DISCLAIMER: THIS PAGE CONTAINS A GENERAL EDUCATIONAL DISCUSSION ON THE BELOW TOPICS. IT IS NOT HEALTH ADVICE AND SHOULD NOT BE CONSTRUED AS SUCH. YOU SHOULD NEVER RELY UPON THE INFORMATION GIVEN HERE. YOUR PARTICULAR CIRCUMSTANCES MAY WELL REQUIRE AN ENTIRELY DIFFERENT APPROACH. YOU SHOULD NOT MAKE ANY CHANGES IN YOUR MEDICATIONS, DIET, ACTIVITY, LIFESTYLE, ETC. WITHOUT FIRST CONSULTING A LICENSED PHYSICIAN IN YOUR AREA.
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Aneurysm-This term refers to a localized dilation of an artery or chamber of the heart. The behavior and prognosis for aneurysms varies, depending on their size and location. Aneurysms of the heart are usually the result of a prior heart attack. They generally don't require surgical resection. They may result in congestive heart failure and arrhythmias. Aneurysms of the main artery of the body, the aorta, generally require resection once they reach a certain size-anywhere from 4.5 to 6.0 centimeters in diameter. Aneurysms of the blood vessels in the brain can lead to catastrophic cerebral hemorrhages. Prophylactic surgical resection may be recommended based on their size and location.
Angina Pectoris-This is simply Latin for "pain in the chest" but is used to refer to any symptom caused by a temporary reduction in oxygen supply (ischemia) to the muscle of the heart (myocardium). The most common cause is coronary artery disease whereby atherosclerosis narrows the interior of the coronary arteries. At times when the heart has to work harder and requires more oxygen, the blood flow cannot increase as it normally does through these narrowed arteries, resulting in myocardial ischemia. This most typically occurs with physical exertion but can also happen with emotional stress, after meals, in association with noncardiac diseases stressing the heart and sometimes for no apparent reason.
The symptoms can occur in the chest, shoulders, either arm, back, upper stomach, neck or jaw in variable combinations. It is typically described as a heaviness, tightness, constriction, squeezing, dull ache, indigestion or gas pain. It may be associated with shortness of breath, sweating, weakness or nausea. Sometimes it manifests only as one of these associated symptoms, such as shortness of breath, without any chest pain or discomfort. The angina attack generally resolves within several minutes. In some people, the angina may resolve even if they continue what they were doing to provoke it (known as "walk-through" angina) but more commonly patients will need to stop, rest and possibly take nitroglycerin. Note that noncardiac causes of chest discomfort may mimic angina and may also respond to nitroglycerin. Severe angina is known as unstable angina.
The diagnosis of whether a patient's symptoms are from the heart (angina) or not (noncardiac chest pain) is determined by evaluating the patient's risk of having coronary artery disease and the characteristics of the symptoms. Diagnostic testing is carried out most commonly by stress tests as well as coronary angiograms. Ultrafast CT scans can also be used. The determination of whether testing should be done and which test is the best to start with is made by the physician based on the patient's risk factors and the nature of the symptoms.
Most patients with coronary artery disease are treated with an antiplatelet agent and risk factor modification. These decrease the risk of serious complications like a heart attack.
Symptom control is achieved by risk factor modification, antianginal agents, coronary angioplasty and stents or bypass surgery. The latter two are more effective than antianginal medications in controlling symptoms. For certain patients with multiple severe coronary narrowings, bypass surgery also prolongs survival. Experimental procedures include transmyocardial laser revascularization, enhanced external counter pulsation and spinal cord stimulation.
Antibiotic Prophylaxis-Certain types of valvular and congenital heart diseases can become infected at the site of the defect if bacteria get into the bloodstream. Patients with these conditions are advised to take antibiotics one hour before any medical or dental procedure that may introduce bacteria into the bloodstream.
Aorta-The main artery of the body. The heart pumps all the blood into the aorta. Branches from the aorta brings blood to all parts of the body.
Aortic Dissection-This used to be called a dissecting aneurysm. It refers to a tear in the wall of the aorta. It can be caused by inherited disorders of connective tissue, high blood pressure and atherosclerosis as well as blunt chest trauma and rapid decelerations typical of automobile accidents. It is characterized by severe, sharp chest pain radiating through to the back. It can be diagnosed by transesophageal echocardiography, MRI, CT scans and cardiac catheterization.The acute treatment includes beta blockers as well as additional intravenous medicine to rapidly reduce the blood pressure if it is elevated. Surgery is recommended for dissections involving the beginning part of the aorta and for dissections involving the more distant segments of the aorta that do not respond to medical therapy.
Aortic Valve-One of the four valves in the heart. It is composed of three cusps. The main pumping chamber of the heart, the left ventricle, ejects blood through this valve into the body's main artery, the aorta, during the portion of the cardiac cycle called systole. During the other part of the cardiac cycle, called diastole, the aortic valve closes so that blood does not leak backwards from the aorta to the left ventricle and the left ventricle fills with blood again from the left atrium for the next heart beat.
Aortic Valve Regurgitation-In this condition, the aortic valve does not close properly. It can be caused by congenital abnormalities of the valve, rheumatic heart disease, aneurysms of the aorta, high blood pressure or excessive build-up of calcium over time. Blood leaks back from the body's main artery (the aorta) to the the main pumping chamber of the heart (the left ventricle). If the leakage becomes severe enough, the left ventricle may dilate and weaken. Eventually, symptoms of shortness of breath (heart failure) occur particularly with exertion or when lying flat. Chest discomfort, swelling of the feet and weakness can also occur.
