. You may want to consider taking part in a stress management program. + +Also, some of the ways people cope with stresssuch as drinking, smoking, or overeatingarent healthy. Learning to manage stress includes adopting healthy habits that will keep your stress levels low and make it easier to deal with stress when it does happen. A healthy lifestyle includes following a healthy diet, being physically active, maintaining a healthy weight, and quitting smoking." +information,What is (are) Coronary Microvascular Disease ?,"Coronary microvascular disease (MVD) is heart disease that affects the tiny coronary (heart) arteries. In coronary MVD, the walls of the heart's tiny arteries are damaged or diseased. + +Coronary MVD is different from traditional coronary heart disease (CHD), also called coronary artery disease. In CHD, a waxy substance called plaque (plak) builds up in the large coronary arteries. + +Plaque narrows the heart's large arteries and reduces the flow of oxygen-rich blood to your heart muscle. The buildup of plaque also makes it more likely that blood clots will form in your arteries. Blood clots can mostly or completely block blood flow through a coronary artery. + +In coronary MVD, however, the heart's tiny arteries are affected. Plaque doesn't create blockages in these vessels as it does in the heart's large arteries. + +Coronary Microvascular Disease + + + +Overview + +Both men and women who have coronary microvascular disease often have diabetes or high blood pressure. Some people who have coronary microvascular disease may have inherited heart muscle diseases. + +Diagnosing coronary microvascular disease has been a challenge for doctors. Standard tests used to diagnose coronary heart disease arent designed to detect coronary microvascular disease. More research is needed to find the best diagnostic tests and treatments for thedisease. + +Outlook + +Most of what is known about coronary MVD comes from the National Heart, Lung, and Blood Institute's Wise study (Women's Ischemia Syndrome Evaluation). + +The WISE study started in 1996. The goal of the study was to learn more about how heart disease develops in women. + +Currently, research is ongoing to learn more about the role of hormones in heart disease and to find better ways to diagnose coronary MVD. + +Studies also are under way to learn more about the causes of coronary MVD, how to treat the disease, and the expected health outcomes for people with coronary MVD." +causes,What causes Coronary Microvascular Disease ?,"The same risk factors that cause atherosclerosis may cause coronary microvascular disease. Atherosclerosis is a disease in which plaque builds up inside the arteries. + +Risk factors for atherosclerosis include: + +Diabetes. It is a disease in which the bodys blood sugar level is too high because the body doesnt make enough insulin or doesnt use its insulin properly. + +Family history of early heart disease. Your risk of atherosclerosis increases if your father or a brother was diagnosed with heart disease before age 55, or if your mother or a sister was diagnosed with heart disease before age 65. + +High blood pressure. Blood pressure is considered high if it stays at or above 140/90mmHg over time. If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher. (The mmHg is millimeters of mercurythe units used to measure blood pressure.) + +Insulin resistance. This condition occurs if the body cant use its insulin properly. Insulin is a hormone that helps move blood sugar into cells where its used for energy. Overtime, insulin resistance can lead to diabetes. + +Lack of physical activity. Physical inactivity can worsen some other risk factors for atherosclerosis, such as unhealthy blood cholesterol levels, high blood pressure, diabetes, and overweight or obesity. + +Older age. As you age, your risk for atherosclerosis increases. The process of atherosclerosis begins in youth and typically progresses over many decades before disease develops. + +Overweight and obesity. The terms overweight and obesity refer to body weight thats greater than what is considered healthy for a certain height. + +Smoking. Smoking can damage and tighten blood vessels, lead to unhealthy cholesterol levels, and raise blood pressure. Smoking also doesnt allow enough oxygen to reach the bodys tissues. + +Unhealthy blood cholesterol levels. This includes high LDL (bad) cholesterol and low HDL (good) cholesterol. + +Unhealthy diet. An unhealthy diet can raise your risk for atherosclerosis. Foods that are high in saturated and trans fats, cholesterol, sodium (salt), and sugar can worsen other risk factors for atherosclerosis. + +In women, coronary microvascular disease also may be linked to low estrogen levels occurring before or after menopause. Also, the disease may be linked to anemia or conditions that affect blood clotting. Anemia is thought to slow the growth of cells needed to repair damaged blood vessels. + +Researchers continue to explore other possible causes of coronary microvascular disease." +susceptibility,Who is at risk for Coronary Microvascular Disease? ?,"Coronary microvascular disease can affect both men and women. However, women may be at risk for coronary microvascular disease if they have lower than normal levels of estrogen at any point in their adult lives. (This refers to the estrogen that the ovaries produce, not the estrogen used in hormone therapy.) Low estrogen levels before menopause can raise younger womens risk for the disease. Causes of low estrogen levels in younger women can be mental stress or a problem with the function of theovaries. + +The causes of coronary microvascular disease and atherosclerosis are also considered risk factors for the disease." +symptoms,What are the symptoms of Coronary Microvascular Disease ?,"The signs and symptoms of coronary microvascular disease (MVD) often differ from the signs and symptoms of traditional coronary heart disease (CHD). + +Many women with coronary MVD have angina (an-JI-nuh or AN-juh-nuh). Angina is chest pain or discomfort that occurs when your heart muscle doesn't get enough oxygen-rich blood. + +Angina may feel like pressure or squeezing in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. + +Angina also is a common symptom of CHD. However, the angina that occurs in coronary MVD may differ from the typical angina that occurs in CHD. In coronary MVD, the chest pain usually lasts longer than 10 minutes, and it can last longer than 30 minutes. Typical angina is more common in women older than 65. + +Other signs and symptoms of coronary MVD are shortness of breath, sleep problems, fatigue (tiredness), and lack of energy. + +Coronary MVD symptoms often are first noticed during routine daily activities (such as shopping, cooking, cleaning, and going to work) and times of mental stress. It's less likely that women will notice these symptoms during physical activity (such as jogging or walking fast). + +This differs from CHD, in which symptoms often first appear while a person is being physically activesuch as while jogging, walking on a treadmill, or going up stairs." +exams and tests,How to diagnose Coronary Microvascular Disease ?,"Your doctor will diagnose coronary microvascular disease (MVD) based on your medical history, a physical exam, and test results. He or she will check to see whether you have any risk factors for heart disease. + +For example, your doctor may measure your weight and height to check for overweight or obesity. He or she also may recommend tests for high blood cholesterol, metabolic syndrome, and diabetes. + +Your doctor may ask you to describe any chest pain, including when it started and how it changed during physical activity or periods of stress. He or she also may ask about other symptoms, such as fatigue (tiredness), lack of energy, and shortness of breath. Women may be asked about their menopausal status. + +Specialists Involved + +Cardiologists and doctors who specialize in family and internal medicine might help diagnose and treat coronary MVD. Cardiologists are doctors who specialize in diagnosing and treating heart diseases and conditions. + +Diagnostic Tests + +The risk factors for coronary MVD and traditional coronary heart disease (CHD) often are the same. Thus, your doctor may recommend tests for CHD, such as: + +Coronary angiography (an-jee-OG-rah-fee). This test uses dye and special x rays to show the insides of your coronary arteries. Coronary angiography can show plaque buildup in the large coronary arteries. This test often is done during a heart attack to help find blockages in the coronary arteries. + +Stress testing. This test shows how blood flows through your heart during physical stress, such as exercise. Even if coronary angiography doesn't show plaque buildup in the large coronary arteries, a stress test may still show abnormal blood flow. This may be a sign of coronary MVD. + +Cardiac MRI (magnetic resonance imaging) stress test. Doctors may use this test to evaluate people who have chest pain. + +Unfortunately, standard tests for CHD aren't designed to detect coronary MVD. These tests look for blockages in the large coronary arteries. Coronary MVD affects the tiny coronary arteries. + +If test results show that you don't have CHD, your doctor might still diagnose you with coronary MVD. This could happen if signs are present that not enough oxygen is reaching your heart's tiny arteries. + +Coronary MVD symptoms often first occur during routine daily tasks. Thus, your doctor may ask you to fill out a questionnaire called the Duke Activity Status Index (DASI). The questionnaire will ask you how well you're able to do daily activities, such as shopping, cooking, and going to work. + +The DASI results will help your doctor decide which kind of stress test you should have. The results also give your doctor information about how well blood is flowing through your coronary arteries. + +Your doctor also may recommend blood tests, including a test for anemia. Anemia is thought to slow the growth of cells needed to repair damaged blood vessels. + +Research is ongoing for better ways to detect and diagnose coronary MVD. Currently, researchers have not agreed on the best way to diagnose the disease." +treatment,What are the treatments for Coronary Microvascular Disease ?,"Relieving pain is one of the main goals of treating coronary microvascular disease (MVD). Treatments also are used to control risk factors and other symptoms. Treatments may include medicines, such as: + +ACE inhibitors and beta blockers to lower blood pressure and decrease the hearts workload + +Aspirin to help prevent blood clots or control inflammation + +Nitroglycerin to relax blood vessels, improve blood flow to the heart muscle, and treat chest pain + +Statin medicines to control or lower your blood cholesterol. + +Take all medicines regularly, as your doctor prescribes. Dont change the amount of your medicine or skip a dose unless your doctor tells you to. + +If youre diagnosed with coronary MVD and also haveanemia, you may benefit from treatment for that condition. Anemia is thought to slow the growth of cells needed to repair damaged blood vessels. + +If youre diagnosed with and treated for coronary MVD, you should get ongoing care from your doctor. Research is under way to find the best treatments for coronary MVD." +prevention,How to prevent Coronary Microvascular Disease ?,"No specific studies have been done on how to prevent coronary microvascular disease. + +Researchers dont yet know how or in what way preventing coronary microvascular disease differs from preventing coronary heart disease. Coronary microvascular disease affects the tiny coronary arteries; coronary heart disease affects the large coronary arteries. + +Taking action to control risk factors for heart disease can help prevent or delay coronary heart disease. You cant control some risk factors, such as older age and family history of heart disease. However, you can take steps to prevent or control other risk factors, such as high blood pressure, overweight and obesity, high blood cholesterol, diabetes, and smoking. + +Heart-healthy lifestyle changes and ongoing medical care can help you lower your risk for heartdisease. + +Heart-Healthy Lifestyle Changes + +Your doctor may recommend heart-healthy lifestyle changes if you have coronary microvascular disease. Heart-healthy lifestyle changes include: + +Heart-healthy eating + +Maintaining a healthy weight + +Managing stress + +Physical activity + +Quitting smoking + +Heart-Healthy Eating + +Your doctor may recommend a heart-healthy eating plan, which should include: + +Fat-free or low-fat dairy products, such as skim milk + +Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week + +Fruits, such as apples, bananas, oranges, pears, and prunes + +Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans + +Vegetables, such as broccoli, cabbage, and carrots + +Whole grains, such as oatmeal, brown rice, and corn tortillas. + +When following a heart-healthy diet, you should avoid eating: + +A lot of red meat + +Palm and coconut oils + +Sugary foods and beverages + +Two nutrients in your diet make blood cholesterol levels rise: + +Saturated fatfound mostly in foods that come from animals + +Trans fat (trans fatty acids)found in foods made with hydrogenated oils and fats, such as stick margarine; baked goods, such as cookies, cakes, and pies; crackers; frostings; and coffee creamers. Some trans fats also occur naturally in animal fats andmeats. + +Saturated fat raises your blood cholesterol more than anything else in your diet. When you follow a heart-healthy eating plan, only 5 percent to 6 percent of your daily calories should come from saturated fat. Food labels list the amounts of saturated fat. To help you stay on track, here are some examples: + +1,200 calories a day + +8 grams of saturated fat a day + +1,500 calories a day + +10 grams of saturated fat a day + +1,800 calories a day + +12 grams of saturated fat a day + +2,000 calories a day + +13 grams of saturated fat a day + +2,500 calories a day + +17 grams of saturated fat a day + +Not all fats are bad. Monounsaturated and polyunsaturated fats actually help lower blood cholesterollevels. + +Some sources of monounsaturated and polyunsaturated fats are: + +Avocados + +Corn, sunflower, and soybean oils + +Nuts and seeds, such as walnuts + +Olive, canola, peanut, safflower, and sesame oils + +Peanut butter + +Salmon and trout + +Tofu + +Sodium + +You should try to limit the amount of sodium that you eat. This means choosing and preparing foods that are lower in salt and sodium. Try to use low-sodium and no added salt foods and seasonings at the table or while cooking. Food labels tell you what you need to know about choosing foods that are lower in sodium. Try to eat no more than 2,300 milligrams of sodium a day. If you have high blood pressure, you may need to restrict your sodium intake even more. + +Dietary Approaches to Stop Hypertension + +Your doctor may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium and salt. + +The DASH eating plan is a good heart-healthy eating plan, even for those who dont have high blood pressure. Read more about DASH. + +Alcohol + +Try to limit alcohol intake. Too much alcohol canraise your blood pressure and triglyceride levels, a type of fat found in the blood. Alcohol also adds extra calories, which may cause weight gain. + +Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is: + +12 ounces of beer + +5 ounces of wine + +1 ounces of liquor + +Maintaining a Healthy Weight + +Maintaining a healthy weight is important for overall health and can lower your risk for coronary heart disease. Aim for a Healthy Weight by following a heart-healthy eating plan and keeping physically active. + +Knowing your body mass index (BMI) helps you find out if youre a healthy weight in relation to your height and gives an estimate of your total body fat. To figure out your BMI, check out the National Heart, Lung, and Blood Institutes (NHLBI) online BMI calculator or talk to your doctor. A BMI: + +Below 18.5 is a sign that you are underweight. + +Between 18.5 and 24.9 is in the normal range. + +Between 25 and 29.9 is considered overweight. + +Of 30 or more is considered obese. + +A general goal to aim for is a BMI below 25. Your doctor or health care provider can help you set an appropriate BMI goal. + +Measuring waist circumference helps screen for possible health risks. If most of your fat is around your waist rather than at your hips, youre at a higher risk for heart disease and type 2 diabetes. This risk may be high with a waist size that is greater than 35 inches for women or greater than 40 inches for men. To learn how to measure your waist, visit Assessing Your Weight and Health Risk. + +If youre overweight or obese, try to lose weight. A loss of just 3 percent to 5 percent of your current weight can lower your triglycerides, blood glucose, and the risk of developing type 2 diabetes. Greater amounts of weight loss can improve blood pressure readings, lower LDL cholesterol, and increase HDL cholesterol. + +Managing Stress + +Research shows that the most commonly reported trigger for a heart attack is an emotionally upsetting eventparticularly one involving anger. Also, some of the ways people cope with stresssuch as drinking, smoking, or overeatingarent healthy. + +Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Consider healthy stress-reducing activities, such as: + +A stress management program + +Meditation + +Physical activity + +Relaxation therapy + +Talking things out with friends or family + +Physical Activity + +Routine physical activity can lower many coronary heart disease risk factors, including LDL (bad) cholesterol, high blood pressure, and excess weight. Physical activity also can lower your risk for diabetes and raise your HDL cholesterol level. HDL is the good cholesterol that helps prevent coronary heart disease. + +Everyone should try to participate in moderate-intensity aerobic exercise at least 2hours and 30minutes per week, or vigorous aerobic exercise for 1hour and 15minutes per week. Aerobic exercise, such as brisk walking, is any exercise in which your heart beats faster and you use more oxygen than usual. The more active you are, the more you will benefit. Participate in aerobic exercise for at least 10minutes at a time spread throughout the week. + +Read more about physical activity at: + +Physical Activity and Your Heart + +U.S. Department of Health and Human Services 2008 Physical Activity Guidelines forAmericans + +Talk with your doctor before you start a new exercise plan. Ask your doctor how much and what kinds of physical activity are safe for you. + +Quitting Smoking + +If you smoke, quit. Smoking can raise your risk for coronary heart disease and heart attack and worsen other coronary heart disease risk factors. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke. + +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. + +Read more about quitting smoking at Smoking and Your Heart. + +Ongoing Medical Care + +Learn more about heart disease and the traits, conditions, and habits that can raise your risk for developing it. Talk with your doctor about your risk factors for heart disease and how to controlthem. + +If lifestyle changes arent enough, your doctor may prescribe medicines to control your risk factors. Take all of your medicines as your doctor advises. Visit your doctor regularly and have recommended testing. + +Know your numbers. Ask your doctor for these three tests and have the results explained toyou: + +Blood pressure measurement. + +Fasting blood glucose. This test is for diabetes. + +Lipoprotein panel. This test measures total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol, and triglycerides (a type of fat in the blood). + +Finally, know your family history of heart disease. If you or someone in your family has heart disease, tell your doctor." +outlook,What is the outlook for Electrocardiogram ?,"An electrocardiogram (EKG) is painless and harmless. A nurse or technician will attach soft, sticky patches called electrodes to the skin of your chest, arms, and legs. The patches are about the size of a quarter. + +Often, 12 patches are attached to your body. This helps detect your heart's electrical activity from many areas at the same time. The nurse may have to shave areas of your skin to help the patches stick. + +After the patches are placed on your skin, you'll lie still on a table while the patches detect your heart's electrical signals. A machine will record these signals on graph paper or display them on a screen. + +The entire test will take about 10 minutes. + +EKG + + + +Special Types of Electrocardiogram + +The standard EKG described above, called a resting 12-lead EKG, only records seconds of heart activity at a time. It will show a heart problem only if the problem occurs during the test. + +Many heart problems are present all the time, and a resting 12-lead EKG will detect them. But some heart problems, like those related to an irregular heartbeat, can come and go. They may occur only for a few minutes a day or only while you exercise. + +Doctors use special EKGs, such as stress tests and Holter and event monitors, to help diagnose these kinds of problems. + +Stress Test + +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 an EKG is done. If you can't exercise, you'll be given medicine to make your heart work hard and beat fast. + +For more information, go to the Health Topics Stress Testing article. + +Holter and Event Monitors + +Holter and event monitors are small, portable devices. They record your heart's electrical activity while you do your normal daily activities. A Holter monitor records your heart's electrical activity for a full 24- or 48-hour period. + +An event monitor records your heart's electrical activity only 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. + +For more information, go to the Health Topics Holter and Event Monitors article." +outlook,What is the outlook for Electrocardiogram ?,"After an electrocardiogram (EKG), the nurse or technician will remove the electrodes (soft patches) from your skin. You may develop a rash or redness where the EKG patches were attached. This mild rash often goes away without treatment. + +You usually can go back to your normal daily routine after an EKG." +susceptibility,Who is at risk for Electrocardiogram? ?,"An electrocardiogram (EKG) has no serious risks. It's a harmless, painless test that detects the heart's electrical activity. EKGs don't give off electrical charges, such as shocks. + +You may develop a mild rash where the electrodes (soft patches) were attached. This rash often goes away without treatment." +information,What is (are) Coronary Heart Disease Risk Factors ?,"Coronary heart disease risk factors are conditions or habits that raise your risk of coronary heart disease (CHD) and heart attack. These risk factors also increase the chance that existing CHD will worsen. + +CHD, also called coronary artery disease, is a condition in which a waxy substance called plaque (plak) builds up on the inner walls of 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. Reduced blood flow can cause chest pain, especially when you're active. Eventually, an area of plaque can rupture (break open). This causes a blood clot to form on the surface of the plaque. + +If the clot becomes large enough, it can block the flow of oxygen-rich blood to the portion of heart muscle fed by the artery. Blocked blood flow to the heart muscle causes a heart attack. + +Overview + +There are many known CHD risk factors. You can control some risk factors, but not others. Risk factors you can control include: + +High blood cholesterol and triglyceride levels (a type of fat found in the blood) + +High blood pressure + +Diabetes and prediabetes + +Overweight and obesity + +Smoking + +Lack of physical activity + +Unhealthy diet + +Stress + +The risk factors you can't control are age, gender, and family history of CHD. + +Many people have at least one CHD risk factor. Your risk of CHD and heart attack increases with the number of risk factors you have and their severity. Also, some risk factors put you at greater risk of CHD and heart attack than others. Examples of these risk factors include smoking and diabetes. + +Many risk factors for coronary heart disease start during childhood. This is even more common now because many children are overweight and dont get enough physical activity. + +Researchers continue to study and learn more about CHD risk factors. + +Outlook + +Following a healthy lifestyle can help you and your children prevent or control many CHD risk factors. + +Because many lifestyle habits begin during childhood, parents and families should encourage their children to make heart healthy choices. For example, you and your children can lower your risk of CHD if you maintain a healthy weight, follow a healthy diet, do physical activity regularly, and don't smoke. + +If you already have CHD, lifestyle changes can help you control your risk factors. This may prevent CHD from worsening. Even if you're in your seventies or eighties, a healthy lifestyle can lower your risk of dying from CHD. + +If lifestyle changes aren't enough, your doctor may recommend other treatments to help control your risk factors. + +Your doctor can help you find out whether you have CHD risk factors. He or she also can help you create a plan for lowering your risk of CHD, heart attack, and other heart problems. + +If you have children, talk with their doctors about their heart health and whether they have CHD risk factors. If they do, ask your doctor to help create a treatment plan to reduce or control these risk factors." +susceptibility,Who is at risk for Coronary Heart Disease Risk Factors? ?,"High Blood Cholesterol and Triglyceride Levels + +Cholesterol + +High blood cholesterol is a condition in which your blood has too much cholesterola waxy, fat-like substance. The higher your blood cholesterol level, the greater your risk of coronary heart disease (CHD) and heart attack. + +Cholesterol travels through the bloodstream in small packages called lipoproteins. Two major kinds of lipoproteins carry cholesterol throughout your body: + +Low-density lipoproteins (LDL). LDL cholesterol sometimes is called ""bad"" cholesterol. This is because it carries cholesterol to tissues, including your heart arteries. A high LDL cholesterol level raises your risk of CHD. + +High-density lipoproteins (HDL). HDL cholesterol sometimes is called ""good"" cholesterol. This is because it helps remove cholesterol from your arteries. A low HDL cholesterol level raises your risk of CHD. + +Many factors affect your cholesterol levels. For example, after menopause, women's LDL cholesterol levels tend to rise, and their HDL cholesterol levels tend to fall. Other factorssuch as age, gender, diet, and physical activityalso affect your cholesterol levels. + +Healthy levels of both LDL and HDL cholesterol will prevent plaque from building up in your arteries. Routine blood tests can show whether your blood cholesterol levels are healthy. Talk with your doctor about having your cholesterol tested and what the results mean. + +Children also can have unhealthy cholesterol levels, especially if they're overweight or their parents have high blood cholesterol. Talk with your child's doctor about testing your child' cholesterol levels. + +To learn more about high blood cholesterol and how to manage the condition, go to the Health Topics High Blood Cholesterol article. + +Triglycerides + +Triglycerides are a type of fat found in the blood. Some studies suggest that a high level of triglycerides in the blood may raise the risk of CHD, especially in women. + +High Blood Pressure + +""Blood pressure"" is the force of blood pushing against the walls of your arteries as your heart pumps blood. If this pressure rises and stays high over time, it can damage your heart and lead to plaque buildup.All levels above 120/80 mmHg raise your risk of CHD. This risk grows as blood pressure levels rise. Only one of the two blood pressure numbers has to be above normal to put you at greater risk of CHD and heart attack. + + + +Most adults should have their blood pressure checked at least once a year. If you have high blood pressure, you'll likely need to be checked more often. Talk with your doctor about how often you should have your blood pressure checked. + +Children also can develop high blood pressure, especially if they're overweight. Your child's doctor should check your child's blood pressure at each routine checkup. + +Both children and adults are more likely to develop high blood pressure if they're overweight or have diabetes. + +For more information about high blood pressure and how to manage the condition, go to the Health Topics High Blood Pressure article. + +Diabetes and Prediabetes + +Diabetes is a disease in which the body's blood sugar level is too high. The two types of diabetes are type 1 and type 2. + +In type 1 diabetes, the body's blood sugar level is high because the body doesn't make enough insulin. Insulin is a hormone that helps move blood sugar into cells, where it's used for energy. In type 2 diabetes, the body's blood sugar level is high mainly because the body doesn't use its insulin properly. + +Over time, a high blood sugar level can lead to increased plaque buildup in your arteries. Having diabetes doubles your risk of CHD. + +Prediabetes is a condition in which your blood sugar level is higher than normal, but not as high as it is in diabetes. If you have prediabetes and don't take steps to manage it, you'll likely develop type 2 diabetes within 10 years. You're also at higher risk of CHD. + +Being overweight or obese raises your risk of type 2 diabetes. With modest weight loss and moderate physical activity, people who have prediabetes may be able to delay or prevent type 2 diabetes. They also may be able to lower their risk of CHD and heart attack. Weight loss and physical activity also can help control diabetes. + +Even children can develop type 2 diabetes. Most children who have type 2 diabetes are overweight. + +Type 2 diabetes develops over time and sometimes has no symptoms. Go to your doctor or local clinic to have your blood sugar levels tested regularly to check for diabetes and prediabetes. + +For more information about diabetes and heart disease, go to the Health Topics Diabetic Heart Disease article. For more information about diabetes and prediabetes, go to the National Institute of Diabetes and Digestive and Kidney Diseases' (NIDDK's) Introduction to Diabetes. + +Overweight and Obesity + +The terms ""overweight"" and ""obesity"" refer to body weight that's greater than what is considered healthy for a certain height. More than two-thirds of American adults are overweight, and almost one-third of these adults are obese. + +The most useful measure of overweight and obesity is body mass index (BMI).You can use the National Heart, Lung, and Blood Institute's (NHLBI's) online BMI calculator to figure out your BMI, or your doctor can help you. + +Overweight is defined differently for children and teens than it is for adults. Children are still growing, and boys and girls mature at different rates. Thus, BMIs for children and teens compare their heights and weights against growth charts that take age and gender into account. This is called BMI-for-age percentile. + +Being overweight or obese can raise your risk of CHD and heart attack. This is mainly because overweight and obesity are linked to other CHD risk factors, such as high blood cholesterol and triglyceride levels, high blood pressure, and diabetes. + +For more information, go to the Health Topics Overweight and Obesity article. + +Smoking + +Smoking tobacco or long-term exposure to secondhand smoke raises your risk of CHD and heart attack. + +Smoking triggers a buildup of plaque in your arteries. Smoking also increases the risk of blood clots forming in your arteries. Blood clots can block plaque-narrowed arteries and cause a heart attack.Some research shows that smoking raises your risk of CHD in part by lowering HDL cholesterol levels. + +The more you smoke, the greater your risk of heart attack. The benefits of quitting smoking occur no matter how long or how much you've smoked. Heart disease risk associated with smoking begins to decrease soon after you quit, and for many people it continues to decrease over time. + +Most people who smoke start when they're teens. Parents can help prevent their children from smoking by not smoking themselves. Talk with your child about the health dangers of smoking and ways to overcome peer pressure to smoke. + +For more information, including tips on how to quit smoking, go to the Health Topics Smoking and Your Heart article and the NHLBI's ""Your Guide to a Healthy Heart."" + +For more information about children and smoking, go to the U.S. Department of Health and Human Services' (HHS') Kids and Smoking Web page and the CDC's Smoking and Tobacco Use Web page. + +Lack of Physical Activity + +Inactive people are nearly twice as likely to develop CHD as those who are active. A lack of physical activity can worsen other CHD risk factors, such as high blood cholesterol and triglyceride levels, high blood pressure, diabetes and prediabetes, and overweight and obesity. + +It's important for children and adults to make physical activity part of their daily routines. One reason many Americans aren't active enough is because of hours spent in front of TVs and computers doing work, schoolwork, and leisure activities. + +Some experts advise that children and teens should reduce screen time because it limits time for physical activity. They recommend that children aged 2 and older should spend no more than 2 hours a day watching TV or using a computer (except for school work). + +Being physically active is one of the most important things you can do to keep your heart healthy. The good news is that even modest amounts of physical activity are good for your health. The more active you are, the more you will benefit. + +For more information, go to HHS' ""2008 Physical Activity Guidelines for Americans,"" the Health Topics Physical Activity and Your Heart article, and the NHLBI's ""Your Guide to Physical Activity and Your Heart."" + +Unhealthy Diet + +An unhealthy diet can raise your risk of CHD. For example, foods that are high in saturated and trans fats and cholesterol raise LDL cholesterol. Thus, you should try to limit these foods. + +It's also important to limit foods that are high in sodium (salt) and added sugars. A high-salt diet can raise your risk of high blood pressure. + +Added sugars will give you extra calories without nutrients like vitamins and minerals. This can cause you to gain weight, which raises your risk of CHD. Added sugars are found in many desserts, canned fruits packed in syrup, fruit drinks, and nondiet sodas. + +Stress + +Stress and anxiety may play a role in causing CHD. Stress and anxiety also can trigger your arteries to tighten. This can raise your blood pressure and your risk of heart attack. + +The most commonly reported trigger for a heart attack is an emotionally upsetting event, especially one involving anger. Stress also may indirectly raise your risk of CHD if it makes you more likely to smoke or overeat foods high in fat and sugar. + +Age + +In men, the risk for coronary heart disease (CHD) increases starting around age 45. In women, the risk for CHD increases starting around age 55. Most people have some plaque buildup in their heart arteries by the time theyre in their 70s. However, only about 25 percent of those people have chest pain, heart attacks, or other signs of CHD. + +Gender + +Some risk factors may affect CHD risk differently in women than in men. For example, estrogen provides women some protection against CHD, whereas diabetes raises the risk of CHD more in women than in men. + +Also, some risk factors for heart disease only affect women, such as preeclampsia, a condition that can develop during pregnancy. Preeclampsia is linked to an increased lifetime risk of heart disease, including CHD, heart attack, heart failure, and high blood pressure. (Likewise, having heart disease risk factors, such as diabetes or obesity, increases a womans risk of preeclampsia.) + +Family History + +A family history of early CHD is a risk factor for developing CHD, specifically if a father or brother is diagnosed before age 55, or a mother or sister is diagnosed before age 65." +prevention,How to prevent Coronary Heart Disease Risk Factors ?,"You can prevent and control many coronary heart disease (CHD) risk factors with heart-healthy lifestyle changes and medicines. Examples of risk factors you can control include high blood cholesterol, high blood pressure, and overweight and obesity. Only a few risk factorssuch as age, gender, and family historycant be controlled. + +To reduce your risk of CHD and heart attack, try to control each risk factor you can. The good news is that many lifestyle changes help control several CHD risk factors at the same time. For example, physical activity may lower your blood pressure, help control diabetes and prediabetes, reduce stress, and help control your weight. + +Heart-Healthy Lifestyle Changes + +A heart-healthy lifestyle can lower the risk of CHD. If you already have CHD, a heart-healthy lifestyle may prevent it from getting worse. Heart-healthy lifestyle changes include: + +Heart-healthy eating + +Maintaining a healthy weight + +Managing stress + +Physical activity + +Quitting smoking + +Many lifestyle habits begin during childhood. Thus, parents and families should encourage their children to make heart-healthy choices, such as following a healthy diet and being physically active. Make following a healthy lifestyle a family goal. Making lifestyle changes can be hard. But if you make these changes as a family, it may be easier for everyone to prevent or control their CHD risk factors. + +For tips on how to help your children adopt healthy habits, visit We Can! Ways to Enhance Childrens Activity & Nutrition. + +Heart-Healthy Eating + +Your doctor may recommend heart-healthy eating, which should include: + +Fat-free or low-fat dairy products, such as skim milk + +Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week + +Fruits, such as apples, bananas, oranges, pears, and prunes + +Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans + +Vegetables, such as broccoli, cabbage, and carrots + +Whole grains, such as oatmeal, brown rice, and corn tortillas + +When following a heart-healthy diet, you should avoid eating: + +A lot of red meat + +Palm and coconut oils + +Sugary foods and beverages + +Two nutrients in your diet make blood cholesterol levels rise: + +Saturated fatfound mostly in foods that come from animals + +Trans fat (trans fatty acids)found in foods made with hydrogenated oils and fats, such as stick margarine; baked goods, such as cookies, cakes, and pies; crackers; frostings; and coffee creamers. Some trans fats also occur naturally in animal fats andmeats. + +Saturated fat raises your blood cholesterol more than anything else in your diet. When you follow a heart-healthy eating plan, only 5 percent to 6 percent of your daily calories should come from saturated fat. Food labels list the amounts of saturated fat. To help you stay on track, here are some examples: + +1,200 calories a day + +8 grams of saturated fat a day + +1,500 calories a day + +10 grams of saturated fat a day + +1,800 calories a day + +12 grams of saturated fat a day + +2,000 calories a day + +13 grams of saturated fat a day + +2,500 calories a day + +17 grams of saturated fat a day + +Not all fats are bad. Monounsaturated and polyunsaturated fats actually help lower blood cholesterol levels. + +Some sources of monounsaturated and polyunsaturated fats are: + +Avocados + +Corn, sunflower, and soybean oils + +Nuts and seeds, such as walnuts + +Olive, canola, peanut, safflower, and sesame oils + +Peanut butter + +Salmon and trout + +Tofu + +Sodium + +You should try to limit the amount of sodium that you eat. This means choosing and preparing foods that are lower in salt and sodium. Try to use low-sodium and no added salt foods and seasonings at the table or while cooking. Food labels tell you what you need to know about choosing foods that are lower in sodium. Try to eat no more than 2,300 milligrams of sodium a day. If you have high blood pressure, you may need to restrict your sodium intake even more. + +Dietary Approaches to Stop Hypertension + +Your doctor may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium and salt. + +The DASH eating plan is a good heart-healthy eating plan, even for those who dont have high blood pressure. Read more about DASH. + +Alcohol + +Try to limit alcohol intake. Too much alcohol canraise your blood pressure and triglyceride levels, a type of fat found in the blood. Alcohol also adds extra calories, which may cause weight gain. + +Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is: + +12 ounces of beer + +5 ounces of wine + +1 ounces of liquor + +Maintaining a Healthy Weight + +Maintaining a healthy weight is important for overall health and can lower your risk for coronary heart disease. Aim for a Healthy Weight by following a heart-healthy eating plan and keeping physically active. + +Knowing your body mass index (BMI) helps you find out if youre a healthy weight in relation to your height and gives an estimate of your total body fat. To figure out your BMI, check out NHLBIs online BMI calculator or talk to your doctor. A BMI: + +Below 18.5 is a sign that you are underweight. + +Between 18.5 and 24.9 is in the normal range. + +Between 25 and 29.9 is considered overweight. + +Of 30 or more is considered obese. + +A general goal to aim for is a BMI of less than 25. Your doctor or health care provider can help you set an appropriate BMI goal. + +Measuring waist circumference helps screen for possible health risks. If most of your fat is around your waist rather than at your hips, youre at a higher risk for heart disease and type 2 diabetes. This risk may be high with a waist size that is greater than 35 inches for women or greater than 40 inches for men. To learn how to measure your waist, visit Assessing Your Weight and Health Risk. + +If youre overweight or obese, try to lose weight. A loss of just 3 percent to 5 percent of your current weight can lower your triglycerides, blood glucose, and the risk of developing type 2 diabetes. Greater amounts of weight loss can improve blood pressure readings, lower LDL cholesterol, and increase HDL cholesterol. + +Managing Stress + +Research shows that the most commonly reported trigger for a heart attack is an emotionally upsetting eventparticularly one involving anger. Also, some of the ways people cope with stresssuch as drinking, smoking, or overeatingarent healthy. + +Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Consider healthy stress-reducing activities, such as: + +A stress management program. + +Meditation + +Physical activity + +Relaxation therapy + +Talking things out with friends or family + +Physical Activity + +Routine physical activity can lower many CHD risk factors, including LDL (bad) cholesterol, high blood pressure, and excess weight. Physical activity also can lower your risk for diabetes and raise your HDL cholesterol level. HDL is the good cholesterol that helps prevent CHD. + +Everyone should try to participate in moderate-intensity aerobic exercise at least 2hours and 30minutes per week, or vigorous aerobic exercise for 1 hour and 15 minutes per week. Aerobic exercise, such as brisk walking, is any exercise in which your heart beats faster and you use more oxygen than usual. The more active you are, the more you will benefit. Participate in aerobic exercise for at least 10 minutes at a time spread throughout the week. + +Read more about physical activity at: + +Physical Activity and Your Heart + +U.S. Department of Health and Human Services 2008 Physical Activity Guidelines for Americans + +Talk with your doctor before you start a new exercise plan. Ask your doctor how much and what kinds of physical activity are safe for you. + +Quitting Smoking + +If you smoke, quit. Smoking can raise your risk for coronary heart disease and heart attack and worsen other coronary heart disease risk factors. