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        "diseases_conditions.ts": "2018-02-02 05:08:28",
        "diseases_conditions.title": "Childhood Interstitial Lung Disease",
        "diseases_conditions.diseases_conditions_detail": "
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What Is Childhood Interstitial Lung Disease?
Childhood interstitial (in-ter-STISH-al) lung disease, or chILD, is a broad term for a group of rare lung diseases that can affect babies, children, and teens. These diseases have some similar symptoms, such as chronic cough, rapid breathing, and shortness of breath.
These diseases also harm the lungs in similar ways. For example, they damage the tissues that surround the lungs' alveoli (al-VEE-uhl-eye; air sacs) and bronchial tubes (airways). Sometimes these diseases directly damage the air sacs and airways.
The various types of chILD can decrease lung function, reduce blood oxygen levels, and disturb the breathing process.
Overview
Researchers have only begun to study, define, and understand chILD in the last decade. Currently, they don't know how many children have chILD. They also don't know how many children have each type of chILD.
Diagnosing chILD and its specific diseases is hard because chILD is rare and complex. Also, chILD is a broad term for a group of diseases with similar symptoms—it's not a precise diagnosis.
Interstitial lung disease (ILD) also occurs in adults. However, the cause of ILD in adults may be different than the cause in children. Some types of chILD are similar to the adult forms of the disease. They may even have the same names as the adult forms, such as hypersensitivity pneumonitis (noo-mo-NI-tis), immunodeficiency-associated lung disease, and bronchiolitis (brong-ke-o-LI-tis) obliterans.
However, research shows that the course and outcomes of these diseases often are very different for children than for adults.
Some ILDs only occur in children. They include:
Outlook
Each form of chILD may differ in its severity and how it's treated. Thus, getting a correct diagnosis is vital for understanding and treating your child's illness.
You may want to consult a pediatric pulmonologist. This is a doctor who specializes in diagnosing and treating children who have lung diseases and conditions. This doctor's training and experience can help him or her diagnose chILD.
The outlook for children who have chILD also depends on the specific type of disease they have. Some diseases are very severe and lead to early death. Others are chronic (long-term) diseases that parents and the child's medical team must work together to manage.
At this time, chILD has no cure. However, some children who have certain diseases, such as NEHI, may slowly improve over time.
Researchers are now starting to learn more about the causes of chILD. They're also trying to find distinct patterns and traits for the various forms of chILD. This information may help doctors better understand these diseases.
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Types of Childhood Interstitial Lung Disease

The broad term \"childhood interstitial lung disease\" (chILD) refers to a group of rare lung diseases that can affect babies, children, and teens. Some of these diseases are more common in certain age groups.

Diseases more common in infancy include:

Diseases more common in children older than 2 years of age and teens include:

The various types of chILD can affect many parts of the lungs, including the alveoli (air sacs), bronchial tubes (airways), and capillaries. (Capillaries are the tiny blood vessels that surround the air sacs.) The structures of the lung that chILD may affect are shown in the illustration below.

\"Normal

Figure

Normal Lungs and Lung Structures. Figure A shows the location of the lungs and airways in the body. Figure B is a detailed view of the lung structures that childhood interstitial lung disease may affect, such as the bronchioles, neuroendocrine cells, (more...)

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Other Names for Childhood Interstitial Lung Disease

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What Causes Childhood Interstitial Lung Disease?

Researchers don't yet know all of the causes of childhood interstitial lung disease (chILD). Many times, these diseases have no clear cause.

Some conditions and factors that may cause or lead to chILD include:

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Who Is at Risk for Childhood Interstitial Lung Disease?

Childhood interstitial lung disease (chILD) is rare. Most children are not at risk for chILD. However, some factors increase the risk of developing chILD. These risk factors include:

Certain types of chILD are more common in infants and young children, while others can occur in children of any age. For more information, go to \"Types of Childhood Interstitial Lung Disease.\"

The risk of death seems to be higher for children who have chILD and pulmonary hypertension, developmental or growth disorders, bone marrow transplants, or certain surfactant problems.

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What Are the Signs and Symptoms of Childhood Interstitial Lung Disease?

Childhood interstitial lung disease (chILD) has many signs and symptoms because the disease has many forms. Signs and symptoms may include:

If your child has any of these signs and symptoms, contact his or her doctor. The doctor may refer you to a pediatric pulmonologist. This is a doctor who specializes in diagnosing and treating children who have lung diseases and conditions.

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How Is Childhood Interstitial Lung Disease Diagnosed?

Doctors diagnose childhood interstitial lung disease (chILD) based on a child's medical and family histories and the results from tests and procedures. To diagnose chILD, doctors may first need to rule out other diseases as the cause of a child's symptoms.

Early diagnosis of chILD may help doctors stop or even reverse lung function problems. Often though, doctors find chILD hard to diagnose because:

Going to a pediatric pulmonologist who has experience with chILD is helpful. A pediatric pulmonologist is a doctor who specializes in diagnosing and treating children who have lung diseases and conditions.

Medical and Family Histories

Your child's medical history can help his or her doctor diagnose chILD. The doctor may ask whether your child:

The doctor also may ask how old your child was when symptoms began, and whether other family members have or have had severe lung diseases. If they have, your child may have an inherited form of chILD.

Diagnostic Tests and Procedures

No single test can diagnose the many types of chILD. Thus, your child's doctor may recommend one or more of the following tests. For some of these tests, infants and young children may be given medicine to help them relax or sleep.

  • A chest x ray. This painless test creates pictures of the structures inside your child's chest, such as the heart, lungs, and blood vessels. A chest x ray can help rule out other lung diseases as the cause of your child's symptoms.
  • A high-resolution CT scan (HRCT). An HRCT scan uses x rays to create detailed pictures of your child's lungs. This test can show the location, extent, and severity of lung disease.
  • Lung function tests. These tests measure how much air your child can breathe in and out, how fast he or she can breathe air out, and how well your child's lungs deliver oxygen to the blood. Lung function tests can assess the severity of lung disease. Infants and young children may need to have these tests at a center that has special equipment for children.
  • Bronchoalveolar lavage (BRONG-ko-al-VE-o-lar lah-VAHZH). For this procedure, the doctor injects a small amount of saline (salt water) through a tube inserted in the child's lungs. The fluid helps bring up cells from the tissues around the air sacs. The doctor can then look at these cells under a microscope. This procedure can help detect an infection, lung injury, bleeding, aspiration, or an airway problem.
  • Various tests to rule out conditions such as asthma, cystic fibrosis, acid reflux, heart disease, neuromuscular disease, and immune deficiency.
  • Various tests for systemic diseases linked to chILD. Systemic diseases are diseases that involve many of the body's organs.
  • Blood tests to check for inherited (genetic) diseases and disorders.

If these tests don't provide enough information, your child's doctor may recommend a lung biopsy. A lung biopsy is the most reliable way to diagnose chILD and the specific disease involved.

A lung biopsy is a surgical procedure that's done in a hospital. Before the biopsy, your child will receive medicine to make him or her sleep.

During the biopsy, the doctor will take small samples of lung tissue from several places in your child's lungs. This often is done using video-assisted thoracoscopy (thor-ah-KOS-ko-pe).

For this procedure, the doctor inserts a small tube with a light and camera (endoscope) into your child's chest through small cuts between the ribs. The endoscope provides a video image of the lungs and allows the doctor to collect tissue samples.

After the biopsy, the doctor will look at these samples under a microscope.

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How Is Childhood Interstitial Lung Disease Treated?

Childhood interstitial lung disease (chILD) is rare, and little research has been done on how to treat it. At this time, chILD has no cure. However, some children who have certain diseases, such as neuroendocrine cell hyperplasia of infancy, may slowly improve over time.

Current treatment approaches include supportive therapy, medicines, and, in the most serious cases, lung transplants.

Supportive Therapy

Supportive therapy refers to treatments that help relieve symptoms or improve quality of life. Supportive approaches used to relieve common chILD symptoms include:

  • Oxygen therapy. If your child's blood oxygen level is low, he or she may need oxygen therapy. This treatment can improve breathing, support growth, and reduce strain on the heart.
  • Bronchodilators. These medications relax the muscles around your child’s airways, which helps open the airways and makes breathing easier.
  • Breathing devices. Children who have severe disease may need ventilators or other devices to help them breathe easier.
  • Extra nutrition. This treatment can help improve your child's growth and help him or her gain weight. Close monitoring of growth is especially important.
  • Techniques and devices to help relieve lung congestion. These may include chest physical therapy (CPT) or wearing a vest that helps move mucus (a sticky substance) to the upper airways so it can be coughed up. CPT may involve pounding the chest and back over and over with your hands or a device to loosen mucus in the lungs so that your child can cough it up.
  • Supervised pulmonary rehabilitation (PR). PR is a broad program that helps improve the well-being of people who have chronic (ongoing) breathing problems.

Medicines

Corticosteroids are a common treatment for many children who have chILD. These medicines help reduce lung inflammation.

Other medicines can help treat specific types or causes of chILD. For example, antimicrobial medicines can treat a lung infection. Acid-blocking medicines can prevent acid reflux, which can lead to aspiration.

Lung Transplant

A lung transplant may be an option for children who have severe chILD if other treatments haven't worked.

Currently, lung transplants are the only effective treatment for some types of chILD that have a high risk of death, such as alveolar capillary dysplasia and certain surfactant dysfunction mutations.

Early diagnosis of these diseases gives children the chance to receive lung transplants. So far, chILD doesn't appear to come back in patients' transplanted lungs.

For more information about this treatment, go to the Health Topics Lung Transplant article.

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How Can Childhood Interstitial Lung Disease Be Prevented?

At this time, most types of childhood interstitial lung disease (chILD) can't be prevented. People who have a family history of inherited (genetic) interstitial lung disease may want to consider genetic counseling. A counselor can explain the risk of children inheriting chILD.

You and your child can take steps to help prevent infections and other illnesses that worsen chILD and its symptoms. For example:

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Living With Childhood Interstitial Lung Disease

Caring for a child who has childhood interstitial lung disease (chILD) can be challenging. However, you can take steps to help your child manage his or her disease.

Make sure your child gets ongoing care and seek support to help you, your child, and your other family members cope with the effects of chILD on daily life.

Ongoing Care

Work with your child's health care team to manage your child's symptoms and keep him or her as healthy as possible.

This team may include doctors, nurses, dietitians, social workers, physical therapists, and home health aides. Each of these specialists may have services that can help you and your child cope with his or her lung disease.

You also can take other steps to help manage your child's care. For example:

  • Give your child all of his or her prescribed medicines. Make sure to take your child to all followup medical visits.
  • Work with your child's health care team to ensure that your child is getting good nutrition. Your child's health care team also can suggest physical activities that meet your child's needs.
  • Ask your child's doctor about warning signs of worsening lung disease and when to seek emergency medical care. Agree on a plan of action if these warning signs occur.
  • Keep complete records of your child's care and any instructions you receive. This information can help you manage care at home and inform various doctors about your child's medical history and status.

Many children who have chILD need oxygen therapy to help them breathe easier. Portable oxygen units can make it easier for your child to move around and do many daily activities.

If your child's doctor prescribes oxygen therapy, work with a home equipment provider to make sure you have the supplies and equipment you need. Trained personnel will show you how to use the equipment correctly and safely.

Ongoing Support

Your child may need support to help other people in his or her life understand the special needs related to chILD. For example, you may want to talk with your child's teachers about your child's illness. You can work with the teachers to decide how to meet your child's special school-related needs.

You also may want to alert relatives, caregivers, friends, and parents of friends about your child's illness. Let them know about your child's usual care and any signs or symptoms that require emergency care.

Taking care of yourself also is important. Managing your child's disease and ongoing care can be stressful. You and your family members may feel sad, guilty, or overwhelmed.

Social workers and mental health providers can help you cope with your feelings and provide support. They also can connect you with family support groups. Taking part in a support group can show you how other people have coped with chILD.

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Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.

NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.

Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.

By taking part in a clinical trial, your child can gain access to new treatments before they're widely available. Your child also will have the support of a team of health care providers, who will likely monitor his or her health closely. Even if your child doesn't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.

Children (aged 18 and younger) get special protection as research subjects. Almost always, parents must give legal consent for their child to take part in a clinical trial.

When researchers think that a trial's potential risks are greater than minimal, both parents must give permission for their child to enroll. Also, children aged 7 and older often must agree (assent) to take part in clinical trials.

If you agree to have your child take part in a clinical trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw your child from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.

For more information about clinical trials related to childhood interstitial lung disease, talk with your doctor. For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.

You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:

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How the Heart Works

To understand congenital heart defects, it's helpful to know how a healthy heart works. Your child's heart is a muscle about the size of his or her fist. The heart works like a pump and beats 100,000 times a day.

The heart has two sides, separated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to pick up oxygen. The left side of the heart receives the oxygen-rich blood from the lungs and pumps it to the body.

The heart has four chambers and four valves and is connected to various blood vessels. Veins are blood vessels that carry blood from the body to the heart. Arteries are blood vessels that carry blood away from the heart to the body.

\"A

Figure

A Healthy Heart Cross-Section. The illustration shows a cross-section of a healthy heart and its inside structures. The blue arrow shows the direction in which oxygen-poor blood flows from the body to the lungs. The red arrow shows the direction in which (more...)

Heart Chambers

The heart has four chambers or \"rooms.\"

Heart Valves

Four valves control the flow of blood from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart.

  • The tricuspid (tri-CUSS-pid) valve is in the right side of the heart, between the right atrium and the right ventricle.
  • The pulmonary (PULL-mun-ary) valve is in the right side of the heart, between the right ventricle and the entrance to the pulmonary artery. This artery carries blood from the heart to the lungs.
  • The mitral (MI-trul) valve is in the left side of the heart, between the left atrium and the left ventricle.
  • The aortic (ay-OR-tik) valve is in the left side of the heart, between the left ventricle and the entrance to the aorta. This artery carries blood from the heart to the body.

Valves are like doors that open and close. They open to allow blood to flow through to the next chamber or to one of the arteries. Then they shut to keep blood from flowing backward.

When the heart's valves open and close, they make a \"lub-DUB\" sound that a doctor can hear using a stethoscope.

  • The first sound—the \"lub\"—is made by the mitral and tricuspid valves closing at the beginning of systole (SIS-toe-lee). Systole is when the ventricles contract, or squeeze, and pump blood out of the heart.
  • The second sound—the \"DUB\"—is made by the aortic and pulmonary valves closing at the beginning of diastole (di-AS-toe-lee). Diastole is when the ventricles relax and fill with blood pumped into them by the atria.

Arteries

The arteries are major blood vessels connected to your heart.

Veins

The veins also are major blood vessels connected to your heart.

For more information about how a healthy heart works, go to the Health Topics How the Heart Works article. This article contains animations that show how your heart pumps blood and how your heart's electrical system works.

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Types of Congenital Heart Defects

With congenital heart defects, some part of the heart doesn’t form properly before birth. This changes the normal flow of blood through the heart.

There are many types of congenital heart defects. Some are simple, such as a hole in the septum. The hole allows blood from the left and right sides of the heart to mix. Another example of a simple defect is a narrowed valve that blocks blood flow to the lungs or other parts of the body.

Other heart defects are more complex. They include combinations of simple defects, problems with the location of blood vessels leading to and from the heart, and more serious problems with how the heart develops.

Examples of Simple Congenital Heart Defects

Holes in the Heart (Septal Defects)

The septum is the wall that separates the chambers on left and right sides of the heart. The wall prevents blood from mixing between the two sides of the heart. Some babies are born with holes in the septum. These holes allow blood to mix between the two sides of the heart.

