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Diseases
Diagnostic Methods
Drug Treatments
Interventions
Diseases
angina
pectoris—Chest discomfort (usually described as
pressure or pain) occurring beneath the breastbone when
the heart is not getting enough oxygen. Typically, it
occurs with exercise or emotional stress, lasts only
a few minutes, and goes away with rest. Angina pectoris,
or simply "angina," results when blood flow
to the heart muscle is inadequate because heart arteries
have been narrowed by cholesterol deposits or when there
is an imbalance between oxygen demand and oxygen supply
caused by hypertension or valvular disease.
arrhythmia—See
cardiac arrhythmia.
atherosclerosis—A
gradual process that occurs when cholesterol collects
under the inner lining of artery walls due to damage
from uncontrolled high blood pressure, smoking, diabetes,
or high blood cholesterol. The deposits (cholesterol
plaques) eventually result in fibrosis and calcification,
which may narrow or block the artery and hinder blood
flow. Also called "hardening of the arteries," the disease
can produce angina pectoris, heart attack, or stroke.
atrial
fibrillation—See fibrillation.
calcification—A
process that occurs when tissue or noncellular material
in the body becomes hardened by deposits of calcium
salts.
cardiac
arrhythmia—Irregularity of the heartbeat caused
by damage to or defect in the heart tissue and its electrical
system. Three common types of arrhythmia are: 1) very
rapid ventricular contractions (tachycardia) that don’t
pump enough blood flow to other organs; 2) an excessively
slow heartbeat (bradychardia); or 3) most common, extra
or "premature" beats.
cardiomyopathy—A
disorder that appears in several forms and results in
weakening of the heart muscles. The heart enlarges,
its chambers become enlarged, and the left ventricular
wall becomes thin. Cardiomyopathy may be caused by viruses,
alcohol, or an inherited defect.
cerebrovascular
accident—See stroke.
CHF—See
congestive heart failure.
congenital
heart disease/defects—A range of mild to serious
heart abnormalities existing at birth. Congenital heart
disease, which can be caused by heredity or by damage
to the developing fetus, often involves malformations
of the heart valves or abnormal blood flow between the
right and the left heart chambers.
congestive
heart failure (CHF)—A potentially lethal
condition produced by a heart attack, poorly controlled
hypertension, or cardiomyopathy. If the left chambers
of the heart fail, then blood backs up into the lungs,
causing congestion there. If the right chambers of the
heart fail, then blood backs up into the legs and the
liver, causing congestion and swelling (called edema).
Often, both sides fail simultaneously. Most forms of
heart disease, including valvular and pericardial disease,
eventually lead to congestive heart failure. Some forms
of congestive heart disease damage the blood vessels
causing "cor pulmonale."
coronary
artery disease—See ischemic heart disease.
coronary
heart disease—See ischemic heart disease.
cor
pulmonale—Enlargement and eventual failure of the
right ventricle of the heart. Cor pulmonale is caused
by lung disease. When a lung disease, such as emphysema,
destroys lung blood vessels, the right side of the heart
must exert more effort to pump blood into the lungs.
Eventually, the right ventricle fails.
diabetes
mellitus—A metabolic disease caused by an absolute
or a relative deficiency of insulin, a hormone that
controls how the body processes glucose, protein, and
fats. When the body's insulin supply is decreased, it
cannot process carbohydrates and it compensates by overprocessing
fats and protein. The condition is characterized by
chronic high blood sugar and sugar in the urine. Diabetes
mellitus can result in coma. Over time, complications
can include nerve injury, blindness, kidney failure,
and premature atherosclerosis with all of its complications.
fibrillation—Abnormal
uncontrolled rapid contraction of the fibers in the
heart. When the process involves the two upper chambers
of the heart (the atria), the condition is called "atrial
fibrillation." When it involves the lower, ventricular
chambers, the condition is called "ventricular
fibrillation."
fibrosis—A
process producing scar tissue that forms as a reaction
to injury or during a healing process.