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke. 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. + +Read more about quitting smoking at Smoking and Your Heart. + +Medicines + +Sometimes lifestyle changes arent enough to control your blood cholesterol levels. For example, you may need statin medications to control or lower your cholesterol. By lowering your cholesterol level, you can decrease your chance of having a heart attack or stroke. Doctors usually prescribe statins for people who have: + +Coronary heart disease, peripheral artery disease, or had a prior stroke + +Diabetes + +High LDL cholesterol levels + +Doctors may discuss beginning statin treatment with those who have an elevated risk for developing heart disease or having a stroke. + +Your doctor also may prescribe other medications to: + +Decrease your chance of having a heart attack or dying suddenly. + +Lower your blood pressure. + +Prevent blood clots, which can lead to heart attack or stroke. + +Prevent or delay the need for a procedure or surgery, such as percutaneous coronary intervention or coronary artery bypass grafting. + +Reduce your hearts workload and relieve CHD. + +Take all medicines regularly, as your doctor prescribes. Dont change the amount of your medicine or skip a dose unless your doctor tells you to.You should still follow a heart-healthy lifestyle, even if you take medicines to treat your CHD." +information,What is (are) High Blood Pressure ?,"Espaol + +High blood pressure is a common disease in which blood flows through blood vessels (arteries) at higher than normal pressures. + +Measuring Blood Pressure + +Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps blood. High blood pressure, sometimes called hypertension, happens when this force is too high. Health care workers check blood pressure readings the same way for children, teens, and adults. They use a gauge, stethoscope or electronic sensor, and a blood pressure cuff. With this equipment, they measure: + +Systolic Pressure: blood pressure when the heart beats while pumping blood + +Diastolic Pressure: blood pressure when the heart is at rest between beats + +Health care workers write blood pressure numbers with the systolic number above the diastolic number. For example: + + + +118/76 mmHg People read ""118 over 76"" millimeters of mercury. + +Normal Blood Pressure + +Normal blood pressure for adults is defined as a systolic pressure below 120 mmHg and a diastolic pressure below 80 mmHg. It is normal for blood pressures to change when you sleep, wake up, or are excited or nervous. When you are active, it is normal for your blood pressure to increase. However, once the activity stops, your blood pressure returns to your normal baseline range. + +Blood pressure normally rises with age and body size. Newborn babies often have very low blood pressure numbers that are considered normal for babies, while older teens have numbers similar to adults. + +Abnormal Blood Pressure + +Abnormal increases in blood pressure are defined as having blood pressures higher than 120/80 mmHg. The following table outlines and defines high blood pressure severity levels. + +Stages of High Blood Pressure in Adults + +The ranges in the table are blood pressure guides for adults who do not have any short-term serious illnesses. People with diabetes or chronic kidney disease should keep their blood pressure below 130/80 mmHg. + +Although blood pressure increases seen in prehypertension are less than those used to diagnose high blood pressure, prehypertension can progress to high blood pressure and should be taken seriously. Over time, consistently high blood pressure weakens and damages your blood vessels, which can lead to complications. + +Types of High Blood Pressure + +There are two main types of high blood pressure: primary and secondary high blood pressure. + +Primary High Blood Pressure + +Primary, or essential, high blood pressure is the most common type of high blood pressure. This type of high blood pressure tends to develop over years as a person ages. + +Secondary High Blood Pressure + +Secondary high blood pressure is caused by another medical condition or use of certain medicines. This type usually resolves after the cause is treated or removed." +causes,What causes High Blood Pressure ?,"Changes, either fromgenesor the environment, in the bodys normal functions may cause high blood pressure, including changes to kidney fluid and salt balances, therenin-angiotensin-aldosterone system,sympathetic nervous systemactivity, and blood vessel structure and function. + +Biology and High Blood Pressure + +Researchers continue to study how various changes in normal body functions cause high blood pressure. The key functions affected in high blood pressure include: + +Kidney fluid and salt balances + +Renin-angiotensin-aldosterone system + +Sympathetic nervous system activity + +Blood vessel structure and function + + + +Kidney Fluid and Salt Balances + +The kidneys normally regulate the bodys salt balance by retaining sodium and water and excreting potassium. Imbalances in this kidney function can expand blood volumes, which can cause high blood pressure. + + + +Renin-Angiotensin-Aldosterone System + +The renin-angiotensin-aldosterone system makes angiotensin and aldosterone hormones. Angiotensin narrows or constricts blood vessels, which can lead to an increase in blood pressure. Aldosterone controls how the kidneys balance fluid and salt levels. Increased aldosterone levels or activity may change this kidney function, leading to increased blood volumes and high blood pressure. + + + +Sympathetic Nervous System Activity + +The sympathetic nervous system has important functions in blood pressure regulation, including heart rate, blood pressure, and breathing rate. Researchers are investigating whether imbalances in this system cause high blood pressure. + + + +Blood Vessel Structure and Function + +Changes in the structure and function of small and large arteries may contribute to high blood pressure. The angiotensin pathway and the immune system may stiffen small and large arteries, which can affect blood pressure. + + + +Genetic Causes of High Blood Pressure + +Much of the understanding of the body systems involved in high blood pressure has come from genetic studies. High blood pressure often runs in families. Years of research have identified many genes and other mutations associated with high blood pressure, some in the renal salt regulatory and renin-angiotensin-aldosterone pathways. However, these known genetic factors only account for 2 to 3percent of all cases. Emerging research suggests that certain DNA changes during fetal development also may cause the development of high blood pressure later in life. + +Environmental Causes of High Blood Pressure + +Environmental causes of high blood pressure include unhealthy lifestyle habits, being overweight or obese, and medicines. + + + +Unhealthy Lifestyle Habits + +Unhealthy lifestyle habits can cause high blood pressure, including: + +High dietary sodium intake and sodium sensitivity + +Drinking excess amounts of alcohol + +Lack of physical activity + + + +Overweight and Obesity + +Research studies show that being overweight or obese can increase the resistance in the blood vessels, causing the heart to work harder and leading to high blood pressure. + + + +Medicines + +Prescription medicines such as asthma or hormone therapies, including birth control pills and estrogen, and over-the-counter medicines such as cold relief medicines may cause this form of high blood pressure. This happens because medicines can change the way your body controls fluid and salt balances, cause your blood vessels to constrict, or impact the renin-angiotensin-aldosterone system leading to high blood pressure. + +Other Medical Causes of High Blood Pressure + +Other medical causes of high blood pressure include other medical conditions such as chronic kidney disease, sleep apnea, thyroid problems, or certain tumors. This happens because these other conditions change the way your body controls fluids, sodium, and hormones in your blood, which leads to secondary high blood pressure." +susceptibility,Who is at risk for High Blood Pressure? ?,"Anyone can develop high blood pressure; however, age, race or ethnicity, being overweight, gender, lifestyle habits, and a family history of high blood pressure can increase your risk for developing high blood pressure. + +Age + +Blood pressure tends to rise with age. About 65 percent of Americans age 60 or older have high blood pressure. However, the risk for prehypertension and high blood pressure is increasing for children and teens, possibly due to the rise in the number of overweight children and teens. + +Race/Ethnicity + +High blood pressure is more common in African American adults than in Caucasian or Hispanic American adults. Compared with these ethnic groups, African Americans: + +Tend to get high blood pressure earlier in life. + +Often, on average, have higher blood pressure numbers. + +Are less likely to achieve target blood pressure goals with treatment. + +Overweight + +You are more likely to develop prehypertension or high blood pressure if youre overweight or obese. The terms overweight and obese refer to body weight thats greater than what is considered healthy for a certain height. + +Gender + +Before age 55, men are more likely than women to develop high blood pressure. After age 55, women are more likely than men to develop high blood pressure. + +Lifestyle Habits + +Unhealthy lifestyle habits can raise your risk for high blood pressure, and they include: + +Eating too much sodium or too little potassium + +Lack of physical activity + +Drinking too much alcohol + +Stress + +Family History + +A family history of high blood pressure raises the risk of developing prehypertension or high blood pressure. Some people have a high sensitivity to sodium and salt, which may increase their risk for high blood pressure and may run in families. Genetic causes of this condition are why family history is a risk factor for this condition." +symptoms,What are the symptoms of High Blood Pressure ?,"Because diagnosis is based on blood pressure readings, this condition can go undetected for years, as symptoms do not usually appear until the body is damaged from chronic high blood pressure. + + + +Complications of High Blood Pressure + +When blood pressure stays high over time, it can damage the body and cause complications. Some common complications and their signs and symptoms include: + +Aneurysms:When an abnormal bulge forms in the wall of an artery. Aneurysms develop and grow for years without causing signs or symptoms until they rupture, grow large enough to press on nearby body parts, or block blood flow. The signs and symptoms that develop depend on the location of the aneurysm. + +Chronic Kidney Disease: When blood vessels narrow in the kidneys, possibly causing kidney failure. + +Cognitive Changes: Research shows that over time, higher blood pressure numbers can lead to cognitive changes. Signs and symptoms include memory loss, difficulty finding words, and losing focus during conversations. + +Eye Damage: When blood vessels in the eyes burst or bleed. Signs and symptoms include vision changes or blindness. + +Heart Attack: When the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart doesnt get oxygen. The most common warning symptoms of a heart attack are chest pain or discomfort, upper body discomfort, and shortness of breath. + +Heart Failure: When the heart cant pump enough blood to meet the bodys needs. Common signs and symptoms of heart failure include shortness of breath or trouble breathing; feeling tired; and swelling in the ankles, feet, legs, abdomen, and veins in the neck. + +Peripheral Artery Disease: A disease in which plaque builds up in leg arteries and affects blood flow in the legs. When people have symptoms, the most common are pain, cramping, numbness, aching, or heaviness in the legs, feet, and buttocks after walking or climbing stairs. + +Stroke: When the flow of oxygen-rich blood to a portion of the brain is blocked. The symptoms of a stroke include sudden onset of weakness; paralysis or numbness of the face, arms, or legs; trouble speaking or understanding speech; and trouble seeing." +exams and tests,How to diagnose High Blood Pressure ?,"For most patients, health care providers diagnose high blood pressure when blood pressure readings areconsistently 140/90 mmHg or above. + +Confirming High Blood Pressure + +A blood pressure test is easy and painless and can be done in a health care providers office or clinic. To prepare for the test: + +Dont drink coffee or smoke cigarettes for 30 minutes prior to the test. + +Go to the bathroom before the test. + +Sit for 5 minutes before the test. + +To track blood pressure readings over a period of time, the health care provider may ask you to come into the office on different days and at different times to take your blood pressure. The health care provider also may ask you to check readings at home or at other locations that have blood pressure equipment and to keep a written log of all your results. + +Whenever you have an appointment with the health care provider, be sure to bring your log of blood pressure readings. Every time you visit the health care provider, he or she should tell you what your blood pressure numbers are; if he or she does not, you should ask for your readings. + +Blood Pressure Severity and Type + +Your health care provider usually takes 23 readings at several medical appointments to diagnose high blood pressure. Using the results of your blood pressure test, your health care provider will diagnose prehypertension or high blood pressure if: + +Your systolic or diastolic readings are consistently higher than 120/80 mmHg. + +Your childs blood pressure numbers are outside average numbers for children of the same age, gender, and height. + +Once your health care provider determines the severity of your blood pressure, he or she can order additional tests to determine if your blood pressure is due to other conditions or medicines or if you have primary high blood pressure. Health care providers can use this information to develop your treatment plan. + +Some people have white coat hypertension. This happens when blood pressure readings are only high when taken in a health care providers office compared with readings taken in any other location. Health care providers diagnose this type of high blood pressure by reviewing readings in the office and readings taken anywhere else. Researchers believe stress, which can occur during the medical appointment, causes white coat hypertension." +treatment,What are the treatments for High Blood Pressure ?,"Based on your diagnosis, health care providers develop treatment plans for high blood pressure that include lifelong lifestyle changes and medicines to control high blood pressure; lifestyle changes such as weight loss can be highly effective in treating high blood pressure. + + + +Treatment Plans + +Health care providers work with you to develop a treatment plan based on whether you were diagnosed with primary or secondary high blood pressure and if there is a suspected or known cause. Treatment plans may evolve until blood pressure control is achieved. + +If your health care provider diagnoses you with secondary high blood pressure, he or she will work to treat the other condition or change the medicine suspected of causing your high blood pressure. If high blood pressure persists or is first diagnosed as primary high blood pressure, your treatment plan will include lifestyle changes. When lifestyle changes alone do not control or lower blood pressure, your health care provider may change or update your treatment plan by prescribing medicines to treat the disease. Health care providers prescribe children and teens medicines at special doses that are safe and effective in children. + +If your health care provider prescribes medicines as a part of your treatment plan, keep up your healthy lifestyle habits. The combination of the medicines and the healthy lifestyle habits helps control and lower your high blood pressure. + +Some people develop resistant or uncontrolled high blood pressure. This can happen when the medications they are taking do not work well for them or another medical condition is leading to uncontrolled blood pressure. Health care providers treat resistant or uncontrolled high blood pressure with an intensive treatment plan that can include a different set of blood pressure medications or other special treatments. + +To achieve the best control of your blood pressure, follow your treatment plan and take all medications as prescribed. Following your prescribed treatment plan is important because it can prevent or delay complications that high blood pressure can cause and can lower your risk for other related problems. + + + +Healthy Lifestyle Changes + +Healthy lifestyle habits can help you control high blood pressure. These habits include: + +Healthy eating + +Being physically active + +Maintaining a healthy weight + +Limiting alcohol intake + +Managing and coping with stress + +To help make lifelong lifestyle changes, try making one healthy lifestyle change at a time and add another change when you feel that you have successfully adopted the earlier changes. When you practice several healthy lifestyle habits, you are more likely to lower your blood pressure and maintain normal blood pressure readings. + + + +Healthy Eating + +To help treat high blood pressure, health care providers recommend that you limit sodium and salt intake, increase potassium, and eat foods that are heart healthy. + +Limiting Sodium and Salt + +A low-sodium diet can help you manage your blood pressure. You should try to limit the amount of sodium that you eat. This means choosing and preparing foods that are lower in salt and sodium. Try to use low-sodium and no added salt foods and seasonings at the table or while cooking. Food labels tell you what you need to know about choosing foods that are lower in sodium. Try to eat no more than 2,300 mg sodium a day. If you have high blood pressure, you may need to restrict your sodium intake even more. + +Your health care provider may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and salt. + +The DASH eating plan is a good heart-healthy eating plan, even for those who dont have high blood pressure. Read more about the DASH eating plan. + +Heart-Healthy Eating + +Your health care provider also may recommend heart-healthy eating, which should include: + +Whole grains + +Fruits, such as apples, bananas, oranges, pears, and prunes + +Vegetables, such as broccoli, cabbage, and carrots + +Legumes, such as kidney beans, lentils, chick peas, black-eyed peas, and lima beans + +Fat-free or low-fat dairy products, such as skim milk + +Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week + +When following a heart-healthy diet, you should avoid eating: + +A lot of red meat + +Palm and coconut oils + +Sugary foods and beverages + +In the National Heart, Lung, and Blood Institute (NHLBI)-sponsored Hispanic Community Health Study/Study of Latinos, which studied Hispanics living in the United States, Cubans ate more sodium and Mexicans ate less sodium than other Hispanic groups in the study. All Hispanic Americans should follow these healthy eating recommendations even when cooking traditional Latino dishes. Try some of these popular Hispanic American heart-healthy recipes. + + + +Being Physically Active + +Routine physical activity can lower high blood pressure and reduce your risk for other health problems. Talk with your health care provider before you start a new exercise plan. Ask him or her how much and what kinds of physical activity are safe for you. + +Everyone should try to participate in moderate-intensity aerobic exercise at least 2 hours and 30minutes per week, or vigorous-intensity aerobic exercise for 1 hour and 15 minutes per week. Aerobic exercise, such as brisk walking, is any exercise in which your heart beats harder and you use more oxygen than usual. The more active you are, the more you will benefit. Participate in aerobic exercise for at least 10 minutes at a time, spread throughout the week. + +Read more about physical activity: + +Physical Activity and Your Heart + +U.S. Department of Health and Human Services'2008 Physical Activity Guidelines for Americans + + + +Maintaining a Healthy Weight + +Maintaining a healthy weight can help you control high blood pressure and reduce your risk for other health problems. If youre overweight or obese, try to lose weight. A loss of just 3 to 5 percent can lower your risk for health problems. Greater amounts of weight loss can improve blood pressure readings, lowerLDL cholesterol, and increase HDL cholesterol. However, research shows that no matter your weight, it is important to control high blood pressure to maintain good health. + +A useful measure of overweight and obesity is body mass index (BMI). BMI measures your weight in relation to your height. To figure out your BMI, check out NHLBIs online BMI calculator or talk to yourhealth care provider. + +A BMI: + +Below 18.5 is a sign that you are underweight. + +Between 18.5 and 24.9 is in the healthy range. + +Between 25 and 29.9 is considered overweight. + +Of 30 or more is considered obese. + +A general goal to aim for is a BMI below 25. Your health care provider can help you set an appropriate BMI goal. + +Measuring waist circumference helps screen for possible health risks. If most of your fat is around your waist rather than at your hips, youre at a higher risk for heart disease and type 2 diabetes. This risk may be high with a waist size that is greater than 35 inches for women or greater than 40 inches for men. To learn how to measure your waist, visit Assessing Your Weight and Health Risk. For more information about losing weight or maintaining your weight, go to Aim for a Healthy Weight. + + + +Limiting Alcohol Intake + +Limit alcohol intake. Too much alcohol will raise your blood pressure and triglyceride levels, a type of fat found in the blood. Alcohol also adds extra calories, which may cause weight gain. + +Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is: + +12 ounces of beer + +5 ounces of wine + +1 ounces of liquor + +Managing and Coping With Stress + +Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health and can lower high blood pressure. Stress management techniques include: + +Being physically active + +Listening to music or focusing on something calm or peaceful + +Performing yoga or tai chi + +Meditating + + + +Medicines + +Blood pressure medicines work in different ways to stop or slow some of the bodys functions that cause high blood pressure. Medicines to lower blood pressure include: + +Diuretics (Water or Fluid Pills): Flush excess sodium from your body, which reduces the amount of fluid in your blood and helps to lower your blood pressure. Diuretics are often used with other high blood pressure medicines, sometimes in one combined pill. + +Beta Blockers: Help your heart beat slower and with less force. As a result, your heart pumps less blood through your blood vessels, which can help to lower your blood pressure. + +Angiotensin-Converting Enzyme (ACE) Inhibitors: Angiotensin-II is a hormone that narrows blood vessels, increasing blood pressure. ACE converts Angiotensin I to Angiotensin II. ACE inhibitors block this process, which stops the production of Angiotensin II, lowering blood pressure. + +Angiotensin II Receptor Blockers (ARBs): Block angiotensin II hormone from binding with receptors in the blood vessels. When angiotensin II is blocked, the blood vessels do not constrict or narrow, which can lower your blood pressure. + +Calcium Channel Blockers: Keep calcium from entering the muscle cells of your heart and blood vessels. This allows blood vessels to relax, which can lower your blood pressure. + +Alpha Blockers: Reduce nerve impulses that tighten blood vessels. This allows blood to flow more freely, causing blood pressure to go down. + +Alpha-Beta Blockers: Reduce nerve impulses the same way alpha blockers do. However, like beta blockers, they also slow the heartbeat. As a result, blood pressure goes down. + +Central Acting Agents: Act in the brain to decrease nerve signals that narrow blood vessels, which can lower blood pressure. + +Vasodilators: Relax the muscles in blood vessel walls, which can lower blood pressure. + +To lower and control blood pressure, many people take two or more medicines. If you have side effects from your medicines, dont stop taking your medicines. Instead, talk with your health care provider about the side effects to see if the dose can be changed or a new medicine prescribed. + +Future Treatments + +Scientists, doctors, and researchers continue to study the changes that cause high blood pressure, to develop new medicines and treatments to control high blood pressure. Possible future treatments under investigation include new combination medicines, vaccines, and interventions aimed at the sympathetic nervous system, such as kidney nerve ablation." +prevention,How to prevent High Blood Pressure ?,"Healthy lifestyle habits, proper use of medicines, and regular medical care can prevent high blood pressure or its complications. + +Preventing High Blood Pressure Onset + +Healthy lifestyle habits can help prevent high blood pressure from developing. It is important to check your blood pressure regularly. Children should have their blood pressure checked starting at 3 years of age. If prehypertension is detected, it should be taken seriously to avoid progressing to high blood pressure. + +Preventing Worsening High Blood Pressure or Complications + +If you have been diagnosed with high blood pressure, it is important to obtain regular medical care and to follow your prescribed treatment plan, which will include healthy lifestyle habit recommendations and possibly medicines. Not only can healthy lifestyle habits prevent high blood pressure from occurring, but they can reverse prehypertension and help control existing high blood pressure or prevent complications and long-term problems associated with this condition, such as coronary heart disease, stroke, or kidney disease." +treatment,What are the treatments for Metabolic Syndrome ?,"Heart-healthy lifestyle changes are the first line of treatment for metabolic syndrome. Lifestyle changes include heart-healthy eating, losing and maintaining a healthy weight, managing stress, physical activity, and quittingsmoking. + +If lifestyle changes arent enough, your doctor may prescribe medicines. Medicines are used to treat and control risk factors, such as high blood pressure, high triglycerides, low HDL (good) cholesterol, and high blood sugar. + +Goals of Treatment + +The major goal of treating metabolic syndrome is to reduce the risk of coronary heart disease. Treatment is directed first at lowering LDL cholesterol and high blood pressure and managing diabetes (if these conditions are present). + +The second goal of treatment is to prevent the onset of type2 diabetes, if it hasnt already developed. Long-term complications of diabetes often include heart and kidney disease, vision loss, and foot or leg amputation. If diabetes is present, the goal of treatment is to reduce your risk for heart disease by controlling all of your risk factors. + + + +Heart-Healthy Lifestyle Changes + +Heart-Healthy Eating + +Heart-healthy eating is an important part of a heart-healthy lifestyle. Your doctor may recommend heart-healthy eating, which should include: + +Fat-free or low-fat dairy products, such as skim milk + +Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week + +Fruits, such as apples, bananas, oranges, pears, and prunes + +Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans + +Vegetables, such as broccoli, cabbage, and carrots + +Whole grains, such as oatmeal, brown rice, and corn tortillas + +When following a heart-healthy diet, you should avoid eating: + +A lot of red meat + +Palm and coconut oils + +Sugary foods and beverages + +Two nutrients in your diet make blood cholesterol levels rise: + +Saturated fatfound mostly in foods that come from animals + +Trans fat (trans fatty acids)found in foods made with hydrogenated oils and fats, such as stick margarine; baked goods, such as cookies, cakes, and pies; crackers; frostings; and coffee creamers. Some trans fats also occur naturally in animal fats and meats. + +Saturated fat raises your blood cholesterol more than anything else in your diet. When you follow a heart-healthy eating plan, only 5percent to 6percent of your daily calories should come from saturated fat. Food labels list the amounts of saturated fat. To help you stay on track, here are some examples: + +If you eat: + +Try to eat no more than: + +1,200 calories a day + +8 grams of saturated fat a day + +1,500 calories a day + +10 grams of saturated fat a day + +1,800 calories a day + +12 grams of saturated fat a day + +2,000 calories a day + +13 grams of saturated fat a day + +2,500 calories a day + +17 grams of saturated fat a day + +Not all fats are bad. Monounsaturated and polyunsaturated fats actually help lower blood cholesterol levels. Some sources of monounsaturated and polyunsaturated fats are: + +Avocados + +Corn, sunflower, and soybean oils + +Nuts and seeds, such as walnuts + +Olive, canola, peanut, safflower, and sesame oils + +Peanut butter + +Salmon and trout + +Tofu + +Sodium + +You should try to limit the amount of sodium that you eat. This means choosing and preparing foods that are lower in salt and sodium. Try to use low-sodium and no added salt foods and seasonings at the table or while cooking. Food labels tell you what you need to know about choosing foods that are lower in sodium. Try to eat no more than 2,300milligrams of sodium a day. If you have high blood pressure, you may need to restrict your sodium intake even more. + +Dietary Approaches to Stop Hypertension + +Your doctor may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium and salt. + +The DASH eating plan is a good heart-healthy eating plan, even for those who dont have high blood pressure. Read more about DASH. + +Limiting Alcohol + +Try to limit alcohol intake. Too much alcohol can raise your blood pressure and triglyceride levels, a type of fat found in the blood. Alcohol also adds extra calories, which may cause weightgain. + +Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is: + +12 ounces of beer + +5 ounces of wine + +1 ounces of liquor + + + +Maintaining a Healthy Weight + +If you have metabolic syndrome and are overweight or obese, your doctor will recommend weight loss. He or she can help you create a weight-loss plan and goals. Maintaining a healthy weight can lower your risk for metabolic syndrome, coronary heart disease, and other health problems. Aim for a Healthy Weight by following a heart-healthy eating plan and keeping physically active. + +Knowing your body mass index (BMI) helps you find out if youre a healthy weight in relation to your height and gives an estimate of your total body fat. To figure out your BMI, check out the National Heart, Lung, and Blood Institutes (NHLBI) online BMI calculator or talk to your doctor. A BMI: + +Below 18.5 is a sign that you are underweight. + +Between 18.5 and 24.9 is in the normal range. + +Between 25.0 and 29.9 is considered overweight. + +Of 30.0 or higher is considered obese. + +A general goal to aim for is a BMI of less than 25. Your doctor or health care provider can help you set an appropriate BMI goal. + +Measuring waist circumference helps screen for possible health risks. If most of your fat is around your waist rather than at your hips, youre at a higher risk for heart disease and type2 diabetes. This risk may be higher with a waist size that is greater than 35 inches for women or greater than 40 inches for men. + +If youre overweight or obese, try to lose weight. A loss of just 3percent to 5percent of your current weight can lower your triglycerides, blood glucose, and the risk of developing type2 diabetes. Greater amounts of weight loss can improve blood pressure readings, lower LDL (bad) cholesterol, and increase HDL cholesterol. + + + +Managing Stress + +Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Consider healthy stress-reducing activities, such as: + +A stress management program + +Meditation + +Physical activity + +Relaxation therapy + +Talking things out with friends or family + + + +Physical Activity + +Regular physical activity can lower your risk for metabolic syndrome, coronary heart disease, and other health problems. Everyone should try to participate in moderate-intensity aerobic exercise at least 2hours and 30minutes per week or vigorous aerobic exercise for 1hour and 15minutes per week. Aerobic exercise, such as brisk walking, is any exercise in which your heart beats faster and you use more oxygen than usual. The more active you are, the more you will benefit. Participate in aerobic exercise for at least 10minutes at a time spread throughout the week. + +Talk with your doctor before you start a new exercise plan. Ask your doctor how much and what kinds of physical activity are safe for you. + +Read more about physical activity at: + +Physical Activity and Your Heart + +U.S. Department of Health and Human Services 2008 Physical Activity Guidelines for Americans + + + +Quitting Smoking + +If you smoke, quit. Smoking can raise your risk for heart disease and heart attack and worsen other heart disease risk factors. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke. + +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. For more information about how to quit smoking, go to the Smoking and Your Heart Health Topic. + + + +Medicines + +Sometimes lifestyle changes arent enough to control your risk factors for metabolic syndrome. For example, you may need statin medications to control or lower your cholesterol. By lowering your blood cholesterol level, you can decrease your chance of having a heart attack or stroke. Doctors usually prescribe statins for people who have: + +Diabetes + +Heart disease or had a prior stroke + +High LDL cholesterol levels + +Doctors may discuss beginning statin treatment with those who have an elevated risk for developing heart disease or having a stroke. + +Your doctor also may prescribe other medications to: + +Decrease your chance of having a heart attack or dying suddenly. + +Lower your blood pressure. + +Prevent blood clots, which can lead to heart attack or stroke. + +Reduce your hearts workload and relieve symptoms of coronary heart disease. + +Take all medicines regularly, as your doctor prescribes. Dont change the amount of your medicine or skip a dose unless your doctor tells you to. You should still follow a heart-healthy lifestyle, even if you take medicines to treat your risk factors for metabolic syndrome." +prevention,How to prevent Metabolic Syndrome ?,"Making heart-healthy lifestyle choices is the best way to prevent metabolic syndrome by: + +Being physically active + +Following a heart-healthy eating plan + +Knowing your weight, waist measurement, and body mass index + +Maintaining a healthy weight + +Make sure to schedule routine doctor visits to keep track of your cholesterol, blood pressure, and blood sugar levels. Speak with your doctor about a blood test called a lipoprotein panel, which shows your levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides." +information,What is (are) Heart Attack ?,"Espaol + +A heart attack happens when the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart cant get oxygen. If blood flow isnt restored quickly, the section of heart muscle begins to die. + +Heart attack treatment works best when its given right after symptoms occur. If you think you or someone else is having a heart attack, even if youre not sure, call 911 right away. + +Overview + +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 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. 