Atrial septal defect (ASD). An ASD is a hole in the part of the septum that separates the atria—the upper chambers of the heart. The hole allows oxygen-rich blood from the left atrium to flow into the right atrium, instead of flowing into the left ventricle as it should. Many children who have ASDs have few, if any, symptoms.

\"Cross-Section

Figure

Cross-Section of a Normal Heart and a Heart With an Atrial Septal Defect. Figure A shows the structure and blood flow inside a normal heart. Figure B shows a heart with an atrial septal defect. The hole allows oxygen-rich blood from the left atrium to mix (more...)

ASDs can be small, medium, or large. Small ASDs allow only a little blood to leak from one atrium to the other. They don't affect how the heart works and don't need any special treatment. Many small ASDs close on their own as the heart grows during childhood.

Medium and large ASDs allow more blood to leak from one atrium to the other. They’re less likely to close on their own.

About half of all ASDs close on their own over time. Medium and large ASDs that need treatment can be repaired using a catheter procedure or open-heart surgery.

Ventricular septal defect (VSD). A VSD is a hole in the part of the septum that separates the ventricles—the lower chambers of the heart. The hole allows oxygen-rich blood to flow from the left ventricle into the right ventricle, instead of flowing into the aorta and out to the body as it should.

\"Cross-Section

Figure

Cross-Section of a Normal Heart and a Heart With an Atrial Septal Defect Cross-Section of a Normal Heart and a Heart With a Ventricular Septal Defect. Figure A shows the structure and blood flow inside a normal heart. Figure B shows two common locations (more...)

VSDs can be small, medium, or large. Small VSDs don't cause problems and may close on their own. Medium VSDs are less likely to close on their own and may require treatment.

Large VSDs allow a lot of blood to flow from the left ventricle to the right ventricle. As a result, the left side of the heart must work harder than normal. Extra blood flow increases blood pressure in the right side of the heart and the lungs.

The heart’s extra workload can cause heart failure and poor growth. If the hole isn't closed, high blood pressure can scar the arteries in the lungs.

Doctors use open-heart surgery to repair VSDs.

Patent Ductus Arteriosus

Patent ductus arteriosus (PDA) is a fairly common heart defect that can occur soon after birth. In PDA, abnormal blood flow occurs between the aorta and the pulmonary artery.

Before birth, these arteries are connected by a blood vessel called the ductus arteriosus. This blood vessel is an essential part of fetal blood circulation. Within minutes or up to a few days after birth, the ductus arteriosus closes.

In some babies, however, the ductus arteriosus remains open (patent). The opening allows oxygen-rich blood from the aorta to mix with oxygen-poor blood from the pulmonary artery. This can strain the heart and increase blood pressure in the lung arteries.

A heart murmur might be the only sign of PDA. (A heart murmur is an extra or unusual sound heard during a heartbeat.) Other signs and symptoms can include shortness of breath, poor feeding and growth, tiring easily, and sweating with exertion.

PDA is treated with medicines, catheter-based procedures, and surgery. Small PDAs often close without treatment.

Narrowed Valves

Simple congenital heart defects also can involve the heart's valves. These valves control the flow of blood from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart (the aorta and the pulmonary artery).

Valves can have the following types of defects:

  • Stenosis (steh-NO-sis). This defect occurs if the flaps of a valve thicken, stiffen, or fuse together. As a result, the valve cannot fully open. Thus, the heart has to work harder to pump blood through the valve.
  • Atresia (ah-TRE-ze-AH). This defect occurs if a valve doesn't form correctly and lacks a hole for blood to pass through. Atresia of a valve generally results in more complex congenital heart disease.
  • Regurgitation (re-GUR-jih-TA-shun). This defect occurs if a valve doesn't close tightly. As a result, blood leaks back through the valve.

The most common valve defect is pulmonary valve stenosis, which is a narrowing of the pulmonary valve. This valve allows blood to flow from the right ventricle into the pulmonary artery. The blood then travels to the lungs to pick up oxygen.

Pulmonary valve stenosis can range from mild to severe. Most children who have this defect have no signs or symptoms other than a heart murmur. Treatment isn't needed if the stenosis is mild.

In babies who have severe pulmonary valve stenosis, the right ventricle can get very overworked trying to pump blood to the pulmonary artery. These infants may have signs and symptoms such as rapid or heavy breathing, fatigue (tiredness), and poor feeding. Older children who have severe pulmonary valve stenosis may have symptoms such as fatigue while exercising.

Some babies may have pulmonary valve stenosis and PDA or ASDs. If this happens, oxygen-poor blood can flow from the right side of the heart to the left side. This can cause cyanosis (si-ah-NO-sis). Cyanosis is a bluish tint to the skin, lips, and fingernails. It occurs because the oxygen level in the blood leaving the heart is below normal.

Severe pulmonary valve stenosis is treated with a catheter procedure.

Example of a Complex Congenital Heart Defect

Complex congenital heart defects need to be repaired with surgery. Advances in treatment now allow doctors to successfully repair even very complex congenital heart defects.

The most common complex heart defect is tetralogy of Fallot (teh-TRAL-o-je of fah-LO), which is a combination of four defects:

In tetralogy of Fallot, not enough blood is able to reach the lungs to get oxygen, and oxygen-poor blood flows to the body.

\"Cross-Section

Figure

Cross-Section of a Normal Heart and a Heart With an Atrial Septal Defect Cross-Section of a Normal Heart and a Heart With a Ventricular Septal Defect Cross-Section of a Normal Heart and a Heart With Tetralogy of Fallot. Figure A shows the structure and (more...)

Babies and children who have tetralogy of Fallot have episodes of cyanosis, which can be severe. In the past, when this condition wasn't treated in infancy, older children would get very tired during exercise and might faint. Tetralogy of Fallot is repaired in infancy now to prevent these problems.

Tetralogy of Fallot must be repaired with open-heart surgery, either soon after birth or later in infancy. The timing of the surgery will depend on how narrow the pulmonary artery is.

Children who have had this heart defect repaired need lifelong medical care from a specialist to make sure they stay as healthy as possible.

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Other Names for Congenital Heart Defects

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What Causes Congenital Heart Defects?

If your child has a congenital heart defect, you may think you did something wrong during your pregnancy to cause the problem. However, doctors often don't know why congenital heart defects occur.

Heredity may play a role in some heart defects. For example, a parent who has a congenital heart defect may be more likely than other people to have a child with the defect. Rarely, more than one child in a family is born with a heart defect.

Children who have genetic disorders, such as Down syndrome, often have congenital heart defects. In fact, half of all babies who have Down syndrome have congenital heart defects.

Smoking during pregnancy also has been linked to several congenital heart defects, including septal defects.

Researchers continue to search for the causes of congenital heart defects.

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What Are the Signs and Symptoms of Congenital Heart Defects?

Many congenital heart defects cause few or no signs and symptoms. A doctor may not even detect signs of a heart defect during a physical exam.

Some heart defects do cause signs and symptoms. They depend on the number, type, and severity of the defects. Severe defects can cause signs and symptoms, usually in newborns. These signs and symptoms may include:

Congenital heart defects don't cause chest pain or other painful symptoms.

Heart defects can cause heart murmurs (extra or unusual sounds heard during a heartbeat). Doctors can hear heart murmurs using a stethoscope. However, not all murmurs are signs of congenital heart defects. Many healthy children have heart murmurs.

Normal growth and development depend on a normal workload for the heart and normal flow of oxygen-rich blood to all parts of the body. Babies who have congenital heart defects may have cyanosis and tire easily while feeding. As a result, they may not gain weight or grow as they should.

Older children who have congenital heart defects may get tired easily or short of breath during physical activity.

Many types of congenital heart defects cause the heart to work harder than it should. With severe defects, this can lead to heart failure. Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. Symptoms of heart failure include:

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How Are Congenital Heart Defects Diagnosed?

Severe congenital heart defects generally are diagnosed during pregnancy or soon after birth. Less severe defects often aren't diagnosed until children are older.

Minor defects often have no signs or symptoms. Doctors may diagnose them based on results from a physical exam and tests done for another reason.

Specialists Involved

Pediatric cardiologists are doctors who specialize in the care of babies and children who have heart problems. Cardiac surgeons are specialists who repair heart defects using surgery.

Physical Exam

During a physical exam, the doctor will:

  • Listen to your child's heart and lungs with a stethoscope
  • Look for signs of a heart defect, such as cyanosis (a bluish tint to the skin, lips, or fingernails), shortness of breath, rapid breathing, delayed growth, or signs of heart failure

Diagnostic Tests

Echocardiography

Echocardiography (echo) is a painless test that uses sound waves to create a moving picture of the heart. During the test, the sound waves (called ultrasound) bounce off the structures of the heart. A computer converts the sound waves into pictures on a screen.

Echo allows the doctor to clearly see any problem with the way the heart is formed or the way it's working.

Echo is an important test for both diagnosing a heart problem and following the problem over time. The test can show problems with the heart's structure and how the heart is reacting to those problems. Echo will help your child's cardiologist decide if and when treatment is needed.

During pregnancy, if your doctor suspects that your baby has a congenital heart defect, fetal echo can be done. This test uses sound waves to create a picture of the baby's heart while the baby is still in the womb.

Fetal echo usually is done at about 18 to 22 weeks of pregnancy. If your child is diagnosed with a congenital heart defect before birth, your doctor can plan treatment before the baby is born.

EKG (Electrocardiogram)

An EKG is a simple, painless test that records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through the heart.

An EKG can detect if one of the heart's chambers is enlarged, which can help diagnose a heart problem.

Chest X Ray

A chest x ray is a painless test that creates pictures of the structures in the chest, such as the heart and lungs. This test can show whether the heart is enlarged. It also can show whether the lungs have extra blood flow or extra fluid, a sign of heart failure.

Pulse Oximetry

For this test, a small sensor is attached to a finger or toe (like an adhesive bandage). The sensor gives an estimate of how much oxygen is in the blood.

Cardiac Catheterization

During cardiac catheterization (", "diseases_conditions.last_update": "June 11, 2014.", "diseases_conditions.category_1_x_diseases_conditions_id": { "22": { "category_1_x_diseases_conditions.id": 22, "category_1.id": 3, "category_1.ts": "2018-02-02 04:25:06", "category_1.title": "c" } } }, "23": { "diseases_conditions.id": 23, "diseases_conditions.ts": "2018-02-02 05:09:00", "diseases_conditions.title": "Coronary Heart Disease", "diseases_conditions.diseases_conditions_detail": "

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What Is Coronary Heart Disease?

Coronary heart disease (CHD) is a disease in which a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle.

When plaque builds up in the arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis). The buildup of plaque occurs over many years.

\"Atherosclerosis.\"

Figure

Atherosclerosis. Figure A shows the location of the heart in the body. Figure B shows a normal coronary artery with normal blood flow. The inset image shows a cross-section of a normal coronary artery. Figure C shows a coronary artery narrowed by plaque. (more...)

Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart.

If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. Over time, ruptured plaque also hardens and narrows the coronary arteries.

Overview

If the flow of oxygen-rich blood to your heart muscle is reduced or blocked, angina (an-JI-nuh or AN-juh-nuh) or a heart attack can occur.

Angina is chest pain or discomfort. It may feel like pressure or squeezing in your chest. The pain also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.

A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle is cut off. If blood flow isn’t restored quickly, the section of heart muscle begins to die. Without quick treatment, a heart attack can lead to serious health problems or death.

Over time, CHD can weaken the heart muscle and lead to heart failure and arrhythmias (ah-RITH-me-ahs). Heart failure is a condition in which your heart can't pump enough blood to meet your body’s needs. Arrhythmias are problems with the rate or rhythm of the heartbeat.

Outlook

CHD is the most common type of heart disease. In the United States, CHD is the #1 cause of death for both men and women. Lifestyle changes, medicines, and medical procedures can help prevent or treat CHD. These treatments may reduce the risk of related health problems.

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Other Names for Coronary Heart Disease

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What Causes Coronary Heart Disease?

Research suggests that coronary heart disease (CHD) starts when certain factors damage the inner layers of the coronary arteries. These factors include:

Plaque might begin to build up where the arteries are damaged. The buildup of plaque in the coronary arteries may start in childhood.

Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause angina (chest pain or discomfort).

If the plaque ruptures, blood cell fragments called platelets (PLATE-lets) stick to the site of the injury. They may clump together to form blood clots.

Blood clots can further narrow the coronary arteries and worsen angina. If a clot becomes large enough, it can mostly or completely block a coronary artery and cause a heart attack.

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Who Is at Risk for Coronary Heart Disease?

In the United States, coronary heart disease (CHD) is the #1 cause of death for both men and women. Each year, more than 400,000 Americans die from CHD.

Certain traits, conditions, or habits may raise your risk for CHD. The more risk factors you have, the more likely you are to develop the disease.

You can control many risk factors, which may help prevent or delay CHD.

Major Risk Factors

Although older age and a family history of early heart disease are risk factors, it doesn't mean that you’ll develop CHD if you have one or both. Controlling other risk factors often can lessen genetic influences and help prevent CHD, even in older adults.

Emerging Risk Factors

Researchers continue to study other possible risk factors for CHD.

High levels of a protein called C-reactive protein (CRP) in the blood may raise the risk of CHD and heart attack. High levels of CRP are a sign of inflammation in the body.

Inflammation is the body's response to injury or infection. Damage to the arteries' inner walls may trigger inflammation and help plaque grow.

Research is under way to find out whether reducing inflammation and lowering CRP levels also can reduce the risk of CHD and heart attack.

High levels of triglycerides (tri-GLIH-seh-rides) in the blood also may raise the risk of CHD, especially in women. Triglycerides are a type of fat.

Other Risks Related to Coronary Heart Disease

Other conditions and factors also may contribute to CHD, including:

  • Sleep apnea. Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. Untreated sleep apnea can increase your risk for high blood pressure, diabetes, and even a heart attack or stroke.
  • Stress. Research shows that the most commonly reported \"trigger\" for a heart attack is an emotionally upsetting event, especially one involving anger.
  • Alcohol. Heavy drinking can damage the heart muscle and worsen other CHD risk factors. Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day.
  • Preeclampsia (pre-e-KLAMP-se-ah). This condition can occur during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine. Preeclampsia is linked to an increased lifetime risk of heart disease, including CHD, heart attack, heart failure, and high blood pressure.

For more detailed information, go to the Health Topics Coronary Heart Disease Risk Factors article.

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What Are the Signs and Symptoms of Coronary Heart Disease?

A common symptom of coronary heart disease (CHD) is angina. Angina is chest pain or discomfort that occurs if an area of your heart muscle doesn't get enough oxygen-rich blood.

Angina may feel like pressure or squeezing in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. The pain tends to get worse with activity and go away with rest. Emotional stress also can trigger the pain.

Another common symptom of CHD is shortness of breath. This symptom occurs if CHD causes heart failure. When you have heart failure, your heart can't pump enough blood to meet your body’s needs. Fluid builds up in your lungs, making it hard to breathe.

The severity of these symptoms varies. They may get more severe as the buildup of plaque continues to narrow the coronary arteries.

Signs and Symptoms of Heart Problems Related to Coronary Heart Disease

Some people who have CHD have no signs or symptoms—a condition called silent CHD. The disease might not be diagnosed until a person has signs or symptoms of a heart attack, heart failure, or an arrhythmia (an irregular heartbeat).

Heart Attack

A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle is cut off. This can happen if an area of plaque in a coronary artery ruptures (breaks open).

Blood cell fragments called platelets stick to the site of the injury and may clump together to form blood clots. If a clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.

