Common Diagnoses

WHAT IS IT?

Inadequate oxygenation of cardiac muscle.

WHAT IS IT?

Atrial fibrillation (AF) is the most common heart rhythm disorder seen by doctors. It’s a big public health issue in terms of not only the sheer number of patients affected, but also by the fact that managing these specific arrhythmias (which is the medical name for heart rhythm problems) is expensive. 

Also Known As: A Fib, AF, Atrial Fib, auricular fibrillation, supraventricular arrhythmia, supraventricular tachyarrhythmia 

BASIC FACTS

The heart has an electrical system that controls both the speed and rhythm of each heartbeat. This electrical system is controlled by the autonomic nervous system, which also handles critical functions such as breathing and digestion — all those functions that need to happen automatically rather than under our conscious control. 

AF is a major risk factor for stroke (increasing stroke risk about 5-fold) with the absolute level of risk somewhat dependent on the number of additional risk factors for stroke in a given individual.

Patterns of AF

Doctors tend to label AF by its pattern of occurrence. Episodes that last seven days or less (often less than 24 hours) are called “paroxysmal AF” and they usually stop on their own.  However, when AF lasts longer than seven days, it is considered “persistent” and may require treatment before the episode stops. When AF lasts longer than a year it is considered “permanent”.  If an individual has two or more AF episodes, whether the arrhythmia stops on its own or must be stopped via therapy, the condition is considered “recurrent AF”.

By the Numbers

In the United States, about 2.2 million people have AF. This is the most common arrhythmia that doctors see in practice, and AF is the cause of about one-third of all hospitalizations related to cardiac rhythm problems. AF tends to occur more frequently in older people, primarily because the older you are, the more likely you are to have heart disease or other health problems.

CAUSES & RISK FACTORS

Some health conditions associated with AF include:

Acute conditions

One acute condition associated with AF is excessive alcohol consumption.

Other acute conditions relate to medical factors such as surgery, lung disease, asthma attacks, extreme body stress due to conditions such as pneumonia, or the occurrence of a metabolic disorder, such as hyperthyroidism (overactive thyroid gland). 

Chronic conditions

A number of chronic or long-term conditions also can lead to AF. For the most part, these consist of existing heart problems, such as congenital heart defects, particularly atrial septal defect, or heart valve diseases such as those related to prior rheumatic fever.

Age & Family

AF tends to occur more frequently in older people primarily because the older you are, the more likely you are to have heart disease or other health problems.

SIGNS & SYMPTOMS

Probably the most recognizable sign of AF is heart palpitations, where your heart beats so fast that you think it is racing and/or you can feel it thumping or flopping in your chest. It may be accompanied by chest pain; lightheadedness or dizziness, especially if you are exerting yourself; weakness; or shortness of breath, including difficulty breathing when lying down. AF symptoms will vary depending on the degree of pulse irregularity and resultant heart rate, underlying functional status, how long the AF lasts, and individual patient factors.

WHAT IS IT?

Coronary artery disease occurs when the arteries supplying the heart with oxygen and nutrients narrow and become blocked.

Also Known As: Atherosclerosis, Hardening of the Arteries

BASIC FACTS

The heart requires oxygen and nutrients so it can keep pumping, and this fuel is carried to the heart muscle within the blood that flows through the coronary arteries. So, the coronary arteries serve as fuel pipelines to the heart muscle. 

Atherosclerosis (the build up of “plaque”) is by far the commonest cause of blockages in our arteries.  When atherosclerosis affects the coronary arteries, it is referred to as “coronary artery disease” or CAD.

Patients with one or more risk factors for CAD are susceptible to the increased buildup of fatty deposits known as “atheroma”. This buildup begins to encroach upon the inner channel through which blood is flowing. 

CAUSES & RISK FACTORS

Risk factors for developing CAD include:

• Hyperlipidemia-high cholesterol level, particularly the “bad” component known as Low-Density Lipoprotein (LDL)
• High blood pressure 
• Diabetes
• Cigarette smoking
• Obesity
• Poor dietary habits
• Lack of exercise
• Strong family history of CAD
• Increasing age
• Stress and tension

SIGNS & SYMPTOMS

The most common symptom of coronary artery disease is “angina” or chest pain. If you have angina or any of the symptoms listed below that last for more than 5 minutes, CALL 9-1-1. These symptoms could be the signs of a heart attack (also called myocardial infarction or MI).