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. + +Heart With Muscle Damage and a Blocked Artery + + + +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. + +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. + +Don't Wait--Get Help Quickly + +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 911 + +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 911 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." +causes,What causes Heart Attack ?,"Coronary Heart Disease + +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. + +Coronary Artery Spasm + +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" +susceptibility,Who is at risk for Heart Attack? ?,"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. + +Risk Factors You Can Control + +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 factorssuch as obesity, high blood pressure, and high blood sugartend 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 You Can't Control + +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." +symptoms,What are the symptoms of Heart Attack ?,"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. + +Most Common Symptoms + +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. + +Other Common Signs and Symptoms + +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. + +Quick Action Can Save Your Life: Call 911 + +The signs and symptoms of a heart attack can develop suddenly. However, they also can develop slowlysometimes 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 911 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 911 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 911 to take aspirin or do anything else you think might help." +exams and tests,How to diagnose Heart Attack ?,"Your doctor will diagnose a heart attack based on your signs and symptoms, your medical and family histories, and test results. + +Diagnostic Tests + +EKG (Electrocardiogram) + +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. + +Blood Tests + +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 CKMB tests, and serum myoglobin tests. Blood tests often are repeated to check for changes over time. + +Coronary Angiography + +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 ascoronary 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." +treatment,What are the treatments for Heart Attack ?,"Early treatment for a heart attack can prevent or limit damage to the heart muscle. Acting fast, by calling 911 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. + +Immediate Treatment + +Certain treatments usually are started right away if a heart attack is suspected, even before the diagnosis is confirmed. These include: + +Aspirin to prevent further blood clotting + +Nitroglycerin to reduce your hearts workload and improve blood flow through the coronary arteries + +Oxygen therapy + +Treatment for chest pain + +Once the diagnosis of a heart attack is confirmed or strongly suspected, doctors start treatments promptly to try to restore blood flow through the blood vessels supplying the heart. The two main treatments are clot-busting medicines and percutaneous coronary intervention, also known 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 coronary intervention is a nonsurgical procedure that opens blocked or narrowed coronary arteries. A thin, flexible tube (catheter) 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 located at the tip of the catheter is inflated to compress the plaque and related clot 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 to keep the blood vessel open to prevent blockages in the artery in the months or years after the procedure. + +Other Treatments for Heart Attack + +Other treatments for heart attack include: + +Medicines + +Medical procedures + +Heart-healthy lifestyle changes + +Cardiac rehabilitation + + + +Medicines + +Your doctor may prescribe one or more of the following medicines. + +ACE inhibitors. ACE inhibitors lower blood pressure and reduce strain on your heart. They also help slow down further weakening of the heart muscle. + +Anticlotting medicines. Anticlotting medicines stop platelets from clumping together and forming unwanted blood clots. Examples of anticlotting medicines include aspirin and clopidogrel. + +Anticoagulants. Anticoagulants, or blood thinners, prevent blood clots from forming in your arteries. These medicines also keep existing clots from getting larger. + +Beta blockers. Beta blockers decrease your hearts workload. These medicines also are used to relieve chest pain and discomfort and to help prevent another heart attack. Beta blockers also are used to treat arrhythmias (irregular heartbeats). + +Statin medicines. Statins control or lower your blood cholesterol. By lowering your blood cholesterol level, you can decrease your chance of having another heart attack orstroke. + +You also may be given medicines to relieve pain and anxiety, and treat arrhythmias.Take all medicines regularly, as your doctor prescribes. Dont change the amount of your medicine or skip a dose unless your doctor tells you to. + + + +Medical Procedures + +Coronary artery bypass grafting also may be used to treat a heart attack. During coronary artery bypass grafting, a surgeon removes a healthy artery or vein from your body. The artery or vein is then connected, or grafted, to bypass the blocked section of the 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. + + + +Heart-Healthy Lifestyle Changes + +Treatment for a heart attack usually includes making heart-healthy lifestyle changes. Your doctor also may recommend: + +Heart-healthy eating + +Maintaining a healthy weight + +Managing stress + +Physical activity + +Quitting smoking + +Taking these steps can lower your chances of having another heart attack. + + + +Heart-Healthy Eating + +Your doctor may recommend a heart-healthy eating plan, which should include: + +Fat-free or low-fat dairy products, such as skim milk + +Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week + +Fruits, such as apples, bananas, oranges, pears, and prunes + +Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans + +Vegetables, such as broccoli, cabbage, and carrots + +Whole grains, such as oatmeal, brown rice, and corn tortillas + +When following a heart-healthy diet, you should avoid eating: + +A lot of red meat + +Palm and coconut oils + +Sugary foods and beverages + +Two nutrients in your diet make blood cholesterol levels rise: + +Saturated fatfound mostly in foods that come from animals + +Trans fat (trans fatty acids)found in foods made with hydrogenated oils and fats, such as stick margarine; baked goods, such as cookies, cakes, and pies; crackers; frostings; and coffee creamers. Some trans fats also occur naturally in animal fats andmeats. + +Saturated fat raises your blood cholesterol more than anything else in your diet. When you follow a heart-healthy eating plan, only 5 percent to 6 percent of your daily calories should come from saturated fat. Food labels list the amounts of saturated fat. To help you stay on track, here are some examples: + +If you eat: + +Try to eat no more than: + +1,200 calories a day + +8 grams of saturated fat a day + +1,500 calories a day + +10 grams of saturated fat a day + +1,800 calories a day + +12 grams of saturated fat a day + +2,000 calories a day + +13 grams of saturated fat a day + +2,500 calories a day + +17 grams of saturated fat a day + +Not all fats are bad. Monounsaturated and polyunsaturated fats actually help lower blood cholesterol levels. + +Some sources of monounsaturated and polyunsaturated fats are: + +Avocados + +Corn, sunflower, and soybean oils + +Nuts and seeds, such as walnuts + +Olive, canola, peanut, safflower, and sesame oils + +Peanut butter + +Salmon and trout + +Tofu + +You should try to limit the amount of sodium that you eat. This means choosing and preparing foods that are lower in salt and sodium. Try to use low-sodium and no added salt foods and seasonings at the table or while cooking. Food labels tell you what you need to know about choosing foods that are lower in sodium. Try to eat no more than 2,300 milligrams of sodium a day. If you have high blood pressure, you may need to restrict your sodium intake even more. + +Your doctor may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium and salt. + +The DASH eating plan is a good heart-healthy eating plan, even for those who dont have high blood pressure. Read more about DASH. + +Try to limit alcohol intake. Too much alcohol can raise your blood pressure and triglyceride levels, a type of fat found in the blood. Alcohol also adds extra calories, which may cause weight gain. + +Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is: + +12 ounces of beer + +5 ounces of wine + +1 ounces of liquor + + + +Maintaining a Healthy Weight + +Maintaining a healthy weight is important for overall health and can lower your risk for coronary heart disease and heart attack. Aim for a Healthy Weight by following a heart-healthy eating plan and keeping physically active. + +Knowing your body mass index (BMI) helps you find out if youre a healthy weight in relation to your height and gives an estimate of your total body fat. To figure out your BMI, check out the National Heart, Lung, and Blood Institutes (NHLBI) online BMI calculator or talk to your doctor. A BMI: + +Below 18.5 is a sign that you are underweight. + +Between 18.5 and 24.9 is in the normal range. + +Between 25 and 29.9 is considered overweight. + +Of 30 or more is considered obese. + +A general goal to aim for is a BMI of less than 25. Your doctor or health care provider can help you set an appropriate BMI goal. + +Measuring waist circumference helps screen for possible health risks. If most of your fat is around your waist rather than at your hips, youre at a higher risk for heart disease and type 2 diabetes. This risk may be high with a waist size that is greater than 35 inches for women or greater than 40 inches for men. To learn how to measure your waist, visit Assessing Your Weight and Health Risk. + + + +Managing Stress + +Research shows that the most commonly reported trigger for a heart attack is an emotionally upsetting eventparticularly one involving anger. Also, some of the ways people cope with stresssuch as drinking, smoking, or overeatingarent healthy. + +Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Consider healthy stress-reducing activities, such as: + +A stress management program + +Meditation + +Physical activity + +Relaxation therapy + +Talking things out with friends or family + + + +Physical Activity + +Routine physical activity can lower many risk factors for coronary heart disease, including LDL (bad) cholesterol, high blood pressure, and excess weight. Physical activity also can lower your risk for diabetes and raise your HDL cholesterol level. HDL is the good cholesterol that helps prevent another heart attack. + +Everyone should try to participate in moderate-intensity aerobic exercise at least 2hours and 30minutes per week, or vigorous aerobic exercise for 1hour and 15minutes per week. Aerobic exercise, such as brisk walking, is any exercise in which your heart beats faster and you use more oxygen than usual. The more active you are, the more you will benefit. Participate in aerobic exercise for at least 10minutes at a time spread throughout the week. + +Read more about physical activity at: + +Physical Activity and Your Heart + +U.S. Department of Health and Human Services 2008 Physical Activity Guidelines for Americans + +Talk with your doctor before you start a new exercise plan. Ask your doctor how much and what kinds of physical activity are safe for you. + + + +Quitting Smoking + +If you smoke, quit. Smoking can raise your risk for coronary heart disease and heart attack and worsen other coronary heart disease risk factors. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhandsmoke. + +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. + +Read more about quitting smoking at Smoking and Your Heart. + + + +Cardiac Rehabilitation + +Your doctor may recommend cardiac rehabilitation (cardiac rehab) to help you recover from a heart attack and to help prevent another heart attack. Nearly 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: + +Education, counseling, and training. This part of rehab helps you understand your heart condition and find ways to reduce your risk for future heart problems. The rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and how to deal with your fears about the future. + +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." +prevention,How to prevent Heart Attack ?,"Lowering your risk factors for coronary heart disease can help you prevent a heart attack. Even if you already have coronary heart disease, you still can take steps to lower your risk for a heart attack. These steps involve following a heart-healthy lifestyle and getting ongoingmedical care. + +Heart-Healthy Lifestyle + +A heart-healthy lifestyle can help prevent a heart attack and includes heart-healthy eating, being physically active, quitting smoking, managing stress, and managing your weight. + +Ongoing Care + +Treat Related Conditions + +Treating conditions that make a heart attack more likely also can help lower your risk for a heart attack. These conditions may include: + +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. + +High blood cholesterol. Your doctor may prescribe a statin medicine to lower your cholesterol if diet and exercise arent enough. + +High blood pressure. Your doctor may prescribe medicine to keep your blood pressure under control. + +Have an Emergency Action Plan + +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 youre at high risk for, or have already had, a heart attack. + +Write down a list of medicines you are taking, medicines you are allergic to, your health care providers phone numbers (both during and after office hours), and contact information for a friend or relative. Keep the list in a handy place (for example, fill out this wallet card) to share in a medical emergency. + +Talk with your doctor about the signs and symptoms of a heart attack, when you should call 911, and steps you can take while waiting for medical help to arrive." +information,What is (are) Atrial Fibrillation ?,"Atrial fibrillation (A-tre-al fi-bri-LA-shun), or AF, is the most common type of arrhythmia (ah-RITH-me-ah). An arrhythmia 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. + +AF occurs if rapid, disorganized electrical signals cause the heart's two upper chamberscalled the atria (AY-tree-uh)to fibrillate. The term ""fibrillate"" means to contract very fast and irregularly. + +In AF, blood pools in the atria. It isn't pumped completely into the heart's two lower chambers, called the ventricles (VEN-trih-kuls). As a result, the heart's upper and lower chambers don't work together as they should. + +People who have AF may not feel symptoms. However, even when AF isn't noticed, it can increase the risk of stroke. In some people, AF can cause chest pain or heart failure, especially if the heart rhythm is very rapid. + +AF may happen rarely or every now and then, or it may become an ongoing or long-term heart problem that lasts for years. + +Understanding the Heart's Electrical System + +To understand AF, it helps to understand the heart's internal electrical system. The heart's electrical system controls the rate and rhythm of the heartbeat. + +With each heartbeat, an electrical signal spreads from the top of the heart to the bottom. As the signal travels, it causes the heart to contract and pump blood. + +Each electrical signal begins in a group of cells called the sinus node or sinoatrial (SA) node. The SA node is located in the right atrium. In a healthy adult heart at rest, the SA node sends an electrical signal to begin a new heartbeat 60 to 100 times a minute. (This rate may be slower in very fit athletes.) + +From the SA node, the electrical signal travels through the right and left atria. It causes the atria to contract and pump blood into the ventricles. + +The electrical signal then moves down to a group of cells called the atrioventricular (AV) node, located between the atria and the ventricles. Here, the signal slows down slightly, allowing the ventricles time to finish filling with blood. + +The electrical signal then leaves the AV node and travels to the ventricles. It causes the ventricles to contract and pump blood to the lungs and the rest of the body. The ventricles then relax, and the heartbeat process starts all over again in the SA node. + +For more information about the heart's electrical system and detailed animations, go to the Diseases and Conditions Index How the Heart Works article. + +Understanding the Electrical Problem in Atrial Fibrillation + +In AF, the heart's electrical signals don't begin in the SA node. Instead, they begin in another part of the atria or in the nearby pulmonary veins. The signals don't travel normally. They may spread throughout the atria in a rapid, disorganized way. This can cause the atria to fibrillate. + +The faulty signals flood the AV node with electrical impulses. As a result, the ventricles also begin to beat very fast. However, the AV node can't send the signals to the ventricles as fast as they arrive. So, even though the ventricles are beating faster than normal, they aren't beating as fast as the atria. + +Thus, the atria and ventricles no longer beat in a coordinated way. This creates a fast and irregular heart rhythm. In AF, the ventricles may beat 100 to 175 times a minute, in contrast to the normal rate of 60 to 100 beats a minute. + +If this happens, blood isn't pumped into the ventricles as well as it should be. Also, the amount of blood pumped out of the ventricles to the body is based on the random atrial beats. + +The body may get rapid, small amounts of blood and occasional larger amounts of blood. The amount will depend on how much blood has flowed from the atria to the ventricles with each beat. + +Most of the symptoms of AF are related to how fast the heart is beating. If medicines or age slow the heart rate, the symptoms are minimized. + +AF may be brief, with symptoms that come and go and end on their own. Or, the condition may be ongoing and require treatment. Sometimes AF is permanent, and medicines or other treatments can't restore a normal heart rhythm. + +The animation below shows atrial fibrillation. 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 electrical signal can begin somewhere other than the sinoatrial node. This causes the atria to beat very fast and irregularly. + +Outlook + +People who have AF can live normal, active lives. For some people, treatment can restore normal heart rhythms. + +For people who have permanent AF, treatment can help control symptoms and prevent complications. Treatment may include medicines, medical procedures, and lifestyle changes." +causes,What causes Atrial Fibrillation ?,"Atrial fibrillation (AF) occurs if the heart's electrical signals don't travel through the heart in a normal way. Instead, they become very rapid and disorganized. + +Damage to the heart's electrical system causes AF. The damage most often is the result of other conditions that affect the health of the heart, such as high blood pressure and coronary heart disease. + +The risk of AF increases as you age. Inflammation also is thought to play a role in causing AF. + +Sometimes, the cause of AF is unknown." +susceptibility,Who is at risk for Atrial Fibrillation? ?,"Atrial fibrillation (AF) affects millions of people, and the number is rising. Men are more likely than women to have the condition. In the United States, AF is more common among Whites than African Americans or Hispanic Americans. + +The risk of AF increases as you age. This is mostly because your risk for heart disease and other conditions that can cause AF also increases as you age. However, about half of the people who have AF are younger than 75. + +AF is uncommon in children. + +Major Risk Factors + +AF is more common in people who have: + +High blood pressure + +Coronary heart disease (CHD) + +Heart failure + +Rheumatic (ru-MAT-ik) heart disease + +Structural heart defects, such as mitral valve prolapse + +Pericarditis (PER-i-kar-DI-tis; a condition in which the membrane, or sac, around your heart is inflamed) + +Congenital heart defects + +Sick sinus syndrome (a condition in which the heart's electrical signals don't fire properly and the heart rate slows down; sometimes the heart will switch back and forth between a slow rate and a fast rate) + +AF also is more common in people who are having heart attacks or who have just had surgery. + +Other Risk Factors + +Other conditions that raise your risk for AF include hyperthyroidism (too much thyroid hormone), obesity, diabetes, and lung disease. + +Certain factors also can raise your risk for AF. For example, drinking large amounts of alcohol, especially binge drinking, raises your risk. Even modest amounts of alcohol can trigger AF in some people. Caffeine or psychological stress also may trigger AF in some people. + +Some data suggest that people who have sleep apnea are at greater risk for AF. Sleep apnea is a common disorder that causes one or more pauses in breathing or shallow breaths while you sleep. + +Metabolic syndrome also raises your risk for AF. Metabolic syndrome is the name for a group of risk factors that raises your risk for CHD and other health problems, such as diabetes and stroke. + +Research suggests that people who receive high-dose steroid therapy are at increased risk for AF. This therapy is used for asthma and some inflammatory conditions. It may act as a trigger in people who have other AF risk factors. + +Genetic factors also may play a role in causing AF. However, their role isn't fully known." +symptoms,What are the symptoms of Atrial Fibrillation ?,"Atrial fibrillation (AF) usually causes the heart's lower chambers, the ventricles, to contract faster than normal. + +When this happens, the ventricles can't completely fill with blood. Thus, they may not be able to pump enough blood to the lungs and body. This can lead to signs and symptoms, such as: + +Palpitations (feelings that your heart is skipping a beat, fluttering, or beating too hard or fast) + +Shortness of breath + +Weakness or problems exercising + +Chest pain + +Dizziness or fainting + +Fatigue (tiredness) + +Confusion + +Atrial Fibrillation Complications + +AF has two major complicationsstroke and heart failure. + +Stroke + +During AF, the heart's upper chambers, the atria, don't pump all of their blood to the ventricles. Some blood pools in the atria. When this happens, a blood clot (also called a thrombus) can form. + +If the clot breaks off and travels to the brain, it can cause a stroke. (A clot that forms in one part of the body and travels in the bloodstream to another part of the body is called an embolus.) + +Blood-thinning medicines that reduce the risk of stroke are an important part of treatment for people who have AF. + +Atrial Fibrillation and Stroke + + + +Heart Failure + +Heart failure occurs if the heart can't pump enough blood to meet the body's needs. AF can lead to heart failure because the ventricles are beating very fast and can't completely fill with blood. Thus, they may not be able to pump enough blood to the lungs and body. + +Fatigue and shortness of breath are common symptoms of heart failure. A buildup of fluid in the lungs causes these symptoms. Fluid also can build up in the feet, ankles, and legs, causing weight gain. + +Lifestyle changes, medicines, and procedures or surgery (rarely, a mechanical heart pump or heart transplant) are the main treatments for heart failure." +exams and tests,How to diagnose Atrial Fibrillation ?,"Atrial fibrillation (AF) is diagnosed based on your medical and family histories, a physical exam, and the results from tests and procedures. + +Sometimes AF doesn't cause signs or symptoms. Thus, it may be found during a physical exam or EKG (electrocardiogram) test done for another purpose. + +If you have AF, your doctor will want to find out what is causing it. This will help him or her plan the best way to treat the condition. + +Specialists Involved + +Primary care doctors often are involved in the diagnosis and treatment of AF. These doctors include family practitioners and internists. + +Doctors who specialize in the diagnosis and treatment of heart disease also may be involved, such as: + +Cardiologists. These are doctors who diagnose and treat heart diseases and conditions. + +Electrophysiologists. These are cardiologists who specialize in arrhythmias. + +Medical and Family Histories + +Your doctor will likely ask questions about your: + +Signs and symptoms. What symptoms are you having? Have you had palpitations? Are you dizzy or short of breath? Are your feet or ankles swollen (a possible sign of heart failure)? Do you have any chest pain? + +Medical history. Do you have other health problems, such as a history of heart disease, high blood pressure, lung disease, diabetes, or thyroid problems? + +Family's medical history. Does anyone in your family have a history of AF? Has anyone in your family ever had heart disease or high blood pressure? Has anyone had thyroid problems? Does your family have a history of other illnesses or health problems? + +Health habits. Do you smoke or use alcohol or caffeine? + +Physical Exam + +Your doctor will do a complete cardiac exam. He or she will listen to the rate and rhythm of your heartbeat and take your pulse and blood pressure reading. Your doctor will likely check for any signs of heart muscle or heart valve problems. He or she will listen to your lungs to check for signs of heart failure. + +Your doctor also will check for swelling in your legs or feet and look for an enlarged thyroid gland or other signs of hyperthyroidism (too much thyroid hormone). + +Diagnostic Tests and Procedures + +EKG + +An EKG is a simple, painless test that records the heart's electrical activity. It's the most useful test for diagnosing AF. + +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. + +A standard EKG only records the heartbeat for a few seconds. It won't detect AF that doesn't happen during the test. To diagnose paroxysmal AF, your doctor may ask you to wear a portable EKG monitor that can record your heartbeat for longer periods. + +The two most common types of portable EKGs are Holter and event monitors. + +Holter and Event Monitors + +A Holter monitor records the heart's electrical activity for a full 24- or 48-hour period. You wear small patches called electrodes on your chest. Wires connect these patches to a small, portable recorder. The recorder can be clipped to a belt, kept in a pocket, or hung around your neck. + +You wear the Holter monitor while you do your normal daily activities. This allows the monitor to record your heart for a longer time than a standard EKG. + +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. + +Stress Test + +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. + +Echocardiography + +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 are working. + +Echo 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. + +This test sometimes is called transthoracic (trans-thor-AS-ik) echocardiography. It's painless and noninvasive (no instruments are inserted into the body). For the test, a device called a transducer is moved back and forth over your chest. The device sends special sound waves through your chest wall to your heart. + +The sound waves bounce off the structures of your heart, and a computer converts them into pictures on a screen. + +Transesophageal Echocardiography + +Transesophageal (trans-e-SOF-ah-ge-al) echo, or TEE, uses sound waves to take pictures of your heart through the esophagus. The esophagus is the passage leading from your mouth to your stomach. + +Your heart's upper chambers, the atria, are deep in your chest. They often can't be seen very well using transthoracic echo. Your doctor can see the atria much better using TEE. + +During this test, the transducer is attached to the end of a flexible tube. The tube is guided down your throat and into your esophagus. You'll likely be given medicine to help you relax during the procedure. + +TEE is used to detect blood clots that may be forming in the atria because of AF. + +Chest X Ray + +A chest x ray is a painless test that creates pictures of the structures in your chest, such as your heart and lungs. This test can show fluid buildup in the lungs and signs of other AF complications. + +Blood Tests + +Blood tests check the level of thyroid hormone in your body and the balance of your body's electrolytes. Electrolytes are minerals that help maintain fluid levels and acid-base balance in the body. They're essential for normal health and functioning of your body's cells and organs." +treatment,What are the treatments for Atrial Fibrillation ?,"Treatment for atrial fibrillation (AF) depends on how often you have symptoms, how severe they are, and whether you already have heart disease. General treatment options include medicines, medical procedures, and lifestyle changes. + +Goals of Treatment + +The goals of treating AF include: + +Preventing blood clots from forming, thus lowering the risk of stroke. + +Controlling how many times a minute the ventricles contract. This is called rate control. Rate control is important because it allows the ventricles enough time to completely fill with blood. With this approach, the abnormal heart rhythm continues, but you feel better and have fewer symptoms. + +Restoring a normal heart rhythm. This is called rhythm control. Rhythm control allows the atria and ventricles to work together to efficiently pump blood to the body. + +Treating any underlying disorder that's causing or raising the risk of AFfor example, hyperthyroidism (too much thyroid hormone). + +Who Needs Treatment for Atrial Fibrillation? + +People who have AF but don't have symptoms or related heart problems may not need treatment. AF may even go back to a normal heart rhythm on its own. (This also can occur in people who have AF with symptoms.) + +In some people who have AF for the first time, doctors may choose to use an electrical procedure or medicine to restore a normal heart rhythm. + +Repeat episodes of AF tend to cause changes to the heart's electrical system, leading to persistent or permanent AF. Most people who have persistent or permanent AF need treatment to control their heart rate and prevent complications. + +Specific Types of Treatment + +Blood Clot Prevention + +People who have AF are at increased risk for stroke. This is because blood can pool in the heart's upper chambers (the atria), causing a blood clot to form. If the clot breaks off and travels to the brain, it can cause a stroke. + +Preventing blood clots from forming is probably the most important part of treating AF. The benefits of this type of treatment have been proven in multiple studies. + +Doctors prescribe blood-thinning medicines to prevent blood clots. These medicines include warfarin (Coumadin), dabigatran, heparin, and aspirin. + +People taking blood-thinning medicines need regular blood tests to check how well the medicines are working. + +Rate Control + +Doctors can prescribe medicines to slow down the rate at which the ventricles are beating. These medicines help bring the heart rate to a normal level. + +Rate control is the recommended treatment for most patients who have AF, even though an abnormal heart rhythm continues and the heart doesn't work as well as it should. Most people feel better and can function well if their heart rates are well-controlled. + +Medicines used to control the heart rate include beta blockers (for example, metoprolol and atenolol), calcium channel blockers (diltiazem and verapamil), and digitalis (digoxin). Several other medicines also are available. + +Rhythm Control + +Restoring and maintaining a normal heart rhythm is a treatment approach recommended for people who aren't doing well with rate control treatment. This treatment also may be used for people who have only recently started having AF. The long-term benefits of rhythm control have not been proven conclusively yet. + +Doctors use medicines or procedures to control the heart's rhythm. Patients often begin rhythm control treatment in a hospital so that their hearts can be closely watched. + +The longer you have AF, the less likely it is that doctors can restore a normal heart rhythm. This is especially true for people who have had AF for 6 months or more. + +Restoring a normal rhythm also becomes less likely if the atria are enlarged or if any underlying heart disease worsens. In these cases, the chance that AF will recur is high, even if you're taking medicine to help convert AF to a normal rhythm. + +Medicines. Medicines used to control the heart rhythm include amiodarone, sotalol, flecainide, propafenone, dofetilide, and ibutilide. Sometimes older medicinessuch as quinidine, procainamide, and disopyramideare used. + +Your doctor will carefully tailor the dose and type of medicines he or she prescribes to treat your AF. This is because medicines used to treat AF can cause a different kind of arrhythmia. + +These medicines also can harm people who have underlying diseases of the heart or other organs. This is especially true for patients who have an unusual heart rhythm problem called Wolff-Parkinson-White syndrome. + +Your doctor may start you on a small dose of medicine and then gradually increase the dose until your symptoms are controlled. Medicines used for rhythm control can be given regularly by injection at a doctor's office, clinic, or hospital. Or, you may routinely take pills to try to control AF or prevent repeat episodes. + +If your doctor knows how you'll react to a medicine, a specific dose may be prescribed for you to take on an as-needed basis if you have an episode of AF. + +Procedures. Doctors use several procedures to restore a normal heart rhythm. For example, they may use electrical cardioversion to treat a fast or irregular heartbeat. For this procedure, low-energy shocks are given to your heart to trigger a normal rhythm. You're temporarily put to sleep before you receive the shocks. + +Electrical cardioversion isn't the same as the emergency heart shocking procedure often seen on TV programs. It's planned in advance and done under carefully controlled conditions. + +Before doing electrical cardioversion, your doctor may recommend transesophageal echocardiography (TEE). This test can rule out the presence of blood clots in the atria. If clots are present, you may need to take blood-thinning medicines before the procedure. These medicines can help get rid of the clots. + +Catheter ablation (ab-LA-shun) may be used to restore a normal heart rhythm if medicines or electrical cardioversion don't work. For this procedure, a wire is inserted through a vein in the leg or arm and threaded to the heart. + +Radio wave energy is sent through the wire to destroy abnormal tissue that may be disrupting the normal flow of electrical signals. An electrophysiologist usually does this procedure in a hospital. Your doctor may recommend a TEE before catheter ablation to check for blood clots in the atria. + +Sometimes doctors use catheter ablation to destroy the atrioventricular (AV) node. The AV node is where the heart's electrical signals pass from the atria to the ventricles (the heart's lower chambers). This procedure requires your doctor to surgically implant a device called a pacemaker, which helps maintain a normal heart rhythm. + +Research on the benefits of catheter ablation as a treatment for AF is still ongoing. (For more information, go to the ""Clinical Trials"" section of this article.) + +Another procedure to restore a normal heart rhythm is called maze surgery. For this procedure, the surgeon makes small cuts or burns in the atria. These cuts or burns prevent the spread of disorganized electrical signals. + +This procedure requires open-heart surgery, so it's usually done when a person requires heart surgery for other reasons, such as for heart valve disease (which can increase the risk of AF). + +Approaches To Treating Underlying Causes and Reducing Risk Factors + +Your doctor may recommend treatments for an underlying cause of AF or to reduce AF risk factors. For example, he or she may prescribe medicines to treat an overactive thyroid, lower high blood pressure, or manage high blood cholesterol. + +Your doctor also may recommend lifestyle changes, such as following a healthy diet, cutting back on salt intake (to help lower blood pressure), quitting smoking, and reducing stress. + +Limiting or avoiding alcohol, caffeine, or other stimulants that may increase your heart rate also can help reduce your risk for AF." +prevention,How to prevent Atrial Fibrillation ?,"Following a healthy lifestyle and taking steps to lower your risk for heart disease may help you prevent atrial fibrillation (AF). These steps include: + +Following a heart healthy diet that's low in saturated fat, trans fat, and cholesterol. A healthy diet includes a variety of whole grains, fruits, and vegetables daily. + +Not smoking. + +Being physically active. + +Maintaining a healthy weight. + +If you already have heart disease or other AF risk factors, work with your doctor to manage your condition. In addition to adopting the healthy habits above, which can help control heart disease, your doctor may advise you to: + +Follow the DASH eating plan to help lower your blood pressure. + +Keep your cholesterol and triglycerides at healthy levels with dietary changes and medicines (if prescribed). + +Limit or avoid alcohol. + +Control your blood sugar level if you have diabetes. + +Get ongoing medical care and take your medicines as prescribed. + +For more information about following a healthy lifestyle, visit the National Heart, Lung, and Blood Institute's Aim for a Healthy Weight Web site, ""Your Guide to a Healthy Heart,"" ""Your Guide to Lowering Your Blood Pressure With DASH,"" and ""Your Guide to Physical Activity and Your Heart.""" +information,What is (are) Angina ?,"Espaol + +Angina (an-JI-nuh or AN-juh-nuh) is chest pain or discomfort that occurs if an area of your heart muscle doesn't get enough oxygen-rich blood. + +Angina may feel like pressure or squeezing in your chest. The pain also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. + +Angina isn't a disease; it's a symptom of an underlying heart problem. Angina usually is a symptom of coronary heart disease (CHD). + +CHD is the most common type of heart disease in adults. It occurs if a waxy substance called plaque (plak) builds up on the inner walls of your coronary arteries. These arteries carry oxygen-rich blood to your heart. + +Plaque Buildup in an Artery + + + +Plaque narrows and stiffens the coronary arteries. This reduces the flow of oxygen-rich blood to the heart muscle, causing chest pain. Plaque buildup also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow, which can cause a heart attack. + +Angina also can be a symptom of coronary microvascular disease (MVD). This is heart disease that affects the hearts smallest coronary arteries. In coronary MVD, plaque doesn't create blockages in the arteries like it does in CHD. + +Studies have shown that coronary MVD is more likely to affect women than men. Coronary MVD also is called cardiac syndrome X and nonobstructive CHD. + +Types of Angina + +The major types of angina are stable, unstable, variant (Prinzmetal's), and microvascular. Knowing how the types differ is important. This is because they have different symptoms and require different treatments. + +Stable Angina + +Stable angina is the most common type of angina. It occurs when the heart is working harder than usual. Stable angina has a regular pattern. (Pattern refers to how often the angina occurs, how severe it is, and what factors trigger it.) + +If you have stable angina, you can learn its pattern and predict when the pain will occur. The pain usually goes away a few minutes after you rest or take your angina medicine. + +Stable angina isn't a heart attack, but it suggests that a heart attack is more likely to happen in the future. + +Unstable Angina + +Unstable angina doesn't follow a pattern. It may occur more often and be more severe than stable angina. Unstable angina also can occur with or without physical exertion, and rest or medicine may not relieve the pain. + +Unstable angina is very dangerous and requires emergency treatment. This type of angina is a sign that a heart attack may happen soon. + +Variant (Prinzmetal's) Angina + +Variant angina is rare. A spasm in a coronary artery causes this type of angina. Variant angina usually occurs while you're at rest, and the pain can be severe. It usually happens between midnight and early morning. Medicine can relieve this type of angina. + +Microvascular Angina + +Microvascular angina can be more severe and last longer than other types of angina. Medicine may not relieve this type of angina. + +Overview + +Experts believe that nearly 7 million people in the United States suffer from angina. The condition occurs equally among men and women. + +Angina can be a sign of CHD, even if initial tests don't point to the disease. However, not all chest pain or discomfort is a sign of CHD. + +Other conditions also can cause chest pain, such as: + +Pulmonary embolism (a blockage in a lung artery) + +A lung infection + +Aortic dissection (tearing of a major artery) + +Aortic stenosis (narrowing of the hearts aortic valve) + +Hypertrophic cardiomyopathy (KAR-de-o-mi-OP-ah-thee; heart muscle disease) + +Pericarditis (inflammation in the tissues that surround the heart) + +A panic attack + +All chest pain should be checked by a doctor." +causes,What causes Angina ?,"Underlying Causes + +Angina usually is a symptom of coronary heart disease (CHD). This means that the underlying causes of angina generally are the same as the underlying causes of CHD. + +Research suggests that CHD starts when certain factors damage the inner layers of the coronary arteries. These factors include: + +Smoking + +High amounts of certain fats and cholesterol in the blood + +High blood pressure + +High amounts of sugar in the blood due to insulin resistance or diabetes + +Plaque may begin to build up where the arteries are damaged. When plaque builds up in the arteries, the condition is called atherosclerosis (ath-er-o-skler-O-sis). + +Plaque narrows or blocks the arteries, reducing blood flow to the heart muscle. Some plaque is hard and stable and causes the arteries to become narrow and stiff. This can greatly reduce blood flow to the heart and cause angina. + +Other plaque is soft and more likely to rupture (break open) and cause blood clots. Blood clots can partially or totally block the coronary arteries and cause angina or a heart attack. + +Immediate Causes + +Many factors can trigger angina pain, depending on the type of angina you have. + +Stable Angina + +Physical exertion is the most common trigger of stable angina. Severely narrowed arteries may allow enough blood to reach the heart when the demand for oxygen is low, such as when you're sitting. + +However, with physical exertionlike walking up a hill or climbing stairsthe heart works harder and needs more oxygen. + +Other triggers of stable angina include: + +Emotional stress + +Exposure to very hot or cold temperatures + +Heavy meals + +Smoking + +Unstable Angina + +Blood clots that partially or totally block an artery cause unstable angina. + +If plaque in an artery ruptures, blood clots may form. This creates a blockage. A clot may grow large enough to completely block the artery and cause a heart attack. For more information, go to the animation in ""What Causes a Heart Attack?"" + +Blood clots may form, partially dissolve, and later form again. Angina can occur each time a clot blocks an artery. + +Variant Angina + +A spasm in a coronary artery causes variant angina. The spasm causes the walls of the artery to tighten and narrow. Blood flow to the heart slows or stops. Variant angina can occur in people who have CHD and in those who dont. + +The coronary arteries can spasm as a result of: + +Exposure to cold + +Emotional stress + +Medicines that tighten or narrow blood vessels + +Smoking + +Cocaine use + +Microvascular Angina + +This type of angina may be a symptom of coronary microvascular disease (MVD). Coronary MVD is heart disease that affects the hearts smallest coronary arteries. + +Reduced blood flow in the small coronary arteries may cause microvascular angina. Plaque in the arteries, artery spasms, or damaged or diseased artery walls can reduce blood flow through the small coronary arteries." +susceptibility,Who is at risk for Angina? ?,"Angina is a symptom of an underlying heart problem. Its usually a symptom of coronary heart disease (CHD), but it also can be a symptom of coronary microvascular disease (MVD). So, if youre at risk for CHD or coronary MVD, youre also at risk for angina. + +The major risk factors for CHD and coronary MVD include: + +Unhealthy cholesterol levels. + +High blood pressure. + +Smoking. + +Insulin resistance or diabetes. + +Overweight or obesity. + +Metabolic syndrome. + +Lack of physical activity. + +Unhealthy diet. + +Older age. (The risk increases for men after 45 years of age and for women after 55 years of age.) + +Family history of early heart disease. + +For more detailed information about CHD and coronary MVD risk factors, visit the Diseases and Conditions Index Coronary Heart Disease, Coronary Heart Disease Risk Factors, and Coronary Microvascular Disease articles. + +People sometimes think that because men have more heart attacks than women, men also suffer from angina more often. In fact, overall, angina occurs equally among men and women. + +Microvascular angina, however, occurs more often in women. About 70 percent of the cases of microvascular angina occur in women around the time of menopause. + +Unstable angina occurs more often in older adults. Variant angina is rare; it accounts for only about 2 out of 100 cases of angina. People who have variant angina often are younger than those who have other forms of angina." +symptoms,What are the symptoms of Angina ?,"Pain and discomfort are the main symptoms of angina. Angina often is described as pressure, squeezing, burning, or tightness in the chest. The pain or discomfort usually starts behind the breastbone. + +Pain from angina also can occur in the arms, shoulders, neck, jaw, throat, or back. The pain may feel like indigestion. Some people say that angina pain is hard to describe or that they can't tell exactly where the pain is coming from. + +Signs and symptoms such as nausea (feeling sick to your stomach), fatigue (tiredness), shortness of breath, sweating, light-headedness, and weakness also may occur. + +Women are more likely to feel discomfort in the neck, jaw, throat, abdomen, or back. Shortness of breath is more common in older people and those who have diabetes. Weakness, dizziness, and confusion can mask the signs and symptoms of angina in elderly people. + +Symptoms also vary based on the type of angina you have. + +Because angina has so many possible symptoms and causes, all chest pain should be checked by a doctor. Chest pain that lasts longer than a few minutes and isn't relieved by rest or angina medicine may be a sign of a heart attack. Call 911 right away. + +Stable Angina + +The pain or discomfort: + +Occurs when the heart must work harder, usually during physical exertion + +Doesn't come as a surprise, and episodes of pain tend to be alike + +Usually lasts a short time (5 minutes or less) + +Is relieved by rest or medicine + +May feel like gas or indigestion + +May feel like chest pain that spreads to the arms, back, or other areas + +Unstable Angina + +The pain or discomfort: + +Often occurs at rest, while sleeping at night, or with little physical exertion + +Comes as a surprise + +Is more severe and lasts longer than stable angina (as long as 30 minutes) + +Usually isnt relieved by rest or medicine + +May get worse over time + +May mean that a heart attack will happen soon + +Variant Angina + +The pain or discomfort: + +Usually occurs at rest and during the night or early morning hours + +Tends to be severe + +Is relieved by medicine + +Microvascular Angina + +The pain or discomfort: + +May be more severe and last longer than other types of angina pain + +May occur with shortness of breath, sleep problems, fatigue, and lack of energy + +Often is first noticed during routine daily activities and times of mental stress" +exams and tests,How to diagnose Angina ?,"The most important issues to address when you go to the doctor with chest pain are: + +What's causing the chest pain + +Whether you're having or are about to have a heart attack + +Angina is a symptom of an underlying heart problem, usually coronary heart disease (CHD). The type of angina pain you have can be a sign of how severe the CHD is and whether it's likely to cause a heart attack. + +If you have chest pain, your doctor will want to find out whether it's angina. He or she also will want to know whether the angina is stable or unstable. If it's unstable, you may need emergency medical treatment to try to prevent a heart attack. + +To diagnose chest pain as stable or unstable angina, your doctor will do a physical exam, ask about your symptoms, and ask about your risk factors for and your family history of CHD or other heart diseases. + +Your doctor also may ask questions about your symptoms, such as: + +What brings on the pain or discomfort and what relieves it? + +What does the pain or discomfort feel like (for example, heaviness or tightness)? + +How often does the pain occur? + +Where do you feel the pain or discomfort? + +How severe is the pain or discomfort? + +How long does the pain or discomfort last? + +Diagnostic Tests and Procedures + +If your doctor thinks that you have unstable angina or that your angina is related to a serious heart condition, he or she may recommend one or more tests. + +EKG (Electrocardiogram) + +An EKG is a simple, painless test that detects and records the hearts 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 the heart. + +An EKG can show signs of heart damage due to CHD and signs of a previous or current heart attack. However, some people who have angina have normal EKGs. + +Stress Testing + +During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you cant exercise, you may be given medicine to make your heart work hard and beat fast. + +When your heart is working hard and beating fast, it needs more blood and oxygen. Plaque-narrowed arteries can't supply enough oxygen-rich blood to meet your heart's needs. + +A stress test can show possible signs and symptoms of CHD, such as: + +Abnormal changes in your heart rate or blood pressure + +Shortness of breath or chest pain + +Abnormal changes in your heart rhythm or your heart's electrical activity + +As part of some stress tests, pictures are taken of your heart while you exercise and while you rest. These imaging stress tests can show how well blood is flowing in various parts of your heart. They also can show how well your heart pumps blood when it beats. + +Chest X Ray + +A chest x ray takes pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels. + +A chest x ray can reveal signs of heart failure. It also can show signs of lung disorders and other causes of symptoms not related to CHD. However, a chest x ray alone is not enough to diagnose angina or CHD. + +Coronary Angiography and Cardiac Catheterization + +Your doctor may recommend coronary angiography (an-jee-OG-ra-fee) if he or she suspects you have CHD. This test uses dye and special x rays to show the inside of your 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 your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels. + +Cardiac catheterization usually is done in a hospital. You're awake during the procedure. It usually causes little or no pain, although you may feel some soreness in the blood vessel where your doctor inserts the catheter. + +Computed Tomography Angiography + +Computed tomography (to-MOG-rah-fee) angiography (CTA) uses dye and special x rays to show blood flow through the coronary arteries. This test is less invasive than coronary angiography with cardiac catheterization. + +For CTA, a needle connected to an intravenous (IV) line is put into a vein in your hand or arm. Dye is injected through the IV line during the scan. You may have a warm feeling when this happens. The dye highlights your blood vessels on the CT scan pictures. + +Sticky patches called electrodes are put on your chest. The patches are attached to an EKG machine to record your heart's electrical activity during the scan. + +The CT scanner is a large machine that has a hollow, circular tube in the middle. You lie on your back on a sliding table. The table slowly slides into the opening of the machine. + +Inside the scanner, an x-ray tube moves around your body to take pictures of different parts of your heart. A computer puts the pictures together to make a three-dimensional (3D) picture of the whole heart. + +Blood Tests + +Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels may show that you have risk factors for CHD. + +Your doctor may recommend a blood test to check the level of a protein called C-reactive protein (CRP) in your blood. Some studies suggest that high levels of CRP in the blood may increase the risk for CHD and heart attack. + +Your doctor also may recommend a blood test to check for low levels of hemoglobin (HEE-muh-glow-bin) in your blood. Hemoglobin is an iron-rich protein in red blood cells. It helps the blood cells carry oxygen from the lungs to all parts of your body. If your hemoglobin level is low, you may have a condition called anemia (uh-NEE-me-uh)." +treatment,What are the treatments for Angina ?,"Treatments for angina include lifestyle changes, medicines, medical procedures, cardiac rehabilitation (rehab), and other therapies. The main goals of treatment are to: + +Reduce pain and discomfort and how often it occurs + +Prevent or lower your risk for heart attack and death by treating your underlying heart condition + +Lifestyle changes and medicines may be the only treatments needed if your symptoms are mild and aren't getting worse. If lifestyle changes and medicines don't control angina, you may need medical procedures or cardiac rehab. + +Unstable angina is an emergency condition that requires treatment in a hospital. + +Lifestyle Changes + +Making lifestyle changes can help prevent episodes of angina. You can: + +Slow down or take rest breaks if physical exertion triggers angina. + +Avoid large meals and rich foods that leave you feeling stuffed if heavy meals trigger angina. + +Try to avoid situations that make you upset or stressed if emotional stress triggers angina. Learn ways to handle stress that can't be avoided. + +You also can make lifestyle changes that help lower your risk for coronary heart disease. One of the most important changes is to quit smoking. Smoking can damage and tighten blood vessels and raise your risk for CHD. