Heart Disease

The heart beats about 2.5 billion times over the average lifetime, pushing millions of gallons of blood to every part of the body. This steady flow carries with it oxygen, fuel, hormones, other compounds, and a host of essential cells. It also whisks away the waste products of metabolism. When the heart stops, essential functions fail, some almost instantly.

Given the heart's never-ending workload, it's a wonder it performs so well, for so long, for so many people. But it can also fail, brought down by a poor diet and lack of exercise, smoking, infection, unlucky genes, and more.

A key problem is atherosclerosis. This is the accumulation of pockets of cholesterol-rich gunk inside the arteries. These pockets, called plaque, can limit blood flow through arteries that nourish the heart — the coronary arteries — and other arteries throughout the body. When a plaque breaks apart, it can cause a heart attack or stroke.

Although many people develop some form of cardiovascular disease (a catch-all term for all of the diseases affecting the heart and blood vessels) as they get older, it isn't inevitable. A healthy lifestyle, especially when started at a young age, goes a long way to preventing cardiovascular disease. Lifestyle changes and medications can nip heart-harming trends, like high blood pressure or high cholesterol, in the bud before they cause damage. And a variety of medications, operations, and devices can help support the heart if damage occurs.

Heart diseases include:

  • coronary artery disease: the accumulation of cholesterol-filled plaque in the arteries that nourish heart muscle
  • heart attack (myocardial infarction): the sudden stopping of blood flow to part of the heart muscle
  • heart failure: the inability of the heart to pump as forcefully or efficiently as needed to supply the body with oxygenated blood
  • heart rhythm disorders: heartbeats that are too fast, too slow, or irregular
  • heart valve disorders: problems with the valves that control blood flow from one part of the heart to another part of the heart or to the body.
  • sudden cardiac arrest: the sudden cessation of the heartbeat
  • cardiomyopathy: a disease of the heart muscle that causes the heart to become abnormally enlarged, thickened, and/or stiffened
  • pericarditis: inflammation of the pericardium, a thin sac that surrounds the heart
  • myocarditis: inflammation of the myocardium, the middle layer of the heart wall
  • congenital heart disease: heart diseases or abnormalities in the heart's structure that occur before birth

Heart Disease Articles

New view of heart disease in women

A landmark study found that women are susceptible to a different type of heart disease called microvascular dysfunction. It affects both larger and smaller blood vessels, but is not detected by the standard cardiac tests. More »

Gender matters: Heart disease risk in women

We've come a long way since the days when a woman's worry over heart disease centered exclusively on its threat to the men in her life. We now know it's not just a man's problem. Every year, coronary heart disease, the single biggest cause of death in the United States, claims women and men in nearly equal numbers. In a survey conducted by the American Heart Association, about half of the women interviewed knew that heart disease is the leading cause of death in women, yet only 13% said it was their greatest personal health risk. If not heart disease, then what? Other survey data suggest that on a day-to-day basis, women still worry more about getting breast cancer — even though heart disease kills six times as many women every year. Why the disconnect? Breast cancer affects body image, sexuality, and self-esteem in ways that a diagnosis of heart disease does not. Also, heart disease tends to show up at an older age (on average, a woman's first heart attack occurs at age 70), so the threat may not seem all that real to younger women. Most 50-year-old women know women their age who've had breast cancer but none who've had heart disease. More »

Are erectile dysfunction pills safe for men with heart disease?

In men without cardiovascular disease, erectile dysfunction (ED) pills are very safe. The three rivals -- Viagra, Cialis, and Levitra -- have similar side effects, including headache, facial flushing, nasal congestion, diarrhea, backache, and, in a few Viagra or Levitra users, temporary impaired color vision (men with retinitis pigmentosa, a rare eye disease, should check with their ophthalmologists before using these medications). Headaches and blue vision are one thing, cardiac abnormalities, quite another. Are ED pills safe for the heart? These drugs are safe for healthy hearts, but all men with cardiovascular disease should take special precautions, and some cannot use them under any circumstances. The problem is their effect on arteries. All arteries, not just those in the penis, generate nitric oxide, so any artery can widen in response to Viagra, Levitra, or Cialis, causing blood pressure to drop temporarily by 5-8 mmHg, even in healthy men. More »

Heart disease and erectile function

Men: Don't be surprised if a discussion with your doctor about erection problems veers into a talk about your heart, or vice versa. Problems getting or keeping an erection may be a red flag for heart trouble down the road, and many men with heart disease have sexual concerns they aren't talking about. The connection between heart disease and erection problems (doctors call it erectile dysfunction) isn't far-fetched at all. Both follow the same age-related trajectory and become increasingly common from age 45 onward. They even share common causes. A study of middle-aged California men begun many years ago shows that smoking, overweight, and high cholesterol or high triglycerides — all risk factors for heart disease — were also linked with erection problems 25 years later.  More »