heart
attack—A medical emergency that occurs when a blood
clot forms suddenly in a heart artery and causes a blockage,
usually after the surface of cholesterol plaque in the
artery breaks. A heart attack, also called a myocardial
infarction, usually produces chest pain and shortness
of breath. It may also cause sudden death. If nothing
is done to reopen the blocked artery, the heart muscle
will die and be replaced by scar tissue. More than one
million heart attacks occur every year in the United
States; it is the leading cause of death from heart
disease. Most of these deaths occur outside the hospital.
heart
failure—See congestive heart failure.
high
blood pressure—A condition that occurs when increased
resistance to blood flow through small blood vessels
(arterioles) forces the heart to work harder. When the
heart has to pump harder, the blood travels through
the arteries at a pressure that can damage the inside
walls of blood vessels. High blood pressure affects
some 50 million Americans, its incidence increases with
age, and it is more common among African Americans and
older women. High blood pressure can lead to heart,
brain, kidney, and eye damage, and it increases the
likelihood of stroke and congestive heart failure if
is not treated. These risks are significantly reduced
with proper treatment. High blood pressure is also called
hypertension.
high
cholesterol—See hyperlipidemia.
hyperlipidemia—An
abnormally large amount of lipids (fats) in the circulating
blood. The major components are high-density cholesterol
(HDL), also known as good cholesterol; and low-density
cholesterol (LDL), also known as bad cholesterol; and
triglycerides (TG). Hyperlipidemia is commonly referred
to as high cholesterol.
hypertension—See
high blood pressure.
infective
endocarditis—Inflammation of the innermost covering
of the four valves of the heart (the endocardium). Infective
endocarditis is usually caused by bacteria that have
lodged on the valve and reproduced. People who have
a malformed heart or heart valves are at risk and should
use appropriate prophylactic antibiotics (e.g., amoxicillin)
during procedures such as dental work. Prolonged intravenous
antibiotics are required to treat the disease, and often
heart valve surgery is required.
ischemic
heart disease—A serious problem caused by inadequate
circulation of blood to the heart muscle. Blood flow
to the heart is blocked by obstructions of heart arteries
by cholesterol deposits. Ischemic heart disease is the
underlying disorder for sudden episodes such as heart
attack and sudden death as well as the chronic condition
of angina pectoris. Ischemic heart disease is also called
coronary artery disease or coronary heart disease.
myocardial
infarction—See heart attack.
stenosis—See
valvular heart disease.
stroke—A
medical event that results from sudden blockage of the
blood supply to the brain. The blockage may destroy
brain tissue, thereby producing paralysis, loss of speech,
loss of consciousness, or other serious abnormalities
of the nervous system, on one side of the body.
sudden
death—Death that occurs less than one hour from
the onset of a cardiac event and is unexpected. Sudden
death usually is caused by an abnormal heart rhythm
(ventricular fibrillation) that develops during a heart
attack. Thanks to modern community emergency medical
services, up to one-quarter of such fatalities can be
avoided by emergency squads performing external defibrillation
before the heart attack victim is transported to the
hospital.
TIA—See
transient ischemic attack.
transient
ischemic attack (TIA)—A temporary reduction of blood
flow to the brain. Depending on which portion of the
brain is deprived of blood, a TIA may result in: 1)
vision problems (either a loss of vision or double vision),
2) speech problems (difficulty with speaking or slurring
of words), or 3) sensation problems (an arm or a leg
may feel clumsy). None of these symptoms lasts for more
than a day. Because a third of those who suffer TIA
will have a stroke within five years, physicians see
TIA as a warning.
valvular
heart disease—A heart condition caused when any
of the four major valves that regulate the flow of blood
through the heart and to the lungs is damaged or diseased.
General circulation becomes obstructed (called stenosis)
or leaky (called regurgitation), so the volume of blood
circulated to the body is limited. The heart must pump
harder to move blood forward, and sometimes the blood
flows back into the heart. Valvular heart disease is
also called heart valve disease.
ventricular
fibrillation—See fibrillation.
Diagnostic
Methods
blood
lipid analyses—Tests to measure the level of fats
in the blood—such as total cholesterol, low-density
"bad" cholesterol (LDL), high-density "good"
lipoprotein (HDL) cholesterol, and triglycerides (TG).
