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.
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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.
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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.
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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.
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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.
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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. RETURN TO TOP -B- Bradycardia- A slow heart beat (less than 60 beats per minute) . RETURN TO TOP -C- 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.
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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 ….