It is characterized by discomfort that typically occurs in conditions associated with increased myocardial oxygen consumption such as with increased activity or stress. The pain usually begins slowly and worsens over the next few minutes. Stable angina occurs when the heart has to work harder
than normal, during exercise, for example. It has a regular pattern, and if you already know that you have stable
angina, you will be able to predict the pattern. Once you
stop exercising, or take medication (usually nitroglycerin) the pain goes away, usually within a few minutes.
Unstable angina is more serious, and may be a sign that a heart attack could happen soon. There is no
predictable pattern to this kind of angina; it can just as easily occur during exercise as it can while you are resting. Unstable angina pectoris is also known as Crescendo-angina pectoris. It is considered unstable in the following situation-
• Angina of new onset (present for less than 60 days)
• Angina occur at rest or with minimal exercise & lasts for>10 minutes
• Anginal pain occur at rest.
• The intensity of the chest pain changes.
It should always be treated as an emergency. People with unstable angina are at increased risk for heart attacks,
cardiac arrest, or severe cardiac arrhythmias (irregular heartbeat or abnormal heart rhythm).
It often occurs while someone is resting (usually between
midnight and 8:00 in the morning), and it has no predictable pattern—that is, it is not brought on by exercise or emotion. This kind of angina may cause severe pain, and is usually the result of a spasm in a coronary artery. Most people who have variant angina have severe atherosclerosis (hardening of the arteries), and the spasm is most likely to occur near a buildup of fatty plaque in an artery.
Sometimes referred to as Syndrome X—occurs when tiny vessels in the heart become narrow and stop functioning properly, even if the bigger arteries are not blocked by plaque. Usually it is treated with common angina medications.
Atypical angina often doesn’t cause pain, but you may feel a vague discomfort in your chest, experience shortness of breath, feel tired or nauseous, have indigestion, or pain in your back or neck. Women are more likely than men to have feelings of vague chest discomfort.
A heart attack (myocardial infarction) is the death of heart muscle from the sudden blockage of a coronary artery by a blood clot.Blockage of a coronary artery deprives the heart muscle of blood and oxygen, causing injury to the heart muscle. Injury to the heart muscle causes chest pain and chest pressure sensation. If blood flow is not restored to the heart muscle within 20 to 40 minutes, irreversible death of the heart muscle will begin to occur. Muscle continues to die for six to eight hours at which time the heart attack usually is "complete." The dead heart muscle is eventually replaced by scar tissue.
Premature atrial contractions
These are early extra beats that originate in the atria (upper chambers of the heart). They are harmless and generally do not require treatment.
Premature ventricular contractions
These are among the most common arrhythmias and occur in people with or without heart disease. This is the skipped heartbeat we all occasionally experience. In some people, it can be related to stress, too much caffeine or nicotine, or too much exercise. But sometimes, PVCs can be caused by heart disease or electrolyte imbalance. People who have a lot of PVCs, and/or symptoms associated with them, should be evaluated by a heart doctor. However, in most people, PVCs are usually harmless and rarely need treatment.
Atrial fibrillation is a very common irregular heart rhythm that causes the atria, the upper chambers of the heart, to contract abnormally.
This is an arrhythmia caused by one or more rapid circuits in the atrium. Atrial flutter is usually more organized and regular than atrial fibrillation. This arrhythmia occurs most often in people with heart disease and in the first week after heart surgery. It often converts to atrial fibrillation.
Paroxysmal supraventricular tachycardia
A rapid heart rate, usually with a regular rhythm, originating from above the ventricles. PSVT begins and ends suddenly. There are two main types: accessory path tachycardias and AV nodal reentrant tachycardias. Accessory pathway tachycardias. A rapid heart rate due to an extra abnormal pathway or connection between the atria and the ventricles. The impulses travel through the extra pathways as well as through the usual route. This allows the impulses to travel around the heart very quickly, causing the heart to beat unusually fast.
AV nodal reentrant tachycardia. A rapid heart rate due to more than one pathway through the AV node. It can cause heart palpitations, fainting, or heart failure. In some cases, it can be terminated using simple maneuvers, such as breathing in and bearing down. Some drugs can also stop this heart rhythm.
A rapid heart rhythm originating from the lower chambers (or ventricles) of the heart. The rapid rate prevents the heart from filling adequately with blood. This can be a serious arrhythmia, especially in people with heart disease, and may be associated with more symptoms.
