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Heart Disease
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Congestive Heart Failure
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Heart Disease
General Information on Heart Disease
Cardiovascular disease: A blueprint for understanding the leading killer
By Mayo Clinic staff
You've seen the stories time and again: Exercise to prevent coronary artery
disease. Eat better to reduce your risk of coronary heart disease. Stop smoking
to stop heart disease. Lower your cholesterol to lower your odds of developing
cardiovascular disease.
Coronary artery disease? Coronary heart disease? Heart disease? Cardiovascular
disease? What are all these things? And what's the difference, anyway?
Perhaps you've been bombarded so often with warnings and advice about your heart
that you simply don't pay attention anymore. Or you don't know what these
conditions mean or exactly how destructive they can be to your health.
Understanding the various terms and how they're often used � sometimes
incorrectly � can help you sort through the morass. And if you know more about
the various types of cardiovascular disease, and the havoc they can wreak on
your body, you may be more inclined to take steps to prevent them. You'll also
know more about the ways all of the different manifestations of cardiovascular
disease interact to affect your health, and you'll learn how you can best
control your risks.
Defining cardiovascular disease
First, consider cardiovascular disease. Cardiovascular disease is a broad,
all-encompassing term. It's not a single condition or disorder in itself.
Rather, it's a collection of diseases and conditions. In fact, some types of
cardiovascular disease can even cause other types of cardiovascular disease.
To get technical, cardiovascular disease refers to any disorder in any of the
various parts of your cardiovascular system, which is made up of your heart and
the blood vessels throughout your body, explains Brooks Edwards, M.D., a
cardiologist at Mayo Clinic, Rochester, Minn..
Cardiovascular disease, then, has two main components:
Diseases of the heart (cardio)
Diseases of the blood vessels (vascular)
Although you may hear a lot about preventing cardiovascular disease,
sometimes you can't prevent it. That's because some types of cardiovascular
disease are congenital � you're born with them. Other forms are acquired � you
develop them over the course of your lifetime. These acquired conditions are the
forms you can often help prevent by doing such things as exercising regularly,
eating a balanced diet or quitting smoking. And they make up the vast majority
of cardiovascular diseases.
So, if you have something wrong with your heart, such as an abnormality of the
heart muscle (cardiomyopathy), that's a type of cardiovascular disease.
Likewise, an aneurysm, a bulging section of blood vessel, also is a type of
cardiovascular disease. And even varicose veins are technically classified as a
cardiovascular disease.
But what about those news reports that say cardiovascular disease is the No. 1
killer of American men? What does that mean, really?
Are they getting aneurysms? Dying of varicose veins? Did they have a congenital
heart defect that couldn't be successfully treated? Just what do those reports
mean? Adding to the confusion are the different ways that major organizations
and agencies, including the Centers for Disease Control and Prevention and the
American Heart Association, define cardiovascular disease.
It's no wonder you're left scratching your head. But to help sort through all of
that and help you become a health-savvy consumer the next time you read one of
those reports, here's a closer look at just what cardiovascular disease is.
Diseases of the heart
The heart consists of a muscle (myocardium) that pumps blood, arteries that
supply blood to the heart muscle, and valves to ensure that the blood is pumped
in the correct direction. At any point in the pumping process, or in any part of
the heart, something can go awry. The diseases and conditions affecting the
heart are collectively known as heart disease.
Like cardiovascular disease, the term heart disease is somewhat loose and broad,
and it's often used that way. You may see reports urging you to avoid smoking so
that you reduce your risk of heart disease, for instance. And you can. Or that
heart disease is the leading killer of both men and women. And it is.
But neither exercise nor healthy diet nor low cholesterol can protect you
against all forms of heart disease. There are many types of heart disease, and
not all are the consequences of unhealthy lifestyle habits. Some forms of
cardiomyopathy are caused by viruses, for instance. And some babies are born
with Ebstein's anomaly, a defect in one of the heart's valves that causes blood
to leak and prevents the heart from working at top efficiency.
Most often, when you hear a report about preventing heart disease, it's really a
call to prevent coronary artery disease or coronary heart disease.
Coronary artery disease. These are diseases of the arteries that supply
the heart muscle with blood. Sometimes known as CAD, coronary artery disease is
the most common form of heart disease in industrialized nations and far and away
the leading cause of heart attacks.
Coronary artery disease generally means that blood flow through the arteries has
become impaired. The most common way such obstructions develop is through a
condition called atherosclerosis, a largely preventable type of vascular
disease.
The actively contracting heart muscle needs a steady supply of oxygen and
nutrients to function. They're delivered by blood vessels known as coronary
arteries.
Over the course of your lifetime � actually starting in early childhood � these
arteries, whose inner lining is normally smooth, can slowly become clogged with
clumps of fats, cholesterol and other material, called atherosclerotic plaques.