When You Visit Your Doctor - After a Heart Attack

Have you had chest pain or pressure since you were discharged from the hospital? How severe is it? How long does it last? Does it stay in your chest or radiate to other parts of your body? Did you have this pain before your heart attack? What brings it on? How frequently do you get it? What were you doing just prior to the chest pain? Do you ever get chest pain or pressure at rest? What relieves the chest pain? If you take nitroglycerin, how many doses do you usually need to take before the pain goes away? How often do you take nitroglycerin? Do you get short of breath when you lie down or exert yourself? Do you awaken in the middle of the night short of breath? Do your ankles swell? Do you ever feel lightheaded? Have you fainted? Do you get rapid or pounding heartbeat for no reason? Do you know what each of the medications you are taking does? Do you know the side effects of each medication? Are you having any side effects? Are you taking an aspirin every day? Are you doing everything you can to modify the risk factors that can worsen your coronary artery disease (cigarette smoking, high blood pressure, high cholesterol, and diabetes are the most important risk factors)? Are you participating in a supervised exercise program? Are you resuming your normal activities? Are you sexually active? Have you returned to work? Have you been feeling depressed since your heart attack? Have you been able to reduce the stress in your life? Have you been fatigued? Heart rate, blood pressure, and weight Pulses in your wrist, groin, and feet Listen over the major arteries in the neck, groin, and feet (for abnormal noises) Look at the veins in the neck to see if there is extra fluid in your body Heart and lungs Ankles and legs (for swelling) Blood tests for glucose, lipid panel (cholesterol levels) and C-reactive protein (CRP) Electrocardiogram Echocardiogram Exercise stress test   More »

When You Visit Your Doctor - Heart Block

Have you been dizzy or lightheaded? Have you fainted? Have you been fatigued? Have you had chest pain? Do you get it with exertion or at rest? How frequently do you get it? How long does it last? What brings it on? What relieves it? Is this a change from your usual pattern? Do you get short of breath when you lie down or exert yourself? Do you awaken in the middle of the night short of breath? Do your ankles swell? Do you get rapid or pounding heartbeats for no reason? What medications are you taking (including over-the-counter medications, herbal remedies, and vitamins)? Do you have any other medical problems? Heart rate, blood pressure, and weight Pulses in the wrist and feet Veins in the neck Heart and lungs Ankles and legs (for swelling) Electrocardiogram Echocardiogram Holter monitor Electrophysiologic testing   More »

When You Visit Your Doctor - Mitral Valve Prolapse

Have you had an echocardiogram? What did it show? Does your mitral valve leak? Do you get chest pain? What brings it on? How long does it last? What relieves it? Do you ever get a rapid or pounding heartbeat (palpitations) for no reason? How long does it last? Do you feel faint or develop chest pain or shortness of breath? Have you ever fainted? Do you get short of breath when you lie down or exert yourself? Have you ever taken any medications for your heart? Did you develop any side effects from these medications? Heart rate, blood pressure, and weight Heart (sometimes while you are standing, squatting, or performing other maneuvers) Lungs Electrocardiogram Echocardiogram Holter monitor or event monitor   More »

When You Visit Your Doctor - Peripheral Artery Disease

Do you develop pain, cramps, aches, fatigue, or numbness in your leg muscles when you walk? At what distance do you develop symptoms? Do they go away when you stop walking? Do you ever develop these symptoms at rest? Do you have decreased sensation in your feet? If you are a man, do you have erectile dysfunction? Are you doing everything possible to modify the risk factors that can worsen this disease (smoking cessation, treating elevated blood pressure and cholesterol, and controlling diabetes)? Are you exercising regularly and at progressively more strenuous levels? Are you taking an aspirin every day? If you have diabetes, do you practice meticulous foot care (cleaning, applying moisturizing lotions, and wearing well-fitting protective shoes)? Do you know when to seek emergency medical care for peripheral artery disease (if your leg becomes suddenly painful, pale, cold and numb)? Do you get chest pain or pressure with exertion or at rest? If so, you may have coronary artery disease. Do you have sudden brief episodes of blindness (like a shade being pulled over your eyes) or sudden episodes of weakness in an arm or leg, or difficulty speaking? These could be warning symptoms of stroke. Heart rate, blood pressure, and weight Pulses in your feet and groin, and behind your knees Listen with the stethoscope over your carotid arteries in your neck Heart and lungs Neurologic exam (reflexes and sensation in your legs) Muscles (looking for atrophy in leg muscles) Skin, looking for changes related to reduced circulation Blood tests, including glucose and cholesterol levels Ultrasound of your carotid arteries Doppler Ankle-Arm Indices Exercise Stress Test MRI/MRA Angiography   More »