An erratic, disorganized firing of impulses from the ventricles. The ventricles quiver and are unable to contract or pump blood to the body. This is a medical emergency that must be treated with cardiopulmonary resuscitation (CPR) and defibrillation as soon as possible.
Long QT syndrome
The QT interval is the area on the electrocardiogram that represents the time it takes for the heart muscle to contract and then recover, or for the electrical impulse to fire impulses and then recharge. When the QT interval is longer than normal, it increases the risk of a life-threatening form of ventricular tachycardia. Long QT syndrome is an inherited condition that can cause sudden death in young people. It can be treated with antiarrhythmic drugs, pacemaker, electrical cardioversion, defibrillation, implanted cardioverter/defibrillator, or ablation therapy.
These are slow heart rhythms, which may arise from disease in the heart's electrical conduction system. Examples include sinus node dysfunction and heart block.
Sinus node dysfunction. A slow heart rhythm due to an abnormal sinus node. Significant sinus node dysfunction that causes symptoms is treated with a pacemaker.
Heart block. A delay or complete block of the electrical impulse as it travels from the sinus node to the ventricles. The heart may beat irregularly and, often, more slowly. If serious, heart block is treated with a pacemaker.
Heart Valve Disease
Congenital mitral stenosis is rare. The typical adult patient is a woman whose mitral valve was damaged by rheumatic fever.A narrowing of the mitral valve that occurs when the leaflets become scarred and rigid. Forward bloodflow is impaired, so pressure and fluid are transmitted back to the lungs.
As in mitral stenosis, the cause often is rheumatic fever, but the patient is usually an adult male. Mitral regurgitation can also result from heart attacks or any condition that changes the overall size and configuration of the left ventricle.The mitral valve cannot close properly and blood leaks backward into the left atrium.
Mitral valve prolapse
In this condition, the leaflets of the mitral valve fail to close properly. It is a common condition, particularly among women between the ages of 14 and 30. The underlying cause is unknown, and the majority of patients never have symptoms. In most people with this condition, mitral valve prolapse has no significance.
Valve leaflets are distorted, causing valve narrowing and bloodflow impairment.When a child is born with congenital aortic stenosis, the problem is usually a bicuspid aortic valve, meaning the valve has two flaps instead of the usual three. In about 10% of affected newborns, the aortic valve is so narrow that the child develops severe cardiac symptoms within in the first year of life. In the remaining 90%, congenital aortic stenosis is discovered only when a heart murmur is found during a physical examination.In adulthood, aortic stenosis typically is caused by rheumatic fever or idiopathic calcific aortic stenosis. Some recent research suggests that the same processes that cause atherosclerosis in the arteries of the heart may contribute to the development of aortic stenosis. Aortic stenosis accounts for 25% of all heart valve problems in adults, and 80% of patients are male.
Valve cannot close properly, and blood leaks back into the left ventricle. This decreases the forward flow of oxygenated blood through the aorta, while the backflow into the ventricle eventually dilates (stretches) the ventricle out of shape. In adults, about two-thirds of cases of aortic regurgitation are caused by rheumatic fever, and 75% of patients are male.
In the relatively few newborns with severe congenital pulmonic stenosis, the child develops heart failure or cyanosis (a bluish color to the lips, fingernails and skin) within the first month of life. In most cases, the valve is deformed, with two or three leaflets partially fused.
This usually is caused by an episode of rheumatic fever, which often damages the mitral valve at the same time. Tricuspid stenosis is relatively uncommon in North America and Europe.
Tricuspid regurgitation typically occurs because of pulmonary hypertension, but it also can be caused by heart failure, myocardial infarction, endocarditis or trauma.
Congenital heart disease
Atrial septal defect (ASD)
An ASD is a hole in the part of the septum that separates the atria - the upper chambers of the heart. This heart defect allows oxygen-rich blood from the left atrium to flow into the right atrium instead of flowing to the left ventricle as it should. Many children who have ASDs have few, if any, symptoms.An ASD can be small or large. Small ASDs allow only a little blood to leak from one atrium to the other. Very small ASDs don't affect the way the heart works and therefore don't need any special treatment. Many small ASDs close on their own as the heart grows during childhood. Medium to large ASDs allow more blood to leak from one atrium to the other, and they're less likely to close on their own.