If the blockage isn’t treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.

\"Heart

Figure

Heart With Muscle Damage and a Blocked Artery. Figure A shows the location of the heart in the body. Figure B is an overview of a heart and coronary artery showing damage (dead heart muscle) caused by a heart attack. Figure C is a cross-section of the (more...)

The most common heart attack symptom is chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest that often lasts for more than a few minutes or goes away and comes back.

The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. The feeling can be mild or severe. Heart attack pain sometimes feels like indigestion or heartburn.

The symptoms of angina can be similar to the symptoms of a heart attack. Angina pain usually lasts for only a few minutes and goes away with rest.

Chest pain or discomfort that doesn’t go away or changes from its usual pattern (for example, occurs more often or while you’re resting) might be a sign of a heart attack. If you don’t know whether your chest pain is angina or a heart attack, call 9–1–1.

All chest pain should be checked by a doctor.

Other common signs and symptoms of a heart attack include:

For more information, go to the Health Topics Heart Attack article.

Heart Failure

Heart failure is a condition in which your heart can't pump enough blood to meet your body’s needs. Heart failure doesn't mean that your heart has stopped or is about to stop working.

The most common signs and symptoms of heart failure are shortness of breath or trouble breathing; fatigue; and swelling in the ankles, feet, legs, stomach, and veins in the neck.

All of these symptoms are the result of fluid buildup in your body. When symptoms start, you may feel tired and short of breath after routine physical effort, like climbing stairs.

For more information, go to the Health Topics Heart Failure article.

Arrhythmia

An arrhythmia is a problem with the rate or rhythm of the heartbeat. When you have an arrhythmia, you may notice that your heart is skipping beats or beating too fast.

Some people describe arrhythmias as a fluttering feeling in the chest. These feelings are called palpitations (pal-pih-TA-shuns).

Some arrhythmias can cause your heart to suddenly stop beating. This condition is called sudden cardiac arrest (SCA). SCA usually causes death if it's not treated within minutes.

For more information, go to the Health Topics Arrhythmia article.

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How Is Coronary Heart Disease Diagnosed?

Your doctor will diagnose coronary heart disease (CHD) based on your medical and family histories, your risk factors for CHD, a physical exam, and the results from tests and procedures.

No single test can diagnose CHD. If your doctor thinks you have CHD, he or she may recommend one or more of the following tests.

EKG (Electrocardiogram)

An EKG is a simple, painless test that detects and records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through the heart.

An EKG can show signs of heart damage due to CHD and signs of a previous or current heart attack.

Stress Testing

During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can't exercise, you may be given medicine to raise your heart rate.

When your heart is working hard and beating fast, it needs more blood and oxygen. Plaque-narrowed arteries can't supply enough oxygen-rich blood to meet your heart's needs.

A stress test can show possible signs and symptoms of CHD, such as:

If you can't exercise for as long as what is considered normal for someone your age, your heart may not be getting enough oxygen-rich blood. However, other factors also can prevent you from exercising long enough (for example, lung diseases, anemia, or poor general fitness).

As part of some stress tests, pictures are taken of your heart while you exercise and while you rest. These imaging stress tests can show how well blood is flowing in your heart and how well your heart pumps blood when it beats.

Echocardiography

Echocardiography (echo) uses sound waves to create a moving picture of your heart. The picture shows the size and shape of your heart and how well your heart chambers and valves are working.

Echo also can show areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.

Chest X Ray

A chest x ray takes pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels.

A chest x ray can reveal signs of heart failure, as well as lung disorders and other causes of symptoms not related to CHD.

Blood Tests

Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels might be a sign that you're at risk for CHD.

Coronary Angiography and Cardiac Catheterization

Your doctor may recommend coronary angiography (an-jee-OG-rah-fee) if other tests or factors show that you're likely to have CHD. This test uses dye and special x rays to show the insides of your coronary arteries.

To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization (KATH-eh-ter-ih-ZA-shun).

A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream.

Special x rays are taken while the dye is flowing through your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels.

Cardiac catheterization usually is done in a hospital. You're awake during the procedure. It usually causes little or no pain, although you may feel some soreness in the blood vessel where your doctor inserts the catheter.

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How Is Coronary Heart Disease Treated?

Treatments for coronary heart disease (CHD) include lifestyle changes, medicines, and medical procedures. Treatment goals may include:

  • Relieving symptoms.
  • Reducing risk factors in an effort to slow, stop, or reverse the buildup of plaque.
  • Lowering the risk of blood clots forming. (Blood clots can cause a heart attack.)
  • Widening or bypassing clogged arteries.
  • Preventing complications of CHD.

Lifestyle Changes

Making lifestyle changes often can help prevent or treat CHD. Lifestyle changes might be the only treatment that some people need.

Follow a Healthy Diet

A healthy diet is an important part of a healthy lifestyle. Following a healthy diet can prevent or reduce high blood pressure and high blood cholesterol and help you maintain a healthy weight.

For information about healthy eating, go to the National Heart, Lung, and Blood Institute's (NHLBI's) Aim for a Healthy Weight Web site. This site provides practical tips on healthy eating, physical activity, and controlling your weight.

Therapeutic Lifestyle Changes (TLC). Your doctor may recommend TLC if you have high blood cholesterol. TLC is a three-part program that includes a healthy diet, physical activity, and weight management.

With the TLC diet, less than 7 percent of your daily calories should come from saturated fat. This kind of fat is found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods.

No more than 25 to 35 percent of your daily calories should come from all fats, including saturated, trans, monounsaturated, and polyunsaturated fats.

You also should have less than 200 mg a day of cholesterol. The amounts of cholesterol and the types of fat in prepared foods can be found on the foods' Nutrition Facts labels.

Foods high in soluble fiber also are part of a healthy diet. They help prevent the digestive tract from absorbing cholesterol. These foods include:

  • Whole-grain cereals such as oatmeal and oat bran
  • Fruits such as apples, bananas, oranges, pears, and prunes
  • Legumes such as kidney beans, lentils, chick peas, black-eyed peas, and lima beans

A diet rich in fruits and vegetables can increase important cholesterol-lowering compounds in your diet. These compounds, called plant stanols or sterols, work like soluble fiber.

A healthy diet also includes some types of fish, such as salmon, tuna (canned or fresh), and mackerel. These fish are a good source of omega-3 fatty acids. These acids may help protect the heart from blood clots and inflammation and reduce the risk of heart attack. Try to have about two fish meals every week.

You also should try to limit the amount of sodium (salt) that you eat. This means choosing low-salt and \"no added salt\" foods and seasonings at the table or while cooking. The Nutrition Facts label on food packaging shows the amount of sodium in the item.

Try to limit drinks that contain alcohol. Too much alcohol will raise your blood pressure and triglyceride level. (Triglycerides are a type of fat found in the blood.) Alcohol also adds extra calories, which will cause weight gain.

Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is a glass of wine, beer, or a small amount of hard liquor.

For more information about TLC, go to the NHLBI's \"Your Guide to Lowering Your Cholesterol With TLC.\"

Dietary Approaches to Stop Hypertension (DASH). Your doctor may recommend the DASH eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart h", "diseases_conditions.last_update": "June 11, 2014.", "diseases_conditions.category_1_x_diseases_conditions_id": { "23": { "category_1_x_diseases_conditions.id": 23, "category_1.id": 3, "category_1.ts": "2018-02-02 04:25:06", "category_1.title": "c" } } }, "24": { "diseases_conditions.id": 24, "diseases_conditions.ts": "2018-02-02 05:09:20", "diseases_conditions.title": "Coronary Heart Disease Risk Factors", "diseases_conditions.diseases_conditions_detail": "

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What Are Coronary Heart Disease Risk Factors?

Coronary heart disease risk factors are conditions or habits that raise your risk of coronary heart disease (CHD) and heart attack. These risk factors also increase the chance that existing CHD will worsen.

CHD, also called coronary artery disease, is a condition in which a waxy substance called plaque (plak) builds up on the inner walls of the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle.

Plaque narrows the arteries and reduces blood flow to your heart muscle. Reduced blood flow can cause chest pain, especially when you're active. Eventually, an area of plaque can rupture (break open). This causes a blood clot to form on the surface of the plaque.

If the clot becomes large enough, it can block the flow of oxygen-rich blood to the portion of heart muscle fed by the artery. Blocked blood flow to the heart muscle causes a heart attack.

Overview

There are many known CHD risk factors. You can control some risk factors, but not others. Risk factors you can control include:

The risk factors you can't control are age, gender, and family history of CHD.

Many people have at least one CHD risk factor. Your risk of CHD and heart attack increases with the number of risk factors you have and their severity. Also, some risk factors put you at greater risk of CHD and heart attack than others. Examples of these risk factors include smoking and diabetes.

Many CHD risk factors start during childhood. This is even more common now because many children are overweight and don't get enough physical activity. Some CHD risk factors can even develop within the first 10 years of life.

Researchers continue to study and learn more about CHD risk factors.

Outlook

CHD is the #1 killer of both women and men in the United States. Following a healthy lifestyle can help you and your children prevent or control many CHD risk factors.

Because many lifestyle habits begin during childhood, parents and families should encourage their children to make heart healthy choices. For example, you and your children can lower your risk of CHD if you maintain a healthy weight, follow a healthy diet, do physical activity regularly, and don't smoke.

On average, people at low risk of CHD live nearly 10 years longer than people at high risk of CHD.

If you already have CHD, lifestyle changes can help you control your risk factors. This may prevent CHD from worsening. Even if you're in your seventies or eighties, a healthy lifestyle can lower your risk of dying from CHD.

If lifestyle changes aren't enough, your doctor may recommend other treatments to help control your risk factors.

Your doctor can help you find out whether you have CHD risk factors. He or she also can help you create a plan for lowering your risk of CHD, heart attack, and other heart problems.

If you have children, talk with their doctors about their heart health and whether they have CHD risk factors. If they do, ask your doctor to help create a treatment plan to reduce or control these risk factors.

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Coronary Heart Disease Risk Factors

High Blood Cholesterol and Triglyceride Levels

Cholesterol

High blood cholesterol is a condition in which your blood has too much cholesterol—a waxy, fat-like substance. The higher your blood cholesterol level, the greater your risk of coronary heart disease (CHD) and heart attack.

Cholesterol travels through the bloodstream in small packages called lipoproteins (LI-po-pro-teens). Two major kinds of lipoproteins carry cholesterol throughout your body:

  • Low-density lipoproteins (LDL). LDL cholesterol sometimes is called \"bad\" cholesterol. This is because it carries cholesterol to tissues, including your heart arteries. A high LDL cholesterol level raises your risk of CHD.
  • High-density lipoproteins (HDL). HDL cholesterol sometimes is called \"good\" cholesterol. This is because it helps remove cholesterol from your arteries. A low HDL cholesterol level raises your risk of CHD.

Many factors affect your cholesterol levels. For example, after menopause, women's LDL cholesterol levels tend to rise, and their HDL cholesterol levels tend to fall. Other factors—such as age, gender, diet, and physical activity—also affect your cholesterol levels.

Healthy levels of both LDL and HDL cholesterol will prevent plaque from building up in your arteries. Routine blood tests can show whether your blood cholesterol levels are healthy. Talk with your doctor about having your cholesterol tested and what the results mean.

Children also can have unhealthy cholesterol levels, especially if they're overweight or their parents have high blood cholesterol. Talk with your child's doctor about testing your child' cholesterol levels.

To learn more about high blood cholesterol and how to manage the condition, go to the Health Topics High Blood Cholesterol article.

Triglycerides

Triglycerides are a type of fat found in the blood. Some studies suggest that a high level of triglycerides in the blood may raise the risk of CHD, especially in women.

High Blood Pressure

\"Blood pressure\" is the force of blood pushing against the walls of your arteries as your heart pumps blood. If this pressure rises and stays high over time, it can damage your heart and lead to plaque buildup.

Blood pressure is measured as systolic (sis-TOL-ik) and diastolic (di-a-STOL-ik) pressures. \"Systolic\" refers to blood pressure when the heart beats while pumping blood. \"Diastolic\" refers to blood pressure when the heart is at rest between beats.

You most often will see blood pressure numbers written with the systolic number above or before the diastolic number, such as 120/80 mmHg. (The mmHg is millimeters of mercury—the units used to measure blood pressure.)

All levels above 120/80 mmHg raise your risk of CHD. This risk grows as blood pressure levels rise. Only one of the two blood pressure numbers has to be above normal to put you at greater risk of CHD and heart attack.

Often, high blood pressure has no signs or symptoms. However, the condition can be detected using a simple test that involves placing a blood pressure cuff around your arm.

Most adults should have their blood pressure checked at least once a year. If you have high blood pressure, you'll likely need to be checked more often. Talk with your doctor about how often you should have your blood pressure checked.

Children also can develop high blood pressure, especially if they're overweight. Your child's doctor should check your child's blood pressure at each routine checkup.

In children, blood pressure normally rises with age and body size. Newborns often have very low blood pressure numbers, while older teens have numbers similar to adults. The ranges for normal blood pressure and high blood pressure generally are lower for youth than for adults.

Your child should have routine blood pressure checks starting at 3 years of age. To find out whether a child has high blood pressure, a doctor will compare the child's blood pressure numbers to average numbers for his or her age, gender, and height.

Both children and adults are more likely to develop high blood pressure if they're overweight or have diabetes.

For more information about high blood pressure and how to manage the condition, go to the Health Topics High Blood Pressure article.

Diabetes and Prediabetes

Diabetes is a disease in which the body's blood sugar level is too high. The two types of diabetes are type 1 and type 2.

In type 1 diabetes, the body's blood sugar level is high because the body doesn't make enough insulin. Insulin is a hormone that helps move blood sugar into cells, where it's used for energy. In type 2 diabetes, the body's blood sugar level is high mainly because the body doesn't use its insulin properly.

Over time, a high blood sugar level can lead to increased plaque buildup in your arteries. Having diabetes doubles your risk of CHD.

Prediabetes is a condition in which your blood sugar level is higher than normal, but not as high as it is in diabetes. If you have prediabetes and don't take steps to manage it, you'll likely develop type 2 diabetes within 10 years. You're also at higher risk of CHD.

Being overweight or obese raises your risk of type 2 diabetes. With modest weight loss and moderate physical activity, people who have prediabetes may be able to delay or prevent type 2 diabetes. They also may be able to lower their risk of CHD and heart attack. Weight loss and physical activity also can help control diabetes.

Even children can develop type 2 diabetes. Most children who have type 2 diabetes are overweight.

Type 2 diabetes develops over time and sometimes has no symptoms. Go to your doctor or local clinic to have your blood sugar levels tested regularly to check for diabetes and prediabetes.

For more information about diabetes and heart disease, go to the Health Topics Diabetic Heart Disease article. For more information about diabetes and prediabetes, go to the National Institute of Diabetes and Digestive and Kidney Diseases' (NIDDK's) Introduction to Diabetes.

Overweight and Obesity

The terms \"overweight\" and \"obesity\" refer to body weight that's greater than what is considered healthy for a certain height. More than two-thirds of American adults are overweight, and almost one-third of these adults are obese.

The most useful measure of overweight and obesity is body mass index (BMI). BMI is calculated from your height and weight. In adults, a BMI of 18.5 to 24.9 is considered normal. A BMI of 25 to 29.9 is considered overweight. A BMI of 30 or more is considered obese.

You can use the National Heart, Lung, and Blood Institute's (NHLBI's) online BMI calculator to figure out your BMI, or your doctor can help you.