You may also know this as hardening or narrowing of the arteries. The inner
walls of arteries become narrow slowly because of a buildup of these plaques, or
suddenly by a rupture of a plaque and the formation of a blood clot around the
ruptured plaque.
As a result, the supply of blood � with its oxygen and nutrients � going to the
heart muscle is choked off (myocardial ischemia). As less blood reaches the
heart, it can't function normally, and you begin experiencing the physical
consequences.
Chest pain (angina pectoris) occurs, for instance, when the oxygen demand of the
heart muscle exceeds the oxygen supply because of that narrowing in the coronary
arteries. When the imbalance of oxygen supply lasts for more then a few minutes,
heart muscle can begin to die, causing a heart attack (myocardial infarction).
This may occur without symptoms (silent heart attack), especially in people with
diabetes.
In addition, the lack of blood, even briefly, can lead to serious disorders of
the heart rhythm, known as arrhythmias or dysrhythmias. Coronary artery disease
can even cause sudden death from an arrhythmia without any prior warning.
These consequences of coronary artery disease are also types of cardiovascular
disease in their own right and, in turn, can cause even more types of
cardiovascular disease � weaving a complex interplay of cause and effect. A
heart attack, for instance, can lead to congestive heart failure, and both of
these conditions are types of cardiovascular disease.
There's another confusing twist to coronary artery disease: It's sometimes used
synonymously with coronary heart disease. But you can impress your cardiologist
on the next visit � if not your colleagues around the water cooler � if you know
they're not technically the same things.
Rather, coronary heart disease is a more encompassing term that refers to
diseases of the coronary arteries and their resulting complications � angina, a
heart attack and even scar tissue caused by the heart attack. All are
technically coronary heart diseases. Remember, coronary artery disease is
disease only of the arteries.
Cardiomyopathy. These are diseases of the heart muscle. Some forms of
cardiomyopathy are genetic, while others occur for reasons that are less well
understood. The most common type of cardiomyopathy in developed nations is
ischemic cardiomyopathy, which is caused by the loss of heart muscle from a
heart attack resulting from coronary artery disease. Some forms of
cardiomyopathy affect the contraction of the heart (systolic dysfunction) while
other forms affect the filling, or relaxation, phase of the heart (diastolic
dysfunction).
Valvular heart disease. These are diseases of the valves within the
heart. Blood flows in the correct direction within the heart because of a series
of valves. When a valve is diseased, blood flow may become obstructed, a
condition known as valvular stenosis. Or a valve may leak, causing a condition
known as valvular insufficiency or valvular regurgitation. You may be born with
valvular disease, or the valves can become infected and damaged by bacteria or
other microorganisms, a condition known as infectious endocarditis.
Pericardial disease. These are diseases of the sac (pericardium) that
encases the heart. Diseases of the pericardial sac can secondarily affect the
heart itself. There are several types of pericardial disease, including
inflammation (pericarditis), fluid accumulation (pericardial effusion) and
stiffness (constrictive pericarditis). These forms can occur alone or together.
Causes and consequences vary. For instance, pericardial effusion can occur after
a heart attack and, as a result, prevent your heart from working efficiently.
Congenital heart disease. These are forms of heart disease that develop
before birth (congenital). Some may be apparent right at the time of birth,
while others may not be detected until later in life. Congenital heart disease
can affect the formation of the heart's chambers, muscle or valves, and include
such conditions as narrowing of a section of the aorta (coarctation) and
Ebstein's anomaly.
Congestive heart failure. Congestive heart failure occurs when the heart
no longer pumps normally, although it does continue to work to some degree. With
less effective pumping, vital organs don't get enough blood, causing such signs
and symptoms as shortness of breath, fluid retention and fatigue. This condition
may develop suddenly or over many years. Congestive heart failure occurs as a
result of other cardiovascular conditions that have damaged or weakened the
heart. Among them are coronary artery disease, cardiomyopathy, valvular heart
disease, and some forms of congenital heart disease.
Diseases of the blood vessels
High blood pressure. High blood pressure (hypertension) is perhaps the
most common form of cardiovascular disease in the Western world, affecting about
one in four Americans. It's also one of the most preventable and treatable types
of cardiovascular disease.
But it's more than just a type of cardiovascular disease. High blood pressure is
also a cause of cardiovascular disease and a risk factor for cardiovascular
disease.
Blood pressure is determined by how much blood your heart pumps out and how
narrow your arteries are. The more your heart pumps and the narrower your
arteries � say they're clogged from atherosclerosis � the higher your blood
pressure, and the harder your heart has to work to pump the same amount of
blood.
High blood pressure has far-reaching and serious health consequences. For one
thing, it accelerates the development of atherosclerosis, which, in turn, makes
high blood pressure worse and further increases the risk of other cardiovascular
complications.