• Pain or discomfort in other areas of the upper body including the arms, left shoulder, back, neck, jaw, or stomach
• Difficulty breathing or shortness of breath
• Sweating or “cold sweat”
• Fullness, indigestion, or choking feeling (may feel like “heartburn”)
• Nausea or vomiting
• Light-headedness, dizziness, extreme weakness or anxiety
• Rapid or irregular heart beats

WHAT IS IT?

Heart failure does not mean that your heart has stopped working.  Heart failure refers to a large number of conditions that affect the structure or function of the heart, making it harder for the heart to supply sufficient blood flow to meet the body’s needs.

BASIC FACTS

Heart Failure occurs when one or more of the heart’s four chambers lose the ability to maintain proper blood flow.  This can happen because the heart can’t fill well enough with blood or because the heart can’t contract strongly enough to propel the blood with enough force to maintain proper circulation. In some people, both filling and contraction problems can occur.

Most heart failure patients experience shortness of breath and fatigue. However, because heart failure worsens over time, it is considered a chronic condition and may be underway before there is any obvious indication that something is wrong.

Chronic heart failure that has been stabilized can deteriorate due to any number of factors, such as an unrelated illness or heart attack. Known as acute decompensated heart failure (ADHF), it is the leading cause of hospitalization for patients over the age of 65 and is the most costly cardiovascular disease in Western countries. 

Edema

Fluid can build up in the feet, ankles, legs and elsewhere as a result of higher pressures in the lungs, especially when the right ventricle is affected.  Blood and fluid can back into the lungs because of failure of the left ventricle.  This is called pulmonary edema and may cause coughing, breathlessness with activities, and/or breathlessness when lying down. 

Most conditions that cause heart failure affect both sides of the heart to some degree and most frequently include some impairment of left ventricular function. 

CAUSES & RISK FACTORS

Some causes of Heart Failure Include:

Heart Valve Problems

Whether caused by disease, infection, or a defect present at birth, heart valve problems can also produce heart failure, as can irregular heartbeats (arrhythmias). Indeed, up to 40% of patients with heart failure experience a specific type of arrhythmia called atrial fibrillation and individuals with this combination of heart problems are at high risk for cardiac death.

Diabetes

Because it increases one’s risk of developing hypertension and coronary artery disease, Diabetes is another major contributor to the development of heart failure. In this case, gender makes a big difference in risk. According to the current American College of Cardiology (ACC) guidelines, diabetes only modestly increases the risk of heart failure for men, but it increases the relative risk of heart failure more than 3-fold among women.

Sleep Apnea

Sleep apnea, which affects one’s breathing and reduces the amount of oxygen to the heart, does not necessarily cause heart failure but it can make it worse by increasing the heart’s workload.

SIGNS & SYMPTOMS

The most common signs and symptoms of heart failure include:

• Shortness of breath or trouble breathing
• Fatigue, tiredness
• Swelling in the ankles, feet, legs, and abdomen; occasionally in neck veins.

An individual with heart failure should focus on lifestyle changes. Controlling high blood pressure and weight are critical to improving the disease.  A heart-healthy diet and increased physical activity or exercise can help. Your diet should be low in sodium, which not only stabilizes blood pressure levels but can also help reduce swelling (edema) in your legs, feet, and abdomen.

NOTE: HF-ACTION—a recent large-scale trial of patients with mild to severe heart failure symptoms—placed half of the patients into an aerobic exercise program versus the other half, who simply had usual care. Those that exercised improved the amount of activity they could perform — enhancing the ability to perform day-to-day activities — plus they reported an improved sense of well-being.

WHAT IS IT?

High blood cholesterol (ko-LES-ter-ol), is when too much cholesterol is in your blood.

Also Known As: Hypercholesterolemia, Hyperlipidemia

BASIC FACTS

Cholesterol is a fat-like substance that is made in your body. Cholesterol is also in some foods that you eat. Your body needs some cholesterol to work the right way. Your body makes all the cholesterol it needs.Too much cholesterol in the blood is called high blood cholesterol or hypercholesterolemia.