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke. + +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. + +For more information about how to quit smoking, go to the Diseases and Conditions Index (DCI) Smoking and Your Heart article and the National Heart, Lung, and Blood Institutes (NHLBIs) ""Your Guide to a Healthy Heart."" + +Following a healthy diet is another important lifestyle change. A healthy diet can prevent or reduce high blood pressure and high blood cholesterol and help you maintain a healthy weight. + +A healthy diet includes a variety of fruits and vegetables (including beans and peas). It also includes whole grains, lean meats, poultry without skin, seafood, and fat-free or low-fat milk and dairy products. A healthy diet also is low in sodium (salt), added sugars, solid fats, and refined grains. + +For more information about following a healthy diet, go to the NHLBIs Your Guide to Lowering Your Blood Pressure With DASH and the U.S. Department of Agricultures ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating. + +Other important lifestyle changes include: + +Being physically active. Check with your doctor to find out how much and what kinds of activity are safe for you. For more information, go to the DCI Physical Activity and Your Heart article. + +Maintaining a healthy weight. If youre overweight or obese, work with your doctor to create a reasonable weight-loss plan. Controlling your weight helps you control CHD risk factors. + +Taking all medicines as your doctor prescribes, especially if you have diabetes. + +Medicines + +Nitrates are the medicines most commonly used to treat angina. They relax and widen blood vessels. This allows more blood to flow to the heart, while reducing the hearts workload. + +Nitroglycerin (NI-tro-GLIS-er-in) is the most commonly used nitrate for angina. Nitroglycerin that dissolves under your tongue or between your cheek and gum is used to relieve angina episodes. + +Nitroglycerin pills and skin patches are used to prevent angina episodes. However, pills and skin patches act too slowly to relieve pain during an angina attack. + +Other medicines also are used to treat angina, such as beta blockers, calcium channel blockers, ACE inhibitors, oral antiplatelet medicines, or anticoagulants (blood thinners). These medicines can help: + +Lower blood pressure and cholesterol levels + +Slow the heart rate + +Relax blood vessels + +Reduce strain on the heart + +Prevent blood clots from forming + +People who have stable angina may be advised to get annual flu shots. + +Medical Procedures + +If lifestyle changes and medicines don't control angina, you may need a medical procedure to treat the underlying heart disease. Both angioplasty (AN-jee-oh-plas-tee) and coronary artery bypass grafting (CABG) are commonly used to treat heart disease. + +Angioplasty opens blocked or narrowed coronary arteries. During angioplasty, a thin tube with a balloon or other device on the end is threaded through a blood vessel to the narrowed or blocked coronary artery. + +Once in place, the balloon is inflated to push the plaque outward against the wall of the artery. This widens the artery and restores blood flow. + +Angioplasty can improve blood flow to your heart and relieve chest pain. A small mesh tube called a stent usually is placed in the artery to help keep it open after the procedure. + +During CABG, healthy arteries or veins taken from other areas in your body are used to bypass (that is, go around) your narrowed coronary arteries. Bypass surgery can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. + +You will work with your doctor to decide which treatment is better for you. + +Cardiac Rehabilitation + +Your doctor may recommend cardiac rehab for angina or after angioplasty, CABG, or a heart attack. Cardiac rehab is a medically supervised program that can 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 for future heart problems. The rehab team will help you learn how to adjust to a new lifestyle and deal with your fears about the future. + +For more information about cardiac rehab, go to the DCI Cardiac Rehabilitation article. + +Enhanced External Counterpulsation Therapy + +Enhanced external counterpulsation (EECP) therapy is helpful for some people who have angina. Large cuffs, similar to blood pressure cuffs, are put on your legs. The cuffs are inflated and deflated in sync with your heartbeat. + +EECP therapy improves the flow of oxygen-rich blood to your heart muscle and helps relieve angina. You typically get 35 1-hour treatments over 7 weeks." +prevention,How to prevent Angina ?,"You can prevent or lower your risk for angina and heart disease by making lifestyle changes and treating related conditions. + +Making Lifestyle Changes + +Healthy lifestyle choices can help prevent or delay angina and heart disease. To adopt a healthy lifestyle, you can: + +Quit smoking and avoid secondhand smoke + +Avoid angina triggers + +Follow a healthy diet + +Be physically active + +Maintain a healthy weight + +Learn ways to handle stress and relax + +Take your medicines as your doctor prescribes + +For more information about these lifestyle changes, go to How Is Angina Treated? For more information about preventing and controlling heart disease risk factors, visit the Diseases and Conditions Index Coronary Heart Disease, Coronary Heart Disease Risk Factors, and Coronary Microvascular Disease articles. + +Treating Related Conditions + +You also can help prevent or delay angina and heart disease by treating related conditions, such as high blood cholesterol, high blood pressure, diabetes, and overweight or obesity. + +If you have one or more of these conditions, talk with your doctor about how to control them. Follow your treatment plan and take all of your medicines as your doctor prescribes." +information,What is (are) 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. + +Overview + +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. + +Outlook + +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." +causes,What causes Heart Murmur ?,"Innocent 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. + +Abnormal Heart Murmurs + +Congenital heart defects or acquired heart valve disease often are the cause of abnormal heart murmurs. + +Congenital Heart Defects + +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 hearts mitral valve, causing blood to leak backward through the valve. + +Heart Defects That Can Cause Abnormal Heart Murmurs + + + +For more information, go to the Health Topics Congenital Heart Defects article. + +Acquired Heart Valve Disease + +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. + +Other Causes + +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." +symptoms,What are the symptoms of Heart Murmur ?,"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." +exams and tests,How to diagnose Heart Murmur ?,"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. + +Specialists Involved + +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. + +Physical Exam + +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. + +Evaluating Heart Murmurs + +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. + +Diagnostic Tests and Procedures + +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. + +Chest X Ray + +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. + +EKG + +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 + +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 cant 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)." +treatment,What are the treatments for Heart Murmur ?,"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. + +Innocent (Harmless) Heart Murmurs + +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. + +Abnormal Heart Murmurs + +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." +information,What is (are) Heart Block ?,"Heart block is a problem that occurs with the heart's electrical system. This system controls the rate and rhythm of heartbeats. (""Rate"" refers to the number of times your heart beats per minute. ""Rhythm"" refers to the pattern of regular or irregular pulses produced as the heart beats.) + +With each heartbeat, an electrical signal spreads across the heart from the upper to the lower chambers. As it travels, the signal causes the heart to contract and pump blood. + +Heart block occurs if the electrical signal is slowed or disrupted as it moves through the heart. + +Overview + +Heart block is a type of arrhythmia (ah-RITH-me-ah). An arrhythmia is any problem with the rate or rhythm of the heartbeat. + +Some people are born with heart block, while others develop it during their lifetimes. If you're born with the condition, it's called congenital (kon-JEN-ih-tal) heart block. If the condition develops after birth, it's called acquired heart block. + +Doctors might detect congenital heart block before or after a baby is born. Certain diseases that may occur during pregnancy can cause heart block in a baby. Some congenital heart defects also can cause heart block. Congenital heart defects are problems with the heart's structure that are present at birth. Often, doctors don't know what causes these defects. + +Acquired heart block is more common than congenital heart block. Damage to the heart muscle or its electrical system causes acquired heart block. Diseases, surgery, or medicines can cause this damage. + +The three types of heart block are first degree, second degree, and third degree. First degree is the least severe, and third degree is the most severe. This is true for both congenital and acquired heart block. + +Doctors use a test called an EKG (electrocardiogram) to help diagnose heart block. This test detects and records the heart's electrical activity. It maps the data on a graph for the doctor to review. + +Outlook + +The symptoms and severity of heart block depend on which type you have. First-degree heart block may not cause any severe symptoms. + +Second-degree heart block may result in the heart skipping a beat or beats. This type of heart block also can make you feel dizzy or faint. + +Third-degree heart block limits the heart's ability to pump blood to the rest of the body. This type of heart block may cause fatigue (tiredness), dizziness, and fainting. Third-degree heart block requires prompt treatment because it can be fatal. + +A medical device called a pacemaker is used to treat third-degree heart block and some cases of second-degree heart block. This device uses electrical pulses to prompt the heart to beat at a normal rate. Pacemakers typically are not used to treat first-degree heart block. + +All types of heart block may increase your risk for other arrhythmias, such as atrial fibrillation (A-tre-al fih-brih-LA-shun). Talk with your doctor to learn more about the signs and symptoms of arrhythmias." +causes,What causes Heart Block ?,"Heart block has many causes. Some people are born with the disorder (congenital), while others develop it during their lifetimes (acquired). + +Congenital Heart Block + +One form of congenital heart block occurs in babies whose mothers have autoimmune diseases, such as lupus. People who have these diseases make proteins called antibodies that attack and damage the body's tissues or cells. + +In pregnant women, antibodies can cross the placenta. (The placenta is the organ that attaches the umbilical cord to the mother's womb.) These proteins can damage the baby's heart and lead to congenital heart block. + +Congenital heart defects also may cause congenital heart block. These defects are problems with the heart's structure that are present at birth. Often, doctors don't know what causes these defects. + +Acquired Heart Block + +Many factors can cause acquired heart block. Examples include: + +Damage to the heart from a heart attack. This is the most common cause of acquired heart block. + +Coronary heart disease, also called coronary artery disease. + +Myocarditis (MI-o-kar-DI-tis), or inflammation of the heart muscle. + +Heart failure. + +Rheumatic (roo-MAT-ik) fever. + +Cardiomyopathy (KAR-de-o-mi-OP-a-the), or heart muscle diseases. + +Other diseases may increase the risk of heart block. Examples include sarcoidosis (sar-koy-DOE-sis) and the degenerative muscle disorders Lev's disease and Lenegre's disease. + +Certain types of surgery also may damage the heart's electrical system and lead to heart block. + +Exposure to toxic substances and taking certain medicinesincluding digitalis, beta blockers, and calcium channel blockersalso may cause heart block. Doctors closely watch people who are taking these medicines for signs of problems. + +Some types of heart block have been linked to genetic mutations (changes in the genes). + +An overly active vagus nerve also can cause heart block. You have one vagus nerve on each side of your body. These nerves run from your brain stem all the way to your abdomen. Activity in the vagus nerve slows the heart rate. + +In some cases, acquired heart block may go away if the factor causing it is treated or resolved. For example, heart block that occurs after a heart attack or surgery may go away during recovery. + +Also, if a medicine is causing heart block, the disorder may go away if the medicine is stopped or the dosage is lowered. Always talk with your doctor before you change the way you take your medicines." +susceptibility,Who is at risk for Heart Block? ?,"The risk factors for congenital and acquired heart block are different. + +Congenital Heart Block + +If a pregnant woman has an autoimmune disease, such as lupus, her fetus is at risk for heart block. + +Autoimmune diseases can cause the body to make proteins called antibodies that can cross the placenta. (The placenta is the organ that attaches the umbilical cord to the mother's womb.) These antibodies may damage the baby's heart and lead to congenital heart block. + +Congenital heart defects also can cause heart block. These defects are problems with the heart's structure that are present at birth. Most of the time, doctors don't know what causes congenital heart defects. + +Heredity may play a role in certain heart defects. For example, a parent who has a congenital heart defect might be more likely than other people to have a child with the condition. + +Acquired Heart Block + +Acquired heart block can occur in people of any age. However, most types of the condition are more common in older people. This is because many of the risk factors are more common in older people. + +People who have a history of heart disease or heart attacks are at increased risk for heart block. Examples of heart disease that can lead to heart block include heart failure, coronary heart disease, and cardiomyopathy (heart muscle diseases). + +Other diseases also may raise the risk of heart block, such as sarcoidosis and the degenerative muscle disorders Lev's disease and Lenegre's disease. + +Exposure to toxic substances or taking certain medicines, such as digitalis, also can raise your risk for heart block. + +Well-trained athletes and young people are at higher risk for first-degree heart block caused by an overly active vagus nerve. You have one vagus nerve on each side of your body. These nerves run from your brain stem all the way to your abdomen. Activity in the vagus nerve slows the heart rate." +symptoms,What are the symptoms of Heart Block ?,"Signs and symptoms depend on the type of heart block you have. First-degree heart block may not cause any symptoms. + +Signs and symptoms of second- and third-degree heart block include: + +Fainting + +Dizziness or light-headedness + +Fatigue (tiredness) + +Shortness of breath + +Chest pain + +These symptoms may suggest other health problems as well. If these symptoms are new or severe, call 911 or have someone drive you to the hospital emergency room. If you have milder symptoms, talk with your doctor right away to find out whether you need prompt treatment." +exams and tests,How to diagnose Heart Block ?,"Heart block might be diagnosed as part of a routine doctor's visit or during an emergency situation. (Third-degree heart block often is an emergency.) + +Your doctor will diagnose heart block based on your family and medical histories, a physical exam, and test results. + +Specialists Involved + +Your primary care doctor might be involved in diagnosing heart block. However, if you have the condition, you might need to see a heart specialist. Heart specialists include: + +Cardiologists (doctors who diagnose and treat adults who have heart problems) + +Pediatric cardiologists (doctors who diagnose and treat babies and children who have heart problems) + +Electrophysiologists (cardiologists or pediatric cardiologists who specialize in the heart's electrical system) + +Family and Medical Histories + +Your doctor may ask whether: + +You have any signs or symptoms of heart block + +You have any health problems, such as heart disease + +Any of your family members have been diagnosed with heart block or other health problems + +You're taking any medicines, including herbal products and prescription and over-the-counter medicines + +You smoke or use alcohol or drugs + +Your doctor also may ask about other health habits, such as how physically active you are. + +Physical Exam + +During the physical exam, your doctor will listen to your heart. He or she will listen carefully for abnormal rhythms or heart murmurs (extra or unusual sounds heard during heartbeats). + +Your doctor also may: + +Check your pulse to find out how fast your heart is beating + +Check for swelling in your legs or feet, which could be a sign of an enlarged heart or heart failure + +Look for signs of other diseases that could be causing heart rate or rhythm problems (such as coronary heart disease) + +Diagnostic Tests and Procedures + +EKG (Electrocardiogram) + +Doctors usually use an EKG (electrocardiogram) to help diagnose heart block. This simple test detects and records the heart's electrical activity. + +An EKG shows how fast the heart is beating and its rhythm (steady or irregular). The test also records the strength and timing of electrical signals as they pass through the heart. + +The data are recorded on a graph. Different types of heart block have different patterns on the graph. (For more information, go to ""Types of Heart Block."") + +A standard EKG only records the heart's activity for a few seconds. To diagnose heart rhythm problems that come and go, your doctor may have you wear a portable EKG monitor. + +The most common types of portable EKGs are Holter and event monitors. Your doctor may have you use one of these monitors to diagnose first- or second-degree heart block. + +Holter and Event Monitors + +A Holter monitor records the heart's electrical signals for a full 24- or 48-hour period. You wear one while you do your normal daily activities. This allows the monitor to record your heart for a longer time than a standard EKG. + +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. + +You may wear an event monitor for 1 to 2 months, or as long as it takes to get a recording of your heart during symptoms. + +Electrophysiology Study + +For some cases of heart block, doctors may do electrophysiology studies (EPS). During this test, a thin, flexible wire is passed through a vein in your groin (upper thigh) or arm to your heart. The wire records your heart's electrical signals. + +Other Tests + +To diagnose heart block, your doctor may recommend tests to rule out other types of arrhythmias (irregular heartbeats). For more information, go to ""How Are Arrhythmias Diagnosed?""" +treatment,What are the treatments for Heart Block ?,"Treatment depends on the type of heart block you have. If you have first-degree heart block, you may not need treatment. + +If you have second-degree heart block, you may need a pacemaker. A pacemaker is a small device that's placed under the skin of your chest or abdomen. This device uses electrical pulses to prompt the heart to beat at a normal rate. + +If you have third-degree heart block, you will need a pacemaker. In an emergency, a temporary pacemaker might be used until you can get a long-term device. Most people who have third-degree heart block need pacemakers for the rest of their lives. + +Some people who have third-degree congenital heart block don't need pacemakers for many years. Others may need pacemakers at a young age or during infancy. + +If a pregnant woman has an autoimmune disease, such as lupus, her fetus is at risk for heart block. If heart block is detected in a fetus, the mother might be given medicine to reduce the fetus' risk of developing serious heart block. + +Sometimes acquired heart block goes away if the factor causing it is treated or resolved. For example, heart block that occurs after a heart attack or surgery may go away during recovery. + +Also, if a medicine is causing heart block, the condition may go away if the medicine is stopped or the dosage is lowered. (Always talk with your doctor before you change the way you take your medicines.)" +information,What is (are) Patent Ductus Arteriosus ?,"Patent ductus arteriosus (PDA) is a heart problem that occurs soon after birth in some babies. In PDA, abnormal blood flow occurs between two of the major arteries connected to the heart. + +Before birth, the two major arteriesthe aorta and the pulmonary (PULL-mun-ary) arteryare connected by a blood vessel called the ductus arteriosus. This vessel is an essential part of fetal blood circulation. + +Within minutes or up to a few days after birth, the vessel is supposed to close as part of the normal changes occurring in the baby's circulation. + +In some babies, however, the ductus arteriosus remains open (patent). This opening allows oxygen-rich blood from the aorta to mix with oxygen-poor blood from the pulmonary artery. This can put strain on the heart and increase blood pressure in the lung arteries. + +Normal Heart and Heart With Patent Ductus Arteriosus + + + +Go to the ""How the Heart Works"" section of this article for more details about how a normal heart works compared with a heart that has PDA. + +Overview + +PDA is a type of congenital (kon-JEN-ih-tal) heart defect. A congenital heart defect is any type of heart problem that's present at birth. + +If your baby has a PDA but an otherwise normal heart, the PDA may shrink and go away. However, some children need treatment to close their PDAs. + +Some children who have PDAs are given medicine to keep the ductus arteriosus open. For example, this may be done if a child is born with another heart defect that decreases blood flow to the lungs or the rest of the body. + +Keeping the PDA open helps maintain blood flow and oxygen levels until doctors can do surgery to correct the other heart defect. + +Outlook + +PDA is a fairly common congenital heart defect in the United States. Although the condition can affect full-term infants, it's more common in premature infants. + +On average, PDA occurs in about 8 out of every 1,000 premature babies, compared with 2out of every 1,000 full-term babies. Premature babies also are more vulnerable to the effects of PDA. + +PDA is twice as common in girls as it is in boys. + +Doctors treat the condition with medicines, catheter-based procedures, and surgery. Most children who have PDAs live healthy, normal lives after treatment." +symptoms,What are the symptoms of Patent Ductus Arteriosus ?,"A heart murmur may be the only sign that a baby has patent ductus arteriosus (PDA). A heart murmur is an extra or unusual sound heard during the heartbeat. Heart murmurs also have other causes besides PDA, and most murmurs are harmless. + +Some infants may develop signs or symptoms of volume overload on the heart and excess blood flow in the lungs. Signs and symptoms may include: + +Fast breathing, working hard to breathe, or shortness of breath. Premature infants may need increased oxygen or help breathing from a ventilator. + +Poor feeding and poor weight gain. + +Tiring easily. + +Sweating with exertion, such as while feeding." +information,What is (are) Heart Valve Disease ?,"Heart valve disease occurs if one or more of your heart valves don't work well. The heart has four valves: the tricuspid, pulmonary, mitral,and aortic 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. + +Healthy Heart Cross-Section + + + +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. + +Overview + +How the Heart Valves Work + +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 Valve Problems + +Heart valves can have three basic kinds of problems: regurgitation, stenosis, and atresia. + +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 congenitalheart 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. + +Outlook + +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." +causes,What causes Heart 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 heart valves. + +The cause of congenital heart valve disease isnt known. It occurs before birth as the heart is forming. Congenital heart valve disease can occur alone or with other types of congenital heartdefects. + +Heart Conditions and Other Disorders + +Certain conditions can stretch and distort the heart valves. These conditions include: + +Advanced high blood pressure and heart failure, thiscan enlarge the heart or the main arteries. + +Atherosclerosis in the aorta. Atherosclerosis is a condition in which a waxy substance called plaque builds up inside the arteries. The aorta is the main artery that carries oxygen-rich blood to the body. + +Damage and scar tissue due to a heart attack or injury to the heart. + +Rheumatic Fever + +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 dont 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. + +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 serious infection is called infective endocarditis. + +The germs can enter the bloodstream through needles, syringes, or other medical devices and through breaks in the skin or gums. Often, the bodys defenses fight off the germs and no infection occurs. Sometimes these defenses fail, which leads to infective endocarditis. + +Infective endocarditis 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. + +Infective endocarditis can worsen existing heart valve disease. + +Other Conditions and Factors Linked to 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 isnt 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. + +Diet medicines. The use of fenfluramine and phentermine (fen-phen) sometimes has been linked to heart valve problems. These problems typically stabilize or improve after the medicine is stopped. + +Marfan syndrome. Congenital disorders, such as Marfan syndrome and other connective tissue disorders, can affect the heart valves. + +Metabolic disorders. Relatively uncommon diseases (such as Fabry disease) and other metabolic disorders (such as high blood cholesterol) can affect the heart valves. + +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." +susceptibility,Who is at risk for Heart Valve Disease? ?,"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 failureor previous heart valve diseasealso 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." +symptoms,What are the symptoms of Heart Valve Disease ?,"Major Signs and Symptoms + +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 + +Other Signs and Symptoms + +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." +exams and tests,How to diagnose Heart Valve Disease ?,"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. + +Physical Exam + +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. + +Tests and Procedures + +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. + +EKG + +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. + +Chest X Ray + +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. + +Echocardiography + +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. + +Cardiac Catheterization + +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. + +Stress Test + +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 + +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." +treatment,What are the treatments for Heart Valve Disease ?,"Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines often can treat symptoms successfully 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: + +Medicines + +Repairing or replacing faulty valves + +Lifestyle changes to treat other related heart conditions + +Medicines + +In addition to heart-healthy lifestyle changes, your doctor may prescribe medicines to: + +Lower high blood pressure or high blood cholesterol. + +Prevent arrhythmias (irregular heartbeats). + +Thin the blood and prevent clots (if you have a man-made replacement valve). Doctors also prescribe these medicines for mitral stenosis or other valve defects that raise the risk of blood clots. + +Treat coronary heart disease. Medicines for coronary heart disease can reduce your hearts workload and relieve symptoms. + +Treatheart failure. Heart failure medicines widen blood vessels and rid the body of excess fluid. + +Repairing or Replacing Heart Valves + +Your doctor may recommend repairing or replacing your heart valve(s), even if your heart valve disease isnt causing symptoms. Repairing or replacing a valve can prevent lasting damage to your heart and sudden death. + +The decision to repair or replace heart valves depends on many factors, including: + +The severity of your valve disease + +Whether you need heart surgery for other conditions, such as bypass surgery to treat coronary heart disease. Bypass surgery and valve surgery can be performed at the sametime. + +Your age and general health + +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 infective endocarditis after the surgery, and they dont 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. + +Repairing Heart Valves + +Heart surgeons can repair heart valves by: + +Adding tissue to patch holes or tears or to increase the support at the base of the valve + +Removing or reshaping tissue so the valve can close tighter + +Separating fused valve flaps + +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. + +Heart valves that cannot open fully (stenosis) can be repaired with surgery or with a less invasive catheter procedure called balloon valvuloplasty. This procedure also is called balloonvalvotomy. + +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. Youre awake during the procedure, which usually requires an overnight stay in a hospital. + +Balloon valvuloplasty relieves many symptoms of heart valve disease, but 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. For these people, balloon valvuloplasty often is preferred over surgical repair or replacement. + +Balloon valvuloplasty doesnt 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. + +Replacing Heart Valves + +Sometimes heart valves cant 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 wont need medicines to stop your body from rejecting the valve. + +Man-made valves last longer than biological valves and usually dont have to be replaced. Biological valves usually have to be replaced after about 10 years, although newer ones may last 15years 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 infective endocarditis. + +You and your doctor will decide together whether you should have a man-made or biological replacement valve. + +If youre a woman of childbearing age or if youre athletic, you may prefer a biological valve so you dont have to take blood-thinning medicines. If youre elderly, you also may prefer a biological valve, as it will likely last for the rest of your life. + +Ross Procedure + +Doctors also can treat faulty aortic valves with the Ross procedure. During this surgery, 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 humandonor. + +This is more involved surgery than typical valve replacement, and it has a greater risk of complications. The Ross procedure may be especially useful for children because the surgically replaced valves continue to grow with the child. Also, lifelong treatment with blood-thinning medicines isnt required. But in some patients, one or both valves fail to work well within a few years of the surgery. Researchers continue to study the use of this procedure. + +Other Approaches for Repairing and Replacing Heart Valves + +Some 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 to 5 days, compared with a 5-day stay 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 shorter2to 4weeks versus 6to 8weeks for traditional surgery. + +Transcatheter Valve Therapy + +Interventional cardiologists perform procedures that involve threading clips or other devices to repair faulty heart valves using a catheter (tube) inserted through a large blood vessel. 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. + +Doctors also may use a catheter to replace faulty aortic valves. This procedure is called transcatheter aortic valve replacement (TAVR). For this procedure, the catheter usually is inserted into an artery in the groin (upper thigh) and threaded to the heart. A deflated balloon with a folded replacement valve around it is at the end of the catheter. + +Once the replacement valve is placed properly, 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. + +Lifestyle Changes to Treat Other Related Heart + +To help treat heart conditions related to heart valve disease, your doctor may advise you to make heart-healthy lifestyle changes, such as: + +Heart-healthy eating + +Maintaining a healthy weight + +Managing stress + +Physical activity + +Quitting smoking + +Heart-Healthy Eating + +Your doctor may recommend heart-healthy eating, which should include: + +Fat-free or low-fat dairy products, such as skim milk + +Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week + +Fruits, such as apples, bananas, oranges, pears, and prunes + +Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans + +Vegetables, such as broccoli, cabbage, and carrots + +Whole grains, such as oatmeal, brown rice, and corn tortillas + +When following a heart-healthy diet, you should avoid eating: + +A lot of red meat + +Palm and coconut oils + +Sugary foods and beverages + +Two nutrients in your diet make blood cholesterol levels rise: + +Saturated fatfound mostly in foods that come from animals + +Trans fat (trans fatty acids)found in foods made with hydrogenated oils and fats, such as stick margarine; baked goods, such as cookies, cakes, and pies; crackers; frostings; and coffee creamers. Some trans fats also occur naturally in animal fats and meats. + +Saturated fat raises your blood cholesterol more than anything else in your diet. When you follow a heart-healthy eating plan, only 5percent to 6percent of your daily calories should come from saturated fat. Food labels list the amounts of saturated fat. To help you stay on track, here are some examples: + +AvocadosNot all fats are bad. Monounsaturated and polyunsaturated fats actually help lower blood cholesterol levels. Some sources of monounsaturated and polyunsaturated fats are: + +Corn, sunflower, and soybean oils + +Nuts and seeds, such as walnuts + +Olive, canola, peanut, safflower, and sesame oils + +Peanut butter + +Salmon and trout + +Tofu + +Sodium + +You should try to limit the amount of sodium that you eat. This means choosing and preparing foods that are lower in salt and sodium. Try to use low-sodium and no added salt foods and seasonings at the table or while cooking. Food labels tell you what you need to know about choosing foods that are lower in sodium. Try to eat no more than 2,300milligrams of sodium a day. If you have high blood pressure, you may need to restrict your sodium intake even more. + +Dietary Approaches to Stop Hypertension + +Your doctor may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium and salt. + +The DASH eating plan is a good heart-healthy eating plan, even for those who dont have high blood pressure. Read more about DASH. + +Alcohol + +Try to limit alcohol intake. Too much alcohol can raise your blood pressure and triglyceride levels, a type of fat found in the blood. Alcohol also adds extra calories, which may cause weightgain. + +Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is: + +12 ounces of beer + +5 ounces of wine + +1 ounces of liquor + +Maintaining a Healthy Weight + +Maintaining a healthy weight is important for overall health and can lower your risk for heart valve disease. Aim for a Healthy Weight by following a heart-healthy eating plan and keeping physically active. + +Knowing your body mass index (BMI) helps you find out if youre a healthy weight in relation to your height and gives an estimate of your total body fat. To figure out your BMI, check out the National Heart, Lung, and Blood Institutes online BMI calculator or talk to your doctor. A BMI: + +Below 18.5 is a sign that you are underweight. + +Between 18.5 and 24.9 is in the normal range. + +Between 25.0 and 29.9 is considered overweight. + +Of 30.0 or higher is considered obese. + +A general goal to aim for is a BMI of less than 25. Your doctor or health care provider can help you set an appropriate BMI goal. + +Measuring waist circumference helps screen for possible health risks. If most of your fat is around your waist rather than at your hips, youre at a higher risk for heart disease and type2 diabetes. This risk may be higher with a waist size that is greater than 35 inches for women or greater than 40 inches for men. To learn how to measure your waist, visit Assessing Your Weight and Health Risk. + +If youre overweight or obese, try to lose weight. A loss of just 3 percent to 5 percent of your current weight can lower your triglycerides, blood glucose, and the risk of developing type 2 diabetes. Greater amounts of weight loss can improve blood pressure readings, lower LDL cholesterol, and increase HDL cholesterol. + +Managing Stress + +Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Consider healthy stress-reducing activities, such as: + +A stress management program + +Meditation + +Physical activity + +Relaxation therapy + +Talking things out with friends or family + +Physical Activity + +Regular physical activity can lower many heart valve disease risk factors. + +Everyone should try to participate in moderate-intensity aerobic exercise at least 2hours and 30minutes per week or vigorous aerobic exercise for 1hour and 15minutes per week. Aerobic exercise, such as brisk walking, is any exercise in which your heart beats faster and you use more oxygen than usual. The more active you are, the more you will benefit. Participate in aerobic exercise for at least 10minutes at a time spread throughout the week. + +Talk with your doctor before you start a new exercise plan. Ask your doctor how much and what kinds of physical activity are safe for you. + +Read more about physical activity at: + +Physical Activity and Your Heart + +U.S. Department of Health and Human Services, 2008 Physical Activity Guidelines for Americans + +Quitting Smoking + +If you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels and raise your risk for atherosclerosis and other health problems. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke. 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. + +For more information about how to quit smoking, visit the Smoking and Your Heart Health Topic." +prevention,How to prevent Heart Valve Disease ?,"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 heartvalves. + +Its possible that exercise, a heart-healthy diet, and medicines that lower cholesterol might prevent aortic stenosis (thickening and stiffening of the aortic valve). Researchers continue to study this possibility. + +Heart-healthy eating, physical activity, other heart-healthy lifestyle changes, and medicines aimed at preventing a heart attack, high blood pressure, or heart failure also may help prevent heart valve disease." +information,What is (are) Diabetic Heart Disease ?,"The term ""diabetic heart disease"" (DHD) refers to heart disease that develops in people who have diabetes. Compared with people who don't have diabetes, people who have diabetes: + +Are at higher risk for heart disease + +Have additional causes of heart disease + +May develop heart disease at a younger age + +May have more severe heart disease + +What Is Diabetes? + +Diabetes is a disease in which the body's blood glucose (sugar) level is too high. Normally, the body breaks down food into glucose and carries it to cells throughout the body. The cells use a hormone called insulin to turn the glucose into energy. + +The two main types of diabetes are type 1 and type 2. In type 1 diabetes, the body doesn't make enough insulin. This causes the body's blood sugar level to rise. + +In type 2 diabetes, the body's cells don't use insulin properly (a condition called insulin resistance). At first, the body reacts by making more insulin. Over time, though, the body can't make enough insulin to control its blood sugar level. + +For more information about diabetes, go to the National Institute of Diabetes and Digestive and Kidney Diseases' Introduction to Diabetes Web page. + +What Heart Diseases Are Involved in Diabetic Heart Disease? + +DHD may include coronary heart disease (CHD), heart failure, and/or diabetic cardiomyopathy (KAR-de-o-mi-OP-ah-thee). + +Coronary Heart Disease + +In CHD, a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply your heart muscle with oxygen-rich blood. + +Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. When plaque builds up in the arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis). + +Plaque narrows the coronary 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), irregular heartbeats called arrhythmias (ah-RITH-me-ahs), a heart attack, or even death. + +Heart Failure + +Heart failure is a condition in which your heart can't pump enough blood to meet your body's needs. 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. + +If you have heart failure, you may tire easily and have to limit your activities. CHD can lead to heart failure by weakening the heart muscle over time. + +Diabetic Cardiomyopathy + +Diabetic cardiomyopathy is a disease that damages the structure and function of the heart. This disease can lead to heart failure and arrhythmias, even in people who have diabetes but don't have CHD. + +Overview + +People who have type 1 or type 2 diabetes can develop DHD. The higher a person's blood sugar level is, the higher his or her risk of DHD. + +Diabetes affects heart disease risk in three major ways. + +First, diabetes alone is a very serious risk factor for heart disease, just like smoking, high blood pressure, and high blood cholesterol. In fact, people who have type 2 diabetes have the same risk of heart attack and dying from heart disease as people who already have had heart attacks. + +Second, when combined with other risk factors, diabetes further raises the risk of heart disease. Although research is ongoing, it's clear that diabetes and other conditionssuch as overweight and obesity and metabolic syndromeinteract to cause harmful physical changes to the heart. + +Third, diabetes raises the risk of earlier and more severe heart problems. Also, people who have DHD tend to have less success with some heart disease treatments, such as coronary artery bypass grafting and percutaneous coronary intervention,also known as coronary angioplasty. + +Outlook + +If you have diabetes, you can lower your risk of DHD. Making lifestyle changes and taking prescribed medicines can help you prevent or control many risk factors. + +Taking action to manage multiple risk factors helps improve your outlook. The good news is that many lifestyle changes help control multiple risk factors. For example, physical activity can lower your blood pressure, help control your blood sugar level and your weight, and reduce stress. + +It's also very important to follow your treatment plan for diabetes and see your doctor for ongoing care. + +If you already have DHD, follow your treatment plan as your doctors advises. This may help you avoid or delay serious problems, such as a heart attack or heart failure." +causes,What causes Diabetic Heart Disease ?,"At least four complex processes, alone or combined, can lead to diabetic heart disease (DHD). They include coronary atherosclerosis; metabolic syndrome; insulin resistance in people who have type 2 diabetes; and the interaction of coronary heart disease (CHD), high blood pressure, and diabetes. + +Researchers continue to study these processes because all of the details aren't yet known. + +Coronary Atherosclerosis + +Atherosclerosis is a disease in which plaque builds up inside the arteries. The exact cause of atherosclerosis isn't known. However, studies show that it is a slow, complex disease that may start in childhood. The disease develops faster as you age. + +Coronary atherosclerosis may start when certain factors damage the inner layers of the coronary (heart) arteries. These factors include: + +Smoking + +High amounts of certain fats and cholesterol in the blood + +High blood pressure + +High amounts of sugar in the blood due to insulin resistance or diabetes + +Plaque may begin to build up where the arteries are damaged. Over time, plaque hardens and narrows the arteries. This reduces the flow of oxygen-rich blood to your heart muscle. + +Eventually, an area of plaque can rupture (break open). When this happens, blood cell fragments called platelets (PLATE-lets) stick to the site of the injury. They may clump together to form blood clots. + +Blood clots narrow the coronary arteries even more. This limits the flow of oxygen-rich blood to your heart and may worsen angina (chest pain) or cause a heart attack. + +Metabolic Syndrome + +Metabolic syndrome is the name for a group of risk factors that raises your risk of both CHD and type 2 diabetes. + +If you have three or more of the five metabolic risk factors, you have metabolic syndrome. The risk factors are: + +A large waistline (a waist measurement of 35 inches or more for women and 40 inches or more for men). + +A high triglyceride (tri-GLIH-seh-ride) level (or youre on medicine to treat high triglycerides). Triglycerides are a type of fat found in the blood. + +A low HDL cholesterol level (or you're on medicine to treat low HDL cholesterol). HDL sometimes is called ""good"" cholesterol. This is because it helps remove cholesterol from your arteries. + +High blood pressure (or youre on medicine to treat high blood pressure). + +A high fasting blood sugar level (or you're on medicine to treat high blood sugar). + +It's unclear whether these risk factors have a common cause or are mainly related by their combined effects on the heart. + +Obesity seems to set the stage for metabolic syndrome. Obesity can cause harmful changes in body fats and how the body uses insulin. + +Chronic (ongoing) inflammation also may occur in people who have metabolic syndrome. Inflammation is the body's response to illness or injury. It may raise your risk of CHD and heart attack. Inflammation also may contribute to or worsen metabolic syndrome. + +Research is ongoing to learn more about metabolic syndrome and how metabolic risk factors interact. + +Insulin Resistance in People Who Have Type 2 Diabetes + +Type 2 diabetes usually begins with insulin resistance. Insulin resistance means that the body can't properly use the insulin it makes. + +People who have type 2 diabetes and insulin resistance have higher levels of substances in the blood that cause blood clots. Blood clots can block the coronary arteries and cause a heart attack or even death. + +The Interaction of Coronary Heart Disease, High Blood Pressure, and Diabetes + +Each of these risk factors alone can damage the heart. CHD reduces the flow of oxygen-rich blood to your heart muscle. High blood pressure and diabetes may cause harmful changes in the structure and function of the heart. + +Having CHD, high blood pressure, and diabetes is even more harmful to the heart. Together, these conditions can severely damage the heart muscle. As a result, the heart has to work harder than normal. Over time, the heart weakens and isnt able to pump enough blood to meet the bodys needs. This condition is called heart failure. + +As the heart weakens, the body may release proteins and other substances into the blood. These proteins and substances also can harm the heart and worsen heart failure." +susceptibility,Who is at risk for Diabetic Heart Disease? ?,"People who have type 1 or type 2 diabetes are at risk for diabetic heart disease (DHD). Diabetes affects heart disease risk in three major ways. + +First, diabetes alone is a very serious risk factor for heart disease. Second, when combined with other risk factors, diabetes further raises the risk of heart disease. Third, compared with people who don't have diabetes, people who have the disease are more likely to: + +Have heart attacks and other heart and blood vessel diseases. In men, the risk is double; in women, the risk is triple. + +Have more complications after a heart attack, such as angina (chest pain or discomfort) and heart failure. + +Die from heart disease. + +The higher your blood sugar level is, the higher your risk of DHD. (A higher than normal blood sugar level is a risk factor for heart disease even in people who don't have diabetes.) + +Type 2 diabetes raises your risk of having silent heart diseasethat is, heart disease with no signs or symptoms. You can even have a heart attack without feeling symptoms. Diabetes-related nerve damage that blunts heart pain may explain why symptoms aren't noticed. + +Other Risk Factors + +Other factors also can raise the risk of coronary heart disease (CHD) in people who have diabetes and in those who don't. You can control most of these risk factors, but some you can't. + +For a more detailed discussion of these risk factors, go to the Health Topics Coronary Heart Disease Risk Factors article. + +Risk Factors You Can Control + +Unhealthy blood cholesterol levels. This includes high LDL cholesterol (sometimes called ""bad"" cholesterol) and low HDL cholesterol (sometimes called ""good"" cholesterol). + +High blood pressure. Blood pressure is considered high if it stays at or above 140/90 mmHg over time. If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher. (The mmHg is millimeters of mercurythe units used to measure blood pressure.) + +Smoking. Smoking can damage and tighten blood vessels, lead to unhealthy cholesterol levels, and raise blood pressure. Smoking also can limit how much oxygen reaches the body's tissues. + +Prediabetes. This is a condition in which your blood sugar level is higher than normal, but not as high as it is in diabetes. If you have prediabetes and don't take steps to manage it, you'll likely develop type 2 diabetes within 10 years. + +Overweight or obesity. Being overweight or obese raises your risk of heart disease and heart attack. Overweight and obesity also are linked to other heart disease risk factors, such as high blood cholesterol, high blood pressure, and diabetes. Most people who have type 2 diabetes are overweight. + +Metabolic syndrome. Metabolic syndrome is the name for a group of risk factors that raises your risk of heart disease and type 2 diabetes. Metabolic syndrome also raises your risk of other health problems, such as stroke. + +Lack of physical activity. Lack of physical activity can worsen other risk factors for heart disease, such as unhealthy blood cholesterol levels, high blood pressure, diabetes, and overweight or obesity. + +Unhealthy diet. An unhealthy diet can raise your risk of heart disease. Foods that are high in saturated and trans fats, cholesterol, sodium (salt), and sugar can worsen other heart disease risk factors. + +Stress. Stress and anxiety can trigger your arteries to tighten. This can raise your blood pressure and your risk of having a heart attack. Stress also may indirectly raise your risk of heart disease if it makes you more likely to smoke or overeat foods high in fat and sugar. + +Risk Factors You Can't Control + +Age. As you get older, your risk of heart disease and heart attack rises. In men, the risk of heart disease increases after age 45. In women, the risk increases after age 55. In people who have diabetes, the risk of heart disease increases after age 40. + +Gender. Before age 55, women seem to have a lower risk of heart disease than men. After age 55, however, the risk of heart disease increases similarly in both women and men. + +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 CHD, heart attack, heart failure, and high blood pressure." +symptoms,What are the symptoms of Diabetic Heart Disease ?,"Some people who have diabetic heart disease (DHD) may have no signs or symptoms of heart disease. This is called silent heart disease. Diabetes-related nerve damage that blunts heart pain may explain why symptoms aren't noticed. + +Thus, people who have diabetes should have regular medical checkups. Tests may reveal a problem before they're aware of it. Early treatment can reduce or delay related problems. + +Some people who have DHD will have some or all of the typical symptoms of heart disease. Be aware of the symptoms described below and seek medical care if you have them. + +If you think you're having a heart attack, call 911 right away for emergency care. Treatment for a heart attack works best when it's given right after symptoms occur. + +Coronary Heart Disease + +A common symptom of coronary heart disease (CHD) is angina. Angina is chest pain or discomfort that occurs if your heart muscle doesn't get enough oxygen-rich blood. + +Angina may feel like pressure or squeezing in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. The pain tends to get worse with activity and go away with rest. Emotional stress also can trigger the pain. + +See your doctor if you think you have angina. He or she may recommend tests to check your coronary arteries and to see whether you have CHD risk factors. + +Other CHD signs and symptoms include nausea (feeling sick to your stomach), fatigue (tiredness), shortness of breath, sweating, light-headedness, and weakness. + +Some people don't realize they have CHD until they have a heart attack. A heart attack occurs if a blood clot forms in a coronary artery and blocks blood flow to part of the heart muscle. + +The most common heart attack symptom is chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest that often lasts for more than a few minutes or goes away and comes back. + +The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. The feeling can be mild or severe. Heart attack pain sometimes feels like indigestion or heartburn. Shortness of breath may occur with or before chest discomfort. + +Heart attacks also can cause upper body discomfort in one or both arms, the back, neck, jaw, or upper part of the stomach. Other heart attack symptoms include nausea, vomiting, light-headedness or sudden dizziness, breaking out in a cold sweat, sleep problems, fatigue, and lack of energy. + +Some heart attack symptoms are similar to angina symptoms. 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. + +If you don't know whether your chest pain is angina or a heart attack, call 911 right away for emergency care. + +Not everyone who has a heart attack has typical symptoms. If you've already had a heart attack, your symptoms may not be the same for another one. Also, diabetes-related nerve damage can interfere with pain signals in the body. As a result, some people who have diabetes may have heart attacks without symptoms. + +Heart Failure + +The most common symptoms of heart failure are shortness of breath or trouble breathing, fatigue, and swelling in the ankles, feet, legs, abdomen, and veins in your neck. As the heart weakens, heart failure symptoms worsen. + +People who have heart failure can live longer and more active lives if the condition is diagnosed early and they follow their treatment plans. If you have any form of DHD, talk with your doctor about your risk of heart failure. + +Diabetic Cardiomyopathy + +Diabetic cardiomyopathy may not cause symptoms in its early stages. Later, you may have weakness, shortness of breath, a severe cough, fatigue, and swelling of the legs and feet." +exams and tests,How to diagnose Diabetic Heart Disease ?,"Your doctor will diagnose diabetic heart disease (DHD) based on your signs and symptoms, medical and family histories, a physical exam, and the results from tests and procedures. + +Doctors and researchers are still trying to find out whether routine testing for DHD will benefit people who have diabetes but no heart disease symptoms. + +Initial Tests + +No single test can diagnose DHD, which may involve coronary heart disease (CHD), heart failure, and/or diabetic cardiomyopathy. Initially, your doctor may recommend one or more of the following tests. + +Blood Pressure Measurement + +To measure your blood pressure, your doctor or nurse will use some type of a gauge, a stethoscope (or electronic sensor), and a blood pressure cuff. + +Most often, you'll sit or lie down with the cuff around your arm as your doctor or nurse checks your blood pressure. If he or she doesn't tell you what your blood pressure numbers are, you should ask. + +Blood Tests + +Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels of these substances may show that you're at risk for DHD. + +A blood test also can check the level of a hormone called BNP (brain natriuretic peptide) in your blood. The heart makes BNP, and the level of BNP rises during heart failure. + +Chest X Ray + +A chest x ray takes pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels. A chest x ray can reveal signs of heart failure. + +EKG (Electrocardiogram) + +An EKG is a simple, painless test that detects and records your 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 can show signs of heart damage due to CHD and signs of a previous or current heart attack. + +Stress Test + +Some heart problems are easier to diagnose when your heart is working hard and beating fast. Stress testing gives your doctor information about how your heart works during physical stress. + +During a stress test, you exercise (walk or run on a treadmill or pedal a bicycle) to make your heart work hard and beat fast. Tests are done on your heart while you exercise. If you cant exercise, you may be given medicine to raise your heart rate. + +Urinalysis + +For this test, you'll give a sample of urine for analysis. The sample is checked for abnormal levels of protein or blood cells. In people who have diabetes, protein in the urine is a risk factor for DHD. + +Other Tests and Procedures + +Your doctor may refer you to a cardiologist if your initial test results suggest that you have a form of DHD. A cardiologist is a doctor who specializes in diagnosing and treating heart diseases and conditions. + +The cardiologist may recommend other tests or procedures to get more detailed information about the nature and extent of your DHD. + +For more information about other tests and procedures, go to the diagnosis sections of the Health Topics Coronary Heart Disease, Heart Failure, and Cardiomyopathy articles." +treatment,What are the treatments for Diabetic Heart Disease ?,"Diabetic heart disease (DHD) is treated with lifestyle changes, medicines, and medical procedures. The goals of treating DHD include: + +Controlling diabetes and any other heart disease risk factors you have, such as unhealthy blood cholesterol levels and high blood pressure + +Reducing or relieving heart disease symptoms, such as angina (chest pain or discomfort) + +Preventing or delaying heart disease complications, such as a heart attack + +Repairing heart and coronary artery damage + +Following the treatment plan your doctor recommends is very important. Compared with people who don't have diabetes, people who have the disease are at higher risk for heart disease, have additional causes of heart disease, may develop heart disease at a younger age, and may have more severe heart disease. + +Taking action to manage multiple risk factors helps improve your outlook. The good news is that many lifestyle changes help control multiple risk factors. + +Lifestyle Changes + +Following a healthy lifestyle is an important part of treating diabetes and DHD. Some people who have diabetes can manage their blood pressure and blood cholesterol levels with lifestyle changes alone. + +Following 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 Institutes (NHLBIs) Your Guide to Lowering Your Blood Pressure With DASH and the U.S. Department of Agricultures ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating. + +Maintaining a Healthy Weight + +Controlling your weight helps you control heart disease risk factors. If youre overweight or obese, work with your doctor to create a reasonable weight-loss plan. + +For more information about losing weight or maintaining your weight, go to the Health Topics Overweight and Obesity article. + +Being Physically Active + +Regular physical activity can lower many heart disease risk factors, and it helps control your blood sugar level. Physical activity also can improve how insulin works. (Insulin is a hormone that helps turn glucose into energy.) + +Generally, adults should do at least 150 minutes (2hours and 30 minutes) of moderate-intensity physical activity each week. You dont have to do the activity all at once. You can break it up into shorter periods of at least 10 minutes each. + +Talk with your doctor about what types and amounts and physical activity are safe for you. People who have diabetes must be careful to watch their blood sugar levels and avoid injury to their feet during physical activity. + +For more information about physical activity, go to the U.S. Department of Health and Human Services' ""2008 Physical Activity Guidelines for Americans,"" the Health Topics Physical Activity and Your Heart article, and the NHLBI's ""Your Guide to Physical Activity and Your Heart."" + +Quitting Smoking + +Smoking can damage your blood vessels and raise your risk of heart disease. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke. + +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. + +For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the NHLBI's ""Your Guide to a Healthy Heart."" + +Managing Stress + +Research shows that strong emotions, such as anger, can trigger a heart attack. Learning how to managestress, relax, and cope with problems can improve your emotional and physical health. + +Medicines + +Medicines are an important part of treatment for people who have diabetes and for people who have DHD. + +Medicines can help control blood sugar levels, lower blood pressure, reduce the risk of blood clots, improve blood cholesterol levels, reduce the heart's workload, and treat angina symptoms. + +Your doctor will prescribe medicines based on your specific needs. + +Medical Procedures + +If you have DHD, your doctor may recommend a medical procedure. The type of procedure will depend on the type of heart disease you have. + +For example, both percutaneous coronary intervention (PCI),also known as coronaryangioplasty, and coronary artery bypass grafting (CABG) are used to treat coronary heart disease (CHD). Both of these procedures improve blood flow to your heart. PCI also can relieve chest pain. CABG can relieve chest pain and may help prevent a heart attack. + +If you have heart damage and severe heart failure symptoms, your doctor may recommend a cardiac resynchronization therapy (CRT) device or an implantable cardioverter defibrillator (ICD). + +A CRT device is a type of pacemaker. A pacemaker is a small device that helps control abnormal heart rhythms. Its placed under the skin of the chest or abdomen. A CRT device helps the heart's lower chambers contract at the same time, which may decrease heart failure symptoms. + +An ICD is similar to a pacemaker. An ICD is a small device thats placed under the skin of the chest or abdomen. The device uses electrical pulses or shocks to help control dangerous heart rhythms. + +Your doctor also may recommend a pacemaker or ICD to treat diabetic cardiomyopathy. Other types of surgery also are used to treat this type of heart disease. + +For more information about medical procedures used to treat diabetes-related heart diseases, go to the treatment sections of the Health Topics Coronary Heart Disease, Heart Failure, and Cardiomyopathy articles. + +Diabetes-Specific Treatment Issues + +The treatments described above are used for people who have DHD and for people who have heart disease without diabetes. However, some aspects of heart disease treatment differ for people who have diabetes. + +Treatment for High Blood Pressure and High Blood Cholesterol + +Treatment for high blood pressure and high blood cholesterol often begins earlier in people who have diabetes than in those who don't. People who have diabetes also may have more aggressive treatment goals. + +For example, your doctor may prescribe medicines called statins even if your blood cholesterol levels are in the normal range. Your doctor also may prescribe statins if you're older than 40 and have other heart disease risk factors. + +Target goals for LDL cholesterol (sometimes called ""bad"" cholesterol) and high blood pressure also are lower for people who have diabetes than for those who don't. Studies suggest that most people who have diabetes will need more than one blood pressure medicine to reach their goals. + +Research also has shown that some people who have diabetes may benefit more from certain blood pressure and cholesterol medicines than from others. + +One example is a group of cholesterol medicines called bile acid sequestrants (such as cholestyramine). This type of medicine may offer advantages for people who have type 2 diabetes. It appears to improve blood sugar control and lower LDL cholesterol. + +Treatment for Heart Failure + +Some studies suggest that certain medicines may have advantages for treating heart failure in people who have diabetes. These medicines include ACE inhibitors, angiotensin receptor blockers, aldosterone antagonists, and beta blockers. + +Research shows that two blood sugar medicines (insulin and sulfanylureas) don't seem to reduce the risk of heart failure in people who have type 2 diabetes. A third medicine (metformin) shows promise, but research is still ongoing. + +Heart Attack Prevention + +Doctors may recommend aspirin for people with diabetes who are at increased risk for heart disease and heart attack. Taken each day, low-dose aspirin may prevent blood clots that can lead to a heart attack. + +People with diabetes who are at increased risk include most men older than 50 and most women older than 60 who have one or more of the following risk factors: + +Smoking + +High blood pressure + +High blood cholesterol + +A family history of early heart disease + +A higher than normal level of protein in their urine + +Blood Sugar Control + +Controlling blood sugar levels is good for heart health. For example, controlling blood sugar improves everyday heart function for people who have diabetes and heart failure." +prevention,How to prevent Diabetic Heart Disease ?,"Taking action to control risk factors can help prevent or delay heart disease in people who have diabetes and in those who don't. Your risk of heart disease increases with the number of risk factors you have. + +One step you can take is to adopt a healthy lifestyle. A healthy lifestyle should be part of a lifelong approach to healthy living. A healthy lifestyle includes: + +Following a healthy diet + +Maintaining a healthy weight + +Being physically active + +Quitting smoking + +Managing stress + +You also should know your family history of diabetes and heart disease. If you or someone in your family has diabetes, heart disease, or both, let your doctor know. + +Your doctor may prescribe medicines to control certain risk factors, such as high blood pressure and high blood cholesterol. Take all of your medicines exactly as your doctor advises. + +People who have diabetes also need good blood sugar control. Controlling your blood sugar level is good for heart health. Ask your doctor about the best ways to control your blood sugar level. + +For more information about lifestyle changes and medicines, go to ""How Is Diabetic Heart Disease Treated?""" +information,What is (are) Pulmonary Hypertension ?,"Pulmonary hypertension (PULL-mun-ary HI-per-TEN-shun), or PH, is increased pressure in the pulmonary arteries. These arteries carry blood from your heart to your lungs to pick up oxygen. + +PH causes symptoms such as shortness of breath during routine activity (for example, climbing two flights of stairs), tiredness, chest pain, and a racing heartbeat. As the condition worsens, its symptoms may limit all physical activity. + +Overview + +To understand PH, it helps to understand how your heart and lungs work. Your heart has two sides, separated by an inner wall called the septum. + +Each side of your heart has an upper and lower chamber. The lower right chamber of your heart, the right ventricle (VEN-trih-kul), pumps blood to your pulmonary arteries. The blood then travels to your lungs, where it picks up oxygen. + +The upper left chamber of your heart, the left atrium (AY-tree-um), receives the oxygen-rich blood from your lungs. The blood is then pumped into the lower left chamber of your heart, the left ventricle. From the left ventricle, the blood is pumped to the rest of your body through an artery called the aorta. + +For more information about the heart and lungs, go to the Diseases and Conditions Index How the Heart Works and How the Lungs Work articles. + +PH begins with inflammation and changes in the cells that line your pulmonary arteries. Other factors also can affect the pulmonary arteries and cause PH. For example, the condition may develop if: + +The walls of the arteries tighten. + +The walls of the arteries are stiff at birth or become stiff from an overgrowth of cells. + +Blood clots form in the arteries. + +These changes make it hard for your heart to push blood through your pulmonary arteries and into your lungs. As a result, the pressure in your arteries rises. Also, because your heart is working harder than normal, your right ventricle becomes strained and weak. + +Your heart may become so weak that it can't pump enough blood to your lungs. This causes heart failure. Heart failure is the most common cause of death in people who have PH. + +PH is divided into five groups based on its causes. In all groups, the average pressure in the pulmonary arteries is higher than 25 mmHg at rest or 30 mmHg during physical activity. The pressure in normal pulmonary arteries is 820 mmHg at rest. (The mmHg is millimeters of mercurythe units used to measure blood pressure.) + +Other diseases or conditions, such as heart and lung diseases or blood clots, usually cause PH. Some people inherit the condition (that is, their parents pass the genes for PH on to them). In some cases, the cause isn't known. + +Outlook + +PH has no cure. However, research for new treatments is ongoing. The earlier PH is treated, the easier it is to control. + +Treatments include medicines, procedures, and other therapies. These treatments can relieve PH symptoms and slow the progress of the disease. Lifestyle changes also can help control symptoms." +causes,What causes Pulmonary Hypertension ?,"Pulmonary hypertension (PH) begins with inflammation and changes in the cells that line your pulmonary arteries. Other factors also can affect the pulmonary arteries and cause PH. For example, the condition may develop if: + +The walls of the arteries tighten. + +The walls of the arteries are stiff at birth or become stiff from an overgrowth of cells. + +Blood clots form in the arteries. + +These changes make it hard for your heart to push blood through your pulmonary arteries and into your lungs. Thus, the pressure in the arteries rises, causing PH. + +Many factors can contribute to the process that leads to the different types of PH. + +Group 1 pulmonary arterial hypertension (PAH) may have no known cause, or the condition may be inherited. (""Inherited"" means the condition is passed from parents to children through genes.) + +Some diseases and conditions also can cause group 1 PAH. Examples include HIV infection, congenital heart disease, and sickle cell disease. Also, the use of street drugs (such as cocaine) and certain diet medicines can lead to PAH. + +Many diseases and conditions can cause groups 2 through 5 PH (often called secondary PH), including: + +Mitral valve disease + +Lung diseases, such as COPD (chronic obstructive pulmonary disease) + +Sleep apnea + +Sarcoidosis + +For more information about the types of PH and the diseases, conditions, and factors that can cause them, go to ""Types of Pulmonary Hypertension.""" +susceptibility,Who is at risk for Pulmonary Hypertension? ?,"The exact number of people who have pulmonary hypertension (PH) isn't known. + +Group 1 pulmonary arterial hypertension (PAH) without a known cause is rare. It affects women more often than men. People who have group 1 PAH tend to be overweight. + +PH that occurs with another disease or condition is more common. + +PH usually develops between the ages of 20 and 60, but it can occur at any age. People who are at increased risk for PH include: + +Those who have a family history of the condition. + +Those who have certain diseases or conditions, such as heart and lung diseases, liver disease, HIV infection, or blood clots in the pulmonary arteries. (For more information about the diseases, conditions, and factors that cause PH, go to ""Types of Pulmonary Hypertension."") + +Those who use street drugs (such as cocaine) or certain diet medicines. + +Those who live at high altitudes." +symptoms,What are the symptoms of Pulmonary Hypertension ?,"Signs and symptoms of pulmonary hypertension (PH) may include: + +Shortness of breath during routine activity, such as climbing two flights of stairs + +Tiredness + +Chest pain + +A racing heartbeat + +Pain on the upper right side of the abdomen + +Decreased appetite + +As PH worsens, you may find it hard to do any physical activities. At this point, other signs and symptoms may include: + +Feeling light-headed, especially during physical activity + +Fainting at times + +Swelling in your legs and ankles + +A bluish color on your lips and skin" +exams and tests,How to diagnose Pulmonary Hypertension ?,"Your doctor will diagnose pulmonary hypertension (PH) based on your medical and family histories, a physical exam, and the results from tests and procedures. + +PH can develop slowly. In fact, you may have it for years and not know it. This is because the condition has no early signs or symptoms. + +When symptoms do occur, they're often like those of other heart and lung conditions, such as asthma. This makes PH hard to diagnose. + +Medical and Family Histories + +Your doctor may ask about your signs and symptoms and how and when they began. He or she also may ask whether you have other medical conditions that can cause PH. + +Your doctor will want to know whether you have any family members who have or have had PH. People who have a family history of PH are at higher risk for the condition. + +Physical Exam + +During the physical exam, your doctor will listen to your heart and lungs with a stethoscope. He or she also will check your ankles and legs for swelling and your lips and skin for a bluish color. These are signs of PH. + +Diagnostic Tests and Procedures + +Your doctor may recommend tests and procedures to confirm a diagnosis of PH and to look for its underlying cause. Your doctor also will use test results to find out the severity of your PH. + +Tests and Procedures To Confirm a Diagnosis + +Echocardiography. Echocardiography (EK-o-kar-de-OG-ra-fee), or echo, uses sound waves to create a moving picture of your heart. This test can estimate the pressure in your pulmonary arteries. Echo also can show the size and thickness of your right ventricle and how well it's working. + +Chest x ray. A chest x ray takes pictures of the structures in your chest, such as your heart, lungs, and blood vessels. This test can show whether your pulmonary arteries and right ventricle are enlarged. + +The pulmonary arteries and right ventricle may get larger if the right ventricle has to work hard to pump blood through the pulmonary arteries. + +A chest x ray also may show signs of an underlying lung disease that's causing or contributing to PH. + +EKG (electrocardiogram). An EKG is a simple, painless test that records the heart's electrical activity. This test also shows whether your heart's rhythm is steady or irregular. An EKG may show whether your right ventricle is enlarged or strained. + +Right heart catheterization. This procedure measures the pressure in your pulmonary arteries. It also shows how well your heart is pumping blood to the rest of your body. Right heart catheterization (KATH-e-ter-ih-ZA-shun) can find any leaks between the left and right side of the heart. + +During this procedure, a thin, flexible tube called a catheter is put into a blood vessel in your groin (upper thigh) or neck. The tube is threaded into the right side of your heart and into the pulmonary arteries. Through the tube, your doctor can do tests and treatments on your heart. + +Tests To Look for the Underlying Cause of Pulmonary Hypertension + +PH has many causes, so many tests may need to be done to find its underlying cause. + +Chest CT scan. A chest computed tomography (to-MOG-ra-fee) scan, or chest CT scan, creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. These pictures can show signs of PH or a condition that may be causing PH. + +Chest MRI. Chest magnetic resonance imaging, or chest MRI, shows how your right ventricle is working. The test also shows blood flow in your lungs. Chest MRI also can help detect signs of PH or an underlying condition causing PH. + +Lung function tests. 