What is cardiology?
Cardiology is the study and treatment of disorders of the heart and the blood vessels. A person with heart disease or cardiovascular disease may be referred to a cardiologist.
Cardiology is a branch of internal medicine. A cardiologist is not the same as a cardiac surgeon. A cardiac surgeon opens the chest and performs heart surgery.
A cardiologist specializes in diagnosing and treating diseases of the cardiovascular system. The cardiologist will carry out tests, and they may perform some procedures, such as heart catheterizations, angioplasty, or inserting a pacemaker.
Heart disease relates specifically to the heart, while cardiovascular disease affects the heart, the blood vessels, or both.
To become a cardiologist in the United States, it is necessary to complete 4 years of medical school, 3 years of training in internal medicine, and at least 3 years specializing in cardiology.
When would I need a cardiologist?
Cardiology deals with heart health.
If a person has symptoms of a heart condition, their physician may refer them to a cardiologist.
Symptoms that can indicate a heart problem include:
- shortness of breath
- chest pains
- changes in heart rate or rhythm
- high blood pressure
A cardiologist can carry out tests for a heart murmur or an abnormal heart rhythm.
Heart diseases that a cardiologist can help with include:
- atrial fibrillation
- congenital heart disease
- coronary heart disease
- congestive heart disease
- high bloodcholesterol and triglycerides
- high blood pressure, or hypertension
The cardiologist can give advice about preventing heart disease.
A person may need to see a cardiologist even without symptoms, if they have a family history of heart disease or high cholesterol, if they are or have been a smoker, if they have diabetes, or if they are starting a new exercise program.
What does cardiology involve?
A cardiologist will review a patient’s medical history and carry out a physical examination.
They may check the person’s weight, heart, lungs, blood pressure, and blood vessels, and carry out some tests.
An interventional cardiologist may carry out procedures such as angioplasties, stenting, valvuloplasties, congenital heart defect corrections, and coronary thrombectomies.
They may also carry out or order tests as listed below:
The equipment in a cath lab allows the doctor to see the state of the heart.
Electrocardiogram (ECG or EKG): this records the electrical activity of the heart.
Ambulatory ECG: this records heart rhythms while the person carries out exercise or their regular activities. Small metal electrodes are stuck on to the chest, and these are connected by wires to a Holter monitor, which records the rhythms.
An exercise test, or stress test: this shows the changes of heart rhythm when resting and exercising. It measures the performance and limitations of the heart.
Echocardiogram: this provides an ultrasound picture that shows the structure of the heart chambers and surrounding areas, and it can show how well the heart is working.
Echocardiography can measure how well the heart is pumping blood, known as cardiac output. It can detect inflammation around the heart, known as pericarditis. It can also identify structural abnormalities or infections of the heart valves.
Cardiac catheterization: a small tube in or near the heart collects data and may help relieve a blockage. It can take pictures and check the functioning of the heart and the electrical system. Catheter-based techniques with fluoroscopy can be used to treat congenital cardiac, valvular, and coronary artery diseases.
Nuclear cardiology: nuclear imaging techniques use radioactive materials to study cardiovascular disorders and diseases in a noninvasive way.
Examples are infarction imaging, single-photon-emission computed tomography (SPECT), planar imaging, and myocardial perfusion imaging.
Cardiac electrophysiology is a subspecialty of cardiology. The physician looks at how electric currents inside the heart muscle tissue work, how the current spreads, and what the pattern of the currents mean.
The cardiologist may recommend a pacemaker.
Electrophysiology study (EPS) of the heart: in this test, a catheter is threaded into a vein at the top of the leg. Guided under fluoroscopy, it makes its way to the heart. The catheter measures the electrical signals within the heart.
An EPS of the heart can:
- help to show what is causing symptoms
- help decide if a patient needs a pacemaker
- help decide the best treatment for patients with arrhythmia, or abnormal heart rhythm
- determine how likely a patient is to experience tachycardia or an accelerated heart beat
A cardiac electrophysiologist can provide treatment for abnormal rhythms including cardiac ablation, implantable cardioverter defibrillators, or pacemakers.
Choosing a cardiologist
Patients are often referred to a cardiologist by their physician, but they may wish to choose their own specialist.
The American Heart Association (AHA) advises people to check that their cardiologist is board certified. Patients can check this through the American Board of Internal Medicine (ABIM) or the American Board of Family Medicine (ABFM).
It is also important to choose a doctor whose communication style suits them.
If the cardiologist recommends a treatment that seems risky or expensive, or if the patient is not sure why they need this treatment, the AHA suggest looking for a second opinion.
Everything you need to know about heart disease
Heart disease refers to any condition affecting the heart. There are many types, some of which are preventable.
Unlike cardiovascular disease, which includes problems with the entire circulatory system, heart disease affects only the heart.
According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death in the United States. Around 1 in 4 deaths
in the U.S. occur due to heart disease, and it affects all genders as well as all racial and ethnic groups.
In this article, learn more about the types, causes, and symptoms of heart disease.
There are several different types of heart disease, and they affect the heart in different ways.
The sections below will look at some different types of heart disease in more detail.
Coronary artery disease
It develops when the arteries that supply blood to the heart become clogged with plaque. This causes them to harden and narrow. Plaque contains cholesterol and other substances.
As a result, the blood supply reduces, and the heart receives less oxygen and fewer nutrients. In time, the heart muscle weakens, and there is a risk of heart failure and arrhythmias.
When plaque builds up in the arteries, this is called atherosclerosis.
Congenital heart defects
A person with a congenital heart defect is born with a heart problem. There are many types of congenital heart defect, including:
- Abnormal heart valves:Valves may not open properly or may leak blood.
- Septal defects:There is a hole in the wall between either the lower chambers or the upper chambers of the heart.
- Atresia:One of the heart valves is missing.
Congenital heart disease can involve major structural issues, such as the absence of a ventricle and problems with the main arteries that leave the heart.
Many congenital heart problems do not cause any noticeable symptoms and only become apparent during a routine medical check.
Arrhythmia refers to an irregular heartbeat. It occurs when the electrical impulses that coordinate the heartbeat do not work properly. As a result, the heart may beat too fast, too slowly, or erratically.
There are various types of arrhythmia, including:
- Tachycardia:This refers to a rapid heartbeat.
- Bradycardia:This refers to a slow heartbeat.
- Premature contractions:This refers to an early heartbeat.
- Atrial fibrillation:This is a type of irregular heartbeat.
A person may notice a feeling like a fluttering or a racing heart.
Brief changes in heart rhythm are not a cause for concern, but treatment will be necessary if they persist, as this can affect the heart’s function.
In some cases, arrhythmias can even be life threatening.
In dilated cardiomyopathy, the heart chambers become dilated, meaning that the heart muscle stretches and becomes thinner. The most common causes of dilated cardiomyopathy are prior heart attacks, arrhythmias, and toxins.
As a result, the heart becomes weaker and cannot pump blood properly. It can result in arrhythmia, blood clots in the heart, and heart failure.
It usually affects people aged 20–60 years, according to the AHA.
Also known as heart attack, myocardial infarction involves an interruption of the blood flow to the heart. This can damage or destroy part of the heart muscle.
The most common cause of heart attack is plaque, a blood clot, or both in a coronary artery. It can also occur if an artery suddenly narrows or spasms.
Heart failure can result from untreated coronary artery disease, high blood pressure, arrhythmias, and other conditions. These conditions can affect the heart’s ability to pump properly.
Heart failure can be life threatening, but seeking early treatment for heart-related conditions can help prevent complications.
This condition usually develops when a genetic problem affects the heart muscle. It tends to be an inherited condition.
The walls of the muscle thicken, and contractions become harder. This affects the heart’s ability to take in and pump out blood. In some cases, an obstruction can occur.
There may be no symptoms, and many people do not receive a diagnosis. However, hypertrophic cardiomyopathy can worsen over time and lead to various heart problems.
Anyone with a family history of this condition should ask for screening, as receiving treatment can help prevent complications.
Hypertrophic cardiomyopathy is the main cause of cardiac death among athletes and people aged under 35 years, according to the AHA.
Mitral valve regurgitation
This event occurs when the mitral valve in the heart does not close tightly enough and allows blood to flow back into the heart.
As a result, blood cannot move through the heart or the body efficiently, and it can put pressure on the veins leading from the lungs to the heart. In time, the heart can become enlarged, and heart failure can result.
Mitral valve prolapse
This happens when the valve flaps of the mitral valve do not close properly. Instead, they bulge into the left atrium. This can cause a heart murmur.
Mitral valve prolapse is not usually life threatening, but some people may need treatment.
Genetic factors and connective tissue problems can cause this condition, which affects around 2% of the population.
In aortic stenosis, the pulmonary valve is thick or fused and does not open properly. This makes it hard for the heart to pump blood from the right ventricle into the pulmonary artery.
In aortic stenosis, the aortic valve opening is too narrow, restricting blood flow from the left ventricle to the aorta. It can also impact the pressure in the left atrium.
A person may be born with it, or it may develop over time due to calcium deposits or scarring.
The symptoms of heart disease depend on the specific type a person has. Also, some heart conditions cause no symptoms at all.
The following symptoms may indicate a heart problem:
- angina, or chest pain
- difficulty breathing
- fatigue and lightheadedness
- swelling due to fluid retention, oredema
In children, the symptoms of a congenital heart defect may include cyanosis, or a blue tinge to the skin, and an inability to exercise.
Some signs and symptoms that could indicate heart attack include:
- chest pain
- heart palpitations
- stomach pain
- arm, jaw, back, or leg pain
- a choking sensation
- swollen ankles
- an irregular heartbeat
Heart attack can lead to cardiac arrest, which is when the heart stops and the body can no longer function. A person needs immediate medical attention if they have any symptoms of heart attack.
If cardiac arrest occurs, the person will need:
- immediate medical help (call 911)
- immediate cardiopulmonary resuscitation
- a shock from an automated external defibrillator, if available
Heart disease develops when there is:
- damage to all or part of the heart
- a problem with the blood vessels leading to or from the heart
- a low supply of oxygen and nutrients to the heart
In some cases, there is a genetic cause. However, some lifestyle factors and medical conditions can also increase the risk. These include:
- high blood pressure
- high cholesterol
- a high intake ofalcohol
- overweight andobesity
- a family history of heart disease
- dietary choices
- a history ofpreeclampsia during pregnancy
- low activity levels
- highstress and anxiety levels
The WHO mention poverty and stress as two key factors contributing to a global increase in heart and cardiovascular disease.
The treatment options will vary depending on the type of heart disease a person has, but some common strategies include making lifestyle changes, taking medications, and undergoing surgery.
The following sections will look at some of these options in more detail.
Various medications can help treat heart conditions. The main options include:
- Anticoagulants:Also known as blood thinners, these medications can prevent clots. They include warfarin (Coumadin).
- Antiplatelet therapies:These include aspirin, and they can also prevent clots.
- Angiotensin-converting enzyme inhibitors:These can help treat heart failure and high blood pressure by causing the blood vessels to expand. Benazepril (Lotensin) is one example.
- Angiotensin II receptor blockers:These can also control blood pressure. Valsartan (Diovan) is one example.
- Angiotensin receptor neprilysin inhibitors:These can help open up narrowed arteries to treat heart failure.
- Beta-blockers:Atenolol (Tenormin) and other medications in this class can reduce the heart rate and lower blood pressure. They can also treat arrhythmias and angina.
- Calcium channel blockers: These can lower blood pressure and prevent arrhythmias by reducing the pumping strength of the heart and relaxing the blood vessels. One example is diltiazem (Cardizem).
- Cholesterol-lowering medications:Statins, such as atorvastatin (Lipitor), and other types of drug can help reduce levels of low-density lipoprotein cholesterol in the body.
- Digitalis:Preparations such as digoxin (Lanoxin) can increase the strength of the heart’s pumping action. They can also help treat heart failure and arrhythmias.
- Diuretics:These medications can reduce the heart’s workload, lower blood pressure, and remove excess water from the body. Furosemide (Lasix) is one example.
- Vasodilators:These are medications to lower blood pressure. They do this by relaxing the blood vessels. Nitroglycerin (Nitro Stat) is one example. They can also help ease chest pain. Learn more about vasodilation here.
A doctor will work with the individual to find a suitable option.
Sometimes, side effects occur. If this is the case, it may be necessary to review the medication regimen.
Undergoing heart surgery can help treat blockages and heart problems when medications are not effective.
Some common types of surgery include:
- Coronary artery bypass surgery:This allows blood flow to reach a part of the heart when an artery is blocked. Coronary artery bypass grafting is the most common surgery. A surgeon can use a healthy blood vessel from another part of the body to repair a blocked one.
- Valve replacement or repair:A surgeon can replace or repair a valve that is not functioning properly.
- Repair surgery:A surgeon can repair congenital heart defects, aneurysms, and other problems.
- Device implantation:Pacemakers, balloon catheters, and other devices can help regulate the heartbeat and support blood flow.
- Laser treatment:Transmyocardial laser revascularization can help treat angina.
- Maze surgery:A surgeon can create new paths for electrical signals to pass through. This can help treat atrial fibrillation.
Heart transplants are another option. However, it can be hard to find a suitable donor at the right time.
Some lifestyle measures can help reduce the risk of heart disease. These include:
- Eating a balanced diet:Opt for a heart-healthy diet that is rich in fiber and favors whole grains and fresh fruits and vegetables. Also, it may help to limit the intake of processed foods and added fat, salt, and sugar.
- Exercisingregularly: This can help strengthen the heart and circulatory system, reduce cholesterol, and maintain blood pressure.
- Maintaining a moderate body weight:A person can check their body mass index (BMI) here.
- Quitting or avoiding smoking:Smoking is a major risk factor for heart and cardiovascular conditions.
- Limiting alcohol intake:Females should consume no more than one standard drinkTrusted Source
per day, and males should consume no more than two standard drinks per day.