CAUSES & RISK FACTORS

Eating too much saturated fat and cholesterol raises the level of cholesterol in your blood.  Too much cholesterol in your blood can build up in the walls of arteries. This is called plaque. 

Triglycerides are a type of fat in the bloodstream and fat tissue. Triglycerides can also raise your risk for heart disease. If you have levels that are borderline high (150–199 mg/dL) or high (200 mg/dL or more), you may need treatment. Things that can increase triglyceride levels include:

• Overweight
• Physical inactivity
• Cigarette smoking
• Excessive alcohol use
• Very high carbohydrate diet
• Certain diseases and drugs
• Genetic disorders

SIGNS & SYMPTOMS

There are no signs or symptoms of high cholesterol.  High cholesterol is diagnosed by checking the cholesterol levels in your blood. 

WHAT IS IT?

High blood pressure (HBP), or hypertension, is a serious condition that can lead to coronary heart disease, heart failure, stroke, kidney failure, and other health problems. “Blood pressure” is the force of blood pushing against the walls of the arteries as the heart pumps out blood. If this pressure rises and stays high over time, it can damage the body in many ways.

Also Known As: High Blood Pressure

BASIC FACTS

“Blood pressure” is the force of blood pushing against the walls of the arteries as the heart pumps out blood. When this pressure rises and stays high over time, it can damage the body in many ways. High blood pressure (HBP) is a serious condition that can lead to coronary heart disease, heart failure, stroke, kidney failure, and other health problems.

Categories for High Blood Pressure Levels in Adults (in mmHg, or millimeters of mercury)

CAUSES & RISK FACTORS

In the United States, about 72 million people have HBP. This is about 1 in 3 adults. Blood pressure tends to rise with age. If you’re a male older than 45 or a female older than 55, your risk for HBP is higher. Over half of all Americans aged 60 and older have HBP. 

Certain medical problems and medicines may cause blood pressure to rise. In some women, blood pressure can go up if they use birth control pills, become pregnant, or take hormone replacement therapy.

Certain traits, conditions, or habits may raise your risk for HBP. These include older age, race/ethnicity, overweight or obesity, gender, unhealthy lifestyle habits, a family history of HBP, long-lasting stress, and having prehypertension (blood pressure levels between 120–139/80–89).

Unhealthy Lifestyle Habits

A number of lifestyle habits can raise your risk for HBP, including:

• Eating too much sodium (salt)
• Drinking too much alcohol
• Not getting enough potassium in your diet
• Not doing enough physical activity
• Smoking

SIGNS & SYMPTOMS

• HBP itself usually has no symptoms. Rarely, headaches may occur. Some people only learn that they have HBP after it causes health problems, such as coronary heart disease, stroke, or kidney failure.

Lifestyle Changes

Healthy habits can help you control HBP. Healthy habits include:

• Following a healthy eating plan
• Doing enough physical activity
• Maintaining a healthy weight
• Quitting smoking
• Managing your stress and learning to cope with stress

Goals of Treatment

• The treatment goal for most adults is to get and keep blood pressure below
140/90 mmHg. For adults who have diabetes or chronic kidney disease, the goal is to get and keep blood pressure below 130/80 mmHg.

WHAT IS IT?

Peripheral vascular disease occurs when a fatty material called plaque builds up on the inside walls of the arteries that carry blood from the heart to the head, internal organs, and limbs.

Also Known As: Atherosclerotic Peripheral Arterial Disease, Arm Artery Disease, Circulation Problems, Leg Artery Disease

BASIC FACTS

Peripheral arterial disease (PAD) occurs when a fatty material called plaque builds up on the inside walls of the arteries that carry blood to the limbs. It can impair physical health and diminish a person’s ability to walk.  PAD is a is a common, yet serious disease affecting 8 to 12 million people in the United States.  An estimated 5 percent of U.S. adults over age 50 have PAD. Among adults age 65 and older, 12 to 20 percent may have PAD.

People with PAD have an increased risk for heart attack.Early diagnosis and treatment of PAD are important to prevent disability and save lives.