Overweight is defined differently for children and teens than it is for adults. Children are still growing, and boys and girls mature at different rates. Thus, BMIs for children and teens compare their heights and weights against growth charts that take age and gender into account. This is called BMI-for-age percentile.

For more information about BMI-for-age percentile, go to the Centers for Disease Control and Prevention's (CDC's) BMI-for-age calculator.

Being overweight or obese can raise your risk of CHD and heart attack. This is mainly because overweight and obesity are linked to other CHD risk factors, such as high blood cholesterol and triglyceride levels, high blood pressure, and diabetes.

For more information, go to the Health Topics Overweight and Obesity article.

Smoking

Smoking tobacco or long-term exposure to secondhand smoke raises your risk of CHD and heart attack.

Smoking triggers a buildup of plaque in your arteries. Smoking also increases the risk of blood clots forming in your arteries. Blood clots can block plaque-narrowed arteries and cause a heart attack.

Some research shows that smoking raises your risk of CHD in part by lowering HDL cholesterol levels.

The more you smoke, the greater your risk of heart attack. Studies show that if you quit smoking, you cut your risk of heart attack in half within a year. The benefits of quitting smoking occur no matter how long or how much you've smoked.

Most people who smoke start when they're teens. Parents can help prevent their children from smoking by not smoking themselves. Talk with your child about the health dangers of smoking and ways to overcome peer pressure to smoke.

For more information, including tips on how to quit smoking, go to the Health Topics Smoking and Your Hear t article and the NHLBI's \"Your Guide to a Healthy Heart.\"

For more information about children and smoking, go to the U.S. Department of Health and Human Services' (HHS') Kids and Smoking Web page and the CDC's Smoking and Tobacco Use Web page.

Lack of Physical Activity

Inactive people are nearly twice as likely to develop CHD as those who are active. A lack of physical activity can worsen other CHD risk factors, such as high blood cholesterol and triglyceride levels, high blood pressure, diabetes and prediabetes, and overweight and obesity.

It's important for children and adults to make physical activity part of their daily routines. One reason many Americans aren't active enough is because of hours spent in front of TVs and computers doing work, schoolwork, and leisure activities.

Some experts advise that children and teens should reduce screen time because it limits time for physical activity. They recommend that children aged 2 and older should spend no more than 2 hours a day watching TV or using a computer (except for school work).

Being physically active is one of the most important things you can do to keep your heart healthy. The good news is that even modest amounts of physical activity are good for your health. The more active you are, the more you will benefit.

For more information, go to HHS' \"2008 Physical Activity Guidelines for Americans,\" the Health Topics Physical Activity and Your Heart article, and the NHLBI's \"Your Guide to Physical Activity and Your Heart.\"

Unhealthy Diet

An unhealthy diet can raise your risk of CHD. For example, foods that are high in saturated and trans fats and cholesterol raise LDL cholesterol. Thus, you should try to limit these foods.

Saturated fats are found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods. Trans fats are found in some fried and processed foods. Cholesterol is found in eggs, many meats, dairy products, commercial baked goods, and certain types of shellfish.

It's also important to limit foods that are high in sodium (salt) and added sugars. A high-salt diet can raise your risk of high blood pressure.

Added sugars will give you extra calories without nutrients like vitamins and minerals. This can cause you to gain weight, which raises your risk of CHD. Added sugars are found in many desserts, canned fruits packed in syrup, fruit drinks, and nondiet sodas.

You also should try to limit how much alcohol you drink. Too much alcohol will raise your blood pressure. It also will add calories, which can cause weight gain.

Stress

Stress and anxiety may play a role in causing CHD. Stress and anxiety also can trigger your arteries to tighten. This can raise your blood pressure and your risk of heart attack.

The most commonly reported trigger for a heart attack is an emotionally upsetting event, especially one involving anger. Stress also may indirectly raise your risk of CHD if it makes you more likely to smoke or overeat foods high in fat and sugar.

Age

As you get older, your risk of CHD and heart attack rises. This is in part due to the slow buildup of plaque inside your heart arteries, which can start during childhood.

In men, the risk of CHD increases faster after age 45. In women, the risk of CHD increases faster after age 55.

Most people have some plaque buildup in their heart arteries by the time they're in their seventies. However, only about 25 percent of those people have chest pain, heart attacks, or other signs of CHD.

Gender

Before age 55, women have a lower risk of CHD than men. This is because before menopause, estrogen provides women some protection against CHD. After age 55, however, the risk of CHD increases similarly in both women and men.

Some risk factors may affect CHD risk differently in women than in men. For example, diabetes raises the risk of CHD more in women.

Also, some risk factors for heart disease only affect women, such as preeclampsia (pre-e-KLAMP-se-ah). Preeclampsia is a condition that can develop during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine.

Preeclampsia is linked to an increased lifetime risk of heart disease, including CHD, heart attack, heart failure, and high blood pressure. (Likewise, having heart disease risk factors, such as diabetes or obesity, increases your risk of preeclampsia.)

Family History

Family history plays a role in CHD risk. Your risk increases if your father or a brother was diagnosed with CHD before 55 years of age, or if your mother or a sister was diagnosed with CHD before 65 years of age.

However, having a family history of CHD doesn't mean that you will have it too. This is especially true if your affected family member smoked or had other CHD risk factors that were not well treated.

Making lifestyle changes and taking medicines to treat other risk factors often cen lessen genetic influences and stop or slow the progress of CHD.

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How To Prevent and Control Coronary Heart Disease Risk Factors

You can prevent and control many coronary heart disease (CHD) risk factors with lifestyle changes and medicines. Examples of these controllable risk factors include high blood cholesterol, high blood pressure, and overweight and obesity. Only a few risk factors—such as age, gender, and family history—can't be controlled.

To reduce your risk of CHD and heart attack, try to control each risk factor you can. The good news is that many lifestyle changes help control several CHD risk factors at the same time. For example, physical activity may lower your blood pressure, help control diabetes and prediabetes, reduce stress, and help control your weight.

A Lifelong Approach

Many lifestyle habits begin during childhood. Thus, parents and families should encourage their children to make heart healthy choices, such as following a healthy diet and being physically active. Make following a healthy lifestyle a family goal.

To achieve this goal, you should learn about key health measures, such as weight, body mass index (BMI), waist circumference, and your child's BMI-for-age percentile. For more information about BMI in adults and children, go to \"Coronary Heart Disease Risk Factors.\"

Be aware of your and your family members' blood pressure, blood cholesterol, and blood sugar levels. Once you know these numbers, you can work to bring them into, or keep them within, a healthy range.

Making lifestyle changes can be hard. But if you make these changes as a family, it may be easier for everyone to prevent or control their CHD risk factors.

For tips on how to help your children adopt healthy habits, visit the National Heart, Lung, and Blood Institute's (NHLBI's) We Can!® Ways to Enhance Children's Activity & Nutrition Web site.

Lifestyle Changes

A healthy lifestyle can lower the risk of CHD. If you already have CHD, a healthy lifestyle may prevent it from getting worse. A healthy lifestyle includes:

  • Following a healthy diet
  • Being physically active
  • Maintaining a healthy weight
  • Quitting smoking
  • Managing stress

Following a Healthy Diet

A healthy diet is an important part of a healthy lifestyle. To lower your risk of CHD and heart attack, you and your family should follow a diet that is:

  • Low in saturated and trans fats. Saturated fats are found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods. Trans fats are found in some fried and processed foods. Both types of fat raise your low-density lipoprotein (LDL), or \"bad,\" cholesterol level.
  • High in the types of fat found in fish and olive oil. These fats are rich in omega-3 fatty acids. Omega-3 fatty acids lower your risk of heart attack, in part by helping prevent blood clots.
  • High in fiber. Fiber is found in whole grains, fruits, and vegetables. A fiber-rich diet not only helps lower your LDL cholesterol level, but also provides nutrients that may help protect against CHD.
  • Low in salt and sugar. A low-salt diet can help you manage your blood pressure. A low-sugar diet can help you prevent weight gain and control diabetes and prediabetes.

Research suggests that drinking small to moderate amounts of alcohol regularly also can lower your risk of CHD. One drink a day can lower your risk by raising your high-density lipoprotein (HDL), or \"good,\" cholesterol level. One drink is a glass of wine, beer, or a small amount of hard liquor.

If you don't drink, this isn't a recommendation to start using alcohol. If you're pregnant, if you're planning to become pregnant, or if you have another health condition that could make alcohol use harmful, you shouldn't drink.

Also, too much alcohol can cause you to gain weight and raise your blood pressure and triglyceride level. In women, even one drink a day may raise the risk of certain types of cancer.

Teach your children how to make healthy food choices. For example, have them help you shop for and make healthy foods. Set a good example by following the same heart healthy diet that you ask your children to follow.

For more information about following a healthy diet, go to the NHLBI's Aim for a Healthy Weight Web site, \"Your Guide to a Healthy Heart,\" \"Your Guide to Lowering Your Blood Pressure With DASH,\" and \"Your Guide to Lowering Your Cholesterol With TLC.\" All of these resources provide general information about healthy eating.

Being Physically Active

You don't have to be an athlete to lower your risk of CHD. You can benefit from as little as 60 minutes of moderate-intensity aerobic activity per week.

For major health benefits, adults should do at least 150 minutes (2.5 hours) of moderate-intensity aerobic activity or 75 minutes (1 hour and 15 minutes) of vigorous-intensity aerobic activity each week.

Another option is to do a combination of both. A general rule is that 2 minutes of moderate-intensity activity counts the same as 1 minute of vigorous-intensity activity.

The more active you are, the more you'll benefit. If you're obese, or if you haven't been active in the past, start physical activity slowly and build up the intensity over time.

Children and youth should do 60 minutes or more of physical activity every day. A great way to encourage physical activity is to do it as a family. You also may want to limit your children's TV, video, and computer time to encourage them to be more active.

If you have CHD or symptoms such as chest pain and dizziness, talk with your doctor before you start a new exercise plan. Find out how much and what kinds of physical activity are safe for you. Avoid exercising outdoors when air pollution levels are high or the temperature is very hot or cold.

For more information about physical activity, go to the U.S. Department of Health and Human Services' (HHS') \"2008 Physical Activity Guidelines for Americans,\" the Health Topics Physical Activity and Your Heart article, and the NHLBI's \"Your Guide to Physical Activity and Your Heart.\"

Maintaining a Healthy Weight

Following a healthy diet and being physically active can help you maintain a healthy weight. Controlling your weight helps you control CHD risk factors.

If you're overweight or obese, try to lose weight. A loss of just 5 to 10 percent of your current weight can lower your risk of CHD.

To lose weight, cut back your calorie intake and do more physical activity. Eat smaller portions and choose lower calorie foods. Don't feel that you have to finish the entrees served at restaurants. Many restaurant portions are oversized and have too many calories for the average person.

For overweight children and teens, slowing the rate of weight gain is important. However, reduced-calorie diets aren't advised, unless approved by a doctor.

Quitting Smoking

If you smoke, quit. Smoking can raise your risk of CHD and heart attack and worsen other CHD risk factors. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.

If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.

You can help your children avoid smoking or quit smoking. Talk with them about the health effects of smoking. Teach them how to handle peer pressure to smoke.

Teens who have parents who smoke are more likely to smoke themselves. Set a good example by not smoking or quitting smoking. Set firm rules about no tobacco use in your home.

If you have a child who smokes, help him or her create a plan to quit. Offer your child information and resources on how to quit. Stress the natural rewards that come with quitting, such as freedom from addiction, better fitness and sports performance, and improved appearance. Reinforce the decision to quit with praise.

For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the NHLBI's \"Your Guide to a Healthy Heart.\"

For more information about children and smoking, go to HHS' Kids and Smoking Web page and the Centers for Disease Control and Prevention's Smoking and Tobacco Use Web page.

Managing Stress

Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Having supportive people in your life with whom you can share your feelings or concerns can help relieve stress.

Physical activity, medicine, and relaxation therapy also can help relieve stress. You may want to consider taking part in a stress management program.

Other Lifestyle Concerns

If making lifestyle changes is hard for you, try taking things one step at a time. Learn about the benefits of lifestyle changes. Talk with your doctor, and read some of the resources in \"Links to Other Information About Coronary Heart Disease Risk Factors .\"

Figure out what's stopping you from making or sticking to your lifestyle changes. Try to find ways to overcome these issues. For example, if you're too tired to exercise after work, you may want to try working out before you go to work.

Make a plan to carry out your lifestyle changes that includes specific, realistic goals. Act on your plan and work toward your goals. You may want to do so with the help of a support group or supportive friends and family.

Reward yourself for the gains you've made. Think about what you need to do to maintain your lifestyle changes and avoid unhealthy habits.

Don't give up if you go off your diet or exercise plan or start smoking again. Instead, find out what you need to do to get back on track so you can meet your goals. Many people find that it takes more than one try to make long-term lifestyle changes.

Changing the eating and activity habits of children takes time. Start with small, easy steps. For example, cut out after-dinner snacks or go for an after-dinner walk instead of watching TV.

Set a good example, and try to get your children involved in choosing a new healthy step to take each day. If you make lifestyle changes a group effort, it will make them easier.

Medicines

Sometimes lifestyle changes aren't enough to control your blood pressure, cholesterol levels, or other CHD risk factors. Your doctor also may prescribe medicines. For example, you may need medicines to:

Take your medicines as prescribed. Don't cut back on the dosage unless your doctor tells you to. If you have side effects or other problems related to your medicines, talk with your doctor. He or she may be able to provide other options.

You should still follow a heart healthy lifestyle, even if you take medicines to control your CHD risk factors.

____________ ® We Can! is a registered trademark of HHS.

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Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.

NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has helped doctors learn more about coronary heart disease (CHD) risk factors, as well as ways to prevent or treat them.

The NHLBI continues to support research aimed at learning more about CHD risk factors. For example, NHLBI-supported research includes studies that explore:

  • How risk factors for CHD affect people's health as they age
  • Whether omega-3 fatty acids reduce early signs of heart disease risk
  • How nutritional and behavioral therapies can help treat CHD risk factors

Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat vari", "diseases_conditions.last_update": "June 11, 2014.", "diseases_conditions.category_1_x_diseases_conditions_id": { "24": { "category_1_x_diseases_conditions.id": 24, "category_1.id": 3, "category_1.ts": "2018-02-02 04:25:06", "category_1.title": "c" } } }, "25": { "diseases_conditions.id": 25, "diseases_conditions.ts": "2018-02-02 05:09:40", "diseases_conditions.title": "Coronary Microvascular Disease", "diseases_conditions.diseases_conditions_detail": "

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What Is Coronary Microvascular Disease?

Coronary microvascular disease (MVD) is heart disease that affects the tiny coronary (heart) arteries. In coronary MVD, the walls of the heart's tiny arteries are damaged or diseased.

Coronary MVD is different from traditional coronary heart disease (CHD), also called coronary artery disease. In CHD, a waxy substance called plaque (plak) builds up in the large coronary arteries.

Plaque narrows the heart's large arteries and reduces the flow of oxygen-rich blood to your heart muscle. The buildup of plaque also makes it more likely that blood clots will form in your arteries. Blood clots can mostly or completely block blood flow through a coronary artery.

In coronary MVD, however, the heart's tiny arteries are affected. Plaque doesn't create blockages in these vessels as it does in the heart's large arteries.

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Overview

Studies have shown that women are more likely than men to have coronary MVD. Many researchers think the disease is caused by a drop in estrogen levels during menopause combined with traditional heart disease risk factors.

Both men and women who have coronary MVD often have diabetes or high blood pressure. Some people who have coronary MVD may have inherited heart muscle diseases.