- Managing underlying conditions:Seek treatment for conditions that affect heart health, such as high blood pressure, obesity, and diabetes.
Taking these steps can help boost overall health and reduce the risk of heart disease and its complications.
What to know about high blood
When doctors take a person’s blood pressure, they measure the force that blood exerts on the walls of the arteries as it flows through them.
If blood pressure is too high for too long, it can cause serious damage to the blood vessels.
There are ways of managing high blood pressure, or hypertension. High blood pressure often does not cause symptoms, but regular screening can help a person know if they need to take preventive action.
In the United States, around 75 million people, or 29% of the population, have high blood pressure, according to the Centers for Disease Control and Prevention (CDC).
In this article, we look at the causes of high blood pressure and how to treat it. We also explain the blood pressure measurements that health authorities consider to be healthy and too high.
What is high blood pressure?
Leaving high blood pressure untreated may damage the blood vessels.
The heart is a muscle that pumps blood around the body. As it travels, the blood delivers oxygen to the body’s vital organs.
Sometimes, a problem in the body makes it harder for the heart to pump the blood. This could happen, for example, if an artery becomes too narrow.
Persistent high blood pressure can put a strain on the walls of the arteries. This can lead to a variety of health problems, some of which can be life threatening.
High blood pressure chart
The chart below shows measures for normal and high blood pressure, according to the American Heart Association (AHA).
Doctors measure blood pressure in millimeters of mercury (mm Hg).
Systolic pressure measures the pressure in the arteries as the heart contracts and is the top number on a blood pressure reading. Diastolic, which is the lower number, represents the blood pressure when the heart is resting between beats.
Systolic (mm Hg)
Diastolic (mm Hg)
Stage 1 hypertension
Stage 2 hypertension
140 or above
90 or above
Signs and symptoms
Most people with high blood pressure will not experience any symptoms, which is why people often call hypertension the “silent killer.”
However, once blood pressure reaches about 180/120 mm Hg, it becomes a hypertensive crisis, which is a medical emergency.
At this stage, a person may have:
- blurred ordouble vision
- heart palpitations
Anybody who experiences these symptoms should see their doctor immediately.
Symptoms in women
Hormonal factors mean that the risk of high blood pressure may be different in males and females.
Factors that can increase the risk of high blood pressure in females include:
During pregnancy, high blood pressure can be a sign of preeclampsia, a potentially dangerous condition that can affect the woman and her unborn baby.
Symptoms of preeclampsia include:
- vision changes
- abdominal pain
- swelling due toedema
All women should follow the guidelines for screening and attend all health checks, especially during pregnancy.
Symptoms in teens
Teenagers can develop high blood pressure due to obesity or an underlying medical condition.
Possible medical factors include :
- aspects of metabolic syndrome, such astype 2 diabetes
- kidney disease
- endocrine disease, which affects the hormones
- vascular disease, which affects the blood vessels
- a neurological condition
These conditions may have symptoms of their own.
The symptoms of high blood pressure, if they occur, will be the same as for other groups.
Symptoms in children
High blood pressure can affect children. Having obesity and diabetes increases the risk, but it can also be a sign of:
- heart problems
- kidney problems
- thyroid problems
- a genetic condition, such as Cushing’s syndrome
As with adults, high blood pressure often does not cause symptoms in children.
However, if symptoms do occur, they may include:
- a headache
- blurred vision
They may also have signs of another condition.
Symptoms in babies
Newborns and very young babies can sometimes have high blood pressure due to an underlying health condition, such as kidney or heart disease.
Symptoms may include:
- a failure to thrive
- respiratory distress
Other symptoms will depend on the condition that is causing the high blood pressure.
High blood pressure can occur when certain changes happen in the body or if a person is born with specific genetic features that cause a health condition.
It can affect people with:
- type 2 diabetes
- kidney disease
- obstructive sleep apnea
- underactive or overactive thyroid
- congenital conditions, such as Cushing’s syndrome, acromegaly, or pheochromocytoma
Sometimes, there is no apparent cause. In this case, a doctor will diagnose primary hypertension.
Consuming a high fat diet, carrying excess weight, drinking a lot of alcohol, smoking tobacco, and the use of some medications also increase the risk.
How to lower blood pressure
Treatment will depend on several factors, including:
- how high the blood pressure is
- the risk of cardiovascular disease or a stroke
The doctor will recommend different treatments as blood pressure increases. For slightly high blood pressure, they may suggest making lifestyle changes and monitoring the blood pressure.
If blood pressure is high, they will recommend medication. The options may change over time, according to how severe the hypertension is and whether complications arise, such as kidney disease. Some people may need a combination of several different medications.
Conventional drugs for treating high blood pressure include:
1) Angiotensin converting enzyme inhibitors
Angiotensin converting enzyme (ACE) inhibitors block the actions of some hormones that regulate blood pressure, such as angiotensin II. Angiotensin II causes the arteries to constrict and increases blood volume, resulting in increased blood pressure.
ACE inhibitors can reduce the blood supply to the kidneys, making them less effective. As a result, it is necessary for people taking ACE inhibitors to have regular blood tests.
People should not use ACE inhibitors if they:
- are pregnant
- have a condition that affects the blood supply to the kidneys
ACE inhibitors may cause the following side effects, which usually resolve after a few days:
- a persistent dry cough
If the side effects are persistent or too unpleasant to manage, a doctor may prescribe an angiotensin II receptor antagonist instead.
These alternative medications often cause fewer side effects, but they may include dizziness, headaches, and increased potassium levels in the blood.
2) Calcium channel blockers
Calcium channel blockers (CCBs) aim to decrease calcium levels in the blood vessels. This will relax the vascular smooth muscle, causing the muscle to contract less forcefully, the arteries to widen, and blood pressure to go down.
CCBs may not always be suitable for people with a history of heart disease, liver disease, or circulation issues. A doctor can advise on taking CCBs and which type of CCB is safe to use.
The following side effects may occur, but they usually resolve after a few days:
- redness of the skin, generally on the cheeks or neck
- swollen ankles and feet
- skin rash
- swollen abdomen, in rare cases
Learn more here about calcium channel blockers.
3) Thiazide diuretics
Thiazide diuretics help the kidneys get rid of sodium and water. This lowers blood volume and pressure.
The following side effects can occur, and some of them may persist:
- low blood potassium, which can affect heart and kidney function
- impaired glucose tolerance
- erectile dysfunction
People taking thiazide diuretics should have regular blood and urine tests to monitor their blood sugar and potassium levels.
Beta-blockers were once popular for treating hypertension, but doctors only tend to prescribe them now when other treatments have not been successful.
Beta-blockers slow the heart rate and reduce the force of the heartbeat, causing a drop in blood pressure.
Side effects may include:
- cold hands and feet
- slow heartbeat
- Less common side effects are:
- disturbed sleep
- erectile dysfunction
Beta-blockers are often the standard medication for a person with very high blood pressure, known as a hypertensive crisis.
5) Renin inhibitors
Aliskiren (Tekturna, Rasilez) reduces the production of renin, an enzyme that the kidneys produce.
Renin helps produce a hormone that narrows blood vessels and raises blood pressure. Reducing this hormone causes the blood vessels to widen and blood pressure to fall.
This drug is relatively new, and healthcare professionals are still determining its optimal use and dosage.
Possible side effects include:
- flu-like symptoms
- a cough
It is essential to read the packaging of any medication to check for interactions with other drugs.
Managing the diet can be an effective way of both preventing and treating high blood pressure.
A healthful, balanced diet includes plenty of fruits and vegetables, vegetable and omega oils, and good quality, unrefined carbohydrates, such as whole grains. People who include animal products in their diet should trim all the fat off and avoid processed meats.
Lowering salt intake
Experts recommend reducing salt consumption and increasing potassium intake to manage or prevent high blood pressure. Limiting salt intake to less than 5-6 grams per day could help improve cardiovascular health and reduce systolic blood pressure by 5.6 mm Hg in people with hypertension.
In moderation, plant sources of fats, such as avocados, nuts, olive oil, and omega oils, can be healthful. People should limit their intake of saturated fats and trans fats, common in animal-sourced and processed foods.
The DASH diet
Health experts recommend the DASH diet for people with high blood pressure. The DASH diet focuses on an eating plan that emphasizes whole grains, fruits, vegetables, nuts, seeds, beans, and low-fat dairy products.
Number of weekly servings for those eating 1,600–3,100 calories a day
Number of weekly servings for those on a 2,000-calorie diet
Grains and grain products
Mostly low-fat or non-fat dairy foods
Lean meat, fish, or poultry
Nuts, seeds, and legumes
Fats and candy
Which foods are good for reducing blood pressure? Find out here.
Some studies indicate that consuming some alcohol may help lower blood pressure. However, others report the opposite, noting that even drinking a moderate amount might increase blood pressure levels.
People who regularly drink more than moderate amounts of alcohol will almost always experience elevated blood pressure levels.
Studies into the relationship between caffeine and blood pressure have produced conflicting results. A report published in 2017 concluded that a moderate intake of coffee appears to be safe for people with high blood pressure.
The AHA recommend a range of lifestyle adjustments that can help reduce blood pressure, such as:
- quitting smoking
- eating healthfully
- getting exercise
- following any treatment plan the doctor prescribes
Discuss any planned lifestyle changes with a healthcare professional before introducing them.
Regular exercise may help lower blood pressure.
The AHA note that most healthy people should do at least 150 minutes of moderate intensity physical exercise a week. This could be 30 minutes — or three lots of 10 minutes a day — on 5 days of the week.
This amount of exercise is also appropriate for people with high blood pressure.
However, a person who has not exercised for a while or who has a new diagnosis should talk to their doctor before starting a new physical activity program to ensure the choices they make are suitable for them.
Studies have revealed that losing as little as 5–10 pounds in weight can help reduce blood pressure.
Weight loss will also improve the effectiveness of blood pressure medications.
Ways of achieving and maintaining a healthy weight include:
- getting regular exercise
- following a diet that emphasizes plant-based foods and limits the intake of fat and added sugars
For more advice on maintaining weight loss, click here.
Increasing sleep alone cannot treat hypertension, but too little sleep and poor sleep quality may make it worse.
A 2015 analysis of data from a Korean national health survey found that people who had less than 5 hours of sleep per night were more likely to have hypertension.
In this article, you can find more tips on how to manage high blood pressure.
According to the National Center for Complementary and Integrative Health (NCCIH), the following may help lower blood pressure:
- meditation,yoga, qi gong, and tai chi
- biofeedback and transcendental meditation
- supplements such as garlic, flaxseed, green or black tea, probiotics, cocoa, and roselle (Hibiscus sabdariffa)
The NCCIH add, however, that there is not yet enough evidence to confirm that these can make a difference.
They also warn that:
Some supplements can have adverse effects. They may raise blood pressure or interact with medications.
Meditation and exercise therapies are usually safe, but some poses may not be suitable for people with high blood pressure.
Anyone who is considering an alternative therapy should speak to their doctor first.
Get some tips for lowering blood pressure naturally.
Diastolic and systolic pressure
There are two parts to a blood pressure measurement:
Systolic pressure: This is the blood pressure when the heart contracts.
Diastolic pressure: This is the blood pressure between heartbeats.
If blood pressure is 120/80 mm Hg, it means that the systolic pressure is 120 mm Hg and the diastolic pressure is 80 mm Hg.
Learn more here about what makes systolic and diastolic pressure.
There are different devices for measuring blood pressure. A doctor will often use a manual sphygmomanometer with a stethoscope. This has a pressure cuff that they put around the person’s arm.
Digital devices are suitable for home use, and they available from pharmacies and for purchase online.
When a person gets a blood pressure reading, they will have one of the following:
Normal: Less than 120/80 mm Hg.
Elevated: 120–129/80 mm Hg. At this stage, a doctor will advise the individual to make lifestyle changes to return their blood pressure to the normal range.
Stage 1 hypertension: 130–139/80–89 mm Hg.
Stage 2 hypertension: Over 140/90 mm Hg.
Hypertensive crisis: 180/120 mm Hg or above.
A person with a hypertensive crisis needs immediate medical attention.
A person will typically need more than one reading to confirm a diagnosis, as various factors can affect the result.
Blood pressure can fluctuate:
- according to the time of day
- when a person feelsanxiety or stress
- after eating
However, a doctor will take immediate action if a reading shows very high blood pressure or if there are signs of organ damage or other complications.
Other tests can help confirm a diagnosis.
Urine and blood tests: These can check for underlying problems, such as a urine infection or kidney damage.
Exercise stress test: A healthcare professional will measure a person’s blood pressure before, during, and after using a stationary bicycle or a treadmill. The results can give important clues about heart health.
Electrocardiogram (ECG): An ECG tests electrical activity in the heart. For a person with hypertension and high cholesterol levels, a doctor may order an ECG as a baseline for comparing future results.
Changes in future results might show that coronary artery disease is developing or that the heart wall is thickening.
Holter monitoring: For 24 hours, the individual carries an ECG portable device that connects to their chest through electrodes. This device can provide an overview of blood pressure throughout the day and show how it changes as the level of activity varies.
Echocardiogram: Ultrasound waves show the heart in motion. The doctor will be able to detect problems, such as thickening of the heart wall, defective heart valves, blood clots, and excessive fluid around the heart.
Dangers and side effects of hypertension
A healthy blood pressure is essential for maintaining bodily functions.
High blood pressure can have a severe impact on:
The cardiovascular system: High blood pressure can cause the arteries to harden, increasing the risk of a blockage.
The brain: A blockage in the arteries can lower or prevent blood flow to the brain, leading to a stroke.
The kidneys: High blood pressure can result in kidney damage and chronic kidney disease.
All of these effects can be life threatening.
Can you take decongestants?