The diagnosis can be made by the physician noting a characteristic murmur and a change in the quality of the pulse. The diagnosis can be confirmed by echocardiography and/or cardiac catheterization. Definitive treatment is open heart surgery to replace the valve. This is indicated when symptoms occur or if the left ventricle is sufficiently weakened or dilated even in the absence of symptoms. Severe regurgitation that doesn't yet require surgery is managed by medications such as certain calcium channel blockers (nifedipine) or angiotensin converting enzyme inhibitors.
Aortic Valve Stenosis-In this condition, the aortic valve is unable to open fully. It can be caused by a congenital condition, rheumatic heart disease or by build-up of excessive calcium on the valve. When severe, it can produce symptoms including chest discomfort or shortness of breath with exertion, heart failure and fainting. The diagnosis is made by the characteristic murmur, echocardiography and/or cardiac catheterization. The only available treatment, valve replacement surgery, is indicated when the condition is severe enough to produce symptoms. Results with balloon valvuloplasty on the aortic valve have been disappointing.
Arrhythmia-This term refers to a disturbance in the electrical conduction system of the heart. It can result in a heart beat that is too slow, too fast, irregular or some combination thereof. It can produce symptoms of palpitations, fainting or near fainting, chest discomfort, or shortness of breath. Not uncommonly, it is asymptomatic. Specific types of arrhythmias are discussed elsewhere on this page. The diagnosis is made by recording the heart's electrical activity while the arrhythmia is occuring or by electrophysiologic testing.
Arteriosclerosis-This refers to hardening of the wall of the artery due to calcium buildup. It may not be accompanied by atherosclerosis, which refers to narrowng of the interior of the artery (see below).
Atherosclerosis-This is a disease of the arterial wall. The wall thickens and narrows the interior of the artery. This impairs the blood flow through the vessel. This tissue supplied by that vessel can lack oxygen at times. Involvement of the arteries of the heart results in angina and heart attacks. Involvement of the blood vessels to the brain results in strokes. Other commonly affected vessels include the arteries to the kidneys and legs and the main artery of the body, the aorta.
The wall of the artery thickens as a result of cholesterol and calcium build-up as well as an overgrowth of the cells that the wall is composed of. The collection of cholesterol is like a sludge or gruel. In fact, athero is the Greek word for gruel while sclerosis is the Greek work for hardening.To some extent, it is a natural part of the aging process. It is accelerated by smoking, high blood pressure, high cholesterol levels and diabetes. Some people have an inherited, genetic predisposition to it.
Atherosclerotic Plaque-A localized build-up of atherosclerosis in one segment of an artery (see above).
Atrial Fibrillation-An arrhythmia whereby chaotic electrical activity replaces the normal organized electrical activity of the upper chambers of the heart, the atria. This results in a rapid irregular heart beat that can result in palpitations, chest discomfort, shortness of breath, heart failure, fainting or near fainting. Quite frequently, however, it is asymptomatic. Blood clots may form in the fibrillating atrium. These can break off and travel to other parts of the body and occlude blood vessels. If it goes to the brain, a stroke ensues.
Atrial fibrillation often accompanies other forms of heart disease, which must be screened for when a patient presents with this problem. An overactive thyroid, alcohol, caffeine, tobacco, decongestants, antihistamines and some prescription medications can also cause it as a side effect. In some people, it occurs due to an isolated problem with the electrical conduction system of the heart without any other heart disease or other contributing condition.
The diagnosis is made by recording an ECG during the event. The heart rate can be slowed with digoxin, beta blockers or certain calcium channel blockers. The risk of stroke is vastly reduced with blood thinning agents such as warfarin. Conversion of the fibrillation back to the normal heart rhythm may occur spontaneously. If not; antiarryhthmic medications, electrical cardioversion, the maze procedure, or radiofrequency ablation can be tried. Once back in the normal heart rhythm, patients often have to take an antiarrhythmic medicine chronically to prevent the fibrillation from reoccurring.
Atrial Flutter-Very similar to atrial fibrillation (discussed above) except the electrical activity in the atrium is not quite so chaotic and there is less risk of forming blood clots.
Atrial Premature Contractions-An isolated, early or premature beat that arises from the upper chambers of the heart, the atria. By itself, it is often quite benign. If it causes palpitations that are frequent or intolerable, they can be suppressed by beta blockers, certain calcium channel blockers or digoxin.
Atrium-The two upper chambers of the heart are called the right and left atria and the two lower chambers are called the right and left ventricles. The right atrium receives all the venous blood from the body. The blood then goes through the tricuspid valve into the right ventricle which pumps the blood to the lungs through the pulmonic valve. All the blood from the lungs returns to the left atrium and then through the mitral valve into the left ventricle which pumps the blood out to the body through the aortic valve. The atria serve a reservoir function. When the ventricles are ejecting their blood, the pulmonic and aortic valves are open and the tricuspid and mitral valves are closed so no blood travels backwards. The atria hold the returning venous blood while the tricuspid and mitral valves are closed. Once the ventricles have finished their ejection, the tricuspid and mitral valves between the atria and ventricles open to allow the ventricles to fill again for the next ejection and the pulmonic and aortic valves are closed so that none of the ejected blood leaks back into the ventricles. The electrical impulse that initiates each heart beat normally originates from the top of the right atrium and travels down specialized conduction tissue to the ventricles to cause them to eject their blood.