Abnormal levels of these blood fats can indicate risk
of ischemic heart disease. Blood lipid measurements
should begin early in life, preferably in the preteen
years, especially if there is family history of atherosclerosis.
Blood lipid analyses should be performed after a 12-hour
fast.
blood
pressure measurement—A measure of the force of blood
flow against artery walls. The measurement is taken
with an instrument consisting of an inflatable cuff,
inflating bulb, and a gauge (called a sphygmomanometer).
The sphygmomanometer is placed around the upper arm
and measures blood pressure as it flows through the
arteries. Many automated devices are available so patients
can measure blood pressure at home.
CCU—See
monitoring in the CCU.
cardiac
catheterization—The process of passing a flexible
tube or catheter into the heart through a vein or an
artery to withdraw samples of blood, measure pressures
within the heart chambers or vessels, and inject X-ray
contrast materials to view the heart. Cardiac catheterization
is used to evaluate congenital heart disease and ischemic
heart disease.
coronary
angiography—An X-ray movie of the heart arteries
that uses X-ray contrast material. The X-ray is taken
after inserting a catheter into an artery at the groin
or elbow and guiding it through the aorta and then into
a coronary artery, where the contrast agent is injected.
The contrast agent makes the artery—and any obstructions
or abnormalities—visible on the X-ray image. A similar
process can be used to obtain an image of the mitral
and aortic valves and the functioning of the left side
of the heart.
coronary
care unit (CCU)—During heart emergencies,
patients should be taken to a hospital coronary unit,
or a CCU, for constant supervision by instruments and
nursing staff and continuous electrocardiogram, ECG,
monitoring. This type of monitoring often includes continuous
computerized analysis and an alarm system for abnormal
rhythms. In addition, special catheters can be inserted
to monitor pressure in the heart and the arteries.
ECG—See
electrocardiography/electrocardiogram.
echocardiography—A
noninvasive cardiac imaging procedure, developed in
the 1960s, now widely used to diagnose congenital heart
disease, valve disorders (valvular heart disease), weakened
heart muscle (cardiomyopathy), fluid around the heart,
and other abnormalities or defects. Echocardiography
uses an ultrasound machine, which bounces sound waves
at tissues of the heart and records an image using the
patterns made by reflected sound (or "echoes")
from the heart tissue. Echocardiography has been a major
advance in managing all types of heart disease.
electrocardiography/electrocardiogram
(ECG)—A method of recording the electrical currents
that pass through the heart muscle during each heartbeat.
To record a typical ECG, electrodes are attached to
the arms and legs, and the electrical pulses are recorded
as the patient relaxes on an examining table. The Holter
monitor, a portable device, takes a continuous ECG during
an extended period and provides physicians with information
about a patient’s heart rhythm during a full day of
normal activity to aid in detecting rhythm disturbances.
Newer devices allow patients to activate a portable
recorder whenever they suspect an abnormal heart rhythm.
This test is also referred to as an EKG because the
procedure was developed in the Netherlands and was first
called an "electrokardiogram."
electrophysiologic
studies (EPS)—Invasive procedures used to
record electrical activity to the heart. In EPS procedures,
electrode catheters are guided into the heart chambers
to measure how the heart conducts impulses from one
area to another so a cardiologist can map the heart’s
electrical functioning. EPS procedures are used when
an electrocardiogram or other tests are inconclusive
in diagnosing a cause for unexplained dizziness, fainting,
or palpitations in high-risk patients. The electrodes
may be used to trigger or simulate a patient’s abnormal
heart rhythms to help define the cause and treatment.
Cardiologists may also use the EPS to administer medications
and see their effects on the rhythm problem. The EPS
procedure can be used to destroy abnormal short circuits
in the heart muscle that produce cardiac arrhythmias
by applying high frequency radio waves directly on the
heart muscle (see catheter ablation).
EPS—See
electrophysiologic studies.