Decongestants are a useful over-the-counter remedy when people have a stuffy or runny nose, but some decongestants can raise blood pressure.
Ingredients that can have this effect include:
A person should explain to their pharmacist that they have high blood pressure and ask them to recommend a suitable option.
Is high blood pressure genetic?
The main risk factors for high blood pressure are likely to be environmental, but genetic factors may play a role. Hypertension can run in families, and people from certain ethnic and racial backgrounds appear to have a higher risk.
According to the CDC,
however, people in a family often share similar lifestyles, such as dietary choices.
If a person has genetic factors that increase their susceptibility to high blood pressure, and they also make lifestyle choices that increase this risk, they will likely have a greater chance of developing hypertension.
How much sodium per day?
The AHA recommend that people limit their salt intake to no more than 2,300 milligrams (mg) a day and preferably reducing it to 1,500 mg. On average, people in the U.S. currently consume more than 3,400 mg of sodium daily.
For most people, the natural sodium content in vegetables, for example, is enough for their body’s needs. Avoiding the salt shaker and eating less processed and premade food are good ways to cut salt intake.
Without treatment or taking measures to manage blood pressure, excessive pressure on the artery walls can lead to damage of the blood vessels, which is a form of cardiovascular disease. It can also damage some vital organs.
Possible complications of high blood pressure include:
- heart attack and heart failure
- blood clots
- kidney disease
- thickened, narrow, or torn blood vessels in the eyes
- metabolic syndrome
- brain function and memory problems
Seeking early treatment and managing blood pressure can help prevent many health complications.
The risk factors
for high blood pressure include the following:
Age: The risk increases with age because the blood vessels become less flexible.
Family history and genetic factors: People who have close family members with hypertension are more likely to develop it.
Ethnic background: African Americans have a higher risk of developing hypertension than other groups in the United States.
Obesity and being overweight: People with overweight or obesity are more likely to develop high blood pressure.
Physical inactivity: A sedentary lifestyle increases the risk.
Smoking: When people smoke, the blood vessels narrow, and blood pressure rises. Smoking also reduces the blood’s oxygen content, so the heart pumps faster to compensate. This, too, increases blood pressure.
Alcohol intake: Drinking a lot of alcohol increases the risk of blood pressure and its complications, such as heart disease.
Diet: A diet that is high in unsaturated fat and salt increases the risk of high blood pressure.
High cholesterol: Over 50% of people with high blood pressure have high cholesterol. Consuming unhealthful fats can contribute to a buildup of cholesterol in the arteries.
Mental stress: Stress can have a severe impact on blood pressure, especially when it is chronic. It can occur as a result of both socioeconomic and psychosocial factors.
Stress: Persistent stress can lead to high blood pressure, and it may increase the risk of unhealthful choices, such as smoking.
Diabetes: High blood pressure often occurs alongside type 1 diabetes. Following a treatment plan to manage diabetes can reduce the risk.
Pregnancy: High blood pressure is more likely during pregnancy due to hormonal changes. Hypertension is also a symptom of preeclampsia, a potentially severe placental disorder.
Sleep apnea: People with sleep apnea momentarily stop breathing while they sleep. Experts say there are links with hypertension.
When to see a doctor
Many people with high blood pressure do not have symptoms. For this reason, they must have regular screening, especially those with a higher risk.
This group includes:
- people with obesity or overweight
- African Americans
- those with a previous history of high blood pressure
- those with blood pressure that is at the high end of normal (from 130–139/ 85–89 mm Hg)
- people with certain health conditions
The U.S. Preventive Services Task Force (USPSTF) recommend annual screening for:
- adults aged 40 years or older
- those with an elevated risk of high blood pressure
- Persons with a higher risk include those who:
- have high to normal blood pressure (130 to 139/85 to 89 mm Hg)
- have overweight or obesity
- are African Americans
Adults aged 18–39 years whose blood pressure is normal (less than 130/85 mm Hg) and who do not have other risk factors should have further screening every 3–5 years.
If rescreening in the doctor’s office shows that blood pressure has risen, the USPSTF recommend that the person use an ambulatory blood pressure monitor for 24 hours to assess their blood pressure further. If this continues to show high blood pressure, the doctor will diagnose hypertension.
The USPSTF do not currently recommend routine screening for those aged 17 years and under.
How to spot and treat a heart attack
A heart attack happens when there is a loss of blood supply to part of the heart muscle. It often results from a blockage in a nearby artery.
A person who is experiencing a heart attack — or myocardial infarction — will feel pain in their chest and other parts of their body, as well as other symptoms.
Spotting the early signs of a heart attack and getting prompt treatment is crucial and can save a person’s life.
A heart attack is different from cardiac arrest, in which the heart stops working completely. Both are medical emergencies, and without treatment, a heart attack can lead to cardiac arrest.
This article looks at how heart attacks happen and how to treat and prevent them.
Symptoms of a heart attack
As heart attacks can be fatal, it is crucial to recognize the warnings as soon as possible and contact emergency services.
- a feeling of pressure, tightness, pain, squeezing, or aching in the chest
- pain that spreads to the arms, neck, jaw, or back
- a feeling of crushing or heaviness in the chest
- a feeling similar to heartburn or indigestion
- nausea and sometimes vomiting
- feeling clammy and sweaty
- shortness of breath
- feeling lightheaded or dizzy
- in some cases, anxiety that can feel similar to a panic attack
- coughing or wheezing, if fluid builds up in the lungs
The symptoms can vary in their order and duration — they may last several days or come and go suddenly.
The following may also develop:
- Hypoxemia:This involves low levels of oxygen in the blood.
- Pulmonary edema:This involves fluid accumulating in and around the lungs.
- Cardiogenic shock:This involves blood pressure dropping suddenly because the heart cannot supply enough blood for the rest of the body to work adequately.
Females and males sometimes experience heart attacks differently. Learn about heart attack symptoms in females here.
A heart attack is life threatening and needs emergency attention.
Nowadays, many people survive heart attacks, due to effective treatment. Delaying treatment, however, dramatically reduce the chances of survival.
Call 911 immediately
- Be ready to explain what has happened and where you are.
- Stay calm and follow all instructions from the emergency team.
While waiting for the team to arrive, talk to the person, and reassure them that help is on the way.
If the person stops breathing, take the following steps:
Do manual chest compressions:
- Lock your fingers together and place the base of your hands in the center of the chest.
- Position your shoulders over your hands, lock your elbows, and press hard and fast, at a rate of 100–120 compressions per minute. Press to a depth of 2 inches.
- Continue these movements until the person starts to breathe or move, until someone else can take over, or until you are exhausted.
- If possible, take turns without pausing the compressions.
Use an automatic external defibrillator (AED)
- AEDs are available in shopping malls and many other public places.
- An AED provides a shock that may restart the heart.
- Remain calm and follow the instructions. Most newer AEDs talk you through the steps.
When the emergency team arrives, they will take over the person’s care.
Give the team as much detail as possible about the person’s health and what was happening before the event.
The team will try to stabilize the person’s condition, including providing oxygen.
In the hospital, a medical team will perform tests and provide appropriate treatment.
Many approaches can help, but three common options are:
- medications, including those to dissolve blood clots
- percutaneous coronary intervention, a mechanical method of restoring blood flow to any damaged tissue
- coronary artery bypass grafting, commonly called a heart bypass, diverts blood around damaged areas of the arteries to improve blood flow
The healthcare team will also work with the individual to develop a treatment plan designed to prevent future attacks.
Some people experience complications after a heart attack. Depending on how severe the event was, these may include:
- Depression: This is common after a heart attack, and engaging with loved ones and support groups can help.
- Arrhythmia:The heart beats irregularly, either too fast or too slowly.
- Edema:Fluid accumulates and causes swelling in the ankles and legs.
- Aneurysm:Scar tissue builds up on the damaged heart wall, which causes thinning and stretching of the heart muscle, eventually forming a sac. This can also lead to blood clots.
- Angina:Insufficient oxygen reaches the heart, causing chest pain.
- Heart failure: The heart can no longer pump effectively, leading to fatigue, difficulty breathing, and edema.
- Myocardial rupture: This is a tear in a part of the heart, due to damage caused by a heart attack.
Ongoing treatment and monitoring can help reduce the risk of these complications.
There are various ways to lower the risk of a heart attack. The American Heart Associaton advise people to make heart health a priority.
Ways to do this include:
- avoiding or quittingsmoking
- having a balanced,healthful diet
- getting regularexercise
- managingdiabetes, high cholesterol levels, high blood pressure, and other conditions
- limitingalcohol intake
- maintaining a healthybody weight
- whenever possible, avoidingstress or practicing ways to reduce it
Knowing the symptoms of a heart attack can help a person get prompt treatment, and this increases the chances of a positive outcome.
In the hospital, a doctor will ask about symptoms. When making a diagnosis and drawing up a treatment strategy, they will take into account the person’s:
- overall health
- medical history
- family history
They will also need to carry out tests, which include:
- imaging tests, such as X-rays, CT scans, and echocardiograms
- electrocardiography, to measure electrical activity in the heart
- blood tests, which can confirm that a heart attack has occurred
- cardiac catheterization, which enables a doctor to examine the inside of the heart
Recovering can take time, depending on the severity of the heart attack and other factors, such as the cause and the person’s age.
Some factors involved include:
- Cardiac rehabilitation: The healthcare team will help the person make a plan to restore their health and prevent another heart attack.
- Resuming physical activity:A healthcare provider can help develop a suitable activity plan.
- Returning to work: The timing of this depends on the person’s job and the severity of the heart attack.
- Driving:A doctor will advise about the timing, which varies from person to person.
- Sex:Most people can resume sexual activity after 4–6 weeks. Erectile dysfunction can result from medication use, but treatment can help resolve this.
Many people experience depression during recovery from a heart attack, but counseling, support groups, and treatments can help.
The most common cause of a heart attack is a blockage in one of the arteries near the heart.
This can result from coronary heart disease, in which plaque — made up of cholesterol and other substances — collects in the arteries, narrowing them. Over time, this can obstruct the flow of blood.
Less common causes include:
- the misuse of drugs, such as cocaine, which causes the blood vessels to narrow
- low oxygen levels in the blood, due, for example, to carbon monoxide poisoning
As the AHA note, the following can increase the risk of a heart attack:
- older age
- male sex
- high cholesterol levels
- high blood pressure
- other health conditions, such as obesity or diabetes
- having a diet high in processed foods and added fats, sugars, and salt
- low activity levels
- genetic factors and family history
- a high alcohol intake
- high levels of stress
Often, a heart attack results from a combination of factors.
In addition, the AHA report that Black Americans, Latinx Americans, Native Americans, Native Hawaiians, and some Asian Americans have increased risks of high blood pressure and dying of heart disease, compared with their white counterparts.
A heart attack can be life threatening and needs immediate medical attention.
Key warnings include pain and tightness in the chest, pain in other parts of the body, and difficulty breathing.
If anyone has symptoms of a heart attack, someone should call 911 at once. With prompt treatment, there is often a good chance of a positive outcome.
What to know about congestive heart failure
Despite its name, congestive heart failure does not necessarily mean that the heart has stopped working. However, heart failure is a serious condition in which the heart does not pump blood around the body efficiently.
The body relies on the pumping action of the heart to deliver nutrient- and oxygen-rich blood to each of its cells. When the cells do not receive adequate nourishment, the body cannot function properly.
If the heart becomes weakened and cannot supply the cells with sufficient blood, the person will be tired and breathless. Everyday activities that used to be easy can become challenging.
Heart failure is a serious condition, and there is usually no cure. However, with the right treatment, people can still lead an enjoyable and productive life.
According to the National Heart, Lung, and Blood Institute, approximately 5.7 million people in the United States have heart failure.
Heart failure can be systolic or diastolic, depending on whether it affects the heart’s ability to contract or relax, respectively. In this article, we focus on systolic congestive heart failure, including its causes, symptoms, types, and treatment.
Heart failure, heart attack, and cardiac arrest
A person with congestive heart failure may experience congested lungs.
The following list provides definitions for common heart problems:
- Heart attack: A heart attack is damage to the heart muscle due to the blockage of a coronary artery, which supplies blood to the heart. The heart muscle sustains damage because blood is not getting to it, so it becomes starved of oxygen.
- Systolic heart failure. Systolic heart failure means that the heart muscle cannot pump blood around the body properly. It is not a heart attack.
- Cardiac arrest. A cardiac arrest is when the heart and blood circulation both stop, and the person has no pulse.
Any condition that damages the heart muscle can cause systolic heart failure. These conditions include:
- Coronary artery disease:The coronary arteries supply the heart muscle with blood. If these become blocked or narrowed, the flow of blood reduces, and the heart does not receive the blood supply that it needs.
- Heart attack:A sudden blockage of the coronary arteries causes scarring in the heart’s tissues and decreases how effectively it can pump.
- Nonischemic cardiomyopathy:This disease involves weakness of the heart muscle due to causes other than blockages in the coronary arteries. Possible causes include genetic conditions, drug side effects, and infections.
- Conditions that overwork the heart:Examples include valve disease, hypertension (high blood pressure), diabetes, kidney disease, and heart abnormalities present at birth.
The following are risk factors for congestive heart failure:
- diabetes, especially type 2 diabetes
- thyroid problems, including hyperthyroidism and hypothyroidism
- myocarditis, or the inflammation of the heart muscle, which usually occurs due to a virus and can lead to left sided heart failure
- heart arrhythmias, or abnormal heart rhythms — a fast heartbeat can weaken the heart, and a slow heartbeat can reduce blood flow, causing heart failure
- atrial fibrillation, an irregular and often rapid heartbeat
- hemochromatosis, a condition in which iron accumulates in the tissues
- amyloidosis, where one or more organ systems accumulate deposits of abnormal proteins
The following are possible symptoms of heart failure:
Congested lungs: Fluid builds up in the lungs and causes shortness of breath, even when a person is resting and particularly when they are lying down. It can also cause a hacking, dry cough.