Auricle-see atrium.
Bradycardia- A slow heart beat (less than 60 beats per minute) .
Cardiac Arrest-A cessation of the heart beat. This is the final event in all causes of death. It requires immediate institution of cardiopulmonary resuscitation (CPR) if there is to be any chance of survival with intact brain function. If it occurs outside of the hospital, an ambulance (emergency medical services-911) must be called immediately. Immediate initiation of CPR by qualified bystanders while awaiting the ambulance greatly increases the chance of survival.
Cardiomyopathy-Any disease of the heart muscle that impairs its ability to fill with blood or to eject blood. It can be caused by high blood pressure, coronary artery disease with or without prior myocardial infarctions, diseases of the heart valves, excessive alcohol use, viral infections of the heart muscle, diabetes, prolonged fast heart beats (weeks to months) and other systemic illnesses. In some cases, it occurs on a genetic basis. It causes symptoms of heart failure. It is diagnosed by echocardiography, cardiac catheterization and angiography and endomyocardial biopsy. It is treated with the usual measures for heart failure-tailored for the specific type of cardiomyopathy- as well as treatment against the underlying cause. See also hypertrophic cardiomyopathy.
Carotid Arteries-The right and left carotid arteries supply most of the blood flow to the brain. The right and left vertebral arteries supply a small amount of blood to the back of the brain.
Cerebrovascular Accident-This refers to either an occlusion of a blood vessel to the brain or a hemorrhage into the brain. Occluded blood vessels are the more common cause. These are caused by atherosclerosis of the blood vessels supplying the brain or, less commonly, a blood clot that broke off from the heart. The area of the brain supplied by the occluded vessels dies ( a cerebral infarction). The resulting symptoms and neurologic deficit depend on what area of the brain was affected. The stroke can be diagnosed by CT scans or MRI scans of the brain. The most common cause, atherosclerosis of the carotid arteries, can be diagnosed by an ultrasound test, magnetic resonance angiogram or angiogram. Evaluation of the heart for sources of material that can break off and travel to the brain include transthoracic and transesophageal echocardiography.
Treatment of the nonhemorrhagic type may include aspirin or warfarin as well as rehabilitation programs. Clot dissolving agents may be used acutely (within the first three hours of the event) and some people are investigating acute angioplasty of the carotid arteries. Atherosclerosis of the carotid arteries of sufficient severity may require a procedure called a carotid endarterectomy to open the artery.
Chest Discomfort-Any unusual sensation in the chest. There are myriad causes including coronary artery disease, other types of heart disease, gastrointestinal disorders, lung diseases, inflammation or muscle spasms of the chest wall and anxiety. Doctors usually first set out to determine if it is caused by the heart or not since this is generally the most serious cause. Based on the patient's cardiovascular risk factors and nature of the discomfort, further diagnostic evaluation may include a stress test or coronary angiogram. Ultrafast CT is a newer test that also has some utility.
Claudication-see intermittant claudication.
Congestive Heart Failure-see heart failure
Constrictive Pericarditis-see pericardial constriction.
Coronary Arteries-These are the arteries that supply blood to the heart muscle. They are the first arteries to arise from the body's main artery, the aorta. Even though the heart pumps all the blood, the heart muscle requires its own arterial supply since it is so thick that blood in the chambers of the heart cannot provide oxygen and nutrients through the entire thickness of the heart muscle. There are two coronary arteries that come off the aorta-the right coronary artery and the left main coronary artery. The left main coronary artery divides after one to two centimeters into the left anterior descending artery that goes down the front of the heart and the circumflex artery that wraps around the left side of the heart. The right coronary artery and the two branches of the left main then give rise to further branching. Cardiologists refer to one, two or three vessel disease based on how many of these three arteries are significantly narrowed by atherosclerosis. However, patients can receive quadruple, quintuple etc, coronary bypasses if branches off of the three main arteries are bypassed as well.
Coronary Artery Disease-Atherosclerosis affecting the coronary arteries. This may be asymptomatic, result in stable angina, unstable angina, acute myocardial infarction or cardiac arrest. It can be diagnosed by stress testing, coronary angiography and a new test called ultrafast CT scanning.
Deep Venous Thrombosis- This is more commonly known as phlebitis. It refers to a blood clot that forms in the deep veins of the calves, thigh or pelvis. This can occur with prolonged immobility, such as a long car or airplane ride or prolonged bedrest when ill. Trauma to the leg, cancer and inherited abnormalities of the body's blood coagulation system can also cause it. Patients with cancer and those recovering from recent surgery are also at increased risk.
It can produce symptoms of leg pain and swelling but may also be asymptomatic. The diagnosis is made most commonly by ultrasound evaluation of leg veins. The treatment involve immediate blood thinning with intravenous or subcutaneous heparins, followed by long term therapy with oral warfarin. The most dreaded complication is a pulmonary embolus (see below). Varicose veins with chronic leg swelling may also be a long term consequence. Sometimes, clot dissolving agents are given during the acute treatment to prevent this latter complication as well as lead to more rapid resolution of the acute symptoms.
Diastole-The part of the cardaic cycle when the main pumping chambers of the heart, the ventricles, are filling with blood for the next heart beat.