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. These tests can help detect a lung disease that may be causing PH. + +Polysomnogram (PSG). This test records brain activity, eye movements, heart rate, and blood pressure while you sleep. A PSG also measures the level of oxygen in your blood. A low oxygen level during sleep is common in PH, and it can make the condition worse. + +A PSG usually is done while you stay overnight at a sleep center. For more information about this test, go to the Diseases and Conditions Index Sleep Studies article. + +Lung ventilation/perfusion (VQ) scan. A lung VQ scan measures air and blood flow in your lungs. This test can help detect blood clots in your lung's blood vessels. + +Blood tests. Blood tests are used to rule out other diseases, such as HIV, liver disease, and autoimmune diseases (such as rheumatoid arthritis). + +Finding Out the Severity of Pulmonary Hypertension + +Exercise testing is used to find out the severity of PH. This testing consists of either a 6-minute walk test or a cardiopulmonary exercise test. + +A 6-minute walk test measures the distance you can quickly walk in 6 minutes. A cardiopulmonary exercise test measures how well your lungs and heart work while you exercise on a treadmill or bicycle. + +During exercise testing, your doctor will rate your activity level. Your level is linked to the severity of your PH. The rating system ranges from class 1 to class 4. + +Class 1 has no limits. You can do regular physical activities, such as walking or climbing stairs. These activities don't cause PH symptoms, such as tiredness, shortness of breath, or chest pain. + +Class 2 has slight or mild limits. You're comfortable while resting, but regular physical activity causes PH symptoms. + +Class 3 has marked or noticeable limits. You're comfortable while resting. However, walking even one or two blocks or climbing one flight of stairs can cause PH symptoms. + +Class 4 has severe limits. You're not able to do any physical activity without discomfort. You also may have PH symptoms while at rest. + +Over time, you may need more exercise tests to find out how well your treatments are working. Each time testing is done, your doctor will compare your activity level with the previous one." +treatment,What are the treatments for Pulmonary Hypertension ?,"Pulmonary hypertension (PH) has no cure. However, treatment may help relieve symptoms and slow the progress of the disease. + +PH is treated with medicines, procedures, and other therapies. Treatment will depend on what type of PH you have and its severity. (For more information, go to ""Types of Pulmonary Hypertension."") + +Group 1 Pulmonary Arterial Hypertension + +Group 1 pulmonary arterial hypertension (PAH) includes PH that's inherited, that has no known cause, or that's caused by certain drugs or conditions. Treatments for group 1 PAH include medicines and medical procedures. + +Medicines + +Your doctor may prescribe medicines to relax the blood vessels in your lungs and reduce excess cell growth in the blood vessels. As the blood vessels relax, more blood can flow through them. + +Your doctor may prescribe medicines that are taken by mouth, inhaled, or injected. + +Examples of medicines for group 1 PAH include: + +Phosphodiesterase-5 inhibitors, such as sildenafil + +Prostanoids, such as epoprostenol + +Endothelin receptor antagonists, such as bosentan and ambrisentan + +Calcium channel blockers, such as diltiazem + +Your doctor may prescribe one or more of these medicines. To find out which of these medicines works best, you'll likely have an acute vasoreactivity test. This test shows how the pressure in your pulmonary arteries reacts to certain medicines. The test is done during right heart catheterization. + +Medical and Surgical Procedures + +If you have group 1 PAH, your doctor may recommend one or more of the following procedures. + +Atrial septostomy (sep-TOS-toe-me). For this procedure, a thin, flexible tube called a catheter is put into a blood vessel in your leg and threaded to your heart. The tube is then put through the wall that separates your right and left atria (the upper chambers of your heart). This wall is called the septum. + +A tiny balloon on the tip of the tube is inflated. This creates an opening between the atria. This procedure relieves the pressure in the right atria and increases blood flow. Atrial septostomy is rarely done in the United States. + +Lung transplant. A lung transplant is surgery to replace a person's diseased lung with a healthy lung from a deceased donor. This procedure may be used for people who have severe lung disease that's causing PAH. + +Heartlung transplant. A heartlung transplant is surgery in which both the heart and lung are replaced with healthy organs from a deceased donor. + +Group 2 Pulmonary Hypertension + +Conditions that affect the left side of the heart, such as mitral valve disease, can cause group 2 PH. Treating the underlying condition will help treat PH. Treatments may include lifestyle changes, medicines, and surgery. + +Group 3 Pulmonary Hypertension + +Lung diseases, such as COPD (chronic obstructive pulmonary disease) and interstitial lung disease, can cause group 3 PH. Certain sleep disorders, such as sleep apnea, also can cause group 3 PH. + +If you have this type of PH, you may need oxygen therapy. This treatment raises the level of oxygen in your blood. You'll likely get the oxygen through soft, plastic prongs that fit into your nose. Oxygen therapy can be done at home or in a hospital. + +Your doctor also may recommend other treatments if you have an underlying lung disease. + +Group 4 Pulmonary Hypertension + +Blood clots in the lungs or blood clotting disorders can cause group 4 PH. If you have this type of PH, your doctor will likely prescribe blood-thinning medicines. These medicines prevent clots from forming or getting larger. + +Sometimes doctors use surgery to remove scarring in the pulmonary arteries due to old blood clots. + +Group 5 Pulmonary Hypertension + +Various diseases and conditions, such as thyroid disease and sarcoidosis, can cause group 5 PH. An object, such as a tumor, pressing on the pulmonary arteries also can cause group 5 PH. + +Group 5 PH is treated by treating its cause. + +All Types of Pulmonary Hypertension + +Several treatments may be used for all types of PH. These treatments include: + +Diuretics, also called water pills. These medicines help reduce fluid buildup in your body, including swelling in your ankles and feet. + +Blood-thinning medicines. These medicines help prevent blood clots from forming or getting larger. + +Digoxin. This medicine helps the heart beat stronger and pump more blood. Digoxin sometimes is used to control the heart rate if abnormal heart rhythms, such as atrial fibrillation or atrial flutter, occur. + +Oxygen therapy. This treatment raises the level of oxygen in your blood. + +Physical activity. Regular activity may help improve your ability to be active. Talk with your doctor about a physical activity plan that's safe for you. + +Research is ongoing for better PH treatments. These treatments offer hope for the future." +information,What is (are) Heart 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. + +Overview + +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. + +Outlook + +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." +causes,What causes Heart Palpitations ?,"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. + +Causes Not Related to Heart Problems + +Strong Emotions + +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. + +Vigorous Physical Activity + +Intense activity can make your heart feel like its beating too hard or too fast, even though it's working normally. Intense activity also can cause occasional premature (extra) heartbeats. + +Medical Conditions + +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) + +Hormonal Changes + +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. + +Medicines and Stimulants + +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. + +Causes Related to Heart Problems + +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." +susceptibility,Who is at risk for Heart Palpitations? ?,"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,What are the symptoms of Heart 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)." +exams and tests,How to diagnose Heart Palpitations ?,"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. + +Specialists Involved + +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) + +Medical History + +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. + +Physical Exam + +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. + +Diagnostic Tests + +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. + +Holter or Event Monitor + +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 hearts 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. + +Holter or Event Monitor + + + +Echocardiography + +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. + +Stress Test + +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 cant exercise, you may be given medicine to make your heart work hard and beat fast." +treatment,What are the treatments for Heart Palpitations ?,"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. + +Avoiding Triggers + +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. + +Treating Medical Conditions That May Cause Palpitations + +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." +prevention,How to prevent Heart Palpitations ?,"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." +information,What is (are) Cardiomyopathy ?,"Cardiomyopathy refers to diseases of the heart muscle. These diseases have many causes, signs and symptoms, and treatments. + +In cardiomyopathy, the heart muscle becomes enlarged, thick, or rigid. In rare cases, the muscle tissue in the heart is replaced with scar tissue. + +As cardiomyopathy worsens, the heart becomes weaker. It's less able to pump blood through the body and maintain a normal electrical rhythm. This can lead to heart failure or irregular heartbeats called arrhythmias. In turn, heart failure can cause fluid to build up in the lungs, ankles, feet, legs, or abdomen. + +The weakening of the heart also can cause other complications, such as heart valve problems. + +Overview + +The types of cardiomyopathy are: + +Hypertrophic cardiomyopathy + +Dilated cardiomyopathy + +Restrictive cardiomyopathy + +Arrhythmogenic right ventricular dysplasia + +Unclassified cardiomyopathy + +Cardiomyopathy can be acquired or inherited. ""Acquired"" means you aren't born with the disease, but you develop it due to another disease, condition, or factor. ""Inherited"" means your parents passed the gene for the disease on to you. Many times, the cause of cardiomyopathy isn't known. + +Cardiomyopathy can affect people of all ages. However, people in certain age groups are more likely to have certain types of cardiomyopathy. This article focuses on cardiomyopathy in adults. + +Outlook + +Some people who have cardiomyopathy have no signs or symptoms and need no treatment. For other people, the disease develops quickly, symptoms are severe, and serious complications occur. + +Treatments for cardiomyopathy include lifestyle changes, medicines, surgery, implanted devices to correct arrhythmias, and a nonsurgical procedure. These treatments can control symptoms, reduce complications, and stop the disease from getting worse." +information,What is (are) Stroke ?,"A stroke occurs if the flow of oxygen-rich blood to a portion of the brain is blocked. Without oxygen, brain cells start to die after a few minutes. Sudden bleeding in the brain also can cause a stroke if it damages brain cells. + +If brain cells die or are damaged because of a stroke, symptoms occur in the parts of the body that these brain cells control. Examples of stroke symptoms include sudden weakness; paralysis or numbness of the face, arms, or legs (paralysis is an inability to move); trouble speaking or understanding speech; and trouble seeing. + +A stroke is a serious medical condition that requires emergency care. A stroke can cause lasting brain damage, long-term disability, or even death. + +If you think you or someone else is having a stroke, call 911 right away. 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. During a stroke, every minute counts. + +Overview + +The two main types of stroke are ischemic (is-KE-mik) and hemorrhagic (hem-ah-RAJ-ik). Ischemic is the more common type of stroke. + +An ischemic stroke occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Blood clots often cause the blockages that lead to ischemic strokes. + +A hemorrhagic stroke occurs if an artery in the brain leaks blood or ruptures (breaks open). The pressure from the leaked blood damages brain cells. High blood pressure and aneurysms (AN-u-risms) are examples of conditions that can cause hemorrhagic strokes. (Aneurysms are balloon-like bulges in an artery that can stretch and burst.) + +Another condition thats similar to a stroke is a transient ischemic attack, also called a TIA or mini-stroke. A TIA occurs if blood flow to a portion of the brain is blocked only for a short time. Thus, damage to the brain cells isnt permanent (lasting). + +Like ischemic strokes, TIAs often are caused by blood clots. Although TIAs are not full-blown strokes, they greatly increase the risk of having a stroke. If you have a TIA, its important for your doctor to find the cause so you can take steps to prevent a stroke. + +Both strokes and TIAs require emergency care. + +Outlook + +Stroke is a leading cause of death in the United States. Many factors can raise your risk of having a stroke. Talk with your doctor about how you can control these risk factors and help prevent a stroke. + +If you have a stroke, prompt treatment can reduce damage to your brain and help you avoid lasting disabilities. Prompt treatment also may help prevent another stroke. + +Researchers continue to study the causes and risk factors for stroke. Theyre also finding new and better treatments and new ways to help the brain repair itself after a stroke." +causes,What causes Stroke ?,"Ischemic Stroke and Transient Ischemic Attack + +An ischemic stroke or transient ischemic attack (TIA) occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Many medical conditions can increase the risk of ischemic stroke or TIA. + +For example, atherosclerosis (ath-er-o-skler-O-sis) is a disease in which a fatty substance called plaque builds up on the inner walls of the arteries. Plaque hardens and narrows the arteries, which limits the flow of blood to tissues and organs (such as the heart and brain). + +Plaque in an artery can crack or rupture (break open). Blood platelets (PLATE-lets), which are disc-shaped cell fragments, stick to the site of the plaque injury and clump together to form blood clots. These clots can partly or fully block an artery. + +Plaque can build up in any artery in the body, including arteries in the heart, brain, and neck. The two main arteries on each side of the neck are called the carotid (ka-ROT-id) arteries. These arteries supply oxygen-rich blood to the brain, face, scalp, and neck. + +When plaque builds up in the carotid arteries, the condition is called carotid artery disease. Carotid artery disease causes many of the ischemic strokes and TIAs that occur in the United States. + +An embolic stroke (a type of ischemic stroke) or TIA also can occur if a blood clot or piece of plaque breaks away from the wall of an artery. The clot or plaque can travel through the bloodstream and get stuck in one of the brains arteries. This stops blood flow through the artery and damages brain cells. + +Heart conditions and blood disorders also can cause blood clots that can lead to a stroke or TIA. For example, atrial fibrillation (A-tre-al fi-bri-LA-shun), or AF, is a common cause of embolic stroke. + +In AF, the upper chambers of the heart contract in a very fast and irregular way. As a result, some blood pools in the heart. The pooling increases the risk of blood clots forming in the heart chambers. + +An ischemic stroke or TIA also can occur because of lesions caused by atherosclerosis. These lesions may form in the small arteries of the brain, and they can block blood flow to the brain. + +Hemorrhagic Stroke + +Sudden bleeding in the brain can cause a hemorrhagic stroke. The bleeding causes swelling of the brain and increased pressure in the skull. The swelling and pressure damage brain cells and tissues. + +Examples of conditions that can cause a hemorrhagic stroke include high blood pressure, aneurysms, and arteriovenous (ar-TEER-e-o-VE-nus) malformations (AVMs). + +""Blood pressure"" is the force of blood pushing against the walls of the arteries as the heart pumps blood. If blood pressure rises and stays high over time, it can damage the body in many ways. + +Aneurysms are balloon-like bulges in an artery that can stretch and burst. AVMs are tangles of faulty arteries and veins that can rupture within the brain. High blood pressure can increase the risk of hemorrhagic stroke in people who have aneurysms or AVMs." +susceptibility,Who is at risk for Stroke? ?,"Certain traits, conditions, and habits can raise your risk of having a stroke or transient ischemic attack (TIA). These traits, conditions, and habits are known as risk factors. + +The more risk factors you have, the more likely you are to have a stroke. You can treat or control some risk factors, such as high blood pressure and smoking. Other risk factors, such as age and gender, you cant control. + +The major risk factors for stroke include: + +High blood pressure. High blood pressure is the main risk factor for stroke. Blood pressure is considered high if it stays at or above 140/90 millimeters of mercury (mmHg) over time. If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher. + +Diabetes. Diabetes is a disease in which the blood sugar level is high because the body doesnt make enough insulin or doesnt use its insulin properly. Insulin is a hormone that helps move blood sugar into cells where its used for energy. + +Heart diseases.Coronary heart disease,cardiomyopathy,heart failure, andatrial fibrillationcan cause blood clots that can lead to a stroke. + +Smoking. Smoking can damage blood vessels and raise blood pressure. Smoking also may reduce the amount of oxygen that reaches your bodys tissues. Exposure to secondhand smoke also can damage the blood vessels. + +Age and gender. Your risk of stroke increases as you get older. At younger ages, men are more likely than women to have strokes. However, women are more likely to die from strokes. Women who take birth control pills also are at slightly higher risk of stroke. + +Race and ethnicity. Strokes occur more often in African American, Alaska Native, and American Indian adults than in white, Hispanic, or Asian American adults. + +Personal or family history of stroke or TIA. If youve had a stroke, youre at higher risk for another one. Your risk of having a repeat stroke is the highest right after a stroke. A TIA also increases your risk of having a stroke, as does having a family history of stroke. + +Brainaneurysmsor arteriovenous malformations (AVMs). Aneurysms are balloon-like bulges in an artery that can stretch and burst. AVMs are tangles of faulty arteries and veins that can rupture (break open) within the brain. AVMs may be present at birth, but often arent diagnosed until they rupture. + +Other risk factors for stroke, many of which of you can control, include: + +Alcohol and illegal drug use, including cocaine, amphetamines, and other drugs + +Certain medical conditions, such as sickle cell disease, vasculitis (inflammation of the blood vessels), and bleeding disorders + +Lack of physical activity + +Overweight and Obesity + +Stress and depression + +Unhealthy cholesterol levels + +Unhealthy diet + +Use of nonsteroidal anti-inflammatory drugs (NSAIDs), but not aspirin, may increase the risk of heart attack or stroke, particularly in patients who have had a heart attack or cardiac bypass surgery. The risk may increase the longer NSAIDs are used. Common NSAIDs include ibuprofen and naproxen. + +Following a healthy lifestyle can lower the risk of stroke. Some people also may need to take medicines to lower their risk. Sometimes strokes can occur in people who dont have any known risk factors." +symptoms,What are the symptoms of Stroke ?,"The signs and symptoms of a stroke often develop quickly. However, they can develop over hours or even days. + +The type of symptoms depends on the type of stroke and the area of the brain thats affected. How long symptoms last and how severe they are vary among different people. + +Signs and symptoms of a stroke may include: + +Sudden weakness + +Paralysis (an inability to move) or numbness of the face, arms, or legs, especially on one side of the body + +Confusion + +Trouble speaking or understanding speech + +Trouble seeing in one or both eyes + +Problems breathing + +Dizziness, trouble walking, loss of balance or coordination, and unexplained falls + +Loss of consciousness + +Sudden and severe headache + +A transient ischemic attack (TIA) has the same signs and symptoms as a stroke. However, TIA symptoms usually last less than 12 hours (although they may last up to 24 hours). A TIA may occur only once in a persons lifetime or more often. + +At first, it may not be possible to tell whether someone is having a TIA or stroke. All stroke-like symptoms require medical care. + +If you think you or someone else is having a TIA or stroke, call 911 right away. 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. During a stroke, every minute counts. + +Stroke Complications + +After youve had a stroke, you may develop other complications, such as: + +Blood clots and muscle weakness. Being immobile (unable to move around) for a long time can raise your risk of developing blood clots in the deep veins of the legs. Being immobile also can lead to muscle weakness and decreased muscle flexibility. + +Problems swallowing and pneumonia. If a stroke affects the muscles used for swallowing, you may have a hard time eating or drinking. You also may be at risk of inhaling food or drink into your lungs. If this happens, you may develop pneumonia. + +Loss of bladder control. Some strokes affect the muscles used to urinate. You may need a urinary catheter (a tube placed into the bladder) until you can urinate on your own. Use of these catheters can lead to urinary tract infections. Loss of bowel control or constipation also may occur after a stroke." +exams and tests,How to diagnose Stroke ?,"Your doctor will diagnose a stroke based on your signs and symptoms, your medical history, a physical exam, and test results. + +Your doctor will want to find out the type of stroke youve had, its cause, the part of the brain that's affected, and whether you have bleeding in the brain. + +If your doctor thinks youve had a transient ischemic attack (TIA), he or she will look for its cause to help prevent a future stroke. + +Medical History and Physical Exam + +Your doctor will ask you or a family member about your risk factors for stroke. Examples of risk factors include high blood pressure, smoking, heart disease, and a personal or family history of stroke. Your doctor also will ask about your signs and symptoms and when they began. + +During the physical exam, your doctor will check your mental alertness and your coordination and balance. He or she will check for numbness or weakness in your face, arms, and legs; confusion; and trouble speaking and seeing clearly. + +Your doctor will look for signs of carotid artery disease, a common cause of ischemic stroke. He or she will listen to your carotid arteries with a stethoscope. A whooshing sound called a bruit (broo-E) may suggest changed or reduced blood flow due to plaque buildup in the carotid arteries. + +Diagnostic Tests and Procedures + +Your doctor may recommend one or more of the following tests to diagnose a stroke or TIA. + +Brain Computed Tomography + +A brain computed tomography (to-MOG-rah-fee) scan, or brain CT scan, is a painless test that uses x rays to take clear, detailed pictures of your brain. This test often is done right after a stroke is suspected. + +A brain CT scan can show bleeding in the brain or damage to the brain cells from a stroke. The test also can show other brain conditions that may be causing your symptoms. + +Magnetic Resonance Imaging + +Magnetic resonance imaging (MRI) uses magnets and radio waves to create pictures of the organs and structures in your body. This test can detect changes in brain tissue and damage to brain cells from a stroke. + +An MRI may be used instead of, or in addition to, a CT scan to diagnose a stroke. + +Computed Tomography Arteriogram and Magnetic Resonance Arteriogram + +A CT arteriogram (CTA) and magnetic resonance arteriogram (MRA) can show the large blood vessels in the brain. These tests may give your doctor more information about the site of a blood clot and the flow of blood through your brain. + +Carotid Ultrasound + +Carotid ultrasound is a painless and harmless test that uses sound waves to create pictures of the insides of your carotid arteries. These arteries supply oxygen-rich blood to your brain. + +Carotid ultrasound shows whether plaque has narrowed or blocked your carotid arteries. + +Your carotid ultrasound test may include a Doppler ultrasound. Doppler ultrasound is a special test that shows the speed and direction of blood moving through your blood vessels. + +Carotid Angiography + +Carotid angiography (an-jee-OG-ra-fee) is a test that uses dye and special x rays to show the insides of your carotid arteries. + +For this test, a small tube called a catheter is put into an artery, usually in the groin (upper thigh). The tube is then moved up into one of your carotid arteries. + +Your doctor will inject a substance (called contrast dye) into the carotid artery. The dye helps make the artery visible on x-ray pictures. + +Heart Tests + +EKG (Electrocardiogram) + +An EKG is a simple, painless test that 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 help detect heart problems that may have led to a stroke. For example, the test can help diagnose atrial fibrillation or a previous heart attack. + +Echocardiography + +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 gives information about the size and shape of your heart and how well your heart's chambers and valves are working. + +Echo can detect possible blood clots inside the heart and problems with the aorta. The aorta is the main artery that carries oxygen-rich blood from your heart to all parts of your body. + +Blood Tests + +Your doctor also may use blood tests to help diagnose a stroke. + +A blood glucose test measures the amount of glucose (sugar) in your blood. Low blood glucose levels may cause symptoms similar to those of a stroke. + +A platelet count measures the number of platelets in your blood. Blood platelets are cell fragments that help your blood clot. Abnormal platelet levels may be a sign of a bleeding disorder (not enough clotting) or a thrombotic disorder (too much clotting). + +Your doctor also may recommend blood tests to measure how long it takes for your blood to clot. Two tests that may be used are called PT and PTT tests. These tests show whether your blood is clotting normally." +treatment,What are the treatments for Stroke ?,"Treatment for a stroke depends on whether it is ischemic or hemorrhagic. Treatment for a transient ischemic attack (TIA) depends on its cause, how much time has passed since symptoms began, and whether you have other medical conditions. + +Strokes and TIAs are medical emergencies. If you have stroke symptoms, call 911 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin lifesaving treatment on the way to the emergency room. During a stroke, every minute counts. + +Once you receive immediate treatment, your doctor will try to treat your stroke risk factors and prevent complications by recommending heart-healthy lifestyle changes. + +Treating an Ischemic Stroke or Transient Ischemic Attack + +An ischemic stroke or TIA occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Often, blood clots cause the blockages that lead to ischemic strokes and TIAs. Treatment for an ischemic stroke or TIA may include medicines and medical procedures. + +Medicines + +If you have a stroke caused by a blood clot, you may be given a clot-dissolving, or clot-busting, medication called tissue plasminogen activator (tPA). A doctor will inject tPA into a vein in your arm. This type of medication must be given within 4hours of symptom onset. Ideally, it should be given as soon as possible. The sooner treatment begins, the better your chances of recovery. Thus, its important to know the signs and symptoms of a stroke and to call 911 right away for emergency care. + +If you cant have tPA for medical reasons, your doctor may give you antiplatelet medicine that helps stop platelets from clumping together to form blood clots or anticoagulant medicine (blood thinner) that keeps existing blood clots from getting larger. Two common medicines are aspirin and clopidogrel. + +Medical Procedures + +If you have carotid artery disease, your doctor may recommend a carotid endarterectomy or carotid arteryangioplasty. Both procedures open blocked carotid arteries. + +Researchers are testing other treatments for ischemic stroke, such as intra-arterial thrombolysis and mechanical clot removal in cerebral ischemia (MERCI). + +In intra-arterial thrombolysis, a long flexible tube called a catheter is put into your groin (upper thigh) and threaded to the tiny arteries of the brain. Your doctor can deliver medicine through this catheter to break up a blood clot in the brain. + +MERCI is a device that can remove blood clots from an artery. During the procedure, a catheter is threaded through a carotid artery to the affected artery in the brain. The device is then used to pull the blood clot out through the catheter. + +Treating a Hemorrhagic Stroke + +A hemorrhagic stroke occurs if an artery in the brain leaks blood or ruptures. The first steps in treating a hemorrhagic stroke are to find the cause of bleeding in the brain and then control it. Unlike ischemic strokes, hemorrhagic strokes arent treated with antiplatelet medicines and blood thinners because these medicines can make bleeding worse. + +If youre taking antiplatelet medicines or blood thinners and have a hemorrhagic stroke, youll be taken off the medicine. If high blood pressure is the cause of bleeding in the brain, your doctor may prescribe medicines to lower your blood pressure. This can help prevent further bleeding. + +Surgery also may be needed to treat a hemorrhagic stroke. The types of surgery used include aneurysm clipping, coil embolization, and arteriovenous malformation (AVM) repair. + +Aneurysm Clipping and Coil Embolization + +If an aneurysm (a balloon-like bulge in an artery) is the cause of a stroke, your doctor may recommend aneurysm clipping or coil embolization. + +Aneurysm clipping is done to block off the aneurysm from the blood vessels in the brain. This surgery helps prevent further leaking of blood from the aneurysm. It also can help prevent the aneurysm from bursting again.During the procedure, a surgeon will make an incision (cut) in the brain and place a tiny clamp at the base of the aneurysm. Youll be given medicine to make you sleep during the surgery. After the surgery, youll need to stay in the hospitals intensive care unit for a few days. + +Coil embolization is a less complex procedure for treating an aneurysm. The surgeon will insert a tube called a catheter into an artery in the groin. He or she will thread the tube to the site of the aneurysm.Then, a tiny coil will be pushed through the tube and into the aneurysm. The coil will cause a blood clot to form, which will block blood flow through the aneurysm and prevent it from burstingagain.Coil embolization is done in a hospital. Youll be given medicine to make you sleep during thesurgery. + +Arteriovenous Malformation Repair + +If an AVM is the cause of a stroke, your doctor may recommend an AVM repair. (An AVM is a tangle of faulty arteries and veins that can rupture within the brain.) AVM repair helps prevent further bleeding in the brain. + +Doctors use several methods to repair AVMs. These methods include: + +Injecting a substance into the blood vessels of the AVM to block blood flow + +Surgery to remove the AVM + +Using radiation to shrink the blood vessels of the AVM + +Treating Stroke Risk Factors + +After initial treatment for a stroke or TIA, your doctor will treat your risk factors. He or she may recommend heart-healthy lifestyle changes to help control your risk factors. + +Heart-healthy lifestyle changes may include: + +heart-healthy eating + +maintaining a healthy weight + +managing stress + +physical activity + +quitting smoking + +If lifestyle changes arent enough, you may need medicine to control your risk factors. + +Heart-Healthy Eating + +Your doctor may recommend heart-healthy eating, which should include: + +Fat-free or low-fat dairy products, such as skim milk + +Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week + +Fruits, such as apples, bananas, oranges, pears, and prunes + +Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans + +Vegetables, such as broccoli, cabbage, and carrots + +Whole grains, such as oatmeal, brown rice, and corn tortillas + +When following a heart-healthy diet, you should avoid eating: + +A lot of red meat + +Palm and coconut oils + +Sugary foods and beverages + +Two nutrients in your diet make blood cholesterol levels rise: + +Saturated fatfound mostly in foods that come from animals + +Trans fat (trans fatty acids)found in foods made with hydrogenated oils and fats, such as stick margarine; baked goods, such as cookies, cakes, and pies; crackers; frostings; and coffee creamers. Some trans fats also occur naturally in animal fats and meats. + +Saturated fat raises your blood cholesterol more than anything else in your diet. When you follow a heart-healthy eating plan, only 5percent to 6percent of your daily calories should come from saturated fat. Food labels list the amounts of saturated fat. To help you stay on track, here are some examples: + +1,200 calories a day + +8 grams of saturated fat a day + +1,500 calories a day + +10 grams of saturated fat a day + +1,800 calories a day + +12 grams of saturated fat a day + +2,000 calories a day + +13 grams of saturated fat a day + +2,500 calories a day + +17 grams of saturated fat a day + +Not all fats are bad. Monounsaturated and polyunsaturated fats actually help lower blood cholesterol levels. Some sources of monounsaturated and polyunsaturated fats are: + +Avocados + +Corn, sunflower, and soybean oils + +Nuts and seeds, such as walnuts + +Olive, canola, peanut, safflower, and sesame oils + +Peanut butter + +Salmon and trout + +Tofu + +Sodium + +Try to limit the amount of sodium that you eat. This means choosing and preparing foods that are lower in salt and sodium. Try to use low-sodium and no added salt foods and seasonings at the table or while cooking. Food labels tell you what you need to know about choosing foods that are lower in sodium. Try to eat no more than 2,300 milligrams of sodium a day. If you have high blood pressure, you may need to restrict your sodium intake even more. + +Dietary Approaches to Stop Hypertension + +Your doctor may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium and salt. + +The DASH eating plan is a good heart-healthy eating plan, even for those who dont have high blood pressure. Read more about DASH. + +Alcohol + +Try to limit alcohol intake. Too much alcohol can raise your blood pressure and triglyceride levels, a type of fat found in the blood. Alcohol also adds extra calories, which may cause weight gain. + +Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is: + +12 ounces of beer + +5 ounces of wine + +1 ounces of liquor + +Maintaining a Healthy Weight + +Maintaining a healthy weight is important for overall health and can lower your risk for stroke. Aim for a Healthy Weight by following a heart-healthy eating plan and keeping physically active. + +Knowing your body mass index (BMI) helps you find out if youre a healthy weight in relation to your height and gives an estimate of your total body fat. To figure out your BMI, check out the National Heart, Lung, and Blood Institutes (NHLBI) online BMI calculator or talk to your doctor. A BMI: + +Below 18.5 is a sign that you are underweight. + +Between 18.5 and 24.9 is in the normal range. + +Between 25.0 and 29.9 is considered overweight. + +Of 30.0 or higher is considered obese. + +A general goal to aim for is a BMI of less than 25. Your doctor or health care provider can help you set an appropriate BMI goal. + +Measuring waist circumference helps screen for possible health risks. If most of your fat is around your waist rather than at your hips, youre at a higher risk for heart disease and type2 diabetes. This risk may be high with a waist size that is greater than 35 inches for women or greater than 40 inches for men. To learn how to measure your waist, visit Assessing Your Weight and Health Risk. + +If youre overweight or obese, try to lose weight. A loss of just 3 percent to 5 percent of your current weight can lower your triglycerides, blood glucose, and the risk of developing type 2 diabetes. Greater amounts of weight loss can improve blood pressure readings, lower LDL cholesterol, and increase HDL cholesterol. + +Managing Stress + +Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Consider healthy stress-reducing activities, such as: + +A stress management program + +Meditation + +Physical activity + +Relaxation therapy + +Talking things out with friends or family + +Physical Activity + +Regular physical activity can lower many risk factors for stroke. + +Everyone should try to participate in moderate-intensity aerobic exercise at least 2hours and 30minutes per week or vigorous aerobic exercise for 1hour and 15minutes per week. Aerobic exercise, such as brisk walking, is any exercise in which your heart beats faster and you use more oxygen than usual. The more active you are, the more you will benefit. Participate in aerobic exercise for at least 10minutes at a time spread throughout the week. + +Talk with your doctor before you start a new exercise plan. Ask your doctor how much and what kinds of physical activity are safe for you. + +Read more about physical activity at: + +Physical Activity and Your Heart + +U.S. Department of Health and Human Services, 2008 Physical Activity Guidelines for Americans + +Quitting Smoking + +If you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels and raise your risk for stroke. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke. 