Fluid retention: Less blood reaches the kidneys, which can result in water retention. Water retention can cause swelling of the ankles, legs, and abdomen. It can also cause weight gain.
Fatigue and dizziness: A reduction in the amount of blood reaching the organs of the body can cause feelings of weakness. A drop in blood flow to the brain can also cause dizziness and confusion.
Irregular and rapid heartbeats: The heart might pump more quickly to try to counteract the lower volume of blood that it pumps out with each contraction. It may also activate stress receptors in the body to increase the release of stress hormones.
Many other conditions can cause similar symptoms, so a person should see their doctor for an accurate diagnosis. People who have received a diagnosis of heart failure should monitor their symptoms carefully and report any sudden changes to their doctor immediately.
There are several different types of heart failure. It may affect just one side of the heart — the oxygenated or deoxygenated side — or both sides.
Types of congestive heart failure include:
Left sided heart failure
Left sided heart failure is the most common form of congestive heart failure. It usually develops as a result of coronary artery disease.
The left side of the heart is responsible for pumping blood to the rest of the body. In people with left sided heart failure, blood backs up into the lungs as the heart does not effectively pump it away. This issue can, in turn, cause shortness of breath and fluid buildup.
Right sided heart failure
The right side of the heart pumps blood to the lungs, where it collects oxygen. Right sided heart failure typically follows left sided heart failure. However, it can sometimes occur due to other conditions, such as lung disease or pulmonary hypertension.
Biventricular heart failure
If heart failure affects only the oxygenated side of the heart, it is called left heart failure. If it involves just the deoxygenated side (which pumps blood to the lungs), it is called right heart failure.
In biventricular heart failure, there are problems with both sides of the heart. Biventricular heart failure can occur with cardiomyopathy.
Diastolic heart failure
Diastolic heart failure occurs when the heart muscle is stiffer than usual but pumps normally. As the heart is stiff, it does not fill up with blood properly because it does not relax normally. Doctors refer to this as diastolic dysfunction.
When the heart does not fill up with blood, this results in increased pressure inside the heart, which can cause a backup of fluid into the lungs.
Systolic heart failure
Systolic dysfunction describes the heart’s inability to pump efficiently after filling with blood. It often occurs if the heart becomes weak or enlarged, which can occur on either side of the heart.
If a doctor suspects heart failure, they will recommend further tests, which may include:
- Blood and urine teststo check the person’s blood count, as well as their liver, thyroid, and kidney function and markers of “stretch” in the heart. The doctor may also want to check the blood for specific chemical markers of heart failure.
- Chest X-rayto show whether the heart has become enlarged. It will also show whether there is fluid in the lungs.
- An EKG (electrocardiogram)to record the electrical activity and rhythms of the heart. The test may also reveal any damage to the heart from a heart attack.
- An echocardiogram, which is an ultrasound scan that checks the pumping action of the heart. The doctor measures the percentage of blood that leaves the person’s left ventricle (the main pumping chamber) with each heartbeat. This measurement is called the ejection fraction.
The doctor may also carry out the following additional tests:
- A stress testto see how the heart responds to stress and determine whether there is a lack of oxygen due to blockages in the coronary arteries. The person may have to use an exercise machine, such as a treadmill, or take a medication that stresses the heart.
- A cardiac MRI or CT scanto examine the ejection fraction and the heart arteries and valves. The results can help a doctor determine whether the person has had a heart attack.
- A B-type natriuretic peptide (BNP) blood test— the release of BNP into the blood occurs if the heart becomes overfilled and is struggling to function properly.
- An angiogram,where a doctor injects dye into the coronary arteries to help detect coronary artery disease or narrowed arteries, which can cause heart failure. An angiogram is an X-ray of the blood vessels around the heart.
Prevention and management
Certain lifestyle changes can reduce the risk of heart failure or, at least, slow down its progression. These include:
- giving up smoking, if applicable
- eating a healthful diet that includes plenty of fruit, vegetables, good quality fats, unrefined carbohydrates, and whole grains
- exercising regularly and staying physically active
- maintaining a moderate body weight
- avoiding drinking more alcohol than thenational recommended limitsTrusted Source
- getting enough good quality sleep
- reducing stress where possible, as mental stress can place a strain on the heart over time
In addition, people who already have heart failure should keep up to date with their vaccinations and have a yearly flu shot.
The damage that heart failure can do to the heart’s pumping action is not always reversible. Nevertheless, current treatments can significantly improve the quality of life of people with this condition by keeping it under control and helping relieve many of the symptoms.
Treatment also focuses on treating any conditions that may be causing the heart failure, which, in turn, lessens the burden on the heart. A doctor or cardiologist will discuss treatment options with the person and suggest the best choices, depending on the individual’s circumstances.
Some common treatments for heart failure include:
Many different medications are available to treat the symptoms of congestive heart failure. They include:
- ACE inhibitors:Angiotensin-converting enzyme inhibiting drugs reduce the heart’s workload by helping the arteries relax and lowering blood pressure. ACE inhibitors boost the performance of the heart and can improve the person’s quality of life.
- ARBs:Angiotensin receptor blockers reduce symptoms of heart failure and prevent blood pressure from rising. They include candesartan, losartan, and valsartan.
- ARNIs:Angiotensin receptor-neprilysin inhibitors reduce strain on the heart to help treat heart failure.
- SGLT2 inhibitors:Also called gliflozins, sodium-glucose cotransporter-2 inhibitor drugs may help prevent and treat heart failure, according to a 2019 study.
- Diuretics: Diuretics help relieve ankle swelling and fluid retention. These drugs also relieve breathlessness resulting from heart failure. Diuretics remove water and salt from the kidneys in the urine. The three main types of diuretics are loop diuretics, thiazide diuretics, and potassium-sparing diuretics.
- Anticoagulants: Anticoagulant drugs thin the blood, making it harder for the blood to clot and helping prevent a stroke. The most common anticoagulant is warfarin. Doctors will monitor a person closely when they are taking this medication.
- Digoxin: A drug called digoxin slows down the heartbeat to treat a fast, irregular heart rhythm and improves the strength with which the heart contracts.
- Beta-blockers. All heart failure patients benefit from takingbeta-blockers.
- Antiplatelet drugs. Medications that stop blood platelets from forming clots are called antiplatelets. Aspirin is an antiplatelet drug that can be suitable for people with a very high risk of a heart attack or stroke and a low risk of bleeding or those who have previously had a heart attack or stroke. Currentguidelines no longer recommend the widespread use of aspirin to prevent cardiovascular disease.
Not everyone with heart failure responds to drug treatment. In these cases, there are some surgical options:
Coronary artery bypass graft: Doctors commonly recommend this procedure when coronary artery disease is the cause of congestive heart failure.
Heart valve surgery: This procedure repairs a defective valve that makes the heart pump inefficiently.
Implantable left ventricular assist device (LVAD): For hospital inpatients who have not responded to other treatments, an LVAD can help the heart pump blood. Doctors may use it for individuals who are waiting for a transplant.
Heart transplant: If no other treatments or surgeries help, a transplant is the final option. The medical team will only consider a heart transplant if the person is healthy other than the problem with their heart.
Congestive heart failure affects millions of people in the U.S. Doctors cannot always reverse the damage that it does to the heart, but treatments can provide symptom relief and improve a person’s quality of life.
Anyone who experiences symptoms of heart failure should see a doctor for a diagnosis.
What to know about atherosclerosis
Atherosclerosis happens when arteries become narrow and hard due to a buildup of plaque around the artery wall.
Other terms for the condition include arteriosclerosis and hardening of the arteries.
The plaque that is the cause of atherosclerosis consists of cholesterol, calcium, fat, and other substances, and it can harder over time.
The changes in a person’s arteries disrupt the flow of blood around the body and increase the risk of complications, such as heart attack or stroke. These complications can be life threatening.
What is atherosclerosis?
A person with atherosclerosis may experience difficulty breathing and weakness.
Atherosclerosis is the narrowing of arteries due to plaque buildup on the artery walls.
Arteries carry blood from the heart to the rest of the body. A thin layer of cells forms a lining that keeps them smooth and allows blood to flow easily. This is called the endothelium.
Atherosclerosis happens when the endothelium becomes damaged, due to factors such as smoking, high blood pressure, or high levels of glucose, fat, and cholesterol in the blood.
This damage allows a collection of substances, known as plaque, to build up in the artery wall. These substances include fat and cholesterol.
Over time, plaque can build up and become hard.
If plaque continues to collect, it can block the artery and disrupt the flow of blood around the body.
Sometimes, pieces of plaque break open. If this happens, particles from blood cells, known as platelets, gather in the affected area. These can stick together, forming blood clots.
Atherosclerosis can affect any artery, but it mainly occurs in the larger, high pressure arteries.
Atherosclerosis usually affects older people, but it can start to develop during adolescence. Inside the artery, streaks of white blood cells will appear on the artery wall.
Often, there are no symptoms until a bit of plaque ruptures, or the blood flow becomes restricted. This may take many years to occur.
The symptoms of atherosclerosis depend on which arteries are affected.
Carotid arteries provide blood to the brain. Restricted blood supply can lead to a stroke.
Symptoms of stroke can appear suddenly and include:
- difficulty breathing
- facial numbness
If a person has signs of a stroke, they need immediate medical attention.
Coronary arteries provide blood to the heart. When the blood supply to the heart falls, it can cause angina and heart attack.
A person may experience:
- chest pain
Renal arteries supply blood to the kidneys. If the blood supply becomes limited, chronic kidney disease may develop.
Someone with renal artery blockage significant enough to cause chronic kidney disease may experience:
- loss of appetite
- swelling of the hands and feet
- difficulty concentrating
These arteries supply blood to the arms, legs, and pelvis.
If blood cannot circulate effectively, a person may experience numbness and pain in their limbs. In severe cases, tissue death and gangrene can occur.
Peripheral artery disease also increases the risk of a stroke or heart attack.
Atherosclerosis can be life threatening, but treatment is available. Receiving treatment early can reduce the risk of severe complications.
Treatment aims to slow or stop the development of plaque, prevent blood clots forming, and treat symptoms.
- lifestyle changes
Research shows that the following lifestyle choices might reduce the risk:
- avoiding or quitting smoking
- consuming alcohol in moderation
- getting regular exercise
- following a healthful diet
- maintaining a healthy weight
Adopting these practices from early adulthood may help prevent problems later in life.
A doctor will prescribe medications to suit an individual’s needs, depending on their overall health and other conditions.
Drugs known as statins can help manage a person’s cholesterol levels.
Other medications can lower blood pressure, reduce blood sugar, and prevent clots and inflammation.
People should follow their doctor’s instructions and not discontinue a drug without seeking medical advice. They should also follow a healthful lifestyle, as well as using medication.
Sometimes a person will need surgery to ensure that blood in their arteries continues to flow effectively.
- using a stent to widen the blood vessel
- bypass surgery to carry blood around the affected area
- surgery to remove plaque buildup, for example, in the neck
These options may help a person with severe atherosclerosis.
The complications of atherosclerosis include:
- heart disease, heart attack, or heart failure
- peripheral artery disease
- kidney failure
- irregular heart rhythms and palpitations
- embolism when a piece of the clot breaks off and travels to another part of the bloodstream
What is atrial fibrillation?
Atrial fibrillation is an abnormal heart rhythm, also known as an arrhythmia. Blood flow from the top chambers of the heart to the bottom chambers varies from beat to beat, and the heart cannot pump blood to the rest of the body efficiently.
The Centers for Disease Control and Prevention (CDC) estimate that between 2.7 and 6.1 million people currently have A-fib.
Age is a key risk factor for developing the disorder. According to the CDC, 9 percent of people over the age of 65 years have A-fib in the U.S., but only two percent under 65 years have it.
The heartbeat usually starts from one spot in the right atrium, the upper-right chamber of the heart. However, people with A-fib have a heartbeat that triggers from multiple spots, which means both atria and the ventricles, or lower chambers, beat at their own pace.
The arrhythmia may or may not produce symptoms. Recognizing and treating A-fib early in its development can greatly improve the chances of avoiding complications.
Chest pain is a symptom of A-fib, if symptoms occur at all.
A-fib may not cause any symptoms at all, and, when there are symptoms, they may only occur intermittently.
Often the heart rate is higher than usual with A-fib, but this depends on how many signals get from the atria to the ventricle.
Common symptoms include:
- palpitations, or the feeling of an irregular heartbeat
- breathlessness, particularly when lying flat
- chest pain or pressure
- lowblood pressure
- dizziness, light-headedness, and fainting
Keep a close eye on the symptoms and when they occur or change in severity. Make a note of them for your doctor. This will help them make the diagnosis and decide on the best treatment.
Certain factors increase the risk of developing A-fib.
Age: The older a person is, the higher the risk of A-fib becomes.
Hypertension: Long-term high blood pressure can add strain to the heart and increase the risk of A-fib.
Pulmonary embolism: A blood clot in the lung increases the risk of A-fib.
Heart disease: People with the following conditions have a higher risk of A-fib:
Excessive alcohol consumption: Men who have more than two drink a day and women who have more than one drink daily are at increased risk of A-fib .
Family members with A-fib: A family history of the disease increases the risk of getting it.
Sleep apnea: People with this condition, especially when it is severe, have a higher risk of developing A-fib.
Surgery: A-fib commonly occurs directly after receiving heart surgery.
The treatment of A-fib aims to improve symptoms and reduce the risk of complications. For some people, converting the heart back to a normal rhythm is the best option.
For others, the doctor deems it better to leave the irregular rhythm in place and prescribe medication to control a high heart rate and prevent the formation of blood clots.
In addition to recommending a healthy lifestyle, a doctor will determine the most appropriate treatment depending on symptoms, other conditions they have, and overall health.