Half of all ASDs close on their own or are so small that no treatment is needed. Medium to large ASDs that need treatment can usually be repaired using a catheter procedure.
Ventricular septal defect (VSD)
A VSD is a hole in the part of the septum that separates the ventricles - the lower chambers of the heart. The hole allows oxygen rich blood to flow from the left ventricle into the right ventricle instead of flowing into the aorta and out to the body as it should.A VSD can be small or large. A small VSD doesn't cause problems and may often close on its own. Large VSDs cause the left side of the heart to work too hard and increase blood pressure in the right side of the heart and the lungs because of the extra blood flow. The increased work of the heart can cause heart failure and poor growth. If the hole isn't closed, the high blood pressure in the lungs can cause the delicate arteries in the lungs to scar, a condition called pulmonary arterial hypertension. Open-heart surgery is used to repair VSDs.
Tetralogy of Fallot
The most common complex heart defect is tetralogy of Fallot, a combination of four defects:
Pulmonary valve stenosis.
A large VSD.
An overriding aorta. The aorta sits above both the left and right ventricles over the VSD, rather than just over the left ventricle. As a result, oxygen poor blood from the right ventricle can flow directly into the aorta instead of into the pulmonary artery to the lungs.
Right ventricular hypertrophy. The muscle of the right ventricle is thicker than usual because of having to work harder than normal.
These defects prevent enough blood from flowing to the lungs to get oxygen, while oxygen-poor blood flows directly out to the body.
Babies and children with tetralogy of Fallot have episodes of cyanosis, which can sometimes be severe. In the past, when this condition wasn't treated in infancy, older children would get very tired during exercise and could have fainting spells. Tetralogy of Fallot is now repaired in infancy to prevent these types of symptoms.
Tetralogy of Fallot must be repaired with open heart surgery, either soon after birth or later in infancy, depending on how severely the pulmonary artery is narrowed. Children who have had this heart defect repaired need lifelong medical care from a specialist to make sure they stay as healthy as possible.
Ebstein's anomaly is a rare heart defect in which parts of the tricuspid valve are abnormal. The tricuspid valve separates the right lower heart chamber (right ventricle) from the right upper heart chamber (right atrium).
Hypoplastic left heart syndrome
Hypoplastic left heart syndrome occurs when parts of the left side of the heart (mitral valve, left ventricle, aortic valve, and aorta) do not develop completely. The problem develops before birth when the left ventricle and other structures do not grow properly, including the:
Aorta -- the blood vessel that carries oxygen-rich blood from the left ventricle to the entire body
Entrance and exit of the ventricle
Mitral and aortic valves
This causes the left ventricle and aorta to be poorly developed, or hypoplastic. In most cases, the left ventricle and aorta are much smaller than normal.
Transposition of the great vessels
Transposition of the great vessels is a cyanotic heart defect, the blood goes to the lungs, picks up oxygen, returns to the heart, and then flows right back to the lungs without ever going to the body. Blood from the body returns to the heart and goes back to the body without ever picking up oxygen in the lungs.
Patent ductus arteriosus
Patent ductus arteriosus (PDA) is a condition in which the ductus arteriosus does not close.PDA leads to abnormal blood flow between the aorta and pulmonary artery, two major blood vessels that carry blood from the heart.PDA affects girls more often than boys. The condition is more common in premature infants and those with neonatal respiratory distress syndrome. Infants with genetic disorders, such as Down syndrome, and whose mothers had rubella during pregnancy are at higher risk for PDA.
Coarctation of the aorta
Aortic coarctation is one of the more common heart conditions that are present at birth. A part of the aorta is narrowed, it is hard for blood to pass through the artery.
Total anomalous pulmonary venous return
Total anomalous pulmonary venous return is a heart disease in which none of the four veins that take blood from the lungs to the heart is attached to the left atrium, oxygen-rich blood returns from the lungs to the right atrium or to a vein flowing into the right atrium, instead of the left side of heart.
Inflammatory heart disease
Myocarditis describes any inflammation that occurs within the heart muscle. It is induced by various infections which will include viruses like sarcoidosis, and distinct immune diseases. The most prevalent form of infection is the viral kind that assaults the heart muscle resulting in local inflammation. Once the infection subsides the immune response will still endure. Because of this, myocarditis will continue to plague the heart muscle long after the infection has ceased.There is much uncertainty about the likelihood of recovery in the early phases of the disease. A fair portion of individuals achieve total recovery while some may eventually be inflicted with chronic heart failure due to extravagant damage to the heart muscles.