Holter
monitor—See electrocardiography/electrocardiogram.
invasive
procedure—A medical examination that involves entry
into the body either by incision or by insertion of
an instrument through the skin.
noninvasive
procedure—A medical examination that does not involve
penetration of the skin, except needle sticks.
nuclear
myocardial imaging—A test in which tracer agents
(radionuclides) are injected into the blood stream and
allowed to travel to the heart. Special cameras can
detect the blood flow through the heart and heart-muscle
contractions. Other isotopes are detected only in healthy
heart muscle, so cardiologists can use them to determine
the severity of a heart attack. Imaging abnormalities
also may occur during a stress test, allowing the diagnosis
of ischemic heart disease to be made from a relatively
noninvasive procedure.
sphygmomanometer—See
blood pressure measurement.
stethoscope—A
doctor's instrument for hearing internal body sounds.
Listening to sounds made by various cardiac structures
to identify abnormal heart valves, weakened heart muscle,
and congenital heart disease is called "auscultation."
stress
test—Studying the heart during exercise to identify
the presence of ischemic heart disease or the risk of
developing problems while doing strenuous activities.
The patient typically walks on a treadmill or peddles
a stationary bicycle while connected to an electrocardiograph
(ECG) machine. The ECG measures heart rhythms and can
suggest when the heart muscle is not receiving adequate
blood supply with exertion. To improve its accuracy,
a stress test is often accompanied by an imaging technique
(nuclear myocardial imaging or echocardiography). In
some instances, drugs may be used to simulate heart
activity during exercise. The stress test has three
primary uses: 1) It is particularly helpful for people
with cardiac risk factors who are about to begin an
exercise program, 2) it helps cardiologists evaluate
chest pain, 3) it can be used to evaluate the benefits
of treatment over time.
Drug
Treatments
amiodarone—A
drug used to control an irregular heartbeat, or cardiac
arrhythmia. Although amiodarone is one of the safest
and most effective anti-arrhythmic drugs, it must be
carefully monitored for long-term side effects.
amoxicillin—A
semisynthetic penicillin antibiotic often used to prevent
infective endocarditis after dental procedures in some
patients.
Angiotensin-converting
enzyme (ACE) inhibitors—Drugs that
help prevent narrowing of arteries by blocking formation
of angiotensin II (a protein that narrows the blood
vessels) and by allowing the blood vessels to open properly
and blood pressure to drop. ACE inhibitors have four
uses: 1) treating high blood pressure, 2) helping the
heart heal after a heart attack, 3) possibly preventing
future attacks, and 4) alleviating the symptoms of congestive
heart failure (CHF) to prolong the lives of CHF patients.
aspirin—Acetylsalicylic
acid. Long used to treat pain, fevers, and inflammation,
aspirin is also known to prevent platelets from clumping
in the process of blood clot formation. As a result,
studies have shown that small, regular doses of aspirin
may help prevent heart attacks in: 1) people who have
ischemic heart disease, 2) people who are recovering
from coronary artery bypass graft surgery, and 3) people
who have no symptoms but are at high risk. Aspirin is
also used to prevent strokes and TIAs is people who
have been diagnosed with cardiovascular disease.
beta
blockers—Drugs often used after a heart attack to
relieve stress on the heart by "blocking"
the stimulating effect of the hormone adrenaline. When
adrenaline is blocked, the heart rate slows and irregular
heartbeats are prevented. Beta blockers also are used
to reduce high blood pressure and can prevent both sudden
death and recurrent heart attacks. Beta blockers are
the mainstay drug for treating angina pectoris.
calcium
channel blockers—Drugs that limit calcium entry
into the cells, where it stimulates contraction. When
calcium entry is limited, blood vessels become dilated
and the frequency and force of heart contractions are
decreased. Calcium channel blockers are used to: 1)
treat angina, 2) reduce blood pressure, and 3) suppress
certain cardiac arrhythmias.
cyclosporin—Immunosuppressant
medication used to prevent rejection of a transplanted
organ. Cyclosporin works to suppress the body’s natural
tendency to produce antibodies to attack the foreign
substance—such as a transplanted heart. Cyclosporin
has played a major role in the success of organ transplantation,
but one side effect has been a decrease in the body’s
ability to attack infections. See also cardiac transplantation.
digitalis—See
digoxin.
digoxin—One
of the oldest heart drugs. Digoxin has two uses: 1)
to treat congestive heart failure by increasing the
force of the heart’s contraction, and 2) to treat atrial
fibrillation, a heart rhythm abnormality, by slowing
transmission of the atrial electrical impulses (which
slows the heart rate) and restoring normal heart rate.