Diastolic Blood Pressure-The bottom number of the blood pressure. It should be less than 90.
Dyspnea-This means shortness of breath. This symptom typically occurs with physical exertion. When caused by heart failure, it can also occur lying down and will be relieved by elevating the head. This type of dyspnea is also known as orthopnea.
Dyspnea can be the result of many processes including many diseases of the heart and lungs, anemia, metabolic disturbances, overweight and physical deconditioning.
Diagnostic tests to help sort out the cause for a person's dyspnea may include an X-ray of the chest, echocardiography, stress testing and pulmonary function tests.
Edema-This means swelling. Swelling can be due to fluid retention, injury or inflammation or varicose veins. Varicose veins are the most common cause of swollen ankles.
Fluid retention can be a manifestation of heart disease (heart failure), kidney disease or liver disease. The best test to assess the likelihood of the heart as a cause is an echocardiogram. The liver and kidneys can be evaluated by blood and urine tests, as well as imaging techniques that take pictures of those organs.
Fluid retention caused by varicose veins is often treated by leg elevation and elastic stockings. Diuretics can be used if those measures are not satisfactory. Edema from heart, lung and kidney disease is treated with diuretics as well. Restriction of salt and fluid intake by the patient is also often recommended.
Endocarditis-This refers to an infection of the lining of the interior of the heart. It most commonly occurs on the valves of the heart. Untreated, it can destroy the tissue of the valve, resulting in severe leakage of those valves, heart failure and death.
The infecting organism is most often any one of a number of bacteria. In many cases, it is difficult or impossible to determine how the bacteria got into the blood stream to infect the heart. Prior dental work or medical procedures involving nonsterile parts of the body (such as the rectum) may be responsible. Established infections elsewhere in the body may spread to the blood stream and then the heart. Patients with preexisting valvular or congenital heart disease are at increased risk, as are people who inject recreational drugs.
The potential for dramatic symptoms is noted above. However, patients with endocarditis may manifest only subtle symptoms such as muscle or joint aches, low grade fevers, weight loss or anemia. Some are entirely asymptomatic! In addition to heart failure, the other dreaded complication is that some of the infectious material may break off from the valve and travel through the blood stream and occlude an artery somewhere in the body. The tissue supplied by this artery will die and may become secondarily infected. If the material travels to the brain, a stroke ensues.
The mainstay of diagnosis in culturing the patient's blood to determine if any microorganisms are growing in it as well as echocardiography. Transesophageal echocardiography is particularly helpful. None of these tests are perfect. Blood cultures can be positive from infections other than endocarditis and are sometimes negative even in patients with endocarditis. Ditto for echocardiography.
Treatment is intravenous antibiotics, which often have to be given for as long as six weeks. This can often be done with the help of home intravenous therapy services to avoid prolonged hospitalization. Open heart surgery to remove the infected valve and replace it with a prosthesis is done if antibiotics fail, heart failure from a leaky valve occurs, abscess formation occurs within the heart or material repeatedly breaks off from the valve and occludes blood vessels elsewhere in the body.
Patients with certain types of valvular or congenital heart disease who are felt to be predisposed to endocarditis are advised to take antibiotics prophylactically prior to medical or dental procedures that may seed the blood stream with bacteria.
Fainting-see syncope.
Hardening of the arteries-see atherosclerosis
Heart Attack-this ill defined lay term usually refers to an acute myocardial infarction.
Heart Block-A disturbance in th electrical conduction system of the heart which may occur in isolation or may accompany other coexisting heart problems. Some medications may cause this as a side effect. It may also be the result of a metabolic disturbance.
The heart has a well defined conduction system. The electrical impulse is generated at the top of the right atrium. It then spreads throught both atria and then converges at a small piece of tissue where the two atria meet the two ventricles, called the atrioventricular node or AV node. The impulse travels through the AV node to the ventricles. Below the AV node is the right bundle which brings the electrical signal to the right ventricle and the left bundle which brings the electrical signal to the left ventricle.
Conduction blocks may occur at the AV node, or one or both of the bundles.
The diagnosis is made by recording the ECG. Sometimes, an electrophysiologic study is needed as well.
Treatment begins by correcting any metabolic disturbances and, if possible, stopping any medications that could concievably cause this as a side effect. If these measures are not available or ineffective, consideration may be given towards implantation of a pacemaker. The decision whether a pacemaker is needed is based on (1) where in the conduction system the block has occured, (2) the resulting heart rate, and (3) whether or not the heart block is causing any symptoms.
Heart Failure-This is also known as congestive heart failure or CHF. It refers to an impairment in the ability of the heart to pump blood out to the body in the normal fashion. The organs of the body receive less blood than they need. In addition, the blood returning to the heart backs up into the veins because the heart is congested with the blood it fails to pump out normally.
The veins draining the lungs become engorged and serum seeps out of them into the lung tissue. This causes symptoms of shortness of breath with exertion and when lying down flat. This fluid build up in the lungs is often evident on chest X-rays. The veins draining the body also become engorged and serum seeps out-first to the ankles, then higher up in the legs. Eventually, the liver becomes congested and fluid builds up in the abdominal cavity. At the end stage, the entire body may be swollen. Failure to adequately pump blood to the body's organs may cause symptoms of weakness and lightheadedness and impair the functioning of the kidneys.