Pericarditis is a disease that causes inflammation of the pericardium. The pericardium is the fluid sac that envelopes the heart. It provides lubrication to the heart thus decreasing friction during activity and also firmly secures the heart to the surrounding walls within the cavity.The primay treatment is the administering of anti-inflammatory medications to reduce inflammation. Ibuprofen is once such measure that may be used because of its anti-inflammatory properties. A narcotic pain medication may also be prescribed. Pericardiocentesis may be applicable as a from of progressive treatment. It will remove excessive fluid from the sac and or will detect the pathogen of origin that may have induced the condition.
Endocarditis is induced by an infection of the endocardium or inner lining of the heart resulting in pronounced inflammation. It will present itself when pathogens from other regions of the body infect the bloodstream and affix to defective areas of the heart. If it is not treated speedily it may cause partial or complete damage to the heart valve or may develop into a life-threatening condition. It usually affects individuals who have an artificial heart valve in place or have suffered degeneration of a heart valve. Having a pre-existing heart defect also increases the odds of developing the condition. It does not normally affect healthy people.
Dilated cardiomyopathy is the most common type of the disease. It mostly occurs in adults aged 20 to 60. Men are more likely than women to have this type of cardiomyopathy. Dilated cardiomyopathy affects the heart's ventricles and atria. These are the lower and upper chambers of the heart, respectively. The disease often starts in the left ventricle, the heart's main pumping chamber. The heart muscle begins to dilate. This causes the inside of the chamber to enlarge. The problem often spreads to the right ventricle and then to the atria as the disease gets worse.
Hypertrophic cardiomyopathy (HCM) is very common and can affect people of any age. About 1 out of every 500 people has HCM. It affects men and women equally.
HCM is a common cause of sudden cardiac arrest (SCA) in young people, including young athletes.
HCM occurs if heart muscle cells enlarge and cause the walls of the ventricles (usually the left ventricle) to thicken. Despite this thickening, the ventricle size often remains normal. However, the thickening may block blood flow out of the ventricle. If this happens, the condition is called obstructive hypertrophic cardiomyopathy.
Sometimes, the septum thickens and bulges into the left ventricle. This also can block blood flow out of the left ventricle. (The septum is the wall that divides the left and right sides of the heart.)
If a blockage occurs, the ventricle must work hard to pump blood to the body. Symptoms can include chest pain, dizziness, shortness of breath, or fainting. HCM also can affect the heart's mitral (MI-trul) valve, causing blood to leak backward through the valve. Sometimes the thickened heart muscle doesn't block blood flow out of the left ventricle. This is called nonobstructive hypertrophic cardiomyopathy. The entire ventricle may thicken, or the thickening may happen only at the bottom of the heart. The right ventricle also may be affected. In both types of HCM (obstructive and nonobstructive), the thickened muscle makes the inside of the left ventricle smaller, so it holds less blood. The walls of the ventricle also may stiffen. As a result, the ventricle is less able to relax and fill with blood. These changes can raise blood pressure in the ventricles and the blood vessels of the lungs. Changes also occur to the cells in the damaged heart muscle. This may disrupt the heart's electrical signals and lead to arrhythmias.
Restrictive cardiomyopathy tends to mostly affect older adults. With this disease, the ventricles become stiff and rigid. This happens because abnormal tissue, such as scar tissue, replaces the normal heart muscle.
As a result, the ventricles can't relax normally and fill with blood, and the atria become enlarged. Over time, blood flow in the heart is reduced. This can lead to problems such as heart failure or arrhythmias.
Arrhythmogenic Right Ventricular Dysplasia
Arrhythmogenic right ventricular dysplasia (ARVD) is a rare type of cardiomyopathy. ARVD occurs if the muscle tissue in the right ventricle dies and is replaced with scar tissue.
This process disrupts the heart's electrical signals and causes arrhythmias. Symptoms include palpitations and fainting after physical activity. (Palpitations are feelings that your heart is skipping a beat, fluttering, or beating too hard or too fast.)
ARVD usually affects teens or young adults. It can cause SCA(Sudden cardiac arrest) in young athletes.