Digoxin is derived from the digitalis (foxglove) plant.
diuretics—Drugs
that increase the elimination of salt and water by the
kidneys, resulting in increased urine volume. Diuretics
are usually used to treat hypertension (high blood pressure)
and congestive heart failure.
dobutamine—A
synthetic, adrenaline-like drug that is used to improve
the function of the heart in patients with severe congestive
heart failure. Dobutamine must be given intravenously
and often for several days.
dopamine—A
drug that causes narrowing of the blood vessels. Dopamine
is used to treat patients who have abnormally low blood
pressure (e.g., those in shock). In low doses, dopamine
is used to open vessels leading to the kidneys and thus
increase urine output.
furosemide—A
diuretic that removes excess salt and water from the
body in the treatment of heart failure or hypertension,
it is also known by its generic name, lasix.
heparin—A
drug that inhibits blood clotting. Heparin must be given
intravenously or subcutaneously. New forms of heparin
offer many new applications, including home administration
by patients themselves. Heparin has three primary uses:
1) after heart attack to prevent clotting; 2) during
and following cardiovascular surgery to prevent clotting
and pulmonary embolism; and 3) as preventive therapy
against pulmonary embolism after other major surgical
procedures.
nitrates—Heart
drugs that may increase blood flow through the coronary
arteries. Nitrates may be given orally, intravenously,
or through the skin (via a patch) and are used to treat
angina pectoris and heart attack.
sotalol—A
drug used to control an irregular heartbeat, or cardiac
arrhythmia.
statins—Drugs
that interfere with the manufacture of cholesterol by
the liver and are used to treat high blood cholesterol
levels. Because statins may also promote reabsorption
of cholesterol deposits in the arteries, they are being
studied as a possible means to reverse atherosclerosis.
Cholesterol lowering by statins (e.g., pravastatin,
atorvastatin, simvastatin) has been a major breakthrough,
slowing the progression of atherosclerosis and reducing
heart attack and sudden death. They also decrease the
frequency of angina pectoris.
thrombolytic
agents (or drugs)—Intravenous drugs, including
streptokinase and tissue plasminogen activator (t-PA),
that break up blood clots in the cardiovascular system.
Thrombolytic agents, if given early, may prevent damage
to the heart from a heart attack.
warfarin—An
anticoagulant that prevents blood clots from forming.
Warfarin is used to prevent heart attacks and strokes
in patients with atrial fibrillation and artificial
heart valves.
Interventions
angioplasty—See
percutaneous transluminal coronary angioplasty (PTCA).
assist
devices—See left ventricular assist devices.
bypass
surgery—See coronary artery bypass graft (CABG)
surgery.
cardiac
transplantation—Replacement of a damaged or diseased
heart with a healthy heart from a donor who has died
of other causes. Patients who have end-stage heart disease
but who have good function of other vital organs may
be candidates for transplantation of a donor heart.
Each year, only 2,000–2,500 hearts become available,
but as many as 35,000 patients each year may be on waiting
lists for donor hearts for transplantation. Cardiac
transplantation surgery has become routine in medical
centers specializing in the field, with one- and five-year
survival rates topping 70 percent.
catheter
ablation—An invasive procedure used to treat rapid
heart beats, especially in Wolff-Parkinson-White (WPW)
syndrome. In WPW syndrome, an abnormal conduction pathway
between the atria and the ventricles causes electrical
impulses to pass rapidly to the ventricles, creating
rapid cardiac arrhythmias. A physician guides a catheter
with an electrode at its tip to the area of heart muscle
where there is abnormal electrical activity. The cardiovascular
specialist delivers a painless radiofrequency impulse
that eliminates a tiny area of muscle cells, abolishing
the "short circuit" that was causing the rapid
heartbeats. Catheter ablation can be used to treat other
types of arrhythmias as well. Catheter ablation is also
called radiofrequency ablation.