Heart failure can be caused by myriad things. It can be the end result of many other heart diseases including coronary artery disease, prior heart attacks, valvular heart disease, cardiomyopathies and arrhythmias. It can also be caused by noncardiac illnesses straining the heart. These include high blood pressure, lung disease, diabetes, cigarette smoking, anemia, and infections. The heart condition is exacerbated by overproduction of certain hormones and overactivity of the sympathetic nervous system in a maladaptive attempt by the body to compensate for the weakened heart.
Treatment first entails identifying and treating any cardiac or noncardiac illnesses that may be contributing to the heart failure. The first test used to evaluate the heart is usually the echocardiogram. Some evaluation for coronary artery disease is also often carried out.
The fluid build-up is treated with diuretics and restriction of salt and fluid intake. If the actual heart muscle is weakened (which is most often the case), other heart failure medications such as ACE inhibitors, angiotensin blockers, digoxin and beta blockers may be used. Spironolactone is a diuretic that has benefits to the failing heart in addition to its fluid removing action. ACE inhibitors, angiotensin blockers and spironolactone exert their beneficial effects by counteracting the actions of hormones deleterious to the failing heart. Beta blockers exert their beneficial effect by countering the overactivity of the sympathetic nervous system that is deleterious to the failing heart.
Sometimes, mechanical support with an intraaortic balloon pump or left ventricular assist device is required. Should the aforementioned measures fail, consideration may be given towards cardiac transplantation or other experimental therapies such as left ventricular reduction surgery.
In most cases, the cause of the heart failure can be resolved or at least controlled. The goal of therapy is return patients to their prior level of functioning. The prognosis is quite variable and difficult to predict with certainty in the majority of patients. It is quite possible to lead a long and relatively asymptomatic life.
Hypertrophic Cardiomyopathy-This is a genetic disease that runs in families. The genetic defect causes an overgrowth of the heart muscle. The abnormally thick heart muscle is quite stiff and unable to fill with blood properly. Sometimes, the thickened heart muscle actually obstructs the egress of blood out of the heart. Associated abnormalities of the mitral valve may further exacerbate the obstruction. A variety of arrhythmias may occur as well as leakage of the mitral valve (mitral regurgitation).
The diagnosis is made by echocardiography. It is recommended that first degree family members of the patient be screened with echocardiograms as well. Patients with the obstructive form take prophylactic antibiotics to prevent endocarditis.
Treatment modalities include calcium blockers, beta blockers, diisopyramide (an antiarrhythmic medicine that has additional properties that help hypertrophic cardiomyopathy), open heart surgery to remove some of the thickened heart muscle (septal myomectomy), and mitral valve replacement. Newer, experimental therapies include implantation of a pacemaker (which may aid the functioning of the heart in this condition by altering the electrical activation pattern of the heart) and injecting ethanol into an artery of the heart to thin some of the thickened muscle. The arrhythmias associated with this disease are treated with antiarrhythmic medications or a cardioverter/defibrillator.
Infarction-Death of tissue due to occlusion of the artery supplying that tissue.
Insufficiency-see regurgitation
Intermittant Claudication-Discomfort (pain, aching, cramping, weakness) in the calves or thighs due to atherosclerosis of the blood vessels supplying the leg muscles. Diagnosis is made by ultrasound studies or angiograms of the leg arteries. Treatment includes smoking cessation, walking exercises, pentoxifylline, and cilostazol. If the symptoms are debilitating, occur at rest or result in gangrene, angioplasty, stenting or a bypass operation can be performed on the leg arteries.
Ischemia-Impairment of the functioning of tissue without tissue death due to a reduction in blood flow to that tissue.
Marfan's Syndrome- An inherited disorder of connective tissue that results in eye problems, excessive joint mobility, tall stature, long fingers, mitral valve prolapse with mitral regurgitation and aneurysmal dilatation of the aorta resulting in aortic dissection and aortic regurgitation. Please look up the specific cardiac problems on this page for more information on their diagnosis and management. Cardiac involvement is assessed by echocardiography as well as CT scans or MRI scans to assess the aorta. Beta blockers are administered prophylactically to prevent aortic dilatation and dissection.
Mitral Valve-One of the four valves of the heart. It is composed of two leaflets. It is called the bicuspid valve by some but was named the mitral valve because it is shaped like a bishop's mitre. It connects the left atrium to the left ventricle. When the ventricle is ejecting blood out to the body, the mitral valve is closed to prevent the blood from going backwards to the left atrium and the lungs. After the ventricle finishes ejecting the blood, the valve opens to allow the left ventricle to fill with blood for the next heart beat.
Mitral Valve Prolapse-An excess of tissue in the mitral valve allows the valve to buckle or bow backwards into the left atrium when the valve closes. The valve may leak blood back into the left atrium (mitral regurgitation-see below). Using improved diagnostic echocardiographic techniques, recent studies show the incidence of mitral valve prolapse is only 2.4% and most patients are asymptomatic and enjoy an excellent prognosis. Patients with abnormally thickened leaflets or significant mitral regurgitation require antibiotic prophylaxis before certain medical and dental procedure to prevent infections of the mitral valve. The management of mitral regurgitation is discussed below.