Diagnosing coronary MVD has been a challenge for doctors. Standard tests used to diagnose CHD aren't designed to detect coronary MVD. More research is needed to find the best diagnostic tests and treatments for the disease.

Outlook

Most of what is known about coronary MVD comes from the National Heart, Lung, and Blood Institute's Wise study (Women's Ischemia Syndrome Evaluation).

The WISE study started in 1996. The goal of the study was to learn more about how heart disease develops in women.

Currently, research is ongoing to learn more about the role of hormones in heart disease and to find better ways to diagnose coronary MVD.

Studies also are under way to learn more about the causes of coronary MVD, how to treat the disease, and the expected health outcomes for people with coronary MVD.

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Other Names for Coronary Microvascular Disease

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What Causes Coronary Microvascular Disease?

The same risk factors that cause atherosclerosis (ATH-er-o-skler-O-sis) may cause coronary microvascular disease (MVD). Atherosclerosis is a disease in which plaque builds up inside the arteries.

Risk factors for atherosclerosis include:

In women, coronary MVD also may be linked to low estrogen levels occurring before or after menopause. Also, the disease may be linked to anemia or conditions that affect blood clotting. Anemia is thought to slow the growth of cells needed to repair damaged blood vessels.

Researchers continue to explore other possible causes of coronary MVD.

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Who Is at Risk for Coronary Microvascular Disease?

Studies have shown that women are more likely than men to have coronary microvascular disease (MVD). Women at high risk for the disease often have multiple risk factors for atherosclerosis. (For a detailed list of these risk factors, go to \"What Causes Coronary Microvascular Disease?\")

Women may be at risk for coronary MVD if they have lower than normal levels of estrogen at any point in their adult lives. (This refers to the estrogen that the ovaries produce, not the estrogen used in hormone therapy.)

Low estrogen levels before menopause can raise younger women's risk for coronary MVD. One cause of low estrogen levels in younger women is mental stress. Another cause is a problem with the function of the ovaries.

Women who have high blood pressure before menopause, especially high systolic blood pressure, are at increased risk for coronary MVD. (Systolic blood pressure is the top or first number of a blood pressure measurement.)

After menopause, women tend to have more of the traditional risk factors for atherosclerosis, which also puts them at higher risk for coronary MVD.

Women who have heart disease are more likely to have a worse outcome, such as a heart attack, if they also have anemia. Anemia is thought to slow the growth of cells needed to repair damaged blood vessels.

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What Are the Signs and Symptoms of Coronary Microvascular Disease?

The signs and symptoms of coronary microvascular disease (MVD) often differ from the signs and symptoms of traditional coronary heart disease (CHD).

Many women with coronary MVD have angina (an-JI-nuh or AN-juh-nuh). Angina is chest pain or discomfort that occurs when your heart muscle doesn't get enough oxygen-rich blood.

Angina may feel like pressure or squeezing in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.

Angina also is a common symptom of CHD. However, the angina that occurs in coronary MVD may differ from the typical angina that occurs in CHD. In coronary MVD, the chest pain usually lasts longer than 10 minutes, and it can last longer than 30 minutes. Typical angina is more common in women older than 65.

Other signs and symptoms of coronary MVD are shortness of breath, sleep problems, fatigue (tiredness), and lack of energy.

Coronary MVD symptoms often are first noticed during routine daily activities (such as shopping, cooking, cleaning, and going to work) and times of mental stress. It's less likely that women will notice these symptoms during physical activity (such as jogging or walking fast).

This differs from CHD, in which symptoms often first appear while a person is being physically active—such as while jogging, walking on a treadmill, or going up stairs.

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How Is Coronary Microvascular Disease Diagnosed?

Your doctor will diagnose coronary microvascular disease (MVD) based on your medical history, a physical exam, and test results. He or she will check to see whether you have any risk factors for heart disease.

For example, your doctor may measure your weight and height to check for overweight or obesity. He or she also may recommend tests for high blood cholesterol, metabolic syndrome, and diabetes.

Your doctor may ask you to describe any chest pain, including when it started and how it changed during physical activity or periods of stress. He or she also may ask about other symptoms, such as fatigue (tiredness), lack of energy, and shortness of breath. Women may be asked about their menopausal status.

Specialists Involved

Cardiologists and doctors who specialize in family and internal medicine might help diagnose and treat coronary MVD. Cardiologists are doctors who specialize in diagnosing and treating heart diseases and conditions.

Diagnostic Tests

The risk factors for coronary MVD and traditional coronary heart disease (CHD) often are the same. Thus, your doctor may recommend tests for CHD, such as:

Unfortunately, standard tests for CHD aren't designed to detect coronary MVD. These tests look for blockages in the large coronary arteries. Coronary MVD affects the tiny coronary arteries.

If test results show that you don't have CHD, your doctor might still diagnose you with coronary MVD. This could happen if signs are present that not enough oxygen is reaching your heart's tiny arteries.

Coronary MVD symptoms often first occur during routine daily tasks. Thus, your doctor may ask you to fill out a questionnaire called the Duke Activity Status Index (DASI). The questionnaire will ask you how well you're able to do daily activities, such as shopping, cooking, and going to work.

The DASI results will help your doctor decide which kind of stress test you should have. The results also give your doctor information about how well blood is flowing through your coronary arteries.

Your doctor also may recommend blood tests, including a test for anemia. Anemia is thought to slow the growth of cells needed to repair damaged blood vessels.

Research is ongoing for better ways to detect and diagnose coronary MVD. Currently, researchers have not agreed on the best way to diagnose the disease.

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How Is Coronary Microvascular Disease Treated?

Relieving pain is one of the main goals of treating coronary microvascular disease (MVD). Treatments also are used to control risk factors and other symptoms.

Treatments may include medicines such as:

If you're diagnosed with coronary MVD and also have anemia, you may benefit from treatment for that condition. Anemia is thought to slow the growth of cells needed to repair damaged blood vessels.

If you're diagnosed with and treated for coronary MVD, you should get ongoing care from your doctor.

Research is under way to find the best treatments for coronary MVD.

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How Can Coronary Microvascular Disease Be Prevented?

No specific studies have been done on how to prevent coronary microvascular disease (MVD).

Researchers don't yet known how or in what way preventing coronary MVD differs from preventing coronary heart disease (CHD). Coronary MVD affects the tiny coronary arteries, while CHD affects the large coronary arteries.

Taking action to control heart disease risk factors can help prevent or delay CHD. You can't control some risk factors, such as older age and family history of heart disease. However, you can take steps to prevent or control other risk factors, such as high blood pressure, overweight and obesity, high blood cholesterol, diabetes, and smoking.

Lifestyle changes and ongoing care can help you lower your risk for heart disease.

Lifestyle Changes

Following a healthy diet is an important part of a heart healthy lifestyle. A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas.

A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).

The National Heart, Lung, and Blood Institute's (NHLBI's) Therapeutic Lifestyle Changes (TLC) and Dietary Approaches to Stop Hypertension (DASH) are two programs that promote healthy eating.

If you're overweight or obese, work with your doctor to create a reasonable weight-loss plan. Controlling your weight helps you control heart disease risk factors.

Be as physically active as you can. Physical activity can improve your fitness level and your health. People gain health benefits from as little as 60 minutes of moderate-intensity aerobic activity per week. The more active you are, the more you'll benefit.

For more information about physical activity, go to the Health Topics Physical Activity and Your Heart article and the NHLBI's \"Your Guide to Physical Activity and Your Heart.\"

If you smoke, quit. Smoking can damage and tighten your blood vessels. It also can raise your risk for heart disease and heart attack and worsen other heart disease risk factors.

Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke. For more information about quitting smoking, go to the Health Topics Smoking and Your Heart article and the NHLBI's \"Your Guide to a Healthy Heart.\"

Learn how to manage stress, relax, and cope with problems. This can improve your emotional and physical health. Physical activity, medicine, and relaxation therapy can help relieve stress. You also may want to consider taking part in a stress management program.

Ongoing Care

Learn more about heart disease and the traits, conditions, and habits that can raise your risk for it. Talk with your doctor about your risk factors for heart disease and how to control them.

If lifestyle changes aren't enough, your doctor may prescribe medicines to control your risk factors. Take all of your medicines as your doctor advises.

Know your numbers—ask your doctor for these three tests, and have the results explained to you:

Know your body mass index (BMI) and waist measurement. BMI measures your weight in relation to your height and gives an estimate of your total body fat. You can use the NHLBI's online BMI calculator to figure out your BMI, or your doctor can help you.

In adults, a BMI of 18.5 to 24.9 is considered normal. A BMI of 25 to 29.9 is considered overweight. A BMI of 30 or more is considered obese.

To measure your waistline, stand and place a tape measure around your middle, just above your hipbones. Measure your waist just after you breathe out. A waist measurement of 35 inches or more for women and 40 inches or more for men is a risk factor for heart disease and other health problems.

Know your family history of heart disease. If you or someone in your family has heart disease, tell your doctor.

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Living With Coronary Microvascular Disease

If you have coronary microvascular disease (MVD), you can take action to control it. Follow the steps described in \"How Can Coronary Microvascular Disease Be Prevented?\"

Coronary MVD, like traditional coronary heart disease, increases your risk for a heart attack. If you have signs or symptoms of a heart attack, call 9–1–1 at once.

These signs and symptoms may include chest pain, upper body discomfort, shortness of breath, and nausea (feeling sick to your stomach). For more detailed information about the warning signs of a heart attack, go to the section on warning signs below.

Ongoing Care

If you have coronary MVD, see your doctor regularly to make sure the disease isn't getting worse. Work with your doctor to keep track of your cholesterol, blood pressure, and blood sugar levels. This will help your doctor adjust your treatment as needed.

You may need to see a cardiologist (heart specialist) in addition to your primary care doctor. Talk with your doctor about how often you should schedule office visits or blood tests. Between those visits, call your doctor if you have any new symptoms or your symptoms worsen.

You should:

  • Know your symptoms and how and when to seek medical help.
  • Be able to describe the usual pattern of your symptoms.
  • Know which medicines you take and when and how to take them.
  • Know how to control your symptoms, including angina.
  • Know the limits of your physical activity.
  • Learn ways to avoid or cope with stress.

Warning Signs

If you have coronary MVD, learn the warning signs of a heart attack. The signs and symptoms of a heart attack include:

  • Chest pain or discomfort. This involves uncomfortable pressure, squeezing, fullness, or pain in the center or left side of the chest that can be mild or strong. This pain or discomfort often lasts more than a few minutes or goes away and comes back.
  • Upper body discomfort in one or both arms, the back, neck, jaw, or upper part of the stomach.
  • Shortness of breath, which may occur with or before chest discomfort.
  • Nausea (feeling sick to your stomach), vomiting, light-headedness or fainting, or breaking out in a cold sweat.
  • Sleep problems, fatigue (tiredness), and lack of energy.

If you think you're having a heart attack, call 9–1–1 at once. Early treatment can prevent or limit damage to your heart muscle. Do not drive to the hospital or let someone else drive you. Instead, call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room.

Let the people you see regularly know you're at risk for a heart attack. They can seek emergency care if you suddenly faint, collapse, or have other severe symptoms.

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Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.

NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has helped doctors learn more about heart disease, its risk factors, and ways to prevent and treat the disease.

The NHLBI continues to support research aimed at learning more about heart disease, including coronary microvascular disease (MVD). For example, NHLBI-supported research includes studies that:

  • Examine heart attack risks and recovery in young women (aged 18–55)
  • Explore whether taking daily vitamin D or fish oil (omega-3) supplements reduces the risk of heart disease and other conditions
  • Examine the role that hormones play in women's heart disease risk

Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.

For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.

By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.

If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.

If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.

For more information about clinical trials related to coronary microvascular disease, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:

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What Causes Cough?

Coughing occurs when the nerve endings in your airways become irritated. Certain irritants and allergens, medical conditions, and medicines can irritate these nerve endings.

Irritants and Allergens

An irritant is something you're sensitive to. For example, smoking or inhaling secondhand smoke can irritate your lungs. Smoking also can lead to medical conditions that can cause a cough. Other irritants include air pollution, paint fumes, or scented products like perfumes or air fresheners.

An allergen is something you're allergic to, such as dust, animal dander, mold, or pollens from trees, grasses, and flowers.

Coughing helps clear your airways of irritants and allergens. This helps prevent infections.

Medical Conditions

Many medical conditions can cause acute, subacute, or chronic cough.

Common causes of an acute cough are a common cold or other upper respiratory infections. Examples of other upper respiratory infections include the flu, pneumonia, and whooping cough. An acute cough lasts less than 3 weeks.

A lingering cough that remains after a cold or other respiratory infection is gone often is called a subacute cough. A subacute cough lasts 3 to 8 weeks.

Common causes of a chronic cough are upper airway cough syndrome (UACS), asthma, and gastroesophageal reflux disease (GERD). A chronic cough lasts more than 8 weeks.

\"UACS\" is a term used to describe conditions that inflame the upper airways and cause a cough. Examples include sinus infections and allergies. These conditions can cause mucus (a slimy substance) to run down your throat from the back of your nose. This is called postnasal drip.

Asthma is a long-term lung disease that inflames and narrows the airways. GERD is a condition in which acid from your stomach backs up into your throat.

Other conditions that can cause a chronic cough include:

  • Respiratory infections. A cough from an upper respiratory infection can develop into a chronic cough.
  • Chronic bronchitis (bron-KI-tis). This condition occurs if the lining of the airways is constantly irritated and inflamed. Smoking is the main cause of chronic bronchitis.
  • Bronchiectasis (brong-ke-EK-tah-sis). This is a condition in which damage to the airways causes them to widen and become flabby and scarred. This prevents the airways from properly moving mucus out of your lungs. An infection or other condition that injures the walls of the airways usually causes bronchiectasis.
  • COPD (chronic obstructive pulmonary disease). COPD is a disease that prevents enough air from flowing in and out of the airways.
  • Lung cancer. In rare cases, a chronic cough is due to lung cancer. Most people who develop lung cancer smoke or used to smoke.
  • Heart failure. Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. Fluid can build up in the body and lead to many symptoms. If fluid builds up in the lungs, it can cause a chronic cough.

Medicines

Certain medicines can cause a chronic cough. Examples of these medicines are ACE inhibitors and beta blockers. ACE inhibitors are used to treat high blood pressure (HBP). Beta blockers are used to treat HBP, migraine headaches, and glaucoma.

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Who Is At Risk for Cough?

People at risk for cough include those who:

Women are more likely than men to develop a chronic cough. For more information about the substances and conditions that put you at risk for cough, go to \"What Causes Cough?\"

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What Are the Signs and Symptoms of Cough?

When you cough, mucus (a slimy substance) may come up. Coughing helps clear the mucus in your airways from a cold, bronchitis, or other condition. Rarely, people cough up blood. If this happens, you should call your doctor right away.

A cough may be a symptom of a medical condition. Thus, it may occur with other signs and symptoms of that condition. For example, if you have a cold, you may have a runny or stuffy nose. If you have gastroesophageal reflux disease, you may have a sour taste in your mouth.

A chronic cough can make you feel tired because you use a lot of energy to cough. It also can prevent you from sleeping well and interfere with work and socializing. A chronic cough also can cause headaches, chest pain, loss of bladder control, sweating, and, rarely, fractured ribs.

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How Is the Cause of Cough Diagnosed?

Your doctor will diagnose the cause of your cough based on your medical history, a physical exam, and test results.

Medical History

Your doctor will likely ask questions about your cough. He or she may ask how long you've had it, whether you're coughing anything up (such as mucus, a slimy substance), and how much you cough.