 CAUSES & RISK FACTORS

• Smoking. Smoking increases the risk of developing PAD three to five times. On average, smokers who develop PAD experience symptoms 10 years earlier than nonsmokers who develop PAD.
• Diabetes. One in three people over age 50 with diabetes is likely to have PAD. Anyone over age 50 with diabetes should be screened for PAD.
• Other diseases and conditions, such as:
  • Kidney disease
  • High blood pressure or a family history of high blood pressure
  • A high cholesterol level or a family history of high cholesterol
  • Heart disease or a family history of heart disease
  • A family history of stroke
  • Age. Men who are older than age 50 and women who are older than age 55 are at higher risk for PAD.

SIGNS & SYMPTOMS

At least half of the people who have peripheral arterial disease (PAD) don’t have any signs or symptoms of the disease.

Other signs and symptoms of PAD include:

• Pain, numbness, aching, and heaviness in the muscles
• Cramping in the legs, thighs, calves, and feet
• A weak or absent pulse in the legs or feet
• Sores or wounds on toes, feet, or legs that heal slowly, poorly, or not at all
• Color changes in skin, paleness, or blueness (called cyanosis)
• A decreased temperature in one leg compared to the other leg
• Poor nail growth and decreased hair growth on toes and legs
• Erectile dysfunction, especially among people with diabetes

WHAT IS IT?
Heart valve disease is a condition in which one or more of your heart valves don’t work properly. The heart has four valves: the tricuspid (tri-CUSS-pid), pulmonary (PULL-mun-ary), mitral (MI-trul), and aortic (ay-OR-tik) valves. 

These valves have tissue flaps that open and close with each heartbeat. The flaps make sure blood flows in the right direction through your heart’s four chambers and to the rest of your body. Birth defects, age-related changes, infections, or other conditions can cause one or more of your heart valves to not open fully or to let blood leak back into the heart chambers. This can make your heart work harder and affect its ability to pump blood. 

BASIC FACTS
Heart valves can have three basic kinds of problems:
Regurgitation, or backflow, occurs when a valve doesn’t close tightly. Blood leaks back into the heart chamber rather than flowing forward through the heart or into an artery.
Stenosis occurs when the flaps of a valve thicken, stiffen, or fuse together. This prevents the heart valve from fully opening, and not enough blood flows through the valve.
Atresia occurs when a valve lacks an opening for blood to pass through.

CAUSES & RISK FACTORS
Some causes and risk factors for heart valve disorders include:

Heart Conditions and Other Disorders
Damage and scar tissue due to a heart attack or injury to the heart.
Advanced high blood pressure and heart failure. These conditions can enlarge the heart or the main arteries.
Narrowing of the aorta due to atherosclerosis (ath-er-o-skler-O-sis).

Age-Related Changes
Men older than 65 and women older than 75 are prone to developing calcium and other deposits on their heart valves. These deposits stiffen and thicken the valve flaps and limit blood flow (stenosis).

Rheumatic Fever
Some people have heart valve disease due to untreated strep throat or other infections with strep bacteria, which progress to rheumatic fever.

Infections
Common germs that enter through the bloodstream and get carried to the heart can sometimes infect the inner surface of the heart, including the heart valves. This rare, but sometimes life-threatening infection is called endocarditis (EN-do-kar-DI-tis).
A number of other conditions and factors are sometimes linked to heart valve disease. However, it’s often unknown how these conditions actually cause heart valve disease. 

SIGNS & SYMPTOMS
The main sign of heart valve disease is an unusual heart sound called a heart murmur. Your doctor can hear a heart murmur with a stethoscope.
Other common signs and symptoms of heart valve disease relate to heart failure, which heart valve disease can eventually cause. These symptoms include:
Unusual fatigue (tiredness)Shortness of breath, especially when you exert yourself or when you’re lying down
Swelling of your ankles, feet, or sometimes the abdomen
Heart valve disease can cause chest pain that may only happen when you exert yourself. You also may notice a fluttering, racing, or irregular heartbeat. Some types of heart valve disease, such as aortic or mitral valve stenosis, can cause dizziness or fainting.

• Unusual fatigue (tiredness)
• Shortness of breath, especially when you exert yourself or when you’re lying down
• Swelling of your ankles, feet, or sometimes the abdomen

Heart valve disease can cause chest pain that may only happen when you exert yourself.