Mitral Valve Regurgitation-In this condition, blood leaks back into the left atrium when the mitral valve closes and causes symptoms of heart failure. The most common causes include mitral valve prolapse, diseases of the heart muscle (the mitral valve is attached to the heart muscle and may not closes properly if the muscle dilates or weakens), rheumatic heart disease, infections on the mitral valve, and hypertrophic cardiomyopathy. The diagnosis is made by echocardiography and cardiac catheterization. Surgery on the valve (repair or replacement) is recommended if symptoms develop and also in the absence of symtoms if the main pumping chamber of the heart is becoming weak or dilated.
Mitral Valve Stenosis-An inability of the mitral valve to open fully. This results in blood backing up in the left atrium and lungs, which in turn leads to symptoms of heart failure. The left atrium dilates, often resulting in atrial fibrillation. Blood clots may form in the left atrium. If they break off and travel to the brain, a stroke ensues.
The most common cause is rheumatic heart disease. The diagnosis is made by echocardiography. Symptoms are controlled by keeping the heart rate slow with medicines like beta blockers or digoxin which allows more time for the left atrium to empty. Blood clots are prevented by blood thinning medication such as warfarin. Mitral valve repair or replacement is carried out if they symptoms are severe or not adequately controlled with medical therapy. Balloon valvuloplasty is also an option for some.
Murmur-One of the abnormal sounds from the heart a physician hears with a stethoscope. The presence of a murmur may indicate valvular or congenital heart disease but murmurs are also commonly produced by the normal flow of blood through the heart. These latter types of murmurs are also called innocent murmurs, flow murmurs or physiologic murmurs. The various causes of murmurs can be differentiated based on how they sound and when they occur in the cardiac cycle as well as by echocardiography and cardiac catheterization.
MVP-see Mitral Valve Prolapse.
Myocardial Infarction-Death of a region of the muscle supplied by an occluded coronary artery. This is commonly referred to as a "heart attack." A previously stable atherosclerotic plaque in a coronary artery-one that was only partially occluding the artery and producing either a stable anginal pattern or no symptoms at all-ruptures its surface due to shear stress from the blood flow around it and/or inflammation in the plaque. This results in blood clotting on the surface of the plaque which then totally occludes the artery.
The symptoms are similar to what was described for angina above but much more severe and prolonged. They don't typically respond to nitroglycerin. Rarely, people can have silent heart attacks without symptoms. The myocardial infarction may lead to heart failure, arrhythmias and sudden death. Most deaths occur prior to arrival in the hospital. That is why it is imperative to activate the emergency medical system (911 in the USA) and get to the nearest emergency room as soon as possible.
There are two types of heart attack patterns seen on the initial ECG. One type requires administration of either clot dissolving agents or angiography followed by angioplasty within twelve hours of the onset of the event (the sooner the better) to get the artery open. The other type doesn't. Both types are treated with antiplatelet therapy with aspirin, anticoagulant therapy with intravenous or subcutaneous heparins, beta blockers and ACE inhibitors.
Patients are initially admitted to the intensive care unit. The size of the heart attack is assessed by cardiac enzymes and echocardiography. If an angiogram was not done acutely, an angiogram or a stress test is generally performed before hospital discharge to see if an angioplasty or bypass operation may be needed.
Patients with an uncomplicated myocardial infarction not requiring additional procedures often go home from the hospital after about 5 days. Long term therapy of the heart attack survivor includes risk factor modification, a cardiac rehabilitation program and continuation of aspirin, beta blockers and ACE inhibitors.
Quite frequently, patients present with symptoms suggestive of a heart attack but it cannot be determined right away whether it is a heart attack, severe (unstable) angina or a noncardiac event. Such patients are admitted to a cardiac unit or ICU and are treated with many of the same medicines used for clear cut heart attacks while awaiting the results of diagnostic testing which include repeated ECGs, cardiac enzymes and possible echocardiography, stress testing or angiography.
Myocarditis-Inflammation of the muscle of the heart. This may be due to a viral infection or result from unknown causes. This is usually no specific treatment for the inflammation per se. The resulting weakness of the heart muscle and heart failure is treated with medications.
Myocardium-The muscle of the heart.
Normal Sinus Rhythm-The normal electrical activation pattern of the heart. This produces a heart rate between 60 and 100 beats per minute.
Orthopnea-Shortness of breath when lying flat. It is relieved by putting extra pillows under the head or sitting up. It is a symptom of heart failure.
Palpitations-An awareness of one's heart beat. It may represent a true disturbance in the electrical activity of the heart (an arrhythmia-see above) or simply an awareness of a forceful but otherwise normal heart beat. This latter cause is quite benign as are palpitations that are due to isolated skips in the heart beat. It is quite common for people to become aware of their heart beat when they first lie down in bed at night. It is also common to feel palpitations with excessive physical activity and anxiety.
Palpitations are evaluated by recording the electrical activity of the heart during the event. Palpitations that are due to serious arrhythmias mandate complete evaluation and treatment of that arrhythmia. Palpitations due to other causes are often treated with the simple reassurance of their benign nature but if they are intolerable, medications such as beta blockers can be used.
Pericardial Constriction-Scarring of the pericardium squeezes and constricts the heart, preventing it from filling with the venous return from the body. This results in generalized swelling and weakness. It can be caused by prior pericarditis, radiation therapy to the chest and sometimes after open heart surgery. The diagnosis can be made by echocardiography, CT scans, MRI scans and cardiac catheterization. If the swelling cannot be controlled with diuretics, the pericardium can be stripped away surgically.