For A-fib, medications are used to control the heart rate, prevent clots from forming. Sometimes medications or a procedure is used to try to restore a regular rhythm.
When a doctor thinks the best option is to let someone stay in A-fib, they may prescribe anticoagulant medications, or blood-thinners. These medications make it harder for blood to clot.
However, stopping bleeding becomes more difficult in a person who takes these medications. The doctor will weigh the risk of developing a clot against the risk of falling and causing a bleed in the brain.
These medications include:
- direct-acting oral anticoagulants (DOACs), including rivaroxaban, apixaban, and edoxaban
Elderly people with an increased risk of falling often use aspirin but also have a high risk of forming a clot. Aspirin reduces clotting factor but not to the same extent as other medications, so any bleeding is easier to manage.
People taking warfarin or other anti-clotting agents should advise any medical professional treating them of their current medications, especially if they will be having a procedure or surgery or have been in an accident.
While taking anticoagulants, make sure the doctor knows about any planned or existing pregnancy or any signs of bleeding, such as:
- very large bruises
- nausea and light-headedness
- vomiting blood
- coughing up blood
- unusually heavy menstrual flow
- gums that bleed regularly
- bloody or black stool
- blood in the urine
- suddenback pain that is very severe
Take blood thinners exactly as the doctor advises for the best chance of preventing a clotting-related complication and avoiding excessive thinning of the blood.
Managing heart rate
If the heart rate is high, bringing it down is important to avoid heart failure and reduce the symptoms of A-fib.
Several medications can help by slowing conduction of the signals that tell the heart to beat.
- beta-blockers, such as propranolol, timolol, and atenolol
- calcium-channel blockers, such as diltiazem and verapamil
Normalizing heart rhythm
Instead of putting a person on blood thinners and heart rate-controlling medicine, doctors may try to return the heart rhythm to normal using medication.
This is called chemical or pharmacologic cardioversion.
Medications called sodium channel blockers, such as flecainide and quinidine, and potassium channel blockers, such as amiodarone and sotalol, are examples of medications that help to convert A-fib to regular heart rhythm.
The surgeon might install a pacemaker to moderate heart rhythm.
When a person does not tolerate A-fib medication needed for someone who has an irregular heart rhythm or doesn’t respond to pharmacologic cardioversion, surgical and non-surgical procedures can be used to control the heart rate or try to convert to a regular rhythm to help prevent complications from A-fib.
Options for converting A-fib to a regular rhythm include:
Electrical cardioversion: The surgeon delivers an electric shock to the heart, which briefly resets the abnormal rhythm to a regular beat. Before carrying out cardioversion, they will often perform an echocardiogram by inserting a scope down the throat to produce an image of the heart to make sure no clots are present in the heart.
If they find a clot, a doctor will prescribe anticoagulant medication for several weeks to dissolve it. Cardioversion will then be possible.
Catheter ablation: This destroys the tissue that is causing the irregular rhythm, returning the heart to a regular rhythm. The surgeon may need to repeat this procedure if the A-fib returns.
The surgeon sometimes destroys the area in which the signals travel between the atria and ventricles. This stops the A-fib, but the heart can no longer send a signal to orchestrate a beat. In these instances, the surgeon will then fit a pacemaker.
Surgical ablation: The heart tissue that is causing the irregular rhythm can also be removed in an open-heart surgery called a maze procedure. A surgeon will often carry out this procedure alongside a heart repair.
Pacemaker placement: This device instructs the heart to beat regularly. A surgeon will sometimes place a pacemaker in a person with intermittent A-fib that only occurs intermittently.
When a doctor feels that another condition is responsible for the A-fib, such as hyperthyroidism or sleep apnea, they will treat the underlying condition alongside the arrhythmia.
A-fib can cause potentially life-threatening health issues.
Blood can pool in the atria if the heart is not beating regularly. Blood clots can form in the pools.
A segment of a clot, called an embolus, might break off and travel to different parts of the body through the bloodstream and cause blockages.
An embolus can restrict blood flow to the kidneys, intestine, spleen, brain, or lungs. A blood clot can be fatal.
A stroke occurs when an embolus blocks an artery in the brain and reduces or stops blood flow to part of the brain.
The symptoms of a stroke vary depending on the part of the brain in which it occurs. They can include weakness on one side of the body, confusion, and vision problems, as well as speech and movement difficulties.
Stroke is a key cause of disability in the U.S. and the fifth most common cause of death, according to the CDC.
A-fib can lead to heart failure, especially when the heart rate is high. When the heart rate is irregular, the amount of blood flowing from the atria to the ventricles varies for each heartbeat.
The ventricles may therefore not fill up before a heartbeat. The heart fails to pump enough blood to the body, and the amount of blood waiting to circulate the body instead builds up in the lungs and other areas.
A-fib can also worsen the symptoms of any underlying heart failure.
A study in the Journal of the American Heart Association showed people with A-fib have a higher long-term risk of cognitive difficulties and dementia that have no link to reduced blood flow in the brain.
Controlling the factors that increase the risk of A-fib may help prevent it.
Manage the diet: A heart-healthy diet can help prevent A-fib and other heart diseases. The DASH diet, which the American Heart Association (AHA) promotes, has shown protective effects on heart health.
Abstaining from harmful substances: Tobacco, alcohol, and some illicit drugs, like cocaine, can damage the heart. With or without a diagnosis of A-fib, eliminating tobacco and mood-altering substances and moderating alcohol is vital for protecting the heart. This is also important in a person who already has A-fib.
Stress management: Stress can increase blood pressure and heart rate, which makes the heart work harder. Managing stress levels can help to prevent the progression and development of A-fib. Breathing exercises, mindfulness, meditation, and yoga can all help reduce stress.
Exercise: A physically active lifestyle has profound effects on cardiac health and can help strengthen the heart, reducing the risk of A-fib and other heart conditions.
A-fib is a disorder that causes an irregular heart rhythm.
It occurs more often after the age of 65 years and may or may not cause symptoms. The condition can lead to a stroke when blood pools in the heart and forms a clot that travels to the brain.
Lifestyle adjustments that can help to prevent A-fib include a heart-healthy diet, limiting alcohol intake, not smoking, and getting regular exercise.
There are two treatment options. A doctor might allow an irregular rhythm to continue but control the heart rate and prescribe an anticoagulant to help prevent a stroke. Alternatively, the doctor might try to convert the irregular rhythm back to a regular one with medication or a procedure.
What to know about arrhythmia
An arrhythmia describes an irregular heartbeat. With this condition, a person’s heart may beat too quickly, too slowly, too early, or with an irregular rhythm.
Arrhythmias occur when the electrical signals that coordinate heartbeats are not working correctly. An irregular heartbeat may feel like a racing heart or fluttering.
Many heart arrhythmias are harmless. However, if they are highly irregular or result from a weak or damaged heart, arrhythmias can cause severe and potentially fatal symptoms and complications.
In this article, we define arrhythmia, as well as its causes and symptoms. We also explain the possible treatments and different types.
What is arrhythmia?
A person with arrhythmia may experience chest pain.
Cardiac arrhythmia refers to a group of conditions that cause the heart to beat irregular, too slowly, or too quickly.
There are several categories of arrhythmia, including:
- bradycardia, or a slow heartbeat
- tachycardia, or a fast heartbeat
- irregular heartbeat, also known as a flutter or fibrillation
- early heartbeat, or a premature contraction
Most arrhythmias are not severe and do not cause complications. Some, however, can increase the risk of stroke or cardiac arrest.
Some people may hear doctors use the word “dysrhythmia” when referring to their irregular heartbeat. The words arrhythmia and dysrhythmia mean the same, but the word arrhythmia is more prevalent.
What is a normal heartbeat?
Doctors identify a healthy heartbeat by counting the number of times the heart beats every minute (bpm) during rest. This is known as the resting heart rate.
The range for a healthy resting heart rate varies between individuals, but the American Heart Association (AHA) suggests that it is usually between 60 and 100 bpm.
The fitter a person is, the lower their resting heart rate becomes. Olympic athletes, for example, will usually have a resting heart rate of less than 60 bpm, because their hearts are highly efficient.
The heart should beat with a regular rhythm, consisting of double “ba-bum” beats with even spaces in between each.
One of these beats is the heart contracting to provide oxygen to blood that has already circulated, and the other involves the heart pushing oxygenated blood around the body.
A person can measure their heart rate using their pulse. This is a point at which they can feel the heartbeat through the skin. The best locations on the body for this are:
- the wrists
- the insides of the elbows
- the side of the neck
- the top of the foot
There are several types of arrhythmia, as described here:
This is the irregular beating of the atrial chambers, and nearly always involves tachycardia. Atrial fibrillation (A-fib) is common and mainly develops in adults over 65 years of age.
Instead of producing a single, strong contraction, the chamber fibrillates, or quivers, often producing a rapid heartbeat.
While fibrillation causes many random and different quivers in the atrium, atrial flutter is usually from one area in the atrium that is not conducting properly. This produces a consistent pattern in the abnormal heart conduction.
Some people may experience both flutter and fibrillation.
Atrial flutter can be a serious condition and usually leads to fibrillation without treatment.
The condition known as supraventricular tachycardia (SVT) refers to a rapid but rhythmically regular heartbeat. An individual can experience a burst of accelerated heartbeats that can last from a few seconds to a few hours.
Doctors classify atrial fibrillation and flutter under SVTs.
This condition refers to abnormal electrical impulses that start in the ventricles and cause an abnormally fast heartbeat. This often happens if the heart has a scar from a previous heart attack.
This is an irregular heart rhythm consisting of rapid, uncoordinated, and fluttering contractions of the ventricles. The ventricles do not pump blood but quiver instead.
Ventricular fibrillation can be life threatening and usually has links to heart disease. A heart attack often triggers it.
Long QT syndrome
This syndrome refers to a heart rhythm disorder that sometimes causes rapid, uncoordinated heartbeats. This can result in fainting, which may be life threatening.
It can also occur due to genetic susceptibility or taking certain medications.
Any interruption to the electrical impulses that stimulate heart contractions may result in arrhythmia.
Several factors can cause the heart to work incorrectly, including:
- alcohol abuse
- substance use disorder
- drinking too much coffee
- heart disease, such as congestive heart failure
- high blood pressure
- hyperthyroidism, or an overactive thyroid gland
- scarring of the heart, often due to a heart attack
- certain dietary and herbal supplements
- some medications
- structural changes in the heart
A person with good heart health will hardly ever experience long-term arrhythmia unless they have an external trigger, such as a substance use disorder or an electric shock.
However, an underlying heart problem can mean that electrical impulses do not travel through the heart correctly. This increases the risk of arrhythmia.
Arrhythmia might not cause noticeable symptoms. However, a doctor may detect an arrhythmia during a routine examination or after requesting an electrocardiogram (EKG).
Even if an individual notices symptoms, it does not necessarily mean that they have a severe arrhythmia.
Some people with life threatening arrhythmias may have no symptoms, while others with symptoms may not have a severe arrhythmia.
Symptoms depend on the type of arrhythmia, as follows:
Symptoms of tachycardia
Symptoms of a rapid heartbeat include:
- fainting or nearly fainting
- fluttering in the chest
- chest pain
- sudden weakness
Symptoms of bradycardia
Bradycardia can cause the following symptoms:
- angina, or chest pain
- trouble concentrating
- finding exercise more difficult than usual
- shortness of breath
- fainting or nearly fainting
- profuse sweating
Symptoms of A-fib
When A-fib symptoms occur, they often have a rapid onset and may involve:
- fainting or nearly fainting
Some people may not experience active symptoms due to arrhythmia. However, treatment is still essential for preventing further complications, which may include stroke and heart failure.
Stroke: Atrial fibrillation means that the heart is not pumping effectively. This condition can cause blood to collect in pools and form clots.
If a clot dislodges, it may travel to a brain artery, causing a potentially fatal blockage, or stroke. Stroke can cause brain damage and require emergency treatment.
Heart failure: Prolonged tachycardia or bradycardia can result in heart failure. When the heart is failing, it cannot pump enough blood to the body and its organs. Treatment can usually help improve this.
Treatment for arrhythmia is only necessary if the condition is increasing the risk of more severe arrhythmia or a complication, or if the symptoms are severe.
The various arrhythmias require different treatments.
Treatments for bradycardia
If bradycardia occurs due to an underlying condition, a doctor will need to treat that condition first. If they find no underlying problem, the doctor may advise implanting a pacemaker.
A pacemaker is a small device that a doctor places under the skin of the chest or abdomen to help control abnormal heart rhythms. Pacemakers use electrical pulses to prompt the heart to beat at a regular minimum rate.
Treatments for tachycardia
There are several different treatments for tachycardia:
Vagal maneuvers: Specific movements and exercises that a person can carry out at home might stop some types of arrhythmia that start above the lower half of the heart.
Medications: These will not cure an arrhythmia but are usually effective in reducing the number of tachycardia episodes. Some medications also promote electrical conduction through the heart.
Cardioversion: The doctor may use an electric shock or medication to reset the heart to its regular rhythm.
Ablation therapy: A surgeon inserts one or more catheters into the inner heart. They place the catheters in areas of the heart that they suspect may be the source of the arrhythmia. The surgeon will then use them to destroy small sections of damaged tissue, which often corrects the arrhythmia.
Implantable cardioverter-defibrillator (ICD): A surgeon implants this near the left collarbone. The device then monitors the heart rhythm. If it detects an unusually fast rate, it stimulates the heart to return to its normal speed.
Maze procedure: During the maze procedure, a surgeon makes a series of surgical incisions in the heart. These then heal into scars and form blocks that guide the electrical impulses, helping the heart to beat efficiently.
Ventricular aneurysm surgery: Sometimes, an aneurysm, or bulge, in a blood vessel that leads to the heart can cause arrhythmia. If other treatments are not effective, a surgeon may have to remove the aneurysm.