Left-sided heart failure
The heart's pumping action moves oxygen-rich blood as it travels from the lungs to the left atrium, then on to the left ventricle, which pumps it to the rest of the body. The left ventricle supplies most of the heart's pumping power, so it's larger than the other chambers and essential for normal function. In left-sided or left ventricular (LV) heart failure, the left side of the heart must work harder to pump the same amount of blood.
There are two types of left-sided heart failure. Drug treatments are different for the two types.
Systolic failure: The left ventricle loses its ability to contract normally. The heart can't pump with enough force to push enough blood into circulation.
Diastolic failure (also called diastolic dysfunction): The left ventricle loses its ability to relax normally (because the muscle has become stiff). The heart can't properly fill with blood during the resting period between each beat.
Right-sided heart failure
The heart's pumping action moves "used" blood that returns to the heart through the veins through the right atrium into the right ventricle. The right ventricle then pumps the blood back out of the heart into the lungs to be replenished with oxygen.
Right-sided or right ventricular (RV) heart failure usually occurs as a result of left-sided failure. When the left ventricle fails, increased fluid pressure is, in effect, transferred back through the lungs, ultimately damaging the heart's right side. When the right side loses pumping power, blood backs up in the body's veins. This usually causes swelling in the legs and ankles..
Congestive heart failure
Congestive heart failure is a type of heart failure which requires seeking timely medical attention, although sometimes the two terms are used interchangeably.
As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing congestion in the body's tissues. Often swelling (edema) results. Most often there's swelling in the legs and ankles, but it can happen in other parts of the body, too.
Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath, especially when a person is lying down. This is called pulmonary edema and if left untreated can cause respiratory distress.
Heart failure also affects the kidneys' ability to dispose of sodium and water. This retained water also increases swelling in the body's tissues (edema).
Other Heart Disease
Cor pulmonale is defined as an alteration in the structure and function of the right ventricle caused by a primary disorder of the respiratory system. Pulmonary hypertension is the common link between lung dysfunction and the heart in cor pulmonale. Right-sided ventricular disease caused by a primary abnormality of the left side of the heart or congenital heart disease is not considered cor pulmonale, but cor pulmonale can develop secondary to a wide variety of cardiopulmonary disease processes. Although cor pulmonale commonly has a chronic and slowly progressive course, acute onset or worsening cor pulmonale with life-threatening complications can occur.
Hypertensive Heart Disease
The cause of hypertensive heart disease is chronically elevated blood pressure (BP); however, the causes of elevated BP are diverse.According to the Framingham Study, hypertension accounts for about one quarter of heart failure cases. In the elderly population, as many as 68% of heart failure cases are attributed to hypertension.
Myocardial rupture occurs in the setting of acute myocardial infarction (AMI), blunt and penetrating cardiac trauma, primary cardiac infection, primary and secondary cardiac tumors, infiltrative diseases of the heart, and aortic dissection. Myocardial rupture (or perforation) may also occur iatrogenically during percutaneous cardiac procedures (including device implantation) or open heart surgery (particularly valve replacement). Recently, myocardial rupture has been reported in the setting of stress cardiomyopathy (Takotsubo or regional ventricular ballooning syndrome). The clinical presentation of myocardial rupture depends on the mechanism and site of injury and the hemodynamic effects of the rupture. Mortality is extremely high unless early diagnosis is made and urgent surgical intervention is provided.
A tumor is any type of abnormal growth, whether cancerous (malignant) or noncancerous (benign). Tumors that originate in the heart are called primary tumors. They may develop in any of the heart tissues and may be cancerous or noncancerous. Primary heart tumors are rare, occurring in fewer than 1 of 2,000 people. In adults, about half of noncancerous primary heart tumors are myxomas. Myxomas usually develop in the heart's left upper chamber (atrium). They may develop from embryonic cells located in the inner layer (lining) of the heart's wall.
In infants and children, the most common type of noncancerous primary heart tumor is a rhabdomyoma. Rhabdomyomas, which typically occur in groups, usually grow within the heart wall and develop directly from the heart's muscle cells. Rhabdomyomas commonly develop during infancy or childhood, often as part of a rare disease called tuberous sclerosis. The second most common noncancerous primary tumors in infants and children are fibromas. Fibromas, which typically occur as a single tumor, usually grow on heart valves and develop from the heart's fibrous tissue cells.