Pericardial Effusion-A build-up of fluid within the pericardium. It can be caused by pericarditis, tumors invading the heart, recent open heart surgery and an underactive thyroid gland. The diagnosis is made by echocardiography, CT scan or MRI scan. If the effusion is large or symptomatic and does not adequately resolve with treatment of the underlying cause, the fluid may be drained out-either by inserting a needle through the skin under a local anesthetic or by a minor surgical procedure.
Pericardial Tamponade-When a pericardial effusion exerts pressure on the chambers of the heart, it may impair the return of blood to the heart. This, in turn, impairs the ability of the heart to pump blood out to the body. This results in low blood pressure, a rapid pulse, shortness of breath and weakness. The diagnosis is made by echocardiography or cardiac catheterization. The treatment is urgent drainage of the fluid-either by inserting a needle through the skin under a local anesthetic or by a minor surgical procedure-as well as treating whatever caused the fluid to build up in the first place.
Pericarditis-Inflammation of the pericardium. It may be caused by a viral infection of the pericardium, a systemic inflammatory process such as Lupus, and recent open heart surgery. Sometimes, no cause can be discovered.
The typical symptom is chest pain that is worse as the patient breathes in and worse when lying down. Fevers, palpitations and shortness of breath may also occur. Echocardiograms can be used to determine if there is an accompanying pericardial effusion. The diagnosis is typically made on the basis of the patient's symptoms, a characteristic sound from the heart heard with the stethoscope, called a rub, and by blood tests.
Pericarditis is generally treated with anti-inflammatory agents such as aspirin, nonsteroidal anti-inflammatory agents such as ibuprofen or steroids. Frequently recurrent cases can be treated with colchicine. Rare bacterial infections of the pericardium are treated with antibiotics and surgical drainage of the associated pericardial effusion.
Pericardium-Tissue around the heart that folds back on itself to forms a sac. It provides a frictionless surrounding for the beating heart and helps prevent the heart from moving excessively within the chest. It is not essential for life and can be surgically removed in its entirety if diseased.
Phlebitis-see Deep Veous Thrombosis.
Pulmonary Embolism-See the above discussion of deep venous thrombosis. If the blood clot breaks off from the vein in the leg, it will travel to the right side of the heart and then lodge in a blood vessel of the lung, preventing the flow of blood through that vessel. This manifests as chest pressure or pain that is often worse when the patient breathes in, shortness of breath, low blood pressure and arrhythmias. This can result in sudden death. The diagnosis is made by a nuclear medicine test called a ventilation-perfusion lung scan, spiral CT scan of the chest or a pulmonary artery angiogram. The initial treatment may include clot dissolving agents, as well as anticoagulants such as heparins. Long term treatment is with the oral blood thinning agent warfarin. Sometimes a filter is placed in the main vein that returns blood to the heart from the lower body (the inferior vena cava) to prevent recurrent blood clots from traveling to the lungs. Rarely, surgery is needed to remove the blood clots from the arteries of the lungs.
Pulmonary Hypertension-Elevated blood pressure in the blood vessels of the lungs. It can be caused by many different diseases of the heart and lungs as well as pulmonary emboli, certain systemic inflammatory conditions and certain medications. It sometimes occurs for no apparent cause.Treatment is directed at the underlying cause, if there is one. Otherwise, the options include a calcium channel blocker called nifedipine, an ACE inhibitor called captopril, a medicine called prostacyclin (iloprost) which may be inhaled or given intravenously or a lung transplant.
Pulmonic Valve-The right venticle pumps blood through this valve into the lungs. It is composed of three cusps. When the right ventricle is finished ejecting blood, this valve closes so that blood does not leak backwards from the lungs to the right ventricle as the right ventricle fills with blood from the right atrium for the next heart beat.
Pulmonic Valve Regurgitation-Leakage of the pulmonary valve. The blood flows backwards from the lungs to the right ventricle. This can lead to weakness and swelling.
Pulmonic Valve Stenosis-An inability of the pulmonic valve to open fully, making it difficult for the right ventricle to pump blood to the lungs. If severe, it can be treated with surgery or balloon valvuloplasty.
Regurgitation-When a heart valve does not close properly, the blood leaks backwards through the valve.
Restenosis-The recurrence of an arterial narrowing (stenosis) after an angioplasty or stent procedure.
Rheumatic Heart Disease-Rheumatic fever is caused by a streptococcal bacterial sore throat. If this is not treated promptly with antibiotics, an immune reaction to the bacteria begins that also damages the heart. This most commonly results in stenosis and regurgitation of the valves of the heart. Acute rheumatic fever also causes arthritis, rashes and involuntary jerking motion of the body. The diagnosis is made by blood tests. Mild attacks are treated with aspirin. More severe attacks are treated with steroids. The management of the chronic valvular problems that develop is discussed under the heading for each valve on this page.
Shock-This medical term does not refer to an emotional state. Instead, it refers to a systolic blood pressure (that's the upper number of the blood pressure) less than 90 in association with symptoms due to decreased blood flow to the various organs in the body. Such symptoms can include impaired thinking or loss of consciousness and decreased urine output.
Shock can be caused by many things including hemorrhage, dehydration, many types of heart disease, infections and drug overdoses.
Some rare people naturally run a systolic blood pressure less than 90 without the above mentioned symptoms. That is not shock.