Your doctor also may ask:

Physical Exam

To check for signs of problems related to cough, your doctor will use a stethoscope to listen to your lungs. He or she will listen for wheezing (a whistling or squeaky sound when you breathe) or other abnormal sounds.

Diagnostic Tests

Your doctor may recommend tests based on the results of your medical history and physical exam. For example, if you have symptoms of GERD, your doctor may recommend a pH probe. This test measures the acid level of the fluid in your throat.

Other tests may include:

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How Is Cough Treated?

The best way to treat a cough is to treat its cause. However, sometimes the cause is unknown. Other treatments, such as medicines and a vaporizer, can help relieve the cough itself.

Treating the Cause of a Cough

Acute and Subacute Cough

An acute cough lasts less than 3 weeks. Common causes of an acute cough are a common cold or other upper respiratory infections. Examples of other upper respiratory infections include the flu, pneumonia, and whooping cough. An acute cough usually goes away after the illness that caused it is over.

A subacute cough lasts 3 to 8 weeks. This type of cough remains even after a cold or other respiratory infection is over.

Studies show that antibiotics and cold medicines can't cure a cold. However, your doctor may prescribe medicines to treat another cause of an acute or subacute cough. For example, antibiotics may be given for pneumonia.

Chronic Cough

A chronic cough lasts more than 8 weeks. Common causes of a chronic cough are upper airway cough syndrome (UACS), asthma, and gastroesophageal reflux disease (GERD).

\"UACS\" is a term used to describe conditions that inflame the upper airways and cause a cough. Examples include sinus infections and allergies. These conditions can cause mucus (a slimy substance) to run down your throat from the back of your nose. This is called postnasal drip.

If you have a sinus infection, your doctor may prescribe antibiotics. He or she also may suggest you use a medicine that you spray into your nose. If allergies are causing your cough, your doctor may advise you to avoid the substances that you're allergic to (allergens) if possible.

If you have asthma, try to avoid irritants and allergens that make your asthma worse. Take your asthma medicines as your doctor prescribes.

GERD occurs if acid from your stomach backs up into your throat. Your doctor may prescribe a medicine to reduce acid in your stomach. You also may be able to relieve GERD symptoms by waiting 3 to 4 hours after a meal before lying down, and by sleeping with your head raised.

Smoking also can cause a chronic cough. If you smoke, it's important to quit. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.

Many hospitals have programs that help people quit smoking, or hospital staff can refer you to a program. The Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's \"Your Guide to a Healthy Heart\" booklet have more information about how to quit smoking.

Other causes of a chronic cough include respiratory infections, chronic bronchitis, bronchiectasis, lung cancer, and heart failure. Treatments for these causes may include medicines, procedures, and other therapies. Treatment also may include avoiding irritants and allergens and quitting smoking.

If your chronic cough is due to a medicine you're taking, your doctor may prescribe a different medicine.

Treating the Cough Rather Than the Cause

Coughing is important because it helps clear your airways of irritants, such as smoke and mucus (a slimy substance). Coughing also helps prevent infections.

Cough medicines usually are used only when the cause of the cough is unknown and the cough causes a lot of discomfort.

Medicines can help control a cough and make it easier to cough up mucus. Your doctor may recommend medicines such as:

  • Prescription cough suppressants, also called antitussives. These medicines can help relieve a cough. However, they're usually used when nothing else works. No evidence shows that over-the-counter cough suppressants relieve a cough.
  • Expectorants. These medicines may loosen mucus, making it easier to cough up.
  • Bronchodilators. These medicines relax your airways.

Other treatments also may relieve an irritated throat and loosen mucus. Examples include using a cool-mist humidifier or steam vaporizer and drinking enough fluids. Examples of fluids are water, soup, and juice. Ask your doctor how much fluid you need.

Cough in Children

No evidence shows that cough and cold medicines help children recover more quickly from colds. These medicines can even harm children. Talk with your child's doctor about your child's cough and how to treat it.

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Living With Cough

If you have a cough, you can take steps to recover from the condition that's causing the cough. You also can take steps to relieve your cough. Ongoing care and lifestyle changes can help you.

Ongoing Care

Follow the treatment plan your doctor gives you for treating the cause of your cough. Take all medicines as your doctor prescribes. If you're using antibiotics, continue to take the medicine until it's all gone. You may start to feel better before you finish the medicine, but you should continue to take it.

Ask your doctor about ways to relieve your cough. He or she may recommend cough medicines. These medicines usually are used only when the cause of a cough is unknown and the cough is causing a lot of discomfort.

A cool-mist humidifier or steam vaporizer may help relieve an irritated throat and loosen mucus. Getting enough fluids (for example, water, soup, or juice) may have the same effect. Ask your doctor about how much fluid you need.

Your doctor will let you know when to schedule followup care.

Lifestyle Changes

If you smoke, quit. Ask your doctor about programs and products that can help you quit smoking. The Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's \"Your Guide to a Healthy Heart\" booklet have more information about how to quit smoking.

Try to avoid irritants and allergens that make you cough. Examples of irritants include cigarette smoke, air pollution, paint fumes, and scented products like perfumes or air fresheners. Examples of allergens include dust, animal dander, mold, and pollens from trees, grasses, and flowers.

Follow a healthy diet and be as physically active as you can. A healthy diet includes a variety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish, and fat-free or low-fat milk or milk products. A healthy diet also is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar.

For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute's Aim for a Healthy Weight Web site, \"Your Guide to a Healthy Heart,\" and \"Your Guide to Lowering Your Blood Pressure With DASH.\" All of these resources include general advice about healthy eating.

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Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.

NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.

Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.

By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.

If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.

If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.

For more information about clinical trials related to your disease or condition, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:

For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.

", "diseases_conditions.last_update": "June 11, 2014.", "diseases_conditions.category_1_x_diseases_conditions_id": { "26": { "category_1_x_diseases_conditions.id": 26, "category_1.id": 3, "category_1.ts": "2018-02-02 04:25:06", "category_1.title": "c" } } }, "27": { "diseases_conditions.id": 27, "diseases_conditions.ts": "2018-02-02 05:10:10", "diseases_conditions.title": "Cystic Fibrosis", "diseases_conditions.diseases_conditions_detail": "
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What Is Cystic Fibrosis?

Cystic fibrosis (SIS-tik fi-BRO-sis), or CF, is an inherited disease of the secretory (see-KREH-tor-ee) glands. Secretory glands include glands that make mucus and sweat.

\"Inherited\" means the disease is passed from parents to children through genes. People who have CF inherit two faulty genes for the disease—one from each parent. The parents likely don't have the disease themselves.

CF mainly affects the lungs, pancreas, liver, intestines, sinuses, and sex organs.

Overview

Mucus is a substance made by tissues that line some organs and body cavities, such as the lungs and nose. Normally, mucus is a slippery, watery substance. It keeps the linings of certain organs moist and prevents them from drying out or getting infected.

If you have CF, your mucus becomes thick and sticky. It builds up in your lungs and blocks your airways. (Airways are tubes that carry air in and out of your lungs.)

The buildup of mucus makes it easy for bacteria to grow. This leads to repeated, serious lung infections. Over time, these infections can severely damage your lungs.

The thick, sticky mucus also can block tubes, or ducts, in your pancreas (an organ in your abdomen). As a result, the digestive enzymes that your pancreas makes can't reach your small intestine.

These enzymes help break down food. Without them, your intestines can't fully absorb fats and proteins. This can cause vitamin deficiency and malnutrition because nutrients pass through your body without being used. You also may have bulky stools, intestinal gas, a swollen belly from severe constipation, and pain or discomfort.

CF also causes your sweat to become very salty. Thus, when you sweat, you lose large amounts of salt. This can upset the balance of minerals in your blood and cause many health problems. Examples of these problems include dehydration (a lack of fluid in your body), increased heart rate, fatigue (tiredness), weakness, decreased blood pressure, heat stroke, and, rarely, death.

If you or your child has CF, you're also at higher risk for diabetes or two bone-thinning conditions called osteoporosis (OS-te-o-po-RO-sis) and osteopenia (OS-te-o-PEE-nee-uh).

CF also causes infertility in men, and the disease can make it harder for women to get pregnant. (The term \"infertility\" refers to the inability to have children.)

Outlook

The symptoms and severity of CF vary. If you or your child has the disease, you may have serious lung and digestive problems. If the disease is mild, symptoms may not show up until the teen or adult years.

The symptoms and severity of CF also vary over time. Sometimes you'll have few symptoms. Other times, your symptoms may become more severe. As the disease gets worse, you'll have more severe symptoms more often.

Lung function often starts to decline in early childhood in people who have CF. Over time, damage to the lungs can cause severe breathing problems. Respiratory failure is the most common cause of death in people who have CF.

As treatments for CF continue to improve, so does life expectancy for those who have the disease. Today, some people who have CF are living into their forties or fifties, or longer.

Early treatment for CF can improve your quality of life and increase your lifespan. Treatments may include nutritional and respiratory therapies, medicines, exercise, and other treatments.

Your doctor also may recommend pulmonary rehabilitation (PR). PR is a broad program that helps improve the well-being of people who have chronic (ongoing) breathing problems.

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What Causes Cystic Fibrosis?

A defect in the CFTR gene causes cystic fibrosis (CF). This gene makes a protein that controls the movement of salt and water in and out of your body's cells. In people who have CF, the gene makes a protein that doesn't work well. This causes thick, sticky mucus and very salty sweat.

Research suggests that the CFTR protein also affects the body in other ways. This may help explain other symptoms and complications of CF.

More than a thousand known defects can affect the CFTR gene. The type of defect you or your child has may affect the severity of CF. Other genes also may play a role in the severity of the disease.

How Is Cystic Fibrosis Inherited?

Every person inherits two CFTR genes—one from each parent. Children who inherit a faulty CFTR gene from each parent will have CF.

Children who inherit one faulty CFTR gene and one normal CFTR gene are \"CF carriers.\" CF carriers usually have no symptoms of CF and live normal lives. However, they can pass the faulty CFTR gene to their children.

The image below shows how two parents who are both CF carriers can pass the faulty CFTR gene to their children.

\"Figure

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Who Is at Risk for Cystic Fibrosis?

Cystic fibrosis (CF) affects both males and females and people from all racial and ethnic groups. However, the disease is most common among Caucasians of Northern European descent.

CF also is common among Latinos and American Indians, especially the Pueblo and Zuni. The disease is less common among African Americans and Asian Americans.

More than 10 million Americans are carriers of a faulty CF gene. Many of them don't know that they're CF carriers.

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What Are the Signs and Symptoms of Cystic Fibrosis?

The signs and symptoms of cystic fibrosis (CF) vary from person to person and over time. Sometimes you'll have few symptoms. Other times, your symptoms may become more severe.

One of the first signs of CF that parents may notice is that their baby's skin tastes salty when kissed, or the baby doesn't pass stool when first born.

Most of the other signs and symptoms of CF happen later. They're related to how CF affects the respiratory, digestive, or reproductive systems of the body.

\"Cystic

Figure

Cystic Fibrosis. Figure A shows the organs that cystic fibrosis can affect. Figure B shows a cross-section of a normal airway. Figure C shows an airway with cystic fibrosis. The widened airway is blocked by thick, sticky mucus that contains blood and bacteria. (more...)

Respiratory System Signs and Symptoms

People who have CF have thick, sticky mucus that builds up in their airways. This buildup of mucus makes it easier for bacteria to grow and cause infections. Infections can block the airways and cause frequent coughing that brings up thick sputum (spit) or mucus that's sometimes bloody.

People who have CF tend to have lung infections caused by unusual germs that don't respond to standard antibiotics. For example, lung infections caused by bacteria called mucoid Pseudomonas are much more common in people who have CF than in those who don't. An infection caused by these bacteria may be a sign of CF.

People who have CF have frequent bouts of sinusitis (si-nu-SI-tis), an infection of the sinuses. The sinuses are hollow air spaces around the eyes, nose, and forehead. Frequent bouts of bronchitis (bron-KI-tis) and pneumonia (nu-MO-ne-ah) also can occur. These infections can cause long-term lung damage.

As CF gets worse, you may have more serious problems, such as pneumothorax (noo-mo-THOR-aks) or bronchiectasis (brong-ke-EK-ta-sis).

Some people who have CF also develop nasal polyps (growths in the nose) that may require surgery.

Digestive System Signs and Symptoms

In CF, mucus can block tubes, or ducts, in your pancreas (an organ in your abdomen). These blockages prevent enzymes from reaching your intestines.

As a result, your intestines can't fully absorb fats and proteins. This can cause ongoing diarrhea or bulky, foul-smelling, greasy stools. Intestinal blockages also may occur, especially in newborns. Too much gas or severe constipation in the intestines may cause stomach pain and discomfort.

A hallmark of CF in children is poor weight gain and growth. These children are unable to get enough nutrients from their food because of the lack of enzymes to help absorb fats and proteins.

As CF gets worse, other problems may occur, such as:

Reproductive System Signs and Symptoms

Men who have CF are infertile because they're born without a vas deferens. The vas deferens is a tube that delivers sperm from the testes to the penis.

Women who have CF may have a hard time getting pregnant because of mucus blocking the cervix or other CF complications.

Other Signs, Symptoms, and Complications

Other signs and symptoms of CF are related to an upset of the balance of minerals in your blood.

CF causes your sweat to become very salty. As a result, your body loses large amounts of salt when you sweat. This can cause dehydration (a lack of fluid in your body), increased heart rate, fatigue (tiredness), weakness, decreased blood pressure, heat stroke, and, rarely, death.

CF also can cause clubbing and low bone density. Clubbing is the widening and rounding of the tips of your fingers and toes. This sign develops late in CF because your lungs aren't moving enough oxygen into your bloodstream.

Low bone density also tends to occur late in CF. It can lead to bone-thinning disorders called osteoporosis and osteopenia.

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How Is Cystic Fibrosis Diagnosed?

Doctors diagnose cystic fibrosis (CF) based on the results from various tests.

Newborn Screening

All States screen newborns for CF using a genetic test or a blood test. The genetic test shows whether a newborn has faulty CFTR genes. The blood test shows whether a newborn's pancreas is working properly.

Sweat Test

If a genetic test or blood test suggests CF, a doctor will confirm the diagnosis using a sweat test. This test is the most useful test for diagnosing CF. A sweat test measures the amount of salt in sweat.

For this test, the doctor triggers sweating on a small patch of skin on an arm or leg. He or she rubs the skin with a sweat-producing chemical and then uses an electrode to provide a mild electrical current. This may cause a tingling or warm feeling.

Sweat is collected on a pad or paper and then analyzed. The sweat test usually is done twice. High salt levels confirm a diagnosis of CF.

Other Tests

If you or your child has CF, your doctor may recommend other tests, such as:

  • Genetic tests to find out what type of CFTR defect is causing your CF.
  • A chest x ray. This test creates pictures of the structures in your chest, such as your heart, lungs, and blood vessels. A chest x ray can show whether your lungs are inflamed or scarred, or whether they trap air.
  • A sinus x ray. This test may show signs of sinusitis, a complication of CF.
  • Lung function tests. These tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood.
  • A sputum culture. For this test, your doctor will take a sample of your sputum (spit) to see whether bacteria are growing in it. If you have bacteria called mucoid Pseudomonas, you may have more advanced CF that needs aggressive treatment.

Prenatal Screening

If you're pregnant, prenatal genetic tests can show whether your fetus has CF. These tests include amniocentesis (AM-ne-o-sen-TE-sis) and chorionic villus (ko-re-ON-ik VIL-us) sampling (CVS).