Coronary bypass surgery: A surgeon grafts arteries or veins from elsewhere in the body on to the coronary arteries. This helps the circulation bypass any regions that have become narrow and improve the blood supply to the heart muscle.
To diagnose an arrhythmia, a doctor has to identify the unusual heartbeat and try to find its source or trigger. This will involve a detailed interview, which may touch on medical history, family history, diet, and lifestyle.
A doctor may request the following tests to support an arrhythmia diagnosis:
- blood and urine
- A Holter monitor, a wearable device to record the heart for 1–2 days
- chest X-ray
- a tilt-table test to help identify if sudden decreases in blood pressure or heart rate are the cause
- electrophysiologic testing
- heart catheterization
Risk factors and prevention
The following may increase a person’s risk of arrhythmia:
- being 65 years of age or older
- inherited genetic anomalies
- underlying heart problems
- hypothyroidism or hyperthyroidism
- some prescription medications and over-the-counter drugs
- uncontrolled diabetes
- obstructive sleep apnea
- electrolyte imbalances
- heavy and regular alcohol consumption
- too much caffeine
- illegal drugs
While some of these are unavoidable, a person can take a few steps to reduce their risk of arrhythmia.
These actions include staying active, avoiding the regular use of alcohol or illegal drugs, and limiting caffeine intake.
The AHA recommend at least 150 minutes of moderately intense exercise every week.
Congenital heart disease and heart defects
A congenital heart defect (CHD) is the most common form of congenital heart disease. It is also one of the most common and potentially severe birth abnormalities.
A CHD is a difference in the structure of the heart or a main artery. A person is born with it, and in the United States, nearly 1% of babies are born with a CHD each year.
This type of abnormality can obstruct blood flow in the heart or nearby vessels, or it may cause blood to flow through the heart irregularly.
In the past, it was common for CHDs to cause health issues that proved fatal, but medical and technological advances mean that most people with these differences survive into adulthood. Each person’s outlook depends on the severity of their CHD.
Children who undergo treatment for CHDs should continue to have follow-up monitoring throughout adulthood. Those with complex health needs might require lifelong specialized care.
Doctors classify CHDs depending on the part of the heart most affected. The most common type is a ventricular septal defect. This involves the wall between the heart’s two ventricles never fully developing in utero, leaving a gap.
There are also different types of congenital heart disease. It may be “cyanotic,” in which case an abnormality causes low blood oxygen levels.
Infants with cyanotic congenital heart disease experience breathlessness, fainting, and fatigue, and they may have bluish toes, fingers, and lips.
Alternately, the disease can be “acyanotic.” In this case, there is enough oxygen in the blood, but the heart does not pump the blood around the body effectively.
Certain types of CHD can lead to blood pressure that is higher than usual. This is because the heart must work harder to pump blood, which can weaken it.
Cyanotic heart disease may cause:
- a bluish tinge to the lips, fingers, and toes, called cyanosis
- small size or lowbody weight
- delayed growth, difficulty feeding, and poor appetite, in infants
- a low concentration of oxygen in the body, leading tohyperventilation
- sweating, especially during feedings
- chest pain
- difficulty breathing
Acyanotic heart disease may cause:
- breathlessness, especially during physical activity
- sweating, especially during feedings
- a slow growth rate and a low body weight
- difficulty feeding and poor appetite, in infants
- extreme tiredness
- chest pain
There may be no symptoms soon after birth — these may only arise as a child grows older, and they may need treatment.
A CHD usually develops during the early stages of development.
There is a higher risk if the pregnant person:
- hasrubella, or German measles
- has diabetes,including gestational diabetes, that is not managed well
- takes certain medications, such as isotretinoin (Accutane), a medication mainly for severe acne
- consumes large amounts of alcohol
Genetics may also play a role. At least 15% of people with a CHD also have a genetic disorder. Some genetic disorders may increase the risk of having a CHD.
Tests can show heart problems such as CHDs before and after birth.
Routine ultrasound scans during pregnancy can give information about the structure of the fetal heart.
If the scan indicates a problem, fetal echocardiography can help show a CHD. This is like an ultrasound scan, but it can collect more detailed information about the heart’s chambers.
A newborn with cyanotic congenital heart disease tends to have recognizable symptoms, but those of acyanotic congenital heart disease may not appear until the child is 3 years old or older.
Seek medical advice if a child of any age has any symptoms of congenital heart disease, including breathlessness or difficulty feeding.
A physician typically assesses heart activity using an electrocardiogram, an echocardiogram, or both.
Echocardiography is an imaging technique that usessound waves to create a moving image of the heart. It shows the heart’s size and shape and how well the chambers and valves are working.
This technique can show areas of low blood flow and any part of the muscle that is not contracting effectively. It can also show whether the heart muscle has sustained any damage due to low blood flow.
An electrocardiogram, or ECG, provides information about the heart’s electrical activity, including the rhythms and the size of the chambers.
An X-ray can show any enlargement of the heart and whether there is too much blood in the lungs.
Pulse oximetry, meanwhile, measures the levels of oxygen in the blood of the arteries through a sensor placed on the fingertip, ear, or toe.
Children and adults can have these tests.
Adults may also need to do an exercise stress test. This involves exercising on a treadmill while a health professional measures blood pressure and heart activity.
According to the Centers for Disease Control and Prevention (CDC), around 1in 4 infants with a CHD have an abnormality that is critical and requires surgery during their first year of life.
In other cases, the symptoms improve without treatment or the abnormality is small and does not need treatment. The doctor may recommend watchful waiting to determine whether medication or surgery is necessary.
A person with a CHD may need treatment, such as medication to lower blood pressure, at any age.
A surgeon may correct the CHD through a catheter or an open heart procedure.
The specific approach depends on the CHD. Options include:
Specifically, the surgeon may use a balloon valvuloplasty to repair a valve. This involves passing a small balloon through a catheter and inflating it to widen the valve. A stent or metal coil can then stop the valve from narrowing again.
After surgery, the heart generally works as it should, but some people develop related problems with age.
And if there is scar tissue on the heart, as a result of the surgery, this can increase the risk of problems.
The person may experience:
- an irregular heart rhythm, orarrhythmia
- dizziness and fainting
- swelling of organs or body tissues, known asedema
- fatigue, especially after exertion
Also, mild symptoms of a CHD that do not warrant surgery during childhood may worsen over time and require treatment in adulthood.
CHDs can lead to complications, such as:
A child with a CHD may start walking and talking later than their peers, and they may have learning difficulties. They may also be smaller than others of the same age.
If the heart cannot pump blood around the body effectively, heart failure can result.
This can affect either or both sides of the heart, and the symptoms vary accordingly. Heart failure can be fatal and requires immediate attention.
Uncontrolled high blood pressure in the arteries of the lungs, known as pulmonary hypertension, can lead to irreversible lung damage.
If there is an obstruction in the flow of blood to a part of the brain, a stroke can result.
Blood carries oxygen and glucose to the brain, and without this, brain cells die. The effects of a stroke can include problems with speech, movement, and memory.
Living with a CHD
To reduce the risk of complications, the cdc recommend:
- having a healthful diet to ensure growth and good health
- getting regular exercise, as this helps to strengthen the heart
- taking any necessary medications
- following the doctor’s advice carefully
- discussing any precautions that may be necessary during pregnancy
- knowing the signs of related health conditions, such as cardiovascular problems, liver disease, and diabetes
It is also important to recognize the warning signs of a heart attack, including:
- pain in the chest, back, arm, neck, or jaw
- shortness of breath
- nausea, vomiting, and dizziness
If anyone experiences these symptoms, it is crucial to call 911 immediately or otherwise request emergency medical care.
In the past, CHDs were usually fatal, but medical advances over the last few decades have significantly increased survival rates.
The outlook depends on the:
- severity of the abnormality
- swiftness of the diagnosis
- treatment provided
Doctors now expect that around 96% of people who receive a CHD diagnosis and hospital treatment survive. Meanwhile, research into further advances continues.
In the future, treatment might involve using bioengineered tissues rather than prostheses and fixing any problems in the developing heart before birth.
What to know about coronary heart disease
Coronary heart disease (CHD), or coronary artery disease, develops when the coronary arteries become too narrow. The coronary arteries are the blood vessels that supply oxygen and blood to the heart.
CHD tends to develop when cholesterol builds up on the artery walls, creating plaques. These plaques cause the arteries to narrow, reducing blood flow to the heart. A clot can sometimes obstruct the blood flow, causing serious health problems.
Coronary arteries form the network of blood vessels on the surface of the heart that feed it oxygen. If these arteries narrow, the heart may not receive enough oxygen rich blood, especially during physical activity.
CHD can sometimes lead to heart attack. It is the “most common type of heart disease in he united states” where it accounts for more than 370000 deaths every year.
CHD occurs due to damage in the coronary artery that leads to plaque buildup.
CHD develops as a result of injury or damage to the inner layer of a coronary artery. This damage causes fatty deposits of plaque to build up at the injury site.
These deposits consist of cholesterol and other waste products from cells. This buildup is called atherosclerosis.
If pieces of plaque break off or rupture, platelets will cluster in the area in an attempt to repair the blood vessel. This cluster can block the artery and reduce or block blood flow, which may lead to a heart attack.
Below is a 3-D model of CHD, which is fully interactive.
Explore the model using your mouse pad or touchscreen to understand more about CHD.
Angina may cause the following feelings across the chest:
Angina might also cause the following symptoms:
CHD can also lead to shortness of breath. If the heart and other organs do not receive enough oxygen, any form of exertion can become very tiring, which may cause a person to pant for air.
Heart attack occurs when the heart muscle does not have enough blood or oxygen, such as when a blood clot develops from plaque in one of the coronary arteries.
The formation of a blood clot is called coronary thrombosis. This clot, if it is big enough, can stop the supply of blood to the heart.
Symptoms of a heart attack include:
- chest discomfort
- mild or crushing chest pain
- shortness of breath
- a gray pallor in the face
- general discomfort
- nausea and vomiting
- clammy skin
The first symptom is usually chest pain that spreads to the neck, jaw, ears, arms, and wrists, and possibly to the shoulder blades, back, or abdomen.
Changing position, resting, or lying down is unlikely to bring relief. The pain is often constant but may come and go. It can last from a few minutes to several hours.
A heart attack is a medical emergency that can result in death or permanent heart damage. If a person is showing symptoms of a heart attack, it is vital to call the emergency services immediately.
There is no cure for CHD. However, there are ways that a person can manage the condition.
Treatment tends to involve making healthful lifestyle changes, such as quitting smoking, adopting a healthful diet, and getting regular exercise.
However, some people may need to take medications or undergo medical procedures.
Various medications are available to treat CHD.
Medications that people can take to reduce the risk or impact of CHD include:
- Beta-blockers: A doctor may prescribebeta-blockers to reduce blood pressure and heart rate, especially among people who have already had a heart attack.
- Nitroglycerin patches, sprays, or tablets: These widen the arteries and reduce the heart’s demand for blood, as well as soothe chest pain.
- Angiotensin-converting enzyme inhibitors: These bring down blood pressure and help slow or stop the progression of CHD.
- Calciumchannel blockers: These will widen the coronary arteries, improving blood flow to the heart and reducing hypertension.
- Statins: These may have a positive impact on outcomes in CHD. One2019 review found that although taking statins cannot reduce the overall risk of death from CHD, they can prevent development and reduce the risk of non-fatal heart attacks. However, they might not be effective for people with cholesterol disorders such as hyperlipidemia.
In the past, some people used aspirin to lower their risk of CHD, but current guidelines only recommend this for people with a high risk of heart attack, stroke, angina, or other cardiovascular events. This is because aspirin is a blood thinner, which increases a person’s risk of bleeding.
Doctors now recommend focusing on lifestyle strategies, such as adopting a healthful diet and getting regular moderate to intense exercise. These strategies can reduce the risk of atherosclerosis.
The following surgical procedures can open or replace blocked arteries if they have become very narrow, or if symptoms are not responding to medications:
- Laser surgery: This involves making several very small holes in the heart muscle. These encourage the formation of new blood vessels.
- Coronary bypass surgery: A surgeon will use a blood vessel from another part of the body to create a graft that bypasses the blocked artery. The graft may come from the leg, for example, or an inner chest wall artery.
- Angioplasty and stent placement: A surgeon will insert a catheter into the narrowed part of the artery and pass a deflated balloon through the catheter to the affected area. When they inflate the balloon, it compresses the fatty deposits against the artery walls. They may leave a stent, or mesh tube, in the artery to help keep it open.
On rare occasions, a person may need a heart transplant. However, this is only if the heart has severe damage and treatment is not working.
Controlling blood cholesterol levels can help reduce a person’s risk of CHD. To better control blood cholesterol levels:
- be more physically active
- limit alcohol intake
- avoid tobacco
- adopt a diet with less sugar, salt, and saturated fats
People who already have CHD should ensure that they control these factors by following the doctor’s recommendations.
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The following factors increase a person’s risk of developing CHD:
- havinghigh blood pressure, or hypertension
- having high levels of low-density lipoprotein, or “bad,” cholesterol
- having low levels of high-density lipoprotein, or “good,” cholesterol
- having a diagnosis ofdiabetes, in which the body cannot effectively remove sugar from the bloodstream
- smoking, which increasesinflammation and increases cholesterol deposits in the coronary arteries
Some risk factors are not lifestyle-related. These may include:
- having high levels of the amino acid homocysteine, whichone 2015 studyTrusted Source
linked to a higher incidence of CHD
- having high levels of fibrinogen, a blood protein that encourages the clumping of platelets to form blood clots
- having a family history of CHD
- for women, having been throughmenopause
- for men, being over 45 years of age
Having high levels of lipoprotein(a) specifically is also linked to a higher risk of cardiovascular disease and CHD.