coronary
artery bypass graft (CABG) surgery—A type of operation
used to restore normal blood flow to the heart muscle
when arteries that supply blood to the heart are blocked
or narrowed. CABG surgery involves taking a short length
of blood vessel—often a vein from the thigh or the lower
leg or the internal mammary artery beneath the breastbone—and
using it to connect the diseased blood vessel beyond
the blockage site. CABG is the most common major surgery
performed in the United States; three-fourths of patients
today are still active 15 years after surgery. See also
open-heart surgery.
coronary
stent—A slender coil inserted into the blood vessel
to prevent it from narrowing. When fatty deposits have
built up on the interior walls of the heart arteries,
the passages become narrow, blood flow is reduced, and
angina pectoris results. Cardiologists perform angioplasty
to widen these arteries and restore circulation. After
the angioplasty, they may insert coronary stents.
external
defibrillator—A device used to deliver a direct-current
electric shock through the chest wall to restore a normal
beat to a heart in ventricular fibrillation.
heart
transplant—See cardiac transplantation.
ICD—See
implantable cardioverter defibrillator.
implantable
cardioverter defibrillator (ICD)—A battery-operated
device connected to the heart like a permanent cardiac
pacemaker. When the ventricles contract in an uncoordinated
manner so that blood is not pumped to the rest of the
body, a life-threatening rhythm disturbance (ventricular
tachycardia or ventricular fibrillation) results. To
prevent a recurrence of this problem, a thoracic surgeon
inserts an ICD. Whenever the ICD senses a rhythm disturbance,
it delivers a correcting shock inside the heart.
intraaortic
balloon pump—A device used when a patient develops
shock from a weak heart, usually after an acute heart
attack. An intraaortic balloon pump can temporarily
support patients and allow time for corrective heart
surgery or other treatment.
left
ventricular assist device—A surgically implanted
mechanism to help a weakened heart maintain its pumping
ability. This device is used in patients awaiting heart
transplant to slow the deterioration of their hearts
and keep them alive until the transplant occurs.
open-heart
surgery—Any operation in which the chest is opened
and a heart-lung machine is used to support the patient
while cardiovascular surgeons repair a heart abnormality.
Open-heart surgery is used for coronary artery bypass
graft (CABG) surgery, congenital defect repairs, and
heart valve replacement or repair.
pacemaker—See
permanent cardiac pacemaker.
percutaneous
transluminal coronary angioplasty (PTCA)—A procedure
to open blocked arteries in the heart (or elsewhere
in the body). A catheter is inserted into an artery
in the leg or the arm and guided into the mouth of a
coronary artery. A second, smaller catheter with a balloon
at the tip is inserted inside the first one and guided
to the obstruction, where the balloon is inflated and
deflated to widen that part of the artery and restore
blood circulation.
permanent
cardiac pacemaker—A surgically implanted device
to keep the heart from beating too slowly. Blackouts,
fainting, shortness of breath, and other symptoms caused
by slowed heartbeat or abnormal rhythm may be treated
by implanting a very small, battery-operated pacemaker
beneath the skin. Using a wire and an electrode guided
to the heart, the device stimulates the right side of
the heart. If the pacemaker senses that the heart rate
has slowed, it sends electrical impulses that restore
a sufficiently fast beat. Some pacemakers increase the
heart rate automatically during activity or stress,
and most newer models stimulate both the atrial and
the ventricular chambers to beat in normal sequence.
peripheral
vascular surgery—An operation to restore good circulation.
Three types of peripheral vascular surgery are commonly
done: 1) When narrowing or obstructions block the arteries
to the legs, calf pain, a limited ability to walk, and
mini-strokes (called transient ischemic attacks) can
result. Physicians operate to create a new path around
blocked blood vessels. 2) Patients with narrowing of
the major neck arteries to the brain from atherosclerosis
may undergo removal of the cholesterol deposit. Surgeons
call this procedure an endarterectomy. 3) Vascular surgeons
also replace a portion of the abdominal aorta that has
become dilated and whose walls have become thin before
the damaged vessels can rupture (called an aneurysm).
radiofrequency
ablation—See catheter ablation.
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