In amniocentesis, your doctor inserts a hollow needle through your abdominal wall into your uterus. He or she removes a small amount of fluid from the sac around the baby. The fluid is tested to see whether both of the baby's CFTR genes are normal.

In CVS, your doctor threads a thin tube through the vagina and cervix to the placenta. The doctor removes a tissue sample from the placenta using gentle suction. The sample is tested to see whether the baby has CF.

Cystic Fibrosis Carrier Testing

People who have one normal CFTR gene and one faulty CFTR gene are CF carriers. CF carriers usually have no symptoms of CF and live normal lives. However, carriers can pass faulty CFTR genes on to their children.

If you have a family history of CF or a partner who has CF (or a family history of it) and you're planning a pregnancy, you may want to find out whether you're a CF carrier.

A genetics counselor can test a blood or saliva sample to find out whether you have a faulty CF gene. This type of testing can detect faulty CF genes in 9 out of 10 cases.

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How Is Cystic Fibrosis Treated?

Cystic fibrosis (CF) has no cure. However, treatments have greatly improved in recent years. The goals of CF treatment include:

  • Preventing and controlling lung infections
  • Loosening and removing thick, sticky mucus from the lungs
  • Preventing or treating blockages in the intestines
  • Providing enough nutrition
  • Preventing dehydration (a lack of fluid in the body)

Depending on the severity of CF, you or your child may be treated in a hospital.

Specialists Involved

If you or your child has CF, you may be treated by a CF specialist. This is a doctor who is familiar with the complex nature of CF.

Often, a CF specialist works with a medical team of nurses, physical therapists, dietitians, and social workers. CF specialists often are located at major medical centers.

The United States also has more than 100 CF Care Centers. These centers have teams of doctors, nurses, dietitians, respiratory therapists, physical therapists, and social workers who have special training related to CF care. Most CF Care Centers have pediatric and adult programs or clinics.

For more information about CF Care Centers, go to the Cystic Fibrosis Foundation's Care Center Network Web page.

Treatment for Lung Problems

The main treatments for lung problems in people who have CF are chest physical therapy (CPT), exercise, and medicines. Your doctor also may recommend a pulmonary rehabilitation (PR) program.

Chest Physical Therapy

CPT also is called chest clapping or percussion. It involves pounding your chest and back over and over with your hands or a device to loosen the mucus from your lungs so that you can cough it up.

You might sit down or lie on your stomach with your head down while you do CPT. Gravity and force help drain the mucus from your lungs.

Some people find CPT hard or uncomfortable to do. Several devices have been developed that may help with CPT, such as:

  • An electric chest clapper, known as a mechanical percussor.
  • An inflatable therapy vest that uses high-frequency airwaves to force the mucus that's deep in your lungs toward your upper airways so you can cough it up.
  • A small, handheld device that you exhale through. The device causes vibrations that dislodge the mucus.
  • A mask that creates vibrations that help break the mucus loose from your airway walls.

Breathing techniques also may help dislodge mucus so you can cough it up. These techniques include forcing out a couple of short breaths or deeper breaths and then doing relaxed breathing. This may help loosen the mucus in your lungs and open your airways.

Exercise

Aerobic exercise that makes you breathe harder can help loosen the mucus in your airways so you can cough it up. Exercise also helps improve your overall physical condition.

However, CF causes your sweat to become very salty. As a result, your body loses large amounts of salt when you sweat. Thus, your doctor may recommend a high-salt diet or salt supplements to maintain the balance of minerals in your blood.

If you exercise regularly, you may be able to cut back on your CPT. However, you should check with your doctor first.

Medicines

If you have CF, your doctor may prescribe antibiotics, anti-inflammatory medicines, bronchodilators, or medicines to help clear the mucus. These medicines help treat or prevent lung infections, reduce swelling and open up the airways, and thin mucus. If you have mutations in a gene called G551D, which occurs in about 5 percent of people who have CF, your doctor may prescribe the oral medicine ivacaftor (approved for people with CF who are 6 years of age and older).

Antibiotics are the main treatment to prevent or treat lung infections. Your doctor may prescribe oral, inhaled, or intravenous (IV) antibiotics.

Oral antibiotics often are used to treat mild lung infections. Inhaled antibiotics may be used to prevent or control infections caused by the bacteria mucoid Pseudomonas. For severe or hard-to-treat infections, you may be given antibiotics through an IV tube (a tube inserted into a vein). This type of treatment may require you to stay in a hospital.

Anti-inflammatory medicines can help reduce swelling in your airways due to ongoing infections. These medicines may be inhaled or oral.

Bronchodilators help open the airways by relaxing the muscles around them. These medicines are inhaled. They're often taken just before CPT to help clear mucus out of your airways. You also may take bronchodilators before inhaling other medicines into your lungs.

Your doctor may prescribe medicines to reduce the stickiness of your mucus and loosen it up. These medicines can help clear out mucus, improve lung function, and prevent worsening lung symptoms.

Treatments for Advanced Lung Disease

If you have advanced lung disease, you may need oxygen therapy. Oxygen usually is given through nasal prongs or a mask.

If other treatments haven't worked, a lung transplant may be an option if you have severe lung disease. A lung transplant is surgery to remove a person's diseased lung and replace it with a healthy lung from a deceased donor.

Pulmonary Rehabilitation

Your doctor may recommend PR as part of your treatment plan. PR is a broad program that helps improve the well-being of people who have chronic (ongoing) breathing problems.

PR doesn't replace medical therapy. Instead, it's used with medical therapy and may include:

  • Exercise training
  • Nutritional counseling
  • Education on your lung disease or condition and how to manage it
  • Energy-conserving techniques
  • Breathing strategies
  • Psychological counseling and/or group support

PR has many benefits. It can improve your ability to function and your quality of life. The program also may help relieve your breathing problems. Even if you have advanced lung disease, you can still benefit from PR.

For more information, go to the Health Topics Pulmonary Rehabilitation article.

Treatment for Digestive Problems

CF can cause many digestive problems, such as bulky stools, intestinal gas, a swollen belly, severe constipation, and pain or discomfort. Digestive problems also can lead to poor growth and development in children.

Nutritional therapy can improve your strength and ability to stay active. It also can improve growth and development in children. Nutritional therapy also may make you strong enough to resist some lung infections. A nutritionist can help you create a nutritional plan that meets your needs.

In addition to having a well-balanced diet that's rich in calories, fat, and protein, your nutritional therapy may include:

  • Oral pancreatic enzymes to help you digest fats and proteins and absorb more vitamins.
  • Supplements of vitamins A, D, E, and K to replace the fat-soluble vitamins that your intestines can't absorb.
  • High-calorie shakes to provide you with extra nutrients.
  • A high-salt diet or salt supplements that you take before exercising.
  • A feeding tube to give you more calories at night while you're sleeping. The tube may be threaded through your nose and throat and into your stomach. Or, the tube may be placed directly into your stomach through a surgically made hole. Before you go to bed each night, you'll attach a bag with a nutritional solution to the entrance of the tube. It will feed you while you sleep.

Other treatments for digestive problems may include enemas and mucus-thinning medicines to treat intestinal blockages. Sometimes surgery is needed to remove an intestinal blockage.

Your doctor also may prescribe medicines to reduce your stomach acid and help oral pancreatic enzymes work better.

Treatments for Cystic Fibrosis Complications

A common complication of CF is diabetes. The type of diabetes associated with CF often requires different treatment than other types of diabetes.

Another common CF complication is the bone-thinning disorder osteoporosis. Your doctor may prescribe medicines that prevent your bones from losing their density.

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Living With Cystic Fibrosis

If you or your child has cystic fibrosis (CF), you should learn as much as you can about the disease. Work closely with your doctors to learn how to manage CF.

Ongoing Care

Having ongoing medical care by a team of doctors, nurses, and respiratory therapists who specialize in CF is important. These specialists often are located at major medical centers or CF Care Centers.

The United States has more than 100 CF Care Centers. Most of these centers have pediatric and adult programs or clinics. For more information about CF Care Centers, go to the Cystic Fibrosis Foundation's Care Center Network Web page.

It's standard to have CF checkups every 3 months. Talk with your doctor about whether you should get an annual flu shot and other vaccines. Take all of your medicines as your doctor prescribes. In between checkups, be sure to contact your doctor if you have:

Transition of Care

Better treatments for CF allow people who have the disease to live longer now than in the past. Thus, the move from pediatric care to adult care is an important step in treatment.

If your child has CF, encourage him or her to learn about the dis", "diseases_conditions.last_update": "June 11, 2014.", "diseases_conditions.category_1_x_diseases_conditions_id": { "27": { "category_1_x_diseases_conditions.id": 27, "category_1.id": 3, "category_1.ts": "2018-02-02 04:25:06", "category_1.title": "c" } } }, "28": { "diseases_conditions.id": 28, "diseases_conditions.ts": "2018-02-02 05:10:28", "diseases_conditions.title": "Deep Vein Thrombosis", "diseases_conditions.diseases_conditions_detail": "

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What Is Deep Vein Thrombosis?

Deep vein thrombosis (throm-BO-sis), or DVT, is a blood clot that forms in a vein deep in the body. Blood clots occur when blood thickens and clumps together.

Most deep vein blood clots occur in the lower leg or thigh. They also can occur in other parts of the body.

A blood clot in a deep vein can break off and travel through the bloodstream. The loose clot is called an embolus (EM-bo-lus). It can travel to an artery in the lungs and block blood flow. This condition is called pulmonary embolism (PULL-mun-ary EM-bo-lizm), or PE.

PE is a very serious condition. It can damage the lungs and other organs in the body and cause death.

Blood clots in the thighs are more likely to break off and cause PE than blood clots in the lower legs or other parts of the body. Blood clots also can form in veins closer to the skin's surface. However, these clots won't break off and cause PE.

The animation below shows a deep vein blood clot. Click the \"start\" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.

\"Figure

Figure

The animation shows how a blood clot in a deep vein of the leg can break off, travel to the lungs, and block blood flow.

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Other Names for Deep Vein Thrombosis

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What Causes Deep Vein Thrombosis?

Blood clots can form in your body's deep veins if:

  • A vein's inner lining is damaged. Injuries caused by physical, chemical, or biological factors can damage the veins. Such factors include surgery, serious injuries, inflammation, and immune responses.
  • Blood flow is sluggish or slow. Lack of motion can cause sluggish or slow blood flow. This may occur after surgery, if you're ill and in bed for a long time, or if you're traveling for a long time.
  • Your blood is thicker or more likely to clot than normal. Some inherited conditions (such as factor V Leiden) increase the risk of blood clotting. Hormone therapy or birth control pills also can increase the risk of clotting.
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Who Is at Risk for Deep Vein Thrombosis?

The risk factors for deep vein thrombosis (DVT) include:

  • A history of DVT.
  • Conditions or factors that make your blood thicker or more likely to clot than normal. Some inherited blood disorders (such as factor V Leiden) will do this. Hormone therapy or birth control pills also increase the risk of clotting.
  • Injury to a deep vein from surgery, a broken bone, or other trauma.
  • Slow blood flow in a deep vein due to lack of movement. This may occur after surgery, if you're ill and in bed for a long time, or if you're traveling for a long time.
  • Pregnancy and the first 6 weeks after giving birth.
  • Recent or ongoing treatment for cancer.
  • A central venous catheter. This is a tube placed in a vein to allow easy access to the bloodstream for medical treatment.
  • Older age. Being older than 60 is a risk factor for DVT, although DVT can occur at any age.

Your risk for DVT increases if you have more than one of the risk factors listed above.

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What Are the Signs and Symptoms of Deep Vein Thrombosis?

The signs and symptoms of deep vein thrombosis (DVT) might be related to DVT itself or pulmonary embolism (PE). See your doctor right away if you have signs or symptoms of either condition. Both DVT and PE can cause serious, possibly life-threatening problems if not treated.

Deep Vein Thrombosis

Only about half of the people who have DVT have signs and symptoms. These signs and symptoms occur in the leg affected by the deep vein clot. They include:

  • Swelling of the leg or along a vein in the leg
  • Pain or tenderness in the leg, which you may feel only when standing or walking
  • Increased warmth in the area of the leg that's swollen or painful
  • Red or discolored skin on the leg

Pulmonary Embolism

Some people aren't aware of a deep vein clot until they have signs and symptoms of PE. Signs and symptoms of PE include:

  • Unexplained shortness of breath
  • Pain with deep breathing

Rapid breathing and a fast heart rate also may be signs of PE.

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How Is Deep Vein Thrombosis Diagnosed?

Your doctor will diagnose deep vein thrombosis (DVT) based on your medical history, a physical exam, and test results. He or she will identify your risk factors and rule out other causes of your symptoms.

For some people, DVT might not be diagnosed until after they receive emergency treatment for pulmonary embolism (PE).

Medical History

To learn about your medical history, your doctor may ask about:

  • Your overall health
  • Any prescription medicines you're taking
  • Any recent surgeries or injuries you've had
  • Whether you've been treated for cancer

Physical Exam

Your doctor will check your legs for signs of DVT, such as swelling or redness. He or she also will check your blood pressure and your heart and lungs.

Diagnostic Tests

Your doctor may recommend tests to find out whether you have DVT.

Common Tests

The most common test for diagnosing deep vein blood clots is ultrasound. This test uses sound waves to create pictures of blood flowing through the arteries and veins in the affected leg.

Your doctor also may recommend a D-dimer test or venography (ve-NOG-rah-fee).

A D-dimer test measures a substance in the blood that's released when a blood clot dissolves. If the test shows high levels of the substance, you may have a deep vein blood clot. If your test results are normal and you have few risk factors, DVT isn't likely.

Your doctor may suggest venography if an ultrasound doesn't provide a clear diagnosis. For venography, dye is injected into a vein in the affected leg. The dye makes the vein visible on an x-ray image. The x ray will show whether blood flow is slow in the vein, which may suggest a blood clot.

Other Tests

Other tests used to diagnose DVT include magnetic resonance imaging (MRI) and computed tomography (to-MOG-rah-fee), or CT, scanning. These tests create pictures of your organs and tissues.

You may need blood tests to check whether you have an inherited blood clotting disorder that can cause DVT. This may be the case if you have repeated blood clots that are not related to another cause. Blood clots in an unusual location (such as the liver, kidney, or brain) also may suggest an inherited clotting disorder.

If your doctor thinks that you have PE, he or she may recommend more tests, such as a lung ventilation perfusion scan (VQ scan). A lung VQ scan shows how well oxygen and blood are flowing to all areas of the lungs.

For more information about diagnosing PE, go to the Health Topics Pulmonary Embolism article.

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How Is Deep Vein Thrombosis Treated?

Doctors treat deep vein thrombosis (DVT) with medicines and other devices and therapies. The main goals of treating DVT are to:

  • Stop the blood clot from getting bigger
  • Prevent the blood clot from breaking off and moving to your lungs
  • Reduce your chance of having another blood clot

Medicines

Your doctor may prescribe medicines to prevent or treat DVT.

Anticoagulants

Anticoagulants (AN-te-ko-AG-u-lants) are the most common medicines for treating DVT. They're also known as blood thinners.

These medicines decrease your blood's ability to clot. They also stop existing blood clots from getting bigger. However, blood thinners can't break up blood clots that have already formed. (The body dissolves most blood clots with time.)

Blood thinners can be taken as a pill, an injection under the skin, or through a needle or tube inserted into a vein (called intravenous, or IV, injection).

Warfarin and heparin are two blood thinners used to treat DVT. Warfarin is given in pill form. (Coumadin® is a common brand name for warfarin.) Heparin is given as an injection or through an IV tube. There are different types of heparin. Your doctor will discuss the options with you.