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. + +For more information about how to quit smoking, visit Smoking and Your Heart." +prevention,How to prevent Stroke ?,"Taking action to control your risk factors can help prevent or delay a stroke. If youve already had a stroke, these actions can help prevent another one. + +Be physically active. Physical activity can improve your fitness level and health. Talk with your doctor about what types and amounts of activity are safe for you. + +Dont smoke, or if you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels and raise your risk of stroke. Talk with your doctor about programs and products that can help you quit. Also, secondhand smoke can damage the bloodvessels. + +Maintain a healthy weight. If youre overweight or obese, work with your doctor to create a reasonable weight loss plan. Controlling your weight helps you control risk factors for stroke. + +Make heart-healthy eating choices. Heart-healthy eating can help lower your risk or prevent a stroke. + +Manage stress. Use techniques to lower your stress levels. + +If you or someone in your family has had a stroke, be sure to tell your doctor. By knowing your family history of stroke, you may be able to lower your risk factors and prevent or delay a stroke. If youve had a transient ischemic attack (TIA), dont ignore it. TIAs are warnings, and its important for your doctor to find the cause of the TIA so you can take steps to prevent a stroke." +information,What is (are) Coronary Artery Disease ?,"Coronary artery disease (CAD) is the most common type of heart disease. It is the leading cause of death in the United States in both men and women. CAD happens when the arteries that supply blood to heart muscle become hardened and narrowed. This is due to the buildup of cholesterol and other material, called plaque, on their inner walls. This buildup is called atherosclerosis. As it grows, less blood can flow through the arteries. As a result, the heart muscle can't get the blood or oxygen it needs. This can lead to chest pain (angina) or a heart attack. Most heart attacks happen when a blood clot suddenly cuts off the hearts' blood supply, causing permanent heart damage. Over time, CAD can also weaken the heart muscle and contribute to heart failure and arrhythmias. Heart failure means the heart can't pump blood well to the rest of the body. Arrhythmias are changes in the normal beating rhythm of the heart. NIH: National Heart, Lung, and Blood Institute" +information,What is (are) Heartburn ?,"Heartburn is a painful burning feeling in your chest or throat. It happens when stomach acid backs up into your esophagus, the tube that carries food from your mouth to your stomach. If you have heartburn more than twice a week, you may have GERD. But you can have GERD without having heartburn. Pregnancy, certain foods, alcohol, and some medications can bring on heartburn. Treating heartburn is important because over time reflux can damage the esophagus. Over-the-counter medicines may help. If the heartburn continues, you may need prescription medicines or surgery. If you have other symptoms such as crushing chest pain, it could be a heart attack. Get help immediately." +information,What is (are) High Blood Pressure ?,"Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps blood into the arteries. Your blood pressure is highest when your heart beats, pumping the blood. This is called systolic pressure. When your heart is at rest, between beats, your blood pressure falls. This is called diastolic pressure. Your blood pressure reading uses these two numbers. Usually the systolic number comes before or above the diastolic number. A reading of - 119/79 or lower is normal blood pressure - 140/90 or higher is high blood pressure - Between 120 and 139 for the top number, or between 80 and 89 for the bottom number is called prehypertension. Prehypertension means you may end up with high blood pressure, unless you take steps to prevent it. High blood pressure usually has no symptoms, but it can cause serious problems such as stroke, heart failure, heart attack and kidney failure. You can control high blood pressure through healthy lifestyle habits such as exercise and the DASH diet and taking medicines, if needed. NIH: National Heart, Lung, and Blood Institute" +information,What is (are) Cardiac Arrest ?,"The heart has an internal electrical system that controls the rhythm of the heartbeat. Problems can cause abnormal heart rhythms, called arrhythmias. There are many types of arrhythmia. During an arrhythmia, the heart can beat too fast, too slow, or it can stop beating. Sudden cardiac arrest (SCA) occurs when the heart develops an arrhythmia that causes it to stop beating. This is different than a heart attack, where the heart usually continues to beat but blood flow to the heart is blocked. There are many possible causes of SCA. They include coronary heart disease, physical stress, and some inherited disorders. Sometimes there is no known cause for the SCA. Without medical attention, the person will die within a few minutes. People are less likely to die if they have early defibrillation. Defibrillation sends an electric shock to restore the heart rhythm to normal. You should give cardiopulmonary resuscitation (CPR) to a person having SCA until defibrillation can be done. If you have had an SCA, an implantable cardiac defibrillator (ICD) reduces the chance of dying from a second SCA. NIH: National Heart, Lung, and Blood Institute" +information,Do you have information about Stroke Rehabilitation,Summary : A stroke can cause lasting brain damage. People who survive a stroke need to relearn skills they lose because of the damage. Rehabilitation can help them relearn those skills. Stroke can cause five types of disabilities: - Paralysis or problems controlling movement - Pain and other problems with the senses - Problems using or understanding language - Problems with thinking and memory - Emotional disturbances Stroke rehabilitation involves many kinds of health professionals. The goal is to help survivors become as independent as possible and to have the best possible quality of life. NIH: National Institute of Neurological Disorders and Stroke +information,What is (are) Heart Disease in Women ?,"In the United States, 1 in 4 women dies from heart disease. The most common cause of heart disease in both men and women is narrowing or blockage of the coronary arteries, the blood vessels that supply blood to the heart itself. This is called coronary artery disease, and it happens slowly over time. It's the major reason people have heart attacks. Heart diseases that affect women more than men include - Coronary microvascular disease (MVD) - a problem that affects the heart's tiny arteries - Broken heart syndrome - extreme emotional stress leading to severe but often short-term heart muscle failure The older a woman gets, the more likely she is to get heart disease. But women of all ages should be concerned about heart disease. All women can take steps to prevent it by practicing healthy lifestyle habits. NIH: National Heart, Lung, and Blood Institute" +information,What is (are) Heart Diseases--Prevention ?,"Heart disease is the leading cause of death in the U.S. It is also a major cause of disability. The risk of heart disease increases as you age. You have a greater risk of heart disease if you are a man over age 45 or a woman over age 55. You also are at greater risk if you have a close family member who had heart disease at an early age. Fortunately, there are many things you can do reduce your chances of getting heart disease. You should - Know your blood pressure and keep it under control - Exercise regularly - Don't smoke - Get tested for diabetes and if you have it, keep it under control - Know your cholesterol and triglyceride levels and keep them under control - Eat a lot of fruits and vegetables - Maintain a healthy weight" +information,Do you have information about Coronary Artery Bypass Surgery,"Summary : In coronary artery disease (CAD), the arteries that supply blood and oxygen to your heart muscle grow hardened and narrowed. You may try treatments such as lifestyle changes, medicines, and angioplasty, a procedure to open the arteries. If these treatments don't help, you may need coronary artery bypass surgery. The surgery creates a new path for blood to flow to the heart. The surgeon takes a healthy piece of vein from the leg or artery from the chest or wrist. Then the surgeon attaches it to the coronary artery, just above and below the narrowed area or blockage. This allows blood to bypass (get around) the blockage. Sometimes people need more than one bypass. The results of the surgery usually are excellent. Many people remain symptom-free for many years. You may need surgery again if blockages form in the grafted arteries or veins or in arteries that weren't blocked before. Lifestyle changes and medicines may help prevent arteries from becoming clogged again. NIH: National Heart, Lung, and Blood Institute" +information,What is (are) Congenital Heart Defects ?,"A congenital heart defect is a problem with the structure of the heart. It is present at birth. Congenital heart defects are the most common type of birth defect. The defects can involve the walls of the heart, the valves of the heart, and the arteries and veins near the heart. They can disrupt the normal flow of blood through the heart. The blood flow can slow down, go in the wrong direction or to the wrong place, or be blocked completely. Doctors use a physical exam and special heart tests to diagnose congenital heart defects. They often find severe defects during pregnancy or soon after birth. Signs and symptoms of severe defects in newborns include - Rapid breathing - Cyanosis - a bluish tint to the skin, lips, and fingernails - Fatigue - Poor blood circulation Many congenital heart defects cause few or no signs and symptoms. They are often not diagnosed until children are older. Many children with congenital heart defects don't need treatment, but others do. Treatment can include medicines, catheter procedures, surgery, and heart transplants. The treatment depends on the type of the defect, how severe it is, and a child's age, size, and general health. NIH: National Heart, Lung, and Blood Institute" +information,What is (are) Heart Diseases ?,"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. This is called coronary artery disease and happens slowly over time. It's the major reason people have heart attacks. Other kinds of heart problems may happen to the valves in the heart, or the heart may not pump well and cause heart failure. Some people are born with heart disease. You can help reduce your risk of heart disease by taking steps to control factors that put you at greater risk: - Control your blood pressure - Lower your cholesterol - Don't smoke - Get enough exercise NIH: National Heart, Lung, and Blood Institute" +information,What is (are) High Blood Pressure in Pregnancy ?,"If you are pregnant, high blood pressure can cause problems for you and your unborn baby. You may have had high blood pressure before you got pregnant. Or you may get it once you are pregnant - a condition called gestational hypertension. Either one can cause low birth weight or premature delivery of the baby. Controlling your blood pressure during pregnancy and getting regular prenatal care are important for the health of you and your baby. Treatments for high blood pressure in pregnancy may include close monitoring of the baby, lifestyle changes, and certain medicines. Some pregnant women with high blood pressure develop preeclampsia. It's a sudden increase in blood pressure after the 20th week of pregnancy. It can be life-threatening for both you and the unborn baby. There is no proven way to prevent it. Most women who have signs of preeclampsia are closely monitored to lessen or avoid complications. The only way to ""cure"" preeclampsia is to deliver the baby. NIH: National Heart, Lung, and Blood Institute" +information,Do you have information about Angioplasty,"Summary : If you have coronary artery disease, the arteries in your heart are narrowed or blocked by a sticky material called plaque. Angioplasty is a procedure to restore blood flow through the artery. You have angioplasty in a hospital. The doctor threads a thin tube through a blood vessel in the arm or groin up to the involved site in the artery. The tube has a tiny balloon on the end. When the tube is in place, the doctor inflates the balloon to push the plaque outward against the wall of the artery. This widens the artery and restores blood flow. Doctors may use angioplasty to - Reduce chest pain caused by reduced blood flow to the heart - Minimize damage to heart muscle from a heart attack Many people go home the day after angioplasty, and are able to return to work within a week of coming home. NIH: National Heart, Lung, and Blood Institute" +information,What is (are) Chest Pain ?,"Having a pain in your chest can be scary. It does not always mean that you are having a heart attack. There can be many other causes, including - Other heart problems, such as angina - Panic attacks - Digestive problems, such as heartburn or esophagus disorders - Sore muscles - Lung diseases, such as pneumonia, pleurisy, or pulmonary embolism - Costochondritis - an inflammation of joints in your chest Some of these problems can be serious. Get immediate medical care if you have chest pain that does not go away, crushing pain or pressure in the chest, or chest pain along with nausea, sweating, dizziness or shortness of breath. Treatment depends on the cause of the pain." +information,What is (are) Arrhythmia ?,"An arrhythmia is a problem with the rate or rhythm of your heartbeat. It means that your heart beats too quickly, too slowly, or with an irregular pattern. When the heart beats faster than normal, it is called tachycardia. When the heart beats too slowly, it is called bradycardia. The most common type of arrhythmia is atrial fibrillation, which causes an irregular and fast heart beat. Many factors can affect your heart's rhythm, such as having had a heart attack, smoking, congenital heart defects, and stress. Some substances or medicines may also cause arrhythmias. Symptoms of arrhythmias include - Fast or slow heart beat - Skipping beats - Lightheadedness or dizziness - Chest pain - Shortness of breath - Sweating Your doctor can run tests to find out if you have an arrhythmia. Treatment to restore a normal heart rhythm may include medicines, an implantable cardioverter-defibrillator (ICD) or pacemaker, or sometimes surgery. NIH: National Heart, Lung, and Blood Institute" +information,What is (are) Pulmonary Hypertension ?,"Pulmonary hypertension (PH) is high blood pressure in the arteries to your lungs. It is a serious condition. If you have it, the blood vessels that carry blood from your heart to your lungs become hard and narrow. Your heart has to work harder to pump the blood through. Over time, your heart weakens and cannot do its job and you can develop heart failure. Symptoms of PH include - Shortness of breath during routine activity, such as climbing two flights of stairs - Tiredness - Chest pain - A racing heartbeat - Pain on the upper right side of the abdomen - Decreased appetite As PH worsens, you may find it hard to do any physical activities. There are two main kinds of PH. One runs in families or appears for no known reason. The other kind is related to another condition, usually heart or lung disease. There is no cure for PH. Treatments can control symptoms. They involve treating the heart or lung disease, medicines, oxygen, and sometimes lung transplantation. NIH: National Heart, Lung, and Blood Institute" +information,Do you have information about Heart Transplantation,"Summary : A heart transplant removes a damaged or diseased heart and replaces it with a healthy one. The healthy heart comes from a donor who has died. It is the last resort for people with heart failure when all other treatments have failed. The heart failure might have been caused by coronary heart disease, damaged heart valves or heart muscles, congenital heart defects, or viral infections of the heart. Although heart transplant surgery is a life-saving measure, it has many risks. Careful monitoring, treatment, and regular medical care can prevent or help manage some of these risks. After the surgery, most heart transplant patients can return to their normal levels of activity. However, fewer than 30 percent return to work for many different reasons. NIH: National Heart, Lung, and Blood Institute" +information,Do you have information about Heart Surgery,"Summary : Heart surgery can correct problems with the heart if other treatments haven't worked or can't be used. 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. 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 - Treat heart failure and coronary heart disease - Control abnormal heart rhythms Heart surgery has risks, even though its results often are excellent. Risks include bleeding, infection, irregular heartbeats, and stroke. The risk is higher if you are older or a woman. The risk is also higher if you have other diseases or conditions, such as diabetes, kidney disease, lung disease, or peripheral arterial disease. NIH: National Heart, Lung, and Blood Institute" +information,What is (are) Stroke ?,"A stroke is a medical emergency. Strokes happen when blood flow to your brain stops. Within minutes, brain cells begin to die. There are two kinds of stroke. The more common kind, called ischemic stroke, is caused by a blood clot that blocks or plugs a blood vessel in the brain. The other kind, called hemorrhagic stroke, is caused by a blood vessel that breaks and bleeds into the brain. ""Mini-strokes"" or transient ischemic attacks (TIAs), occur when the blood supply to the brain is briefly interrupted. Symptoms of stroke are - Sudden numbness or weakness of the face, arm or leg (especially on one side of the body) - Sudden confusion, trouble speaking or understanding speech - Sudden trouble seeing in one or both eyes - Sudden trouble walking, dizziness, loss of balance or coordination - Sudden severe headache with no known cause If you have any of these symptoms, you must get to a hospital quickly to begin treatment. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot or by stopping the bleeding. Post-stroke rehabilitation helps individuals overcome disabilities that result from stroke damage. Drug therapy with blood thinners is the most common treatment for stroke. NIH: National Institute of Neurological Disorders and Stroke" +information,What is (are) Low Blood Pressure ?,"You've probably heard that high blood pressure is a problem. Sometimes blood pressure that is too low can also cause problems. Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps out blood into the arteries. Your blood pressure is highest when your heart beats, pumping the blood. This is called systolic pressure. When your heart is at rest, between beats, your blood pressure falls. This is the diastolic pressure. Your blood pressure reading uses these two numbers. Usually they're written one above or before the other, such as 120/80. If your blood pressure reading is 90/60 or lower, you have low blood pressure. Some people have low blood pressure all the time. They have no symptoms and their low readings are normal for them. In other people, blood pressure drops below normal because of a medical condition or certain medicines. Some people may have symptoms of low blood pressure when standing up too quickly. Low blood pressure is a problem only if it causes dizziness, fainting or in extreme cases, shock. NIH: National Heart, Lung, and Blood Institute" +information,What is (are) Heart Failure ?,"Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. Heart failure does not mean that your heart has stopped or is about to stop working. It means that your heart is not able to pump blood the way it should. It can affect one or both sides of the heart. The weakening of the heart's pumping ability causes - Blood and fluid to back up into the lungs - The buildup of fluid in the feet, ankles and legs - called edema - Tiredness and shortness of breath Common causes of heart failure are coronary artery disease, high blood pressure and diabetes. It is more common in people who are 65 years old or older, African Americans, people who are overweight, and people who have had a heart attack. Men have a higher rate of heart failure than women. Your doctor will diagnose heart failure by doing a physical exam and heart tests. Treatment includes treating the underlying cause of your heart failure, medicines, and heart transplantation if other treatments fail. NIH: National Heart, Lung, and Blood Institute" +information,What is (are) Blood Pressure Medicines ?,"High blood pressure, also called hypertension, usually has no symptoms. But it can cause serious problems such as stroke, heart failure, heart attack and kidney failure. If you cannot control your high blood pressure through lifestyle changes such as losing weight and reducing sodium in your diet, you may need medicines. Blood pressure medicines work in different ways to lower blood pressure. Some remove extra fluid and salt from the body. Others slow down the heartbeat or relax and widen blood vessels. Often, two or more medicines work better than one. NIH: National Heart, Lung, and Blood Institute" +information,What is (are) Mitral Valve Prolapse ?,"Mitral valve prolapse (MVP) occurs when one of your heart's valves doesn't work properly. The flaps of the valve are ""floppy"" and don't close tightly. Most people who have the condition are born with it. It also tends to run in families. Most of the time, MVP doesn't cause any problems. Rarely, blood can leak the wrong way through the floppy valve. This can cause - Palpitations (feelings that your heart is skipping a beat, fluttering, or beating too hard or too fast) - Shortness of breath - Cough - Fatigue, dizziness, or anxiety - Migraine headaches - Chest discomfort Most people who have mitral valve prolapse (MVP) don't need treatment because they don't have symptoms and complications. If you need treatment for MVP, medicines can help relieve symptoms or prevent complications. Very few people will need surgery to repair or replace the mitral valve. MVP puts you at risk for infective endocarditis, a kind of heart infection. To prevent it, doctors used to prescribe antibiotics before dental work or certain surgeries. Now, only people at high risk of endocarditis need the antibiotics. NIH: National Heart, Lung, and Blood Institute" +information,Do you have information about Pacemakers and Implantable Defibrillators,"Summary : An arrhythmia is any disorder of your heart rate or rhythm. It means that your heart beats too quickly, too slowly, or with an irregular pattern. Most arrhythmias result from problems in the electrical system of the heart. If your arrhythmia is serious, you may need a cardiac pacemaker or an implantable cardioverter defibrillator (ICD). They are devices that are implanted in your chest or abdomen. A pacemaker helps control abnormal heart rhythms. It uses electrical pulses to prompt the heart to beat at a normal rate. It can speed up a slow heart rhythm, control a fast heart rhythm, and coordinate the chambers of the heart. An ICD monitors heart rhythms. If it senses dangerous rhythms, it delivers shocks. This treatment is called defibrillation. An ICD can help control life-threatening arrhythmias, especially those that can cause sudden cardiac arrest (SCA). Most new ICDs can act as both a pacemaker and a defibrillator. Many ICDs also record the heart's electrical patterns when there is an abnormal heartbeat. This can help the doctor plan future treatment. Getting a pacemaker or ICD requires minor surgery. You usually need to stay in the hospital for a day or two, so your doctor can make sure that the device is working well. You will probably be back to your normal activities within a few days." +information,What is (are) Transient Ischemic Attack ?,"A transient ischemic attack (TIA) is a stroke that comes and goes quickly. It happens when the blood supply to part of the brain stops briefly. Symptoms of a TIA are like other stroke symptoms, but do not last as long. They happen suddenly, and include - Numbness or weakness, especially on one side of the body - Confusion or trouble speaking or understanding speech - Trouble seeing in one or both eyes - Loss of balance or coordination Most symptoms of a TIA disappear within an hour, although they may last for up to 24 hours. Because you cannot tell if these symptoms are from a TIA or a stroke, you should get to the hospital quickly. TIAs are often a warning sign for future strokes. Taking medicine, such as blood thinners, may reduce your risk of a stroke. Your doctor might also recommend surgery. NIH: National Institute of Neurological Disorders and Stroke" +information,What is (are) Heart Attack ?,"Each year over a million people in the U.S. have a heart attack. About half of them die. Many people have permanent heart damage or die because they don't get help immediately. It's important to know the symptoms of a heart attack and call 9-1-1 if someone is having them. Those symptoms include - Chest discomfort - pressure, squeezing, or pain - Shortness of breath - Discomfort in the upper body - arms, shoulder, neck, back - Nausea, vomiting, dizziness, lightheadedness, sweating These symptoms can sometimes be different in women. What exactly is a heart attack? Most heart attacks happen when a clot in the coronary artery blocks the supply of blood and oxygen to the heart. Often this leads to an irregular heartbeat - called an arrhythmia - that causes a severe decrease in the pumping function of the heart. A blockage that is not treated within a few hours causes the affected heart muscle to die. NIH: National Heart, Lung, and Blood Institute" +information,What is (are) Angina ?,"Angina is chest pain or discomfort you feel when there is not enough blood flow to your heart muscle. Your heart muscle needs the oxygen that the blood carries. Angina may feel like pressure or a squeezing pain in your chest. It may feel like indigestion. You may also feel pain in your shoulders, arms, neck, jaw, or back. Angina is a symptom of coronary artery disease (CAD), the most common heart disease. CAD happens when a sticky substance called plaque builds up in the arteries that supply blood to the heart, reducing blood flow. There are three types of angina: - Stable angina is the most common type. It happens when the heart is working harder than usual. Stable angina has a regular pattern. Rest and medicines usually help. - Unstable angina is the most dangerous. It does not follow a pattern and can happen without physical exertion. It does not go away with rest or medicine. It is a sign that you could have a heart attack soon. - Variant angina is rare. It happens when you are resting. Medicines can help. Not all chest pain or discomfort is angina. If you have chest pain, you should see your health care provider. NIH: National Heart, Lung, and Blood Institute" +information,Do you have information about Cardiac Rehabilitation,"Summary : Cardiac rehabilitation (rehab) is a medically supervised program to help people who have - A heart attack - Angioplasty or coronary artery bypass grafting for coronary heart disease - A heart valve repair or replacement - A heart transplant or a lung transplant - Angina - Heart failure The goal is to help you return to an active life, and to reduce the risk of further heart problems. A team of specialists will create a plan for you that includes exercise training, education on heart healthy living, and counseling to reduce stress. You will learn how to reduce your risk factors, such as high blood pressure, high blood cholesterol, depression, and diabetes. Being overweight or obese, smoking, and not exercising are other risk factors. NIH: National Heart, Lung, and Blood Institute" +information,What is (are) Hemorrhagic Stroke ?,"A stroke is a medical emergency. There are two types - ischemic and hemorrhagic. Hemorrhagic stroke is the less common type. It happens when a blood vessel breaks and bleeds into the brain. Within minutes, brain cells begin to die. Causes include a bleeding aneurysm, an arteriovenous malformation (AVM), or an artery wall that breaks open. Symptoms of stroke are - Sudden numbness or weakness of the face, arm or leg (especially on one side of the body) - Sudden confusion, trouble speaking or understanding speech - Sudden trouble seeing in one or both eyes - Sudden trouble walking, dizziness, loss of balance or coordination - Sudden severe headache with no known cause It is important to treat strokes as quickly as possible. With a hemorrhagic stroke, the first steps are to find the cause of bleeding in the brain and then control it. Surgery may be needed. Post-stroke rehabilitation can help people overcome disabilities caused by stroke damage. National Institute of Neurological Disorders and Stroke" +information,What is (are) Ischemic Stroke ?,"A stroke is a medical emergency. There are two types - ischemic and hemorrhagic. Ischemic stroke is the most common type. It is usually caused by a blood clot that blocks or plugs a blood vessel in the brain. This keeps blood from flowing to the brain. Within minutes, brain cells begin to die. Another cause is stenosis, or narrowing of the artery. This can happen because of atherosclerosis, a disease in which plaque builds up inside your arteries. Transient ischemic attacks (TIAs) occur when the blood supply to the brain is interrupted briefly. Having a TIA can mean you are at risk for having a more serious stroke. Symptoms of stroke are - Sudden numbness or weakness of the face, arm or leg (especially on one side of the body) - Sudden confusion, trouble speaking or understanding speech - Sudden trouble seeing in one or both eyes - Sudden trouble walking, dizziness, loss of balance or coordination - Sudden severe headache with no known cause It is important to treat strokes as quickly as possible. Blood thinners may be used to stop a stroke while it is happening by quickly dissolving the blood clot. Post-stroke rehabilitation can help people overcome disabilities caused by stroke damage. NIH: National Institute of Neurological Disorders and Stroke" +information,What is (are) Atrial Fibrillation ?,"An arrhythmia is a problem with the speed or rhythm of the heartbeat. Atrial fibrillation (AF) is the most common type of arrhythmia. The cause is a disorder in the heart's electrical system. Often, people who have AF may not even feel symptoms. But you may feel - Palpitations -- an abnormal rapid heartbeat - Shortness of breath - Weakness or difficulty exercising - Chest pain - Dizziness or fainting - Fatigue - Confusion AF can lead to an increased risk of stroke. In many patients, it can also cause chest pain, heart attack, or heart failure. Doctors diagnose AF using family and medical history, a physical exam, and a test called an electrocardiogram (EKG), which looks at the electrical waves your heart makes. Treatments include medicines and procedures to restore normal rhythm. NIH: National Heart, Lung, and Blood Institute" +information,Do you have information about Blood Thinners,"Summary : If you have some kinds of heart or blood vessel disease, or if you have poor blood flow to your brain, your doctor may recommend that you take a blood thinner. Blood thinners reduce the risk of heart attack and stroke by reducing the formation of blood clots in your arteries and veins. You may also take a blood thinner if you have - An abnormal heart rhythm called atrial fibrillation - Heart valve surgery - Congenital heart defects There are two main types of blood thinners. Anticoagulants, such as heparin or warfarin (also called Coumadin), work on chemical reactions in your body to lengthen the time it takes to form a blood clot. Antiplatelet drugs, such as aspirin, prevent blood cells called platelets from clumping together to form a clot. When you take a blood thinner, follow directions carefully. Make sure that your healthcare provider knows all of the medicines and supplements you are using." +information,What is (are) Diabetic Heart Disease ?,"If you have diabetes or pre-diabetes you have an increased risk for heart disease. Diabetic heart disease can be coronary heart disease (CHD), heart failure, and diabetic cardiomyopathy. Diabetes by itself puts you at risk for heart disease. Other risk factors include - Family history of heart disease - Carrying extra weight around the waist - Abnormal cholesterol levels - High blood pressure - Smoking Some people who have diabetic heart disease have no signs or symptoms of heart disease. Others have some or all of the symptoms of heart disease. Treatments include medications to treat heart damage or to lower your blood glucose (blood sugar), blood pressure, and cholesterol. If you are not already taking a low dose of aspirin every day, your doctor may suggest it. You also may need surgery or some other medical procedure. Lifestyle changes also help. These include a healthy diet, maintaining a healthy weight, being physically active, and quitting smoking. NIH: National Institute of Diabetes and Digestive and Kidney Diseases" +information,What is (are) Heart Valve Diseases ?,"Your heart has four valves. Normally, these valves open to let blood flow through or out of your heart, and then shut to keep it from flowing backward. But sometimes they don't work properly. If they don't, you could have - Regurgitation - when blood leaks back through the valve in the wrong direction - Mitral valve prolapse - when one of the valves, the mitral valve, has ""floppy"" flaps and doesn't close tightly. It's one of the most common heart valve conditions. Sometimes it causes regurgitation. - Stenosis - when the valve doesn't open enough and blocks blood flow Valve problems can be present at birth or caused by infections, heart attacks, or heart disease or damage. 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. But many people have heart murmurs without having a problem. Heart tests can show if you have a heart valve disease. Some valve problems are minor and do not need treatment. Others might require medicine, medical procedures, or surgery to repair or replace the valve. NIH: National Heart, Lung, and Blood Institute" +information,What is (are) catecholaminergic polymorphic ventricular tachycardia ?,"Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a condition characterized by an abnormal heart rhythm (arrhythmia). As the heart rate increases in response to physical activity or emotional stress, it can trigger an abnormally fast and irregular heartbeat called ventricular tachycardia. Episodes of ventricular tachycardia can cause light-headedness, dizziness, and fainting (syncope). In people with CPVT, these episodes typically begin in childhood. If CPVT is not recognized and treated, an episode of ventricular tachycardia may cause the heart to stop beating (cardiac arrest), leading to sudden death. Researchers suspect that CPVT may be a significant cause of sudden death in children and young adults without recognized heart abnormalities." +inheritance,Is catecholaminergic polymorphic ventricular tachycardia inherited ?,"When CPVT results from mutations in the RYR2 gene, it has an autosomal dominant pattern of inheritance. Autosomal dominant inheritance means that one copy of the altered gene in each cell is sufficient to cause the disorder. In about half of cases, an affected person inherits an RYR2 gene mutation from one affected parent. The remaining cases result from new mutations in the RYR2 gene and occur in people with no history of the disorder in their family. When CPVT is caused by mutations in the CASQ2 gene, the condition has an autosomal recessive pattern of inheritance. Autosomal recessive inheritance means that both copies of the gene in each cell have mutations. The parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but they typically do not show signs and symptoms of the condition." +information,What is (are) chronic atrial and intestinal dysrhythmia ?,"Chronic atrial and intestinal dysrhythmia (CAID) is a disorder affecting the heart and the digestive system. CAID disrupts the normal rhythm of the heartbeat; affected individuals have a heart rhythm abnormality called sick sinus syndrome. The disorder also impairs the rhythmic muscle contractions that propel food through the intestines (peristalsis), causing a digestive condition called intestinal pseudo-obstruction. The heart and digestive issues develop at the same time, usually by age 20. Sick sinus syndrome (also known as sinus node dysfunction) is an abnormality of the sinoatrial (SA) node, which is an area of specialized cells in the heart that functions as a natural pacemaker. The SA node generates electrical impulses that start each heartbeat. These signals travel from the SA node to the rest of the heart, signaling the heart (cardiac) muscle to contract and pump blood. In people with sick sinus syndrome, the SA node does not function normally, which usually causes the heartbeat to be too slow (bradycardia), although occasionally the heartbeat is too fast (tachycardia) or rapidly switches from being too fast to being too slow (tachycardia-bradycardia syndrome). Symptoms related to abnormal heartbeats can include dizziness, light-headedness, fainting (syncope), a sensation of fluttering or pounding in the chest (palpitations), and confusion or memory problems. During exercise, many affected individuals experience chest pain, difficulty breathing, or excessive tiredness (fatigue). In intestinal pseudo-obstruction, impairment of peristalsis leads to a buildup of partially digested food in the intestines, abdominal swelling (distention) and pain, nausea, vomiting, and constipation or diarrhea. Affected individuals experience loss of appetite and impaired ability to absorb nutrients, which may lead to malnutrition. These symptoms resemble those caused by an intestinal blockage (obstruction) such as a tumor, but in intestinal pseudo-obstruction no such blockage is found." +frequency,How many people are affected by chronic atrial and intestinal dysrhythmia ?,The prevalence of CAID is unknown. At least 17 affected individuals have been described in the medical literature. +inheritance,Is chronic atrial and intestinal dysrhythmia inherited ?,"This condition is inherited in an autosomal recessive pattern, which means both copies of the gene in each cell have mutations. The parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but they typically do not show signs and symptoms of the condition." +treatment,What are the treatments for chronic atrial and intestinal dysrhythmia ?,"These resources address the diagnosis or management of chronic atrial and intestinal dysrhythmia: - Children's Hospital of Pittsburgh: Chronic Intestinal Pseudo-obstruction - Genetic Testing Registry: Chronic atrial and intestinal dysrhythmia - MedlinePlus Encyclopedia: Heart Pacemakers - MedlinePlus Health Topic: Nutritional Support - MedlinePlus Health Topic: Pacemakers and Implantable Defibrillators - National Heart, Lung, and Blood Institute: What is a Pacemaker? These resources from MedlinePlus offer information about the diagnosis and management of various health conditions: - Diagnostic Tests - Drug Therapy - Surgery and Rehabilitation - Genetic Counseling - Palliative Care" +information,What is (are) pulmonary arterial hypertension ?,"Pulmonary arterial hypertension is a progressive disorder characterized by abnormally high blood pressure (hypertension) in the pulmonary artery, the blood vessel that carries blood from the heart to the lungs. Pulmonary arterial hypertension is one form of a broader condition known as pulmonary hypertension. Pulmonary hypertension occurs when most of the very small arteries throughout the lungs narrow in diameter, which increases the resistance to blood flow through the lungs. To overcome the increased resistance, blood pressure increases in the pulmonary artery and in the right ventricle of the heart, which is the chamber that pumps blood into the pulmonary artery. Ultimately, the increased blood pressure can damage the right ventricle of the heart. Signs and symptoms of pulmonary arterial hypertension occur when increased blood pressure cannot fully overcome the elevated resistance. As a result, the flow of oxygenated blood from the lungs to the rest of the body is insufficient. Shortness of breath (dyspnea) during exertion and fainting spells are the most common symptoms of pulmonary arterial hypertension. People with this disorder may experience additional symptoms, particularly as the condition worsens. Other symptoms include dizziness, swelling (edema) of the ankles or legs, chest pain, and a rapid heart rate." +inheritance,Is pulmonary arterial hypertension inherited ?,"Pulmonary arterial hypertension is usually sporadic, which means it occurs in individuals with no known family history of the disorder. These non-familial cases are described as idiopathic pulmonary arterial hypertension. About 20 percent of these cases are caused by mutations in one of the genes known to be associated with the disease, but most of the time a causative gene mutation has not been identified. Inherited cases of this disorder are known as familial pulmonary arterial hypertension. When the condition is inherited, it most often has an autosomal dominant pattern of inheritance, which means one copy of an altered gene in each cell is sufficient to cause the disorder. However, many people with an altered gene never develop pulmonary arterial hypertension; this phenomenon is called reduced penetrance." +information,What is (are) critical congenital heart disease ?,"Critical congenital heart disease (CCHD) is a term that refers to a group of serious heart defects that are present from birth. These abnormalities result from problems with the formation of one or more parts of the heart during the early stages of embryonic development. CCHD prevents the heart from pumping blood effectively or reduces the amount of oxygen in the blood. As a result, organs and tissues throughout the body do not receive enough oxygen, which can lead to organ damage and life-threatening complications. Individuals with CCHD usually require surgery soon after birth. Although babies with CCHD may appear healthy for the first few hours or days of life, signs and symptoms soon become apparent. These can include an abnormal heart sound during a heartbeat (heart murmur), rapid breathing (tachypnea), low blood pressure (hypotension), low levels of oxygen in the blood (hypoxemia), and a blue or purple tint to the skin caused by a shortage of oxygen (cyanosis). If untreated, CCHD can lead to shock, coma, and death. However, most people with CCHD now survive past infancy due to improvements in early detection, diagnosis, and treatment. Some people with treated CCHD have few related health problems later in life. However, long-term effects of CCHD can include delayed development and reduced stamina during exercise. Adults with these heart defects have an increased risk of abnormal heart rhythms, heart failure, sudden cardiac arrest, stroke, and premature death. Each of the heart defects associated with CCHD affects the flow of blood into, out of, or through the heart. Some of the heart defects involve structures within the heart itself, such as the two lower chambers of the heart (the ventricles) or the valves that control blood flow through the heart. Others affect the structure of the large blood vessels leading into and out of the heart (including the aorta and pulmonary artery). Still others involve a combination of these structural abnormalities. People with CCHD have one or more specific heart defects. The heart defects classified as CCHD include coarctation of the aorta, double-outlet right ventricle, D-transposition of the great arteries, Ebstein anomaly, hypoplastic left heart syndrome, interrupted aortic arch, pulmonary atresia with intact septum, single ventricle, total anomalous pulmonary venous connection, tetralogy of Fallot, tricuspid atresia, and truncus arteriosus." +frequency,How many people are affected by critical congenital heart disease ?,"Heart defects are the most common type of birth defect, accounting for more than 30 percent of all infant deaths due to birth defects. CCHD represents some of the most serious types of heart defects. About 7,200 newborns, or 18 per 10,000, in the United States are diagnosed with CCHD each year." +inheritance,Is critical congenital heart disease inherited ?,"Most cases of CCHD are sporadic, which means they occur in people with no history of the disorder in their family. However, close relatives (such as siblings) of people with CCHD may have an increased risk of being born with a heart defect compared with people in the general population." +information,What is (are) periventricular heterotopia ?,"Periventricular heterotopia is a condition in which nerve cells (neurons) do not migrate properly during the early development of the fetal brain, from about the 6th week to the 24th week of pregnancy. Heterotopia means ""out of place."" In normal brain development, neurons form in the periventricular region, located around fluid-filled cavities (ventricles) near the center of the brain. The neurons then migrate outward to form the exterior of the brain (cerebral cortex) in six onion-like layers. In periventricular heterotopia, some neurons fail to migrate to their proper position and form clumps around the ventricles. Periventricular heterotopia usually becomes evident when seizures first appear, often during the teenage years. The nodules around the ventricles are then typically discovered when magnetic resonance imaging (MRI) studies are done. Affected individuals usually have normal intelligence, although some have mild intellectual disability. Difficulty with reading and spelling (dyslexia) has been reported in some people with periventricular heterotopia. Less commonly, individuals with periventricular heterotopia may have more severe brain malformations, small head size (microcephaly), developmental delays, recurrent infections, blood vessel abnormalities, or other problems. Periventricular heterotopia may also occur in association with other conditions such as Ehlers-Danlos syndrome, which results in extremely flexible joints, skin that stretches easily, and fragile blood vessels." +frequency,How many people are affected by periventricular heterotopia ?,Periventricular heterotopia is a rare condition. Its incidence is unknown. +genetic changes,What are the genetic changes related to periventricular heterotopia ?,"Periventricular heterotopia is related to chromosome 5. Mutations in the ARFGEF2 and FLNA genes cause periventricular heterotopia. In most cases, periventricular heterotopia is caused by mutations in the FLNA gene. This gene provides instructions for producing the protein filamin A, which helps build the network of protein filaments (cytoskeleton) that gives structure to cells and allows them to change shape and move. Certain mutations in the FLNA gene result in an impaired FLNA protein that cannot perform this function, disrupting the normal migration patterns of neurons during brain development. Periventricular heterotopia can also be caused by mutations in the ARFGEF2 gene. This gene provides instructions for making a protein that is involved in the movement (trafficking) of small sac-like structures (vesicles) within the cell. Vesicle trafficking is important in controlling the migration of neurons during the development of the brain. Mutations in the ARFGEF2 gene may disrupt this function, which could result in the abnormal neuronal migration seen in periventricular heterotopia. Researchers believe that mutations in the FLNA or ARFGEF2 genes may also result in weakening of the attachments (adhesion) between cells that form the lining of the ventricles. A weakened ventricular lining could allow some neurons to form clumps around the ventricles while others migrate normally to the exterior of the brain, as seen in periventricular heterotopia. In a few cases, periventricular heterotopia has been associated with abnormalities in chromosome 5. In each case, the affected individual had extra genetic material caused by an abnormal duplication of part of this chromosome. It is not known how this duplicated genetic material results in the signs and symptoms of periventricular heterotopia." +inheritance,Is periventricular heterotopia inherited ?,"Periventricular heterotopia can have different inheritance patterns. When this condition is caused by mutations in the FLNA gene, it is inherited in an X-linked dominant pattern. A condition is considered X-linked if the mutated gene that causes the disorder is located on the X chromosome, one of the two sex chromosomes. The inheritance is dominant if one copy of the altered gene in each cell is sufficient to cause the condition. A characteristic of X-linked inheritance is that fathers cannot pass X-linked traits to their sons. In X-linked periventricular heterotopia, males experience much more severe symptoms of the disorder than females, and in most cases die before birth. In about 50 percent of