A stress test can help a doctor diagnose CHD.
A doctor can perform a physical examination, take a thorough medical history, and order a number of tests to diagnose CHD. For example:
- Electrocardiogram: This records the electrical activity and rhythm of the heart.
- Holter monitor: This is a portable device that a person wears under their clothes for 2 days or more. It records all the electrical activity of the heart, including the heartbeat.
- Echocardiogram: This is anultrasound scan that monitors the pumping heart. It uses sound waves to provide a video image.
- Stresstest: This may involve the use of a treadmill or medication that stresses the heart in order to test how it functions when a person is active.
- Coronary catheterization: A specialist will inject dye through a catheter they have threaded through an artery, often in the leg or arm. The dye shows narrow spots or blockages on an X-ray.
- CT scans: These help the doctor visualize the arteries, detect calcium within fatty deposits, and characterize any heart anomalies.
- Nuclear ventriculography: This uses tracers, or radioactive materials, to create an image of the heart chambers. A doctor will inject the tracers into the vein. The tracers then attach to red blood cells and pass through the heart. Special cameras or scanners trace the movement of the tracers.
- Blood tests: Doctors can run these to measure blood cholesterol levels, especially in people at risk of high blood cholesterol levels.
CHD develops when coronary arteries become too narrow. The condition causes blockages in the arteries that feed oxygen-rich blood to the heart.
CHD can be difficult to treat and may lead to a heart attack or stroke. However, people can take steps to reduce their risk of CHD by getting regular exercise, adopting a healthful diet, and avoiding or quitting tobacco.
People should seek immediate medical attention if they have chest pain and breathlessness, as this could indicate a heart attack.
What causes high cholesterol?
Cholesterol is both good and bad. At normal levels, it is an essential substance for the body. However, if concentrations in the blood get too high, it becomes a silent danger that puts people at risk of heart attack.
Cholesterol is present in every cell of the body and has important natural functions when it comes to digesting foods, producing hormones, and generating vitamin D. The body produces it, but people also consume it in food. It is waxy and fat-like in appearance.
There are two types of cholesterol:
- low-density lipoproteins (LDL), or “bad” cholesterol
- high-density lipoproteins (HDL), or “good” cholesterol
In this article, we will explain the role of cholesterol. We will also discuss the causes of high cholesterol, and its symptoms, treatment, and prevention.
Fast facts on cholesterol:
- Cholesterol is an essential substance that the body produces but which people also consume in foods.
- Risk factors for high cholesterol include family history and the modifiable lifestyle choices of diet and exercise.
- Having high cholesterol does not usually produce any symptoms.
- If lifestyle changes are unsuccessful or cholesterol levels are very high, a doctor may prescribe a lipid-lowering drug, such as a statin.
What is cholesterol?
Eating fresh food and avoiding animal fats and processed items can help people to control cholesterol levels.
Cholesterol is an oil-based substance. It does not mix with the blood, which is water-based.
It travels around the body in lipoproteins.
Two types of lipoprotein carry the parcels of cholesterol:
- Low-density lipoprotein (LDL):Cholesterol that travels in this way is unhealthful or “bad”
- High-density lipoprotein (HDL):Cholesterol that is present in HDL is known as “good”
Cholesterol has four primary functions, without which we could not survive.
- contributing to the structure of cell walls
- making up digestive bile acids in the intestine
- allowing the body to producevitamin D
- enabling the body to make certain hormones
Causes of high cholesterol
A build-up of cholesterol is part of the process that narrows arteries, called atherosclerosis. In atherosclerosis, plaques form and cause restriction of blood flow.
Reducing the intake of fat in the diet helps to manage cholesterol levels. In particular, it is helpful to limit foods that contain:
- Cholesterol:This is present in animal foods, meat, and cheese.
- Saturated fat:This occurs in some meats, dairy products, chocolate, baked goods, deep-fried, and processed foods.
- Trans fats:This occurs in some fried and processed foods.
Excess weight or obesity can also lead to higher blood LDL levels. Genetic factors can contribute to high cholesterol. People with the inherited condition familial hypercholesterolemia have very high LDL levels.
Other conditions that can lead to high cholesterol levels, include:
- liver or kidney disease
- polycystic ovary syndrome
- pregnancy and other conditions that increase levels of female hormones
- underactive thyroid gland
- drugs that increase LDL cholesterol and decrease HDL cholesterol, such as progestins, anabolic steroids, and corticosteroids
High cholesterol symptoms
A person with high cholesterol levels often has no signs or symptoms, but routine screening and regular blood tests can help detect high levels.
A person who does not undergo testing may have a heart attack without warning, because they did not know that they had high cholesterol levels. Regular tests can help to reduce this risk.
Cholesterol in foods
Oily fish like salmon has been shown to actively decrease cholesterol.
A report from Harvard Health has identified 11 cholesterol-lowering foods that actively decrease cholesterol levels:
- barley and whole grains
- eggplant and okra
- vegetable oil (canola, sunflower)
- fruits (mainly apples, grapes, strawberries, and citrus)
- soy and soy-based foods
- fatty fish (particularly salmon, tuna, and sardines)
- foods rich in fiber
Adding these to a balanced diet can help keep cholesterol in check.
The same report also lists foods that are bad for cholesterol levels. These include:
- red meat
- full-fat dairy
- hydrogenated oils
- baked goods
Various low cholesterol recipe books are available to purchase online.
Levels and ranges
In adults, total cholesterol levels less than 200 milligrams per deciliter (mg/dL) are considered healthy.
- A reading between 200 and 239 mg/dL is borderline high.
- A reading of 240 mg/dL and above is considered high.
LDL cholesterol levels should be less than 100 mg/dL.
- 100–129 mg/dL is acceptable for people with no health problems but may be a concern for anyone withheart disease or heart disease risk factors.
- 130—159 mg/dL is borderline high.
- 160–189 mg/dL is high.
- 190 mg/dL or higher is considered very high.
HDL levels should be kept higher. The optimal reading for HDL levels is of 60 mg/dL or higher.
- A reading of less than 40 mg/dL can be a major risk factor for heart disease.
- A reading from 41 mg/dL to 59 mg/dL is borderline low.
Preventing high cholesterol
People who wish to reduce their cholesterol levels or maintain a suitable level can make four major lifestyle decisions.
- eat a heart-healthy diet
- regularly exercise
- avoid smoking
- achieve and maintain a healthy weight
These actions will reduce the risk of coronary heart disease and heart attack.
Since 2013, guidelines on reducing or preventing high cholesterol have focused on addressing lifestyle risks, even at a young age.
Since 2018, new guidelines published in the Journal of the American College of Cardiology also urged doctors also to discuss with individuals the following factors that may increase a person’s risk:
- family history and ethnicity
- certain health conditions that increase the risk of high cholesterol, such aschronic kidney disease or chronic inflammatory conditions
Taking these factors into consideration will lead to a more personalized approach to the treatment and prevention of high cholesterol levels.
How can high cholesterol be treated?
There are a number of ways to treat high cholesterol; these include:
For a person with high cholesterol levels, drug treatment will depend on their cholesterol level and other risk factors.
Recommendatoins usually start with diet and exercise, but people with a higher risk of a heart attack may need to use statins or other medications.
Statins are the leading group of cholesterol-lowering drugs. The statins available on prescription in the United States include:
- atorvastatin(brand named Lipitor)
- fluvastatin (Lescol)
- lovastatin (Mevacor, Altoprev)
- pravastatin (Pravachol)
- rosuvastatincalcium (Crestor)
- simvastatin (Zocor)
Apart from statins, a doctor may prescribe:
- selective cholesterol absorption inhibitors
In 2017, researches noted that a new drug, ezetimibe, can significantly reduce the risk of a major cardiovascular event in people with a high risk of such events. Etezimibe reduces lipid levels by limiting the absorption of cholesterol in the intestine.
The authors of the updated also mentioned another new type of drug: pro-protein convertase subtilisin/kexin 9 (PCSK9) inhibitors. There is evidence that these drugs are effective at reducing cholesterol levels, especially when a person uses them with ezetimibe.
In 2018, new guidelines recommended a stepped approach, depending on how high an individual’s risk is.
If a person has already had a cardiovascular event, such as a heart attack, a doctor may recommend using ezetimibe as well as a statin. For those at very high risk, the guidelines also recommend adding a PCSK9 inhibitor.
However, the guidelines also note that PCSK9 inhibitors are expensive, and insurance companies may not cover their cost. For this reason, this option is likely to be only for those with a very high risk.
The use of statins has caused some debate because, like all drugs, they can have side effects.
- statin-induced myopathy (a muscle tissue disease)
- a slightly greater risk of diabetes and diabetes complications,though this is hotly debated
A person should not stop taking a statin without speaking to a doctor, as they may increase their risk of cardiovascular problems.
A doctor might recommend:
- switching to a different medication
- increasing efforts to reduce cholesterol through lifestyle changes
Complications of high cholesterol
In the past, people have aimed to reduce cholesterol to a target level, for instance, below 100 mg/ dL, but this is no longer the case.
Randomized, controlled clinical trials have not produced enough evidence to support treatment to a specific target.
However, some physicians may still use targets to help guide therapy.
10-year risk of a heart attack
Cholesterol levels play a major part in an individual’s risk of having a heart attack within the next 10 years.
The National Heart, Lung, and Blood Institute provide an online calculator of cardiovascular risk.
Using research evidence, it weighs the risk according to these factors:
- cholesterol levels
- smoking status
- blood pressure
Guidelines published in 2018 consider this calculator and essential tool for assessing cholesterol levels and their risk.
Everything you need to know about hypertension
Hypertension is another name for high blood pressure. It can lead to severe health complications and increase the risk of heart disease, stroke, and sometimes death.
Blood pressure is the force that a person’s blood exerts against the walls of their blood vessels. This pressure depends on the resistance of the blood vessels and how hard the heart has to work.
Hypertension is a primary risk factor for cardiovascular disease, including stroke, heart attack, heart failure, and aneurysm. Keeping blood pressure under control is vital for preserving health and reducing the risk of these dangerous conditions.
In this article, we explain why blood pressure can increase, how to monitor it, and ways to keep it within a normal range.
Management and treatment
Lifestyle adjustments are the standard, first-line treatment for hypertension. We outline some recommendations here:
Regular physical exercise
People can measure blood pressure using a sphygmomanometer.
Current guidelines recommend that all people, including those with hypertension, engage in at least 150 minutes of moderate intensity, aerobic exercise every week, or 75 minutes a week of high intensity exercise.
People should exercise on at least 5 days of the week.
Examples of suitable activities are walking, jogging, cycling, or swimming.
Avoiding or learning to manage stress can help a person control blood pressure.
Meditation, warm baths, yoga, and simply going on long walks are relaxation techniques that can help relieve stress.
People should avoid consuming alcohol, recreational drugs, tobacco, and junk food to cope with stress, as these can contribute to elevated blood pressure and the complications of hypertension.
Smoking can increase blood pressure. Avoiding or quitting smoking reduces the risk of hypertension, serious heart conditions, and other health issues.
People can use specific medications to treat hypertension. Doctors will often recommend a low dose at first. Antihypertensive medications will usually only have minor side effects.
Eventually, people with hypertension will need to combine two or more drugs to manage their blood pressure.
Medications for hypertension include:
- diuretics, including thiazides, chlorthalidone, and indapamide
- beta-blockersand alpha-blockers
- calcium-channel blockers
- central agonists
- peripheral adrenergic inhibitor
- angiotensin-converting enzyme (ACE) inhibitors
- angiotensin receptor blockers
The choice of medication depends on the individual and any underlying medical conditions they may experience.
Anyone on antihypertensive medications should carefully read the labels of any over-the-counter (OTC) drugs they may also take, such as decongestants. These OTC drugs may interact with the medications they are taking to lower their blood pressure.
People can prevent high blood pressure by following a heart-healthy diet.
Reducing salt intake
People’s average salt intake is between 9 grams (g) and 12 g per day in most countries around the world.
The World Health Organization (WHO) recommend reducing intake to under 5 g
a day to help decrease the risk of hypertension and related health problems.
Lowering salt intake can benefit people both with and without hypertension.
Moderating alcohol consumption
Moderate to excessive alcohol consumption can increase blood pressure.
The American Heart Association (AHA) recommend a maximum of two alcoholic drinks a day for men, and one for women.
The following would count as one drink:
- a 12-ounce (oz) bottle of beer
- 4 oz of wine
- 5 oz of 80-proof spirits
- 1 oz of 100-proof spirits
A healthcare provider can help people reduce consumption if they find it difficult to moderate their alcohol intake.
Eating more fruit and vegetables and less fat
People who have high blood pressure or people at high risk of developing high blood pressure should eat as little saturated and total fat as possible.
Instead, experts recommend:
- whole grain, high fiber foods
- a variety of fruit and vegetables
- beans, pulses, and nuts
- fish rich inomega-3 twice a week
- nontropical vegetable oils, for example, olive oil
- skinless poultry and fish
- low fat dairy products
It is important to avoid trans fats, hydrogenated vegetable oils, and animal fats, as well as large portion sizes.
Some fats, such as those in oily fish and olive oil, have protective effects on the heart. However, these are still fats. While they are typically healthful, people with a risk of hypertension should still include them in their total fat intake.
Managing body weight
Excess body weight can contribute to hypertension. A fall in blood pressure usually follows weight loss, as the heart does not have to work so hard to pump blood around the body.
A balanced diet with a calorie intake that matches the individual’s size, sex, and activity level will help.
The DASH diet
The U.S. National Heart, Lung, and Blood Institute (NHLBI) recommend the DASH diet
for people with high blood pressure. DASH stands for “Dietary Approaches to Stop Hypertension.”