High blood pressure can also lead to stroke. That happens when a bit of
cholesterol or other clump of arterial plaque breaks off and blocks blood flow
to the brain. It may also happen when a tiny blood vessel in the brain ruptures
because of damage sustained by high blood pressure. Stroke is sometimes
considered a type of cardiovascular disease. But technically, it's actually a
result of cardiovascular disease.
In addition, high blood pressure can wreak havoc on the heart itself. It can
cause coronary artery disease, congestive heart failure and heart attack. And
the damage doesn't stop there: High blood pressure can also damage other vital
organs, such as your kidneys and eyes.
Aneurysms. An aneurysm is a bulge or weakness in the wall of an artery or
vein. Aneurysms usually enlarge over time, and have the potential to rupture and
cause life-threatening bleeding. Aneurysms can occur in arteries in any location
in your body, but common sites include the abdominal aorta and the arteries at
the base of the brain.
The vast majority of aneurysms occur when an artery wall becomes weak or damaged
by atherosclerosis. And that means in many cases, aneurysms are another type of
cardiovascular disease that's preventable. The usual suspects in blood vessel
damage are often to blame here, too � smoking, high blood pressure, and
unhealthy lifestyle habits that contribute to atherosclerosis.
Brain aneurysms are a different matter and often result from a congenital
weakness in the arteries at the base of the brain.
Claudication. Strictly speaking, this is a symptom of the condition
occlusive arterial disease, but it's often referred to as a disease itself.
Symptoms develop when the arteries to the legs or arms become partially
obstructed, compromising blood flow � similar to how coronary artery disease can
cause angina. When the obstruction is mild, you may have such symptoms as
extremity pain during strenuous exercise. As the disease progresses and arteries
become more obstructed, you may notice symptoms with minimal or no activity at
all and develop ulcers of the skin and soft tissue that don't heal.
As with aneurysms, claudication is most often caused by preventable
atherosclerosis. Claudication isn't just a type of cardiovascular disease. It's
also a symptom of other cardiovascular disease � the pain of claudication can be
a symptom that you have atherosclerosis.
Vasculitis. This is inflammation of the blood vessels. It usually
involves the arteries but may also affect small veins and capillaries. The
inflammation may damage the wall of the artery or vein and impair blood flow to
the region of the body supplied by that vessel. Sometimes vasculitis occurs in
the presence of a generalized disorder, such as lupus or rheumatoid arthritis,
but it sometimes occurs without an associated disease.
Venous incompetence. This is a condition in which blood actually flows
the wrong way in veins. Veins have tiny valves that are designed to promote
blood flow in a forward direction, back to the heart. But if you have such
conditions as infection, inflammation, abnormal blood clotting, or even
high-back pressure in pregnancy, the valves may become damaged and incompetent.
That allows blood to flow backward and pool in the extremities when sitting or
standing, causing a variety of complications, such as prominent and painful
varicose veins, skin changes and ulcers.
Venous thrombosis. This is the abnormal formation of a blood clot
(thrombus) in a vein. This condition may damage the vein and its valves. In
addition, clots that break off and travel in the bloodstream can lodge in the
lungs, a condition known as pulmonary embolism. In some cases, this type of clot
can also cause a stroke.
Varicose veins. This is a condition in which veins become gnarled,
twisted and enlarged. They're usually located on the backs of the calves or on
the inside of the legs, from the groin to the ankle. Compression clothing can help to relieve the symptoms of varicose veins.
When valves in your veins don't function properly, blood can accumulate in your
lower extremities, causing the veins to bulge and twist. The veins appear blue
because they contain less oxygen.
Prevention power
"Cardiovascular disease is not a linear disease," Dr. Edwards says. "People
don't usually have only one of these conditions that make up cardiovascular
disease. Most of the time there's a complex interplay of the conditions, and a
primary disorder may cause a secondary disorder, which can lead to other
disorders and make all of them worse, including the primary disorder."
Furthermore, he notes, one cardiovascular disease can be a manifestation of
another. Case in point: aneurysm. It can be a sign that you have
atherosclerosis.
All of this underscores the complexity that is cardiovascular disease. But in
the end, the most common forms of cardiovascular disease are high blood pressure
and coronary artery disease, both of which are highly preventable.
Some preventive measures you can take:
--Don't smoke or use other tobacco products
--Eat a varied diet, rich in fruits, vegetables and low-fat foods
--Maintain a healthy weight
--Get at least 30 minutes of exercise daily, most days of the week
--Keep your cholesterol levels in normal ranges
--Control your blood sugar if you have diabetes
--Control your blood pressure
You have the power to greatly reduce your risk of cardiovascular disease,
whether it's heart disease, coronary artery disease or coronary heart disease �
or any of their numerous incarnations.
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