Shortness of Breath-see dyspnea and orthopnea
Sinus Bradycardia-This refers to a slowing of the generation of the electrical impulses that cause the heart to beat. These impulses arise from a site high in the right atrium called the sinoatrial or SA node. If the bradycardia is severe and symptomatic, treatment with a pacemaker is required. Other reversible causes including low oxygen levels and medication side effects should first be excluded before a pacemaker is implanted.
Stenosis-This refers to either a narrowing of a blood vessel (most commonly due to atherosclerosis) or to an inability of a heart valve to open fully.
Stroke-see cerebrovascular accident
Supraventricular Tachycardia-This is an arrhythmia where the heart beats abnormally fast. The mechanism is most commonly due to extra conduction tissue at the atrioventricular node-the part of the heart's electrical conduction system which sends the electrical signal generated in the upper chambers of the heart down to the lower chambers. The symptoms can include palpitations, chest discomfort, shortness of breath and fainting. Diagnosis is made by recording the ECG during the event. Treatment includes such antiarrhythmic medications as beta blockers, calcium blockers or digoxin, as well as radiofrequency ablation.
SVT-see supraventricular tachycardia.
Syncope-This means fainting. Fainting and near fainting can be caused by many things. Heart disease can cause fainting by impairing the blood flow to the brain. The heart diseases that most commonly cause this are certain types of arrhythmias and aortic stenosis. A very common form of syncope, called vasovagal or neurocardiogenic syncope is discussed on the page on Tilt Table Testing. A normal pulse and blood pressure during any episode of fainting and near fainting pretty reliably excludes the heart as the cause. Other possible causes include noncardiac causes of low blood pressure such as hemorrhage, dehydration and medications; neurologic disorders and psychiatric disorders. Sometimes, no cause can be found. When a person faints for no apparent reason, their heart rhythm is usually monitored for a period of time, often in the hospital. An echocardiogram and a tilt table test may be performed. Rarely, electrophysiologic testing is required.
Systole-The portion of the cardiac cycle when the main pumping chambers, the ventricles, are ejecting blood.
Systolic Blood Pressure-The upper higher number of the blood pressure. It should be less than 140.
Tachycardia-A rapid heart rate (greater than 100 beats per minute).
Transient Ischemic Attack-Similar to a cerebrovascular accident but the symptoms resolve fully within 24 hours.
Tricuspid Valve-This valve is composed of three leaflets and connects the right atrium to the right ventricle. It is closed when the right ventricle is ejecting blood up to the lungs so that no blood goes backwards to the right atrium. After the right ventricle finishes ejecting blood, the tricuspid valve opens to allow the right ventricle to fill with blood for the next ejection.
Tricuspid Valve Regurgitation-The tricuspid valve is unable to close properly and blood leaks backwards from the right ventricle to the right atrium. This results in swelling and weakness. Tricuspid regurgitation is most commonly caused by high blood pressure in the blood vessels of the lungs, which in turn is due to myriad diseases of the heart and lungs. Primary disease of the tricuspid valve is rare. The most common cause is rheumatic heart disease. The diagnosis is made by echocardiography. Open heart surgery to repair or replace the valve may be required.
Tricuspid Valve Stenosis-The tricuspid valve is unable to open fully. Blood cannot drain properly from the right atrium to the right ventricle. The right atrium becomes engorged with blood and the veins cannot bring blood back to the heart fast enough. This results in swelling and weakness. The diagnosis is made by echocardiography. Open heart surgery to repair or replace the valve may be required.
Unstable Angina-This is caused by a process in the coronary artery similar to what is described above for a myocardial infarction, except that the blood clot in the artery does not totally occlude the artery. It is characterized by a sudden worsening of a previously stable anginal pattern or by the new onset of angina occurring with minimal or no provocation. The anginal is typically more intense and prolonged than in stable angina and more resistant to treatment with nitroglycerin.
This condition require hospitalization. ECGs and cardiac enzymes are performed to insure this is not a frank heart attack. The condition is stabilized with antiplatelet agents, anticoagulants, nitrates and beta blockers. Diagnostically, an angiogram or (after stabilization) a stress test is often performed to confirm whether or not the presenting symptoms were truly from the heart and if so, whether an angioplasty or bypass operation is needed.
Varicose Veins-These are dilated veins in the legs that do not drain the blood out of the legs properly. They occur with aging and are accelerated by pregnancy and phlebitis (deep venous thrombosis). The main symptoms are leg swelling, aching in the calves with standing, a skin rash on the legs and a breakdown of the skin near the ankles. The first treatment is usually leg elevation and elastic stockings. Swelling that does not respond to these measure may respond to diuretics. Finally, surgical vein stripping can be performed.
Ventricle-The two lower chambers of the heart are called the right and left ventricles and the two upper chambers are called the right and left atria. See the discussion of Atrium above for a discussion of how the 4 valves and chambers of the heart work together.
Ventricular Premature Beats-An isolated, early or premature beat that arises from the lower chambers of the heart, the ventricles. By itself, it is often quite benign. If it causes palpitations that are frequent or intolerable, they can be suppressed by beta blockers or other antiarrhythmic medications.
Ventricular Tachycardia-This is a rapid heart beat generated from an abnormal electrical site in the ventricles. In association with certain other heart diseases, its presence confers an increased risk of fainting or dying. In these situations, it can be treated with antiarrhythmic medications or cardioverters/defibrillators.
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