DASH is a flexible and balanced eating plan with a firm grounding in research by the NHLBI who advise that the diet:
- lowers high blood pressure
- improves levels of fats in the bloodstream
- reduces the risk of cardiovascular disease
The NHLBI produce a cookbook called Keep the Beat Recipes that provides meal ideas to help reduce blood pressure.
Research from 2014 suggests that using probiotic supplements for 8 weeks or more may benefit people with hypertension.
Stress can increase the risk of high blood pressure.
The cause of hypertension is often not known. In many cases, it is the result of an underlying condition.
Doctors call high blood pressure that is not due to another condition or disease primary or essential hypertension.
If an underlying condition is the cause of increasing blood pressure, doctors call this secondary hypertension.
Primary hypertension can result from multiple factors, including:
- blood plasma volume
- hormone activity in people who manage blood volume and pressure using medication
- environmental factors, such as stress and lack of exercise
Secondary hypertension has specific causes and is a complication of another health problem.
Chronic kidney disease (CKD) is a common cause of high blood pressure, as the kidneys no longer filter out fluid. This excess fluid leads to hypertension.
Conditions that can lead to hypertension include:
- diabetes, due to kidney problems and nerve damage
- kidney disease
- pheochromocytoma, a rarecancer of an adrenal gland
- Cushing syndrome that corticosteroid drugs can cause
- congenital adrenal hyperplasia, a disorder of the cortisol-secreting adrenal glands
- hyperthyroidism, or an overactive thyroid gland
- hyperparathyroidism, which affectscalcium and phosphorous levels
- sleep apnea
A number of factors increase the risk of hypertension.
- Age: Hypertension is more common in people who are more than 60 years of age. Blood pressure can increase steadily with age as the arteries stiffen and narrow due to plaque buildup.
- Ethnicity: Some ethnic groups are more prone to hypertension than others. African Americans havea higher riskTrusted Source
than other ethnic groups, for example. Size and weight: Being overweight or obese is a primary risk factor.
- Alcohol and tobacco use: Regularly consuming large quantities of alcohol or tobacco can increase blood pressure.
- Sex: According toa 2018 reviewTrusted Source
, males have a higher risk of developing hypertension than females. However, this is only until after women reach menopause.
- Existing health conditions: Cardiovascular disease, diabetes, chronic kidney disease, and highcholesterol levels can lead to hypertension, especially as people age.
Other risk factors include:
- sedentary lifestyle
- salt rich, high fat diet
- lowpotassium intake
Poorly managed stress and a family history of high blood pressure can also contribute to the risk of developing hypertension.
Below is a 3-D model of hypertension, which is fully interactive.
Explore the model using your mouse pad or touchscreen to understand more about hypertension.
Most people experience no symptoms from hypertension and may not be aware they have it.
A person with hypertension may not notice any symptoms, and so people often call it the “silent killer.” Without detection, hypertension can damage the heart, blood vessels, and other organs, such as the kidneys.
It is vital to check blood pressure regularly.
If high blood pressure becomes a hypertensive crisis, a person may experience headaches and nosebleeds.
Long term hypertension can cause complications through atherosclerosis where plaque develops on the walls of blood vessels, causing them to narrow.
This narrowing makes hypertension worse, as the heart must pump harder to circulate the blood.
Hypertension-related atherosclerosis can lead to:
- heart failure and heart attacks
- aneurysm, or abnormal bulge in the wall of an artery that can burst
- kidney failure
- hypertensive retinopathies in the eye, which can lead to blindness
Regular blood pressure monitoring can help people avoid these more severe complications.
A sphygmomanometer, or blood pressure monitor, can help people keep track of their blood pressure.
A doctor’s visit is not always necessary for blood pressure monitoring. Home blood pressure monitors are available for purchase online.
Having high blood pressure for a short time can be a normal response to many situations. Acute stress and intense exercise, for example, can briefly elevate blood pressure in an otherwise healthy person.
For this reason, a diagnosis of hypertension requires several readings that show sustained high blood pressure over time.
The systolic reading of 130 mmHg refers to the pressure as the heart pumps blood around the body. The diastolic reading of 80 mmHg refers to the pressure as the heart relaxes and refills with blood.
The AHA 2017 guidelines define the following ranges of blood pressure:
Normal blood pressure
Less than 120
Less than 80
Between 120 and 129
Less than 80
Stage 1 hypertension
Between 130 and 139
Between 80 and 89
Stage 2 hypertension
At least 140
At least 90
If the reading indicates a hypertensive crisis, wait 2 or 3 minutes and then repeat the test.
If the reading is the same or higher, this indicates a medical emergency.
The person should seek immediate assistance at the nearest hospital.
Everything you need to know about tachycardia
Tachycardia refers to a fast resting heart rate, usually over 100 beats per minute. Depending on its underlying cause and how hard the heart has to work, it can be dangerous.
Some people with tachycardia have no symptoms, and complications never develop. However, it can increase the risk of stroke, heart failure, sudden cardiac arrest, and death.
There are different types of tachycardia, depending on which part of the heart has the problem.
In this article, learn more about the symptoms, causes, and treatment options associated with tachycardia.
What is tachycardia?
Tachycardia refers to a high resting heart rate. In adults, the heart usually beats between 60 and 100 times per minute.
Doctors usually consider a heart rate of over 100 beats per minute to be too fast, though this varies among individuals. Factors such as age and fitness levels can affect it.
When tachycardia is present, either the upper or lower chambers of the heart beat significantly faster.
When the heart beats too rapidly, it pumps less efficiently. Blood flow to the rest of the body, including the heart, reduces.
Also, when the heart beats faster, the heart muscles need more oxygen. In time, oxygen-starved cells can die, leading to heart attack.
Atria, ventricles, and the electrical circuitry of the heart
The human heart consists of four chambers: the atria, which are the two upper chambers, and the ventricles, which are the two lower chambers. (There are left and right atria and ventricles.)
The heart has a natural pacemaker, called the sinoatrial node, in the right atrium. This produces electrical impulses. Each one triggers an individual heartbeat.
As the electrical impulses leave the sinoatrial node, they cross the atria, making the atrial muscles contract. This contraction pushes blood into the ventricles.
The electrical impulses continue to the atrioventricular (AV) node, which is a cluster of cells. The AV node slows down the electrical signals, then sends them on to the ventricles.
In doing so, it allows time for the ventricles to fill with blood. When the ventricular muscles receive the electrical signals, they contract, pumping blood either to the lungs or to the rest of the body.
A problem with the electrical signals can result in a faster-than-normal heartbeat. This is tachycardia.
Tachycardia usually stems from a disruption in the normal electrical impulses that control the heart’s pumping action, or the rate at which the heart pumps.
Depending on the type and cause of tachycardia, the following factors may trigger it:
- a reaction to certain medications
- congenital irregularities of the heart
- consuming excessive amounts ofalcohol or caffeine
- usingcocaine or other recreational drugs
- electrolyte imbalance
- poor blood supply and damage to heart tissues due toheart disease, coronary artery disease, heart valve disease, heart failure, heart muscle disease, tumors, or infections
- hypertension, or high blood pressure
- certain lung conditions,thyroid problems, anemia, and other health concerns
- severe bleeding
- physical and mentalstress, including illness and anxiety
- previous heart surgery
Sometimes, however, the exact cause may not be clear.
The treatment options for tachycardia will depend on various factors, including:
- the cause
- the age of the person
- their overall health
Treatment aims to address the cause, but a doctor may also try to:
- slow the heart rate
- prevent further episodes
- reduce the risk of complications
If there is no clear underlying cause, it may take some time to find a suitable treatment option.
Ways to slow a fast heartbeat
There are several ways to slow a rapid heartbeat during an episode. The following sections will look at these in more detail.
The vagus nerve helps regulate the heartbeat.
Some techniques, or maneuvres , can affect this nerve and help slow the heartbeat. Such techniques include:
- stimulating the gag reflex
- applying abdominal pressure
- applying cold water to the person’s face
- applyinggentle pressure to the area of the neck where the carotid artery is
- holding the nostrils closed while the person blows out through the nose
These may be helpful in an emergency.
A healthcare professional may also apply gentle pressure to the eyeballs while the person has their eyes closed.
A doctor can administer antiarrhythmic drugs either orally or intravenously. These drugs aim to restore a normal heart rhythm and control the heart rate.
Some examples of antiarrhythmic drugs include amiodarone (Cordarone), sotalol (Betapace), and mexiletine (Mexitil).
Cardioversion and defibrillators
A healthcare provider can attach patches, or electrodes, to the person’s body and have a machine deliver an electric shock
to their heart. This affects the electrical impulses in the heart and may restore a normal rhythm.
There are different ways of performing cardioversion. These are as follows:
- In an emergency setting: While waiting for medical help to arrive, a first responder orbystanderTrusted Source
may use an automatic external defibrillator if the person’s heart goes into a rhythm that prevents it from beating properly.
- In the hospital: AcardiologistTrusted Source
may use cardioversion as part of a scheduled treatment.
- Ongoing treatment: An implantable cardioverter defibrillator can continuously monitor the person’s heartbeat. A cardiologist can implant the small device into the chest, where it detects abnormal heartbeats and delivers a shock to restore a normal rhythm when needed.
Some measures can help prevent and manage tachycardia. The following sections will discuss these measures in more detail.
Some ways to prevent tachycardia and other heart issues at home include:
- avoiding the use of tobacco and recreational drugs
- limiting the consumption of alcohol and caffeine
- reducing stress, if possible
- getting enough sleep
- following a healthful diet and getting regular exercise
Medications that can help people manage tachycardia include:
- antiarrhythmic drugs
- calcium channel blockers, such as diltiazem (Cardizem) or verapamil (Calan)
- beta-blockers, such as propranolol (Inderal) or metoprolol (Lopressor)
- blood thinners, such as warfarin (Coumadin) or apixaban (Eliquis)
Radiofrequency catheter ablation
An electrophysiologist can insert catheters into the heart through the blood vessels.
Electrodes at the ends of the catheter can ablate, or damage, small sections of the heart that are responsible for the abnormal heartbeat.
Sometimes, a doctor will recommend surgery to make repairs or changes that can help reduce the risk of tachycardia.
They will only do this if other therapies have not worked or if the person has another heart condition.
Depending on the type and cause of tachycardia, the following symptoms may occur:
- a fastpulse
- chest pain
- lowblood pressure
- heart palpitations
- shortness of breath
- sudden weakness
- a loss of consciousness
- cardiac arrest, in some cases
However, many people have no symptoms and only find out that they have tachycardia during a routine examination.
The risk of complications depends on several factors, including:
- the severity and duration of the tachycardia
- the type
- the overall health of the person
- any other heart conditions they may have
The most common complications include:
- Blood clots:These can significantly increase the risk of heart attack or stroke.
- Heart failure:Without treatment, the heart can become weaker, increasing the risk of heart failure.
- Fainting:A person with a rapid heartbeat may lose consciousness, increasing their risk of a fall or other accident.
- Sudden death:This usually only occurs with ventricular tachycardia or ventricular fibrillation.
The following sections will outline some common types of tachycardia.
In this type, the heart beats faster than usual, but the rhythm is regular, and the impulse comes from the sinoatrial node.
- mental and physical stress
- the use of certain drugs
- some health conditions
Atrial or supraventricular tachycardia
Atrial or supraventricular tachycardia is an accelerated heart rhythm that starts in the upper chambers of the heart.
It is the most common heart rhythm problem in children and young people. Many people first experience it between the ages of 25 and 40 years.
An episode may last from a few minutes to several hours. It is not usually serious, but, in extreme cases, it can lead to unconsciousness and cardiac arrest.
Sometimes, electrical activity in the atria can override the heart’s natural pacemaker. This causes the chambers to contract rapidly and irregularly. This is known as atrial fibrillation .
Most people with A-fib also have another heart condition. It is more likely to affect those over the age of 65 years. Consuming alcohol and smoking tobacco may contribute, as might hypertension and sleep apnea.
This is similar to A-fib, but the rhythms are more organized. Many people have both A-fib and atrial flutter.
Abnormal electrical signals in the lower chambers result in a rapid heart rate. This can result from cardiovascular problems, such as a previous heart attack, and the use of certain drugs.
The speed of the heartbeat does not allow the ventricles to fill and contract properly, thereby reducing blood supply to the body.
The cause and severity of the symptoms will determine how serious it is.
Ventricular fibrillation (V-fib) is a serious cardiac disturbance. The ventricles quiver instead of beating, resulting in poor blood supply to the body.
V-fib is a medical emergency. If a normal heart rhythm does not return quickly, blood circulation can cease, which can lead to death.
The following factors can increase the risk of tachycardia:
- age, as some kinds affect different age groups
- genetic factors
- a personal or family history of heart disease
- a high consumption of caffeine and alcohol
- high blood pressure
- mental stress
- the use of recreational drugs
- thyroid disease
If a person seeks medical advice for a suspected heart rhythm problem, the doctor will:
- ask about their symptoms
- carry out a physical exam
- order some tests
These tests may include:
- Electrocardiogram:Electrodes attached to the skin can measure electrical impulses that the heart produces.
- Echocardiogram:This is a type of ultrasound test that produces a moving image of the heart.
- Wearable devices:The person can carry a Holter monitor or event recorder. These devices can monitor heart rhythms or electrical impulses.
- Blood tests:These help determine whether thyroid or other problems are contributing to tachycardia.
- Graded exercise test:This can help identify how physical activity impacts heart rhythms.
Some of the complications of tachycardia can include:
- fainting and dizziness
- tiredness and fatigue
- shortness of breath
- chest painand tightness, or angina
- low blood pressure and shock
- heart failure
Tachycardia refers to rapid heart rhythms. Some causes include heart disease and various lifestyle factors.
It is possible to have tachycardia without symptoms, but it can lead to complications, such as heart attack or stroke.
Anyone who has concerns about their heart health should seek medical advice, as early treatment can help prevent long-term and possibly life threatening complications.