cases of X-linked periventricular heterotopia, an affected person inherits the mutation from a mother who is also affected. Other cases may result from new mutations in the gene. These cases occur in people with no history of the disorder in their family. Periventricular heterotopia caused by mutations in the ARFGEF2 gene is inherited in an autosomal recessive pattern, which means both copies of the gene in each cell have mutations. Individuals with periventricular heterotopia in whom ARFGEF2 gene mutations have been identified have a severe form of the disorder, including microcephaly, severe developmental delay, and seizures beginning in infancy. Most often, the parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but do not show signs and symptoms of the condition." +treatment,What are the treatments for periventricular heterotopia ?,"These resources address the diagnosis or management of periventricular heterotopia: - Gene Review: Gene Review: FLNA-Related Periventricular Nodular Heterotopia - Genetic Testing Registry: Heterotopia, periventricular, associated with chromosome 5p anomalies - Genetic Testing Registry: Heterotopia, periventricular, autosomal recessive - Genetic Testing Registry: X-linked periventricular heterotopia These resources from MedlinePlus offer information about the diagnosis and management of various health conditions: - Diagnostic Tests - Drug Therapy - Surgery and Rehabilitation - Genetic Counseling - Palliative Care" +information,What is (are) familial atrial fibrillation ?,"Familial atrial fibrillation is an inherited condition that disrupts the heart's normal rhythm. This condition is characterized by uncoordinated electrical activity in the heart's upper chambers (the atria), which causes the heartbeat to become fast and irregular. If untreated, this abnormal heart rhythm can lead to dizziness, chest pain, a sensation of fluttering or pounding in the chest (palpitations), shortness of breath, or fainting (syncope). Atrial fibrillation also increases the risk of stroke and sudden death. Complications of familial atrial fibrillation can occur at any age, although some people with this heart condition never experience any health problems associated with the disorder." +frequency,How many people are affected by familial atrial fibrillation ?,"Atrial fibrillation is the most common type of sustained abnormal heart rhythm (arrhythmia), affecting more than 3 million people in the United States. The risk of developing this irregular heart rhythm increases with age. The incidence of the familial form of atrial fibrillation is unknown; however, recent studies suggest that up to 30 percent of all people with atrial fibrillation may have a history of the condition in their family." +inheritance,Is familial atrial fibrillation inherited ?,"Familial atrial fibrillation appears to be inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to cause the disorder." +treatment,What are the treatments for familial atrial fibrillation ?,"These resources address the diagnosis or management of familial atrial fibrillation: - Genetic Testing Registry: Atrial fibrillation, familial, 1 - Genetic Testing Registry: Atrial fibrillation, familial, 2 - Genetic Testing Registry: Atrial fibrillation, familial, 3 - MedlinePlus Encyclopedia: Arrhythmias - MedlinePlus Encyclopedia: Atrial fibrillation/flutter These resources from MedlinePlus offer information about the diagnosis and management of various health conditions: - Diagnostic Tests - Drug Therapy - Surgery and Rehabilitation - Genetic Counseling - Palliative Care" +information,What is (are) arrhythmogenic right ventricular cardiomyopathy ?,"Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a form of heart disease that usually appears in adulthood. ARVC is a disorder of the myocardium, which is the muscular wall of the heart. This condition causes part of the myocardium to break down over time, increasing the risk of an abnormal heartbeat (arrhythmia) and sudden death. ARVC may not cause any symptoms in its early stages. However, affected individuals may still be at risk of sudden death, especially during strenuous exercise. When symptoms occur, they most commonly include a sensation of fluttering or pounding in the chest (palpitations), light-headedness, and fainting (syncope). Over time, ARVC can also cause shortness of breath and abnormal swelling in the legs or abdomen. If the myocardium becomes severely damaged in the later stages of the disease, it can lead to heart failure." +inheritance,Is arrhythmogenic right ventricular cardiomyopathy inherited ?,"Up to half of all cases of ARVC appear to run in families. Most familial cases of the disease have an autosomal dominant pattern of inheritance, which means one copy of an altered gene in each cell is sufficient to cause the disorder. Rarely, ARVC has an autosomal recessive pattern of inheritance, which means both copies of a gene in each cell have mutations. The parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but they typically do not show signs and symptoms of the condition." +information,What is (are) progressive familial heart block ?,"Progressive familial heart block is a genetic condition that alters the normal beating of the heart. A normal heartbeat is controlled by electrical signals that move through the heart in a highly coordinated way. These signals begin in a specialized cluster of cells called the sinoatrial node (the heart's natural pacemaker) located in the heart's upper chambers (the atria). From there, a group of cells called the atrioventricular node carries the electrical signals to another cluster of cells called the bundle of His. This bundle separates into multiple thin spindles called bundle branches, which carry electrical signals into the heart's lower chambers (the ventricles). Electrical impulses move from the sinoatrial node down to the bundle branches, stimulating a normal heartbeat in which the ventricles contract slightly later than the atria. Heart block occurs when the electrical signaling is obstructed anywhere from the atria to the ventricles. In people with progressive familial heart block, the condition worsens over time: early in the disorder, the electrical signals are partially blocked, but the block eventually becomes complete, preventing any signals from passing through the heart. Partial heart block causes a slow or irregular heartbeat (bradycardia or arrhythmia, respectively), and can lead to the buildup of scar tissue (fibrosis) in the cells that carry electrical impulses. Fibrosis contributes to the development of complete heart block, resulting in uncoordinated electrical signaling between the atria and the ventricles and inefficient pumping of blood in the heart. Complete heart block can cause a sensation of fluttering or pounding in the chest (palpitations), shortness of breath, fainting (syncope), or sudden cardiac arrest and death. Progressive familial heart block can be divided into type I and type II, with type I being further divided into types IA and IB. These types differ in where in the heart signaling is interrupted and the genetic cause. In types IA and IB, the heart block originates in the bundle branch, and in type II, the heart block originates in the atrioventricular node. The different types of progressive familial heart block have similar signs and symptoms. Most cases of heart block are not genetic and are not considered progressive familial heart block. The most common cause of heart block is fibrosis of the heart, which occurs as a normal process of aging. Other causes of heart block can include the use of certain medications or an infection of the heart tissue." +frequency,How many people are affected by progressive familial heart block ?,"The prevalence of progressive familial heart block is unknown. In the United States, about 1 in 5,000 individuals have complete heart block from any cause; worldwide, about 1 in 2,500 individuals have complete heart block." +inheritance,Is progressive familial heart block inherited ?,"Progressive familial heart block types I and II are inherited in an autosomal dominant pattern, which means one copy of an altered gene in each cell is sufficient to cause the disorder. Some people with TRPM4 gene mutations never develop the condition, a situation known as reduced penetrance. In most cases, an affected person has one parent with progressive familial heart block." +symptoms,"What are the symptoms of Cardiac valvular dysplasia, X-linked ?","What are the signs and symptoms of Cardiac valvular dysplasia, X-linked? The Human Phenotype Ontology provides the following list of signs and symptoms for Cardiac valvular dysplasia, X-linked. If the information is available, the table below includes how often the symptom is seen in people with this condition. You can use the MedlinePlus Medical Dictionary to look up the definitions for these medical terms. Signs and Symptoms Approximate number of patients (when available) Abnormality of metabolism/homeostasis - Aortic regurgitation - Congestive heart failure - Mitral regurgitation - Mitral valve prolapse - Short chordae tendineae of the mitral valve - Short chordae tendineae of the tricuspid valve - Tricuspid regurgitation - X-linked recessive inheritance - The Human Phenotype Ontology (HPO) has collected information on how often a sign or symptom occurs in a condition. Much of this information comes from Orphanet, a European rare disease database. The frequency of a sign or symptom is usually listed as a rough estimate of the percentage of patients who have that feature. The frequency may also be listed as a fraction. The first number of the fraction is how many people had the symptom, and the second number is the total number of people who were examined in one study. For example, a frequency of 25/25 means that in a study of 25 people all patients were found to have that symptom. Because these frequencies are based on a specific study, the fractions may be different if another group of patients are examined. Sometimes, no information on frequency is available. In these cases, the sign or symptom may be rare or common." +symptoms,What are the symptoms of Ventricular extrasystoles with syncopal episodes - perodactyly - Robin sequence ?,"What are the signs and symptoms of Ventricular extrasystoles with syncopal episodes - perodactyly - Robin sequence? The Human Phenotype Ontology provides the following list of signs and symptoms for Ventricular extrasystoles with syncopal episodes - perodactyly - Robin sequence. If the information is available, the table below includes how often the symptom is seen in people with this condition. You can use the MedlinePlus Medical Dictionary to look up the definitions for these medical terms. Signs and Symptoms Approximate number of patients (when available) Abnormality of the nose 90% Arrhythmia 90% Brachydactyly syndrome 90% Short distal phalanx of finger 90% Short stature 90% Short toe 90% Tapered finger 90% Aplasia/Hypoplasia of the distal phalanges of the toes 50% Cleft palate 50% Low anterior hairline 50% Reduced number of teeth 50% Abnormality of the metacarpal bones 7.5% Camptodactyly of finger 7.5% Cognitive impairment 7.5% Glossoptosis 7.5% Microcephaly 7.5% Autosomal dominant inheritance - Pierre-Robin sequence - Posteriorly placed tongue - Submucous cleft hard palate - Syncope - Tachycardia - Ventricular extrasystoles - The Human Phenotype Ontology (HPO) has collected information on how often a sign or symptom occurs in a condition. Much of this information comes from Orphanet, a European rare disease database. The frequency of a sign or symptom is usually listed as a rough estimate of the percentage of patients who have that feature. The frequency may also be listed as a fraction. The first number of the fraction is how many people had the symptom, and the second number is the total number of people who were examined in one study. For example, a frequency of 25/25 means that in a study of 25 people all patients were found to have that symptom. Because these frequencies are based on a specific study, the fractions may be different if another group of patients are examined. Sometimes, no information on frequency is available. In these cases, the sign or symptom may be rare or common." +information,What is (are) Left ventricular noncompaction ?,"Left ventricular noncompaction (LVNC) is a rare heart condition. In LVNC the inside wall of the heart is spongy or grooved, instead of smooth. Signs and symptoms of LVNC vary, but may cause life-threatening abnormal heart rhythms and weakness of the heart muscle. Treatments, such as blood thinning medication and defibrillators, are available to control these heart symptoms. In rare cases, heart transplantation is needed." +information,What is (are) Hypoplastic left heart syndrome ?,"Hypoplastic left heart syndrome (HLHS) is a problem with the hearts structure that is present at birth (congenital). It occurs when parts of the left side of the heart (mitral valve, left ventricle, aortic valve, and aorta) do not develop completely. The underdeveloped left side of the heart is unable to provide enough blood flow to the body, which decreases the oxygen-rich blood supply. Babies with HLHS might look normal at birth, but will develop symptoms of HLHS within a few days. These symptoms might include: poor feeding, problems breathing, pounding heart, weak pulse, and ashen or bluish skin color. The cause of HLHs is presently unknown." +treatment,What are the treatments for Hypoplastic left heart syndrome ?,"How might hypoplastic left heart syndrome (HLHS) be treated? Once the diagnosis of HLHS is made, the baby will be admitted to the neonatal intensive care unit. A breathing machine (ventilator) may be needed to help the baby breathe. A medicine called prostaglandin E1 is used to keep blood circulating to the body by keeping the ductus arteriosus open. These measures do not solve the problem and ultimately, the baby will require surgery. The first surgery, called the Norwood operation, occurs within the baby's first few days of life. Stage I of the Norwood procedure consists of building a new aorta by: Using the pulmonary valve and artery Connecting the hypoplastic old aorta and coronary arteries to the new aorta Removing the wall between the atria (atrial septum) Making an artificial connection from either the right ventricle or a body-wide artery to the pulmonary artery to maintain blood flow to the lungs (called a shunt) Afterwards, the baby usually goes home. The child will need to take daily medicines and be closely followed by a pediatric cardiologist, who will determine when the second stage of surgery should be done. Stage II of the operation is called the Glenn shunt or hemi-Fontan procedure. This procedure connects the major vein carrying blue blood from the top half of the body (the superior vena cava) directly to blood vessels to the lungs (pulmonary arteries) to get oxygen. The surgery is usually done when the child is 4 to 6 months of age. During stages I and II, the child may still appear somewhat blue (cyanotic).Stage III, the final step, is called the Fontan procedure. The rest of the veins that carry blue blood from the body (the inferior vena cava) are connected directly to the blood vessels to the lungs. The right ventricle now serves only as the pumping chamber for the body (no longer the lungs and the body). This surgery is usually performed when the baby is 18 months - 3 years old. After this final step, the baby is no longer blue. Some patients may need more surgeries in their 20s or 30s if they develop hard to control arrhythmias or other complications of the Fontan procedure. In some hospitals, heart transplantation is considered a better choice than the three-step surgery process. However, there are few donated hearts available for small infants." +information,What is (are) Long QT syndrome ?,"Long QT syndrome is a disorder of the hearts electrical activity that can cause sudden, uncontrollable, and irregular heartbeats (arrhythmia), which may lead to sudden death. Long QT syndrome can be detected by electrocardiogram (EKG). It can be caused by a variety of different gene mutations (changes). It can also be acquired (noninherited) and may be brought on by certain medicines and other medical conditions." +symptoms,"What are the symptoms of Mitral valve prolapse, familial, X-linked ?","What are the signs and symptoms of Mitral valve prolapse, familial, X-linked? The Human Phenotype Ontology provides the following list of signs and symptoms for Mitral valve prolapse, familial, X-linked. If the information is available, the table below includes how often the symptom is seen in people with this condition. You can use the MedlinePlus Medical Dictionary to look up the definitions for these medical terms. Signs and Symptoms Approximate number of patients (when available) Autosomal dominant inheritance - Disproportionate tall stature - High palate - Mitral regurgitation - Mitral valve prolapse - Pectus excavatum - Reversed usual vertebral column curves - Striae distensae - The Human Phenotype Ontology (HPO) has collected information on how often a sign or symptom occurs in a condition. Much of this information comes from Orphanet, a European rare disease database. The frequency of a sign or symptom is usually listed as a rough estimate of the percentage of patients who have that feature. The frequency may also be listed as a fraction. The first number of the fraction is how many people had the symptom, and the second number is the total number of people who were examined in one study. For example, a frequency of 25/25 means that in a study of 25 people all patients were found to have that symptom. Because these frequencies are based on a specific study, the fractions may be different if another group of patients are examined. Sometimes, no information on frequency is available. In these cases, the sign or symptom may be rare or common." +information,What is (are) Ebstein's anomaly ?,"Ebstein's anomaly is a rare heart defect in which parts of the tricuspid valve (which separates the right ventricle from the right atrium) are abnormal. The abnormality causes the tricuspid valve to leak blood backwards into the right atrium. The backup of blood flow can lead to heart swelling and fluid buildup in the lungs or liver. Sometimes, not enough blood gets out of the heart into the lungs and the person may appear blue. Symptoms range from mild to very severe. Treatment depends on the severity of the defect and may include medications, oxygen therapy, or surgery." +information,What is (are) Prinzmetal's variant angina ?,"Prinzmetal's variant angina is characterized by recurrent episodes of chest pain that occur while an individual is at rest. This condition is a form of unstable angina because the episodes do not occur in a predictable pattern. Prinzmetal's variant angina may occur spontaneously, or it may be caused by exposure to cold, emotional stress, alcohol withdrawal, or vasoconstricting medications. The symptoms of this condition usually respond to treatment. Individuals with Prinzmetals' variant angina may have a higher risk for heart attack or arrhythmia." +causes,What causes Prinzmetal's variant angina ?,"What causes Prinzmetal's variant angina? Prinzmetal's variant angina is caused by coronary artery spasms. A coronary artery spasm is a temporary, abrupt, and focal (restricted to one location) contraction of the muscles in the wall of an artery in the heart. This spasm constricts the artery, slowing or stoping blood flow. A prolonged spasm can cause chest pain, or even a heart attack (myocardial infarction)." +information,What is (are) Pulmonary arterial hypertension ?,"Pulmonary arterial hypertension (PAH) is a progressive condition that affects the heart and lungs. It is characterized by abnormally high blood pressure (hypertension) in the pulmonary artery, the blood vessel that carries blood from the heart to the lungs. The most common signs and symptoms are shortness of breath (dyspnea) during exertion and fainting spells. As the condition worsens, people can experience dizziness, swelling (edema) of the ankles or legs, chest pain, and a racing pulse. Most cases of PAH occur in individuals with no family history of the disorder. Although some cases are due to mutations in the BMPR2 gene and inherited in an autosomal dominant pattern, a gene mutation has not yet been identified in most individuals. When PAH is inherited from an affected relative it is called ""familial"" PAH. Cases with no identifiable cause may be referred to as ""idiopathic"" PAH. PAH can also occur secondary to an underlying disorder such as connective tissue diseases, HIV infection, chronic hemolytic anemia, and congenital heart disease, to name a few. PAH can also be induced by certain drugs and toxins, for example fenfluramine and dexfenfluramine (appetite suppressants now banned by the FDA), toxic rapeseed oil, and amphetamines." +treatment,What are the treatments for Pulmonary arterial hypertension ?,"How might pulmonary arterial hypertension be treated? People with pulmonary arterial hypertension (PAH) benefit from receiving treatment at specialized centers. The Pulmonary Hypertension Association offers a Find a Doctor tool which may aid you in locating your nearest center. Treatment of serious or life threatening PAH may involve continuous IV epoprostenol. Other treatment options, include treprostinil, iloprost, bosentan, ambrisentan, sildenafil, and tadalafil. Many of these treatments can be administered in various forms, such as by shot, IV, or inhalation. A small number of people with PAH respond well to long term oral calcium channel blockers. Blood thinners, diuretics, and supplemental oxygen may be prescribed as needed. Many drugs can be harmful to people with PAH. The following should be avoided: appetite suppressants, cocaine, amphetamines (and related compounds), low oxygen environments (such as high altitudes), and possibly estrogen compounds (oral contraceptives and hormone replacement therapy)." +information,What is (are) Dextrocardia ?,"Dextrocardia is a condition in which the heart is located in the right side of the chest instead of the left. It is usually present from birth (congenital). There are several types of dextrocardia. The simplest type occurs when the shape and structure of the heart is a mirror image of a normal heart. Other types of dextrocardia may involve defects of the walls of the heart, nearby blood vessels, or other organs in the abdomen. Chest X-raxys and echocardiograms can be used to determine which type of dextrocardia is present." +symptoms,What are the symptoms of Conotruncal heart malformations ?,"What are the signs and symptoms of Conotruncal heart malformations? The Human Phenotype Ontology provides the following list of signs and symptoms for Conotruncal heart malformations. If the information is available, the table below includes how often the symptom is seen in people with this condition. You can use the MedlinePlus Medical Dictionary to look up the definitions for these medical terms. Signs and Symptoms Approximate number of patients (when available) Tetralogy of Fallot 90% Transposition of the great arteries 90% Abnormality of the aorta 50% Abnormality of the pulmonary artery 50% Patent ductus arteriosus 50% Hypertelorism 5% Abnormality of metabolism/homeostasis - Autosomal recessive inheritance - Broad hallux - Coarctation of aorta - Complete atrioventricular canal defect - Double outlet right ventricle - Postaxial polydactyly - Truncus arteriosus - The Human Phenotype Ontology (HPO) has collected information on how often a sign or symptom occurs in a condition. Much of this information comes from Orphanet, a European rare disease database. The frequency of a sign or symptom is usually listed as a rough estimate of the percentage of patients who have that feature. The frequency may also be listed as a fraction. The first number of the fraction is how many people had the symptom, and the second number is the total number of people who were examined in one study. For example, a frequency of 25/25 means that in a study of 25 people all patients were found to have that symptom. Because these frequencies are based on a specific study, the fractions may be different if another group of patients are examined. Sometimes, no information on frequency is available. In these cases, the sign or symptom may be rare or common." +information,What is (are) Hypoplastic right heart syndrome ?,"Hypoplastic right heart syndrome is a rare heart defect, present at birth (congenital), that results in low blood oxygen levels. It is caused by underdevelopment of the structures on the right side of the heart (tricuspid valve, right ventricle, pulmonary valve, and pulmonary artery) and commonly associated with atrial septal defect. The underdeveloped right side of the heart is unable to provide enough blood flow to the body, leading to low blood oxygen and cyanosis. It differs from hypoplastic left heart syndrome which involves the underdevelopment of the structures on the left side of the heart." +information,What is (are) Familial progressive cardiac conduction defect ?,"Familial progressive cardiac conduction defect (PCCD) is a is a cardiac (heart) conduction disorder that may progress to complete heart block. Affected people may not have any symptoms, or the condition may cause shortness of breath, dizziness, fainting, abdominal pain, heart failure, or sudden death. Mutations in several genes, including the SCN5A, SCN1B and TRPM4 genes, can cause PCCD. Several other genes may be the cause when PCCD occurs with congenital heart disease. Familial PCCD is usually inherited in an autosomal dominant manner. However, not all people that have the mutated gene will have the condition; in those that do, symptoms and severity can vary (known as reduced penetrance and variable expressivity). Autosomal recessive inheritance and sporadic cases have been reported, but are rare. Treatment includes implantation of a pacemaker." +information,What is (are) Familial atrial fibrillation ?,"Familial atrial fibrillation is an inherited heart condition that disrupts the heart's rhythm. It is characterized by erratic electrical activity in the heart's upper chambers (the atria), causing an irregular response in the heart's lower chambers (the ventricles). This causes a fast and irregular heartbeat (arrhythmia). Signs and symptoms may include dizziness, chest pain, palpitations, shortness of breath, or fainting. Affected people also have an increased risk of stroke and sudden death. While complications may occur at any age, some affected people never have associated health problems. Familial atrial fibrillation may be caused by changes (mutations) in any of various genes, some of which have not been identified. It is most often inherited in an autosomal dominant manner, but autosomal recessive inheritance has been reported." +symptoms,What are the symptoms of Familial atrial fibrillation ?,"What are the signs and symptoms of Familial atrial fibrillation? The Human Phenotype Ontology provides the following list of signs and symptoms for Familial atrial fibrillation. If the information is available, the table below includes how often the symptom is seen in people with this condition. You can use the MedlinePlus Medical Dictionary to look up the definitions for these medical terms. Signs and Symptoms Approximate number of patients (when available) Thromboembolic stroke 75% Autosomal dominant inheritance - The Human Phenotype Ontology (HPO) has collected information on how often a sign or symptom occurs in a condition. Much of this information comes from Orphanet, a European rare disease database. The frequency of a sign or symptom is usually listed as a rough estimate of the percentage of patients who have that feature. The frequency may also be listed as a fraction. The first number of the fraction is how many people had the symptom, and the second number is the total number of people who were examined in one study. For example, a frequency of 25/25 means that in a study of 25 people all patients were found to have that symptom. Because these frequencies are based on a specific study, the fractions may be different if another group of patients are examined. Sometimes, no information on frequency is available. In these cases, the sign or symptom may be rare or common." +treatment,What are the treatments for Familial atrial fibrillation ?,"How might familial atrial fibrillation be treated? We are unaware of treatment recommendations specific to familial atrial fibrillation, but there is information available about treatment for atrial fibrillation in general. Treatment for atrial fibrillation depends on the frequency and severity of symptoms and may involve medications, medical procedures, and lifestyle changes. People who don't have symptoms or related heart problems may not need treatment. The main goals of treatment include: Preventing blot clots and lowering risk of stroke. This may involve blood-thinning medications such as warfarin, dabigatran, heparin, and aspirin. Controlling the rate of contractions of the ventricles (rate control). This may involve medications to restore the heart rate to a normal level, such as beta blockers, calcium channel blockers, and digitalis. Restoring a normal heart rhythm (rhythm control). This is typically for people who don't do well with rate control treatment, or for people who recently began having symptoms. Rhythm control may involve medications or procedures and is usually begun in a hospital for monitoring. Procedures may include cardioversion, catheter ablation, or maze surgery." +symptoms,What are the symptoms of Familial ventricular tachycardia ?,"What are the signs and symptoms of Familial ventricular tachycardia? The Human Phenotype Ontology provides the following list of signs and symptoms for Familial ventricular tachycardia. If the information is available, the table below includes how often the symptom is seen in people with this condition. You can use the MedlinePlus Medical Dictionary to look up the definitions for these medical terms. Signs and Symptoms Approximate number of patients (when available) Abnormality of metabolism/homeostasis - Autosomal dominant inheritance - Paroxysmal ventricular tachycardia - Sudden cardiac death - The Human Phenotype Ontology (HPO) has collected information on how often a sign or symptom occurs in a condition. Much of this information comes from Orphanet, a European rare disease database. The frequency of a sign or symptom is usually listed as a rough estimate of the percentage of patients who have that feature. The frequency may also be listed as a fraction. The first number of the fraction is how many people had the symptom, and the second number is the total number of people who were examined in one study. For example, a frequency of 25/25 means that in a study of 25 people all patients were found to have that symptom. Because these frequencies are based on a specific study, the fractions may be different if another group of patients are examined. Sometimes, no information on frequency is available. In these cases, the sign or symptom may be rare or common." +information,What is (are) Portal hypertension ?,"Portal hypertension is abnormally high blood pressure in branches of the portal vein, the large vein that brings blood from the intestine to the liver. Portal hypertension itself does not cause symptoms, but complications from the condition can lead to an enlarged abdomen, abdominal discomfort, confusion, drowsiness and internal bleeding. It may be caused by a variety of conditions, but cirrhosis is the most common cause in Western countries. Treatment is generally directed toward the cause of the condition, although emergency treatment is sometimes needed for serious complications." +symptoms,"What are the symptoms of Heart-hand syndrome, Slovenian type ?","What are the signs and symptoms of Heart-hand syndrome, Slovenian type? The Human Phenotype Ontology provides the following list of signs and symptoms for Heart-hand syndrome, Slovenian type. If the information is available, the table below includes how often the symptom is seen in people with this condition. You can use the MedlinePlus Medical Dictionary to look up the definitions for these medical terms. Signs and Symptoms Approximate number of patients (when available) Myopathy 5% Aplasia of the middle phalanx of the hand - Autosomal dominant inheritance - Brachydactyly syndrome - Clinodactyly - Dilated cardiomyopathy - Syndactyly - The Human Phenotype Ontology (HPO) has collected information on how often a sign or symptom occurs in a condition. Much of this information comes from Orphanet, a European rare disease database. The frequency of a sign or symptom is usually listed as a rough estimate of the percentage of patients who have that feature. The frequency may also be listed as a fraction. The first number of the fraction is how many people had the symptom, and the second number is the total number of people who were examined in one study. For example, a frequency of 25/25 means that in a study of 25 people all patients were found to have that symptom. Because these frequencies are based on a specific study, the fractions may be different if another group of patients are examined. Sometimes, no information on frequency is available. In these cases, the sign or symptom may be rare or common." +information,What is (are) Catecholaminergic polymorphic ventricular tachycardia ?,"Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a genetic disorder that causes an abnormally fast and irregular heart rhythm in response to physical activity or emotional stress. Signs and symptoms include light-headedness, dizziness, and fainting. Symptoms most often develop between 7 to 9 years of age. If untreated CPVT can cause a heart attack and death. CPVT is caused by mutations in the RYR2 or CASQ2 genes. When a RYR2 gene mutation is involved, the condition is passed through families in an autosomal dominant fashion. When CASQ2 gene mutations are involved, the condition is inherited in an autosomal recessive fashion. In some cases the underlying cause can not be determined. Beta blockers are used to treat CPVT. An Implantable Cardioverter Defibrillator (ICD) may also be needed." +symptoms,"What are the symptoms of Heart-hand syndrome, Spanish type ?","What are the signs and symptoms of Heart-hand syndrome, Spanish type? The Human Phenotype Ontology provides the following list of signs and symptoms for Heart-hand syndrome, Spanish type. If the information is available, the table below includes how often the symptom is seen in people with this condition. You can use the MedlinePlus Medical Dictionary to look up the definitions for these medical terms. Signs and Symptoms Approximate number of patients (when available) Abnormality of the metacarpal bones 90% Brachydactyly syndrome 90% Short toe 50% Abnormality of the cardiovascular system - Autosomal dominant inheritance - Short middle phalanx of finger - Sick sinus syndrome - Ulnar deviation of the 2nd finger - The Human Phenotype Ontology (HPO) has collected information on how often a sign or symptom occurs in a condition. Much of this information comes from Orphanet, a European rare disease database. The frequency of a sign or symptom is usually listed as a rough estimate of the percentage of patients who have that feature. The frequency may also be listed as a fraction. The first number of the fraction is how many people had the symptom, and the second number is the total number of people who were examined in one study. For example, a frequency of 25/25 means that in a study of 25 people all patients were found to have that symptom. Because these frequencies are based on a specific study, the fractions may be different if another group of patients are examined. Sometimes, no information on frequency is available. In these cases, the sign or symptom may be rare or common." +symptoms,"What are the symptoms of Atrial myxoma, familial ?","What are the signs and symptoms of Atrial myxoma, familial? The Human Phenotype Ontology provides the following list of signs and symptoms for Atrial myxoma, familial. If the information is available, the table below includes how often the symptom is seen in people with this condition. You can use the MedlinePlus Medical Dictionary to look up the definitions for these medical terms. Signs and Symptoms Approximate number of patients (when available) Autosomal recessive inheritance - Bacterial endocarditis - Pulmonic valve myxoma - The Human Phenotype Ontology (HPO) has collected information on how often a sign or symptom occurs in a condition. Much of this information comes from Orphanet, a European rare disease database. The frequency of a sign or symptom is usually listed as a rough estimate of the percentage of patients who have that feature. The frequency may also be listed as a fraction. The first number of the fraction is how many people had the symptom, and the second number is the total number of people who were examined in one study. For example, a frequency of 25/25 means that in a study of 25 people all patients were found to have that symptom. Because these frequencies are based on a specific study, the fractions may be different if another group of patients are examined. Sometimes, no information on frequency is available. In these cases, the sign or symptom may be rare or common." +symptoms,What are the symptoms of Atrial septal defect ostium primum ?,"What are the signs and symptoms of Atrial septal defect ostium primum? The Human Phenotype Ontology provides the following list of signs and symptoms for Atrial septal defect ostium primum. If the information is available, the table below includes how often the symptom is seen in people with this condition. You can use the MedlinePlus Medical Dictionary to look up the definitions for these medical terms. Signs and Symptoms Approximate number of patients (when available) Atria septal defect - The Human Phenotype Ontology (HPO) has collected information on how often a sign or symptom occurs in a condition. Much of this information comes from Orphanet, a European rare disease database. The frequency of a sign or symptom is usually listed as a rough estimate of the percentage of patients who have that feature. The frequency may also be listed as a fraction. The first number of the fraction is how many people had the symptom, and the second number is the total number of people who were examined in one study. For example, a frequency of 25/25 means that in a study of 25 people all patients were found to have that symptom. Because these frequencies are based on a specific study, the fractions may be different if another group of patients are examined. Sometimes, no information on frequency is available. In these cases, the sign or symptom may be rare or common." +information,What is (are) Periventricular heterotopia ?,"Periventricular heterotopia is a condition in which the nerve cells (neurons) do not migrate properly during the early development of the fetal brain from about the 6th week to the 24th week of pregnancy. Affected people typically develop recurrent seizures (epilepsy) beginning in mid-adolescence. Intelligence is generally normal; however, some affected people may have mild intellectual disability, including difficulty with reading and/or spelling. Less common signs and symptoms include microcephaly, developmental delay, recurrent infections, and blood vessel abnormalities. Some cases are caused by changes (mutations) in the FLNA gene and are inherited in an X-linked dominant manner. Others are caused by mutations in the ARFGEF2 gene and are inherited in an autosomal recessive manner. Rarely, periventricular heterotopia is associated with duplication of genetic material on chromosome 5. Treatment is generally focused on managing recurrent seizures with medications." +symptoms,What are the symptoms of Periventricular heterotopia ?,"What are the signs and symptoms of periventricular nodular heterotopia? The condition is first noticed when seizures appear, often during the teenage years. The nodules around the ventricles are then typically discovered when magnetic resonance imaging (MRI) studies are done. Patients usually have normal intelligence, although some have mild intellectual disability. Difficulty with reading and spelling (dyslexia) has been reported in some girls with periventricular heterotopia. Less commonly, individuals with periventricular heterotopia may have more severe brain malformations, small head size (microcephaly), developmental delays, recurrent infections, blood vessel abnormalities, or other problems. In the X-linked form of periventricular nodular heterotopia, affected patients are mostly females because in males the symptoms are too serious and they die before birth. The following clinical features have been reported: seizure disorder, mental problems, heart anomalies, stomach immobility, strabismus, short fingers and dyslexia. Periventricular heterotopia may also occur in association with other conditions such as Ehlers-Danlos syndrome (Ehlers-Danlos with periventricular heterotopia) which results in extremely flexible joints, skin that stretches easily, and fragile blood vessels. In the autosomal recessive form of periventricular heterotopia the disorder is severe and may include microcephaly, severe developmental delay, and seizures beginning in infancy. Most often, the parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but do not show any signs or symptoms of this condition." +exams and tests,How to diagnose Periventricular heterotopia ?,"What are the recommended evaluations for patients diagnosed with periventricular nodular heterotopia? The following evaluations are recommended:[1823] Imaging exams of the brain to establish the diagnosis Evaluation by a neurologist Evaluation by a doctor specialized in epilepsy if seizures are present Psychiatric evaluation if necessary Magnetic resonance angiography (MRA) of the brain vessels, carotid arteries, and aorta because of the risk for stroke Evaluation by a cardiologist and either echocardiogram or a heart magnetic resonance imaging (MRI) because of the risk for aortic aneurysm Evaluation by a hematologist if findings suggest a bleeding diathesis." +treatment,What are the treatments for Periventricular heterotopia ?,"How might periventricular nodular heterotopia be treated? Treatment of epilepsy generally follows principles for a seizure disorder caused by a known structural brain abnormality; carbamezipine is most often used, because most patients have focal seizures. However, antiepileptic drugs may be selected based on side effects, tolerability, and efficacy. It is recommended that patients with the X-linked form of the disease have studies evaluating the carotid artery and an abdominal ultrasound because of the risk for aortic or carotid dissection or other vascular anomalies.[1823] Treatment also include surgery for removal of the lesion and more recently, laser ablation guided with magnetic resonance."