Your doctor may treat you with both heparin and warfarin at the same time. Heparin acts quickly. Warfarin takes 2 to 3 days before it starts to work. Once the warfarin starts to work, the heparin is stopped.

Pregnant women usually are treated with just heparin because warfarin is dangerous during pregnancy.

Treatment for DVT using blood thinners usually lasts for 6 months. The following situations may change the length of treatment:

  • If your blood clot occurred after a short-term risk (for example, surgery), your treatment time may be shorter.
  • If you've had blood clots before, your treatment time may be longer.
  • If you have certain other illnesses, such as cancer, you may need to take blood thinners for as long as you have the illness.

The most common side effect of blood thinners is bleeding. Bleeding can happen if the medicine thins your blood too much. This side effect can be life threatening.

Sometimes the bleeding is internal (inside your body). People treated with blood thinners usually have regular blood tests to measure their blood's ability to clot. These tests are called PT and PTT tests.

These tests also help your doctor make sure you're taking the right amount of medicine. Call your doctor right away if you have easy bruising or bleeding. These may be signs that your medicines have thinned your blood too much.

Thrombin Inhibitors

These medicines interfere with the blood clotting process. They're used to treat blood clots in patients who can't take heparin.

Thrombolytics

Doctors prescribe these medicines to quickly dissolve large blood clots that cause severe symptoms. Because thrombolytics can cause sudden bleeding, they're used only in life-threatening situations.

Other Types of Treatment

Vena Cava Filter

If you can't take blood thinners or they're not working well, your doctor may recommend a vena cava filter.

The filter is inserted inside a large vein called the vena cava. The filter catches blood clots before they travel to the lungs, which prevents pulmonary embolism. However, the filter doesn't stop new blood clots from forming.

Graduated Compression Stockings

Graduated compression stockings can reduce leg swelling caused by a blood clot. These stockings are worn on the legs from the arch of the foot to just above or below the knee.

Compression stockings are tight at the ankle and become looser as they go up the leg. This creates gentle pressure up the leg. The pressure keeps blood from pooling and clotting.

There are three types of compression stockings. One type is support pantyhose, which offer the least amount of pressure.

The second type is over-the-counter compression hose. These stockings give a little more pressure than support pantyhose. Over-the-counter compression hose are sold in medical supply stores and pharmacies.

Prescription-strength compression hose offer the greatest amount of pressure. They also are sold in medical supply stores and pharmacies. However, a specially trained person needs to fit you for these stockings.

Talk with your doctor about how long you should wear compression stockings.

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How Can Deep Vein Thrombosis Be Prevented?

You can take steps to prevent deep vein thrombosis (DVT) and pulmonary embolism (PE). If you're at risk for these conditions:

  • See your doctor for regular checkups.
  • Take all medicines as your doctor prescribes.
  • Get out of bed and move around as soon as possible after surgery or illness (as your doctor recommends). Moving around lowers your chance of developing a blood clot.
  • Exercise your lower leg muscles during long trips. This helps prevent blood clots from forming.

If you've had DVT or PE before, you can help prevent future blood clots. Follow the steps above and:

  • Take all medicines that your doctor prescribes to prevent or treat blood clots
  • Follow up with your doctor for tests and treatment
  • Use compression stockings as your doctor directs to prevent leg swelling

Contact your doctor at once if you have any signs or symptoms of DVT or PE. For more information, go to \"What Are the Signs and Symptoms of Deep Vein Thrombosis?\"

Travel Tips

The risk of developing DVT while traveling is low. The risk increases if the travel time is longer than 4 hours or you have other DVT risk factors.

During long trips, it may help to:

  • Walk up and down the aisles of the bus, train, or airplane. If traveling by car, stop about every hour and walk around.
  • Move your legs and flex and stretch your feet to improve blood flow in your calves.
  • Wear loose and comfortable clothing.
  • Drink plenty of fluids and avoid alcohol.

If you have risk factors for DVT, your doctor may advise you to wear compression stockings while traveling. Or, he or she may suggest that you take a blood-thinning medicine before traveling.

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Living With Deep Vein Thrombosis

If you've had a deep vein blood clot, you're at greater risk for another one. During treatment and after:

  • Take steps to prevent deep vein thrombosis (DVT). (For more information, go to \"How Can Deep Vein Thrombosis Be Prevented?\")
  • Check your legs for signs of DVT. These include swollen areas, pain or tenderness, increased warmth in swollen or painful areas, or red or discolored skin on the legs.
  • Contact your doctor right away if you have signs or symptoms of DVT.

Ongoing Health Care Needs

DVT often is treated with blood-thinning medicines. These medicines can thin your blood too much and cause bleeding (sometimes inside the body). This side effect can be life threatening.

Bleeding can occur in the digestive system or the brain. Signs and symptoms of bleeding in the digestive system include:

  • Bright red vomit or vomit that looks like coffee grounds
  • Bright red blood in your stools or black, tarry stools
  • Pain in your abdomen

Signs and symptoms of bleeding in the brain include:

  • Severe pain in your head
  • Sudden changes in your vision
  • Sudden loss of movement in your arms or legs
  • Memory loss or confusion

If you have any of these signs or symptoms, seek medical care right away. If you have a lot of bleeding after a fall or injury, call 9–1–1. This could be a sign that your DVT medicines have thinned your blood too much.

You might want to wear a medical ID bracelet or necklace that states you're at risk of bleeding. If you're injured, the ID will alert medical personnel of your condition.

Talk with your doctor before taking any medicines other than your DVT medicines. This includes over-the-counter medicines. Aspirin, for example, also can thin your blood. Taking two medicines that thin your blood may raise your risk of bleeding.

Ask your doctor about how your diet affects these medicines. Foods that contain vitamin K can change how warfarin (a blood-thinning medicine) works. Vitamin K is found in green, leafy vegetables and some oils, like canola and soybean oils. Your doctor can help you plan a balanced and healthy diet.

Discuss with your doctor whether drinking alcohol will interfere with your medicines. Your doctor can tell you what amount of alcohol is safe for you.

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Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.

Researchers have learned a lot about blood disorders over the years. That knowledge has led to advances in medical knowledge and care. However, many questions remain about various blood disorders, including deep vein thrombosis (DVT).

The NHLBI continues to support research aimed at learning more about DVT. For example, NHLBI-supported research includes studies that:

  • Analyze genetic factors to determine the best doses of blood-thinning medicines for certain populations
  • Explore whether a catheter procedure to dissolve deep vein blood clots can help improve outcomes for people who have DVT

Much of the NHLBI's research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.

For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.

By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.

If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.

If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.

For more information about clinical trials related to deep vein thrombosis, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:

For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.

", "diseases_conditions.last_update": "June 11, 2014.", "diseases_conditions.category_1_x_diseases_conditions_id": { "28": { "category_1_x_diseases_conditions.id": 28, "category_1.id": 4, "category_1.ts": "2018-02-02 04:25:06", "category_1.title": "d" } } }, "29": { "diseases_conditions.id": 29, "diseases_conditions.ts": "2018-02-02 05:10:47", "diseases_conditions.title": "Diabetic Heart Disease", "diseases_conditions.diseases_conditions_detail": "
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What Is Diabetic Heart Disease?

The term \"diabetic heart disease\" (DHD) refers to heart disease that develops in people who have diabetes. Compared with people who don't have diabetes, people who have diabetes:

What Is Diabetes?

Diabetes is a disease in which the body's blood glucose (sugar) level is too high. Normally, the body breaks down food into glucose and carries it to cells throughout the body. The cells use a hormone called insulin to turn the glucose into energy.

The two main types of diabetes are type 1 and type 2. In type 1 diabetes, the body doesn't make enough insulin. This causes the body's blood sugar level to rise.

In type 2 diabetes, the body's cells don't use insulin properly (a condition called insulin resistance). At first, the body reacts by making more insulin. Over time, though, the body can't make enough insulin to control its blood sugar level.

For more information about diabetes, go to the National Institute of Diabetes and Digestive and Kidney Diseases' Introduction to Diabetes Web page.

What Heart Diseases Are Involved in Diabetic Heart Disease?

DHD may include coronary heart disease (CHD), heart failure, and/or diabetic cardiomyopathy (KAR-de-o-mi-OP-ah-thee).

Coronary Heart Disease

In CHD, a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply your heart muscle with oxygen-rich blood.

Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. When plaque builds up in the arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis).

Plaque narrows the coronary arteries and reduces blood flow to your heart muscle. The buildup of plaque also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow.

CHD can lead to chest pain or discomfort called angina (an-JI-nuh or AN-juh-nuh), irregular heartbeats called arrhythmias (ah-RITH-me-ahs), a heart attack, or even death.

Heart Failure

Heart failure is a condition in which your heart can't pump enough blood to meet your body's needs. The term “heart failure” doesn't mean that your heart has stopped or is about to stop working. However, heart failure is a serious condition that requires medical care.

If you have heart failure, you may tire easily and have to limit your activities. CHD can lead to heart failure by weakening the heart muscle over time.

Diabetic Cardiomyopathy

Diabetic cardiomyopathy is a disease that damages the structure and function of the heart. This disease can lead to heart failure and arrhythmias, even in people who have diabetes but don't have CHD.

Overview

People who have type 1 or type 2 diabetes can develop DHD. The higher a person's blood sugar level is, the higher his or her risk of DHD.

Diabetes affects heart disease risk in three major ways.

First, diabetes alone is a very serious risk factor for heart disease, just like smoking, high blood pressure, and high blood cholesterol. In fact, people who have type 2 diabetes have the same risk of heart attack and dying from heart disease as people who already have had heart attacks.

Second, when combined with other risk factors, diabetes further raises the risk of heart disease. Although research is ongoing, it's clear that diabetes and other conditions—such as overweight and obesity and metabolic syndrome—interact to cause harmful physical changes to the heart.

Third, diabetes raises the risk of earlier and more severe heart problems. Also, people who have DHD tend to have less success with some heart disease treatments, such as coronary artery bypass grafting and angioplasty (AN-jee-oh-plas-tee).

Outlook

If you have diabetes, you can lower your risk of DHD. Making lifestyle changes and taking prescribed medicines can help you prevent or control many risk factors.

Taking action to manage multiple risk factors helps improve your outlook. The good news is that many lifestyle changes help control multiple risk factors. For example, physical activity can lower your blood pressure, help control your blood sugar level and your weight, and reduce stress.

It's also very important to follow your treatment plan for diabetes and see your doctor for ongoing care.

If you already have DHD, follow your treatment plan as your doctors advises. This may help you avoid or delay serious problems, such as a heart attack or heart failure.

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What Causes Diabetic Heart Disease?

At least four complex processes, alone or combined, can lead to diabetic heart disease (DHD). They include coronary atherosclerosis; metabolic syndrome; insulin resistance in people who have type 2 diabetes; and the interaction of coronary heart disease (CHD), high blood pressure, and diabetes.

Researchers continue to study these processes because all of the details aren't yet known.

Coronary Atherosclerosis

Atherosclerosis is a disease in which plaque builds up inside the arteries. The exact cause of atherosclerosis isn't known. However, studies show that it is a slow, complex disease that may start in childhood. The disease develops faster as you age.

Coronary atherosclerosis may start when certain factors damage the inner layers of the coronary (heart) arteries. These factors include:

Plaque may begin to build up where the arteries are damaged. Over time, plaque hardens and narrows the arteries. This reduces the flow of oxygen-rich blood to your heart muscle.

Eventually, an area of plaque can rupture (break open). When this happens, blood cell fragments called platelets (PLATE-lets) stick to the site of the injury. They may clump together to form blood clots.

Blood clots narrow the coronary arteries even more. This limits the flow of oxygen-rich blood to your heart and may worsen angina (chest pain) or cause a heart attack.

Metabolic Syndrome

Metabolic syndrome is the name for a group of risk factors that raises your risk of both CHD and type 2 diabetes.

If you have three or more of the five metabolic risk factors, you have metabolic syndrome. The risk factors are:

  • A large waistline (a waist measurement of 35 inches or more for women and 40 inches or more for men).
  • A high triglyceride (tri-GLIH-seh-ride) level (or you’re on medicine to treat high triglycerides). Triglycerides are a type of fat found in the blood.
  • A low HDL cholesterol level (or you're on medicine to treat low HDL cholesterol). HDL sometimes is called \"good\" cholesterol. This is because it helps remove cholesterol from your arteries.
  • High blood pressure (or you’re on medicine to treat high blood pressure).
  • A high fasting blood sugar level (or you're on medicine to treat high blood sugar).

It's unclear whether these risk factors have a common cause or are mainly related by their combined effects on the heart.

Obesity seems to set the stage for metabolic syndrome. Obesity can cause harmful changes in body fats and how the body uses insulin.

Chronic (ongoing) inflammation also may occur in people who have metabolic syndrome. Inflammation is the body's response to illness or injury. It may raise your risk of CHD and heart attack. Inflammation also may contribute to or worsen metabolic syndrome.

Research is ongoing to learn more about metabolic syndrome and how metabolic risk factors interact.

Insulin Resistance in People Who Have Type 2 Diabetes

Type 2 diabetes usually begins with insulin resistance. Insulin resistance means that the body can't properly use the insulin it makes.

People who have type 2 diabetes and insulin resistance have higher levels of substances in the blood that cause blood clots. Blood clots can block the coronary arteries and cause a heart attack or even death.

The Interaction of Coronary Heart Disease, High Blood Pressure, and Diabetes

Each of these risk factors alone can damage the heart. CHD reduces the flow of oxygen-rich blood to your heart muscle. High blood pressure and diabetes may cause harmful changes in the structure and function of the heart.

Having CHD, high blood pressure, and diabetes is even more harmful to the heart. Together, these conditions can severely damage the heart muscle. As a result, the heart has to work harder than normal. Over time, the heart weakens and isn’t able to pump enough blood to meet the body’s needs. This condition is called heart failure.

As the heart weakens, the body may release proteins and other substances into the blood. These proteins and substances also can harm the heart and worsen heart failure.

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Who Is at Risk for Diabetic Heart Disease?

People who have type 1 or type 2 diabetes are at risk for diabetic heart disease (DHD). Diabetes affects heart disease risk in three major ways.

First, diabetes alone is a very serious risk factor for heart disease. Second, when combined with other risk factors, diabetes further raises the risk of heart disease. Third, compared with people who don't have diabetes, people who have the disease are more likely to:

The higher your blood sugar level is, the higher your risk of DHD. (A higher than normal blood sugar level is a risk factor for heart disease even in people who don't have diabetes.)

Type 2 diabetes raises your risk of having “silent” heart disease—that is, heart disease with no signs or symptoms. You can even have a heart attack without feeling symptoms. Diabetes-related nerve damage that blunts heart pain may explain why symptoms aren't noticed.

Other Risk Factors

Other factors also can raise the risk of coronary heart disease (CHD) in people who have diabetes and in those who don't. You can control most of these risk factors, but some you can't.

For a more detailed discussion of these risk factors, go to the Health Topics Coronary Heart Disease Risk Factors article.

Risk Factors You Can Control

Risk Factors You Can't Control

  • Age. As you get older, your risk of heart disease and heart attack rises. In men, the risk of heart disease increases after age 45. In women, the risk increases after age 55. In people who have diabetes, the risk of heart disease increases after age 40.
  • Gender. Before age 55, women seem to have a lower risk of heart disease than men. After age 55, however, the risk of heart disease increases similarly in both women and men.
  • Family history of early heart disease. Your risk increases if your father or a brother was diagnosed with heart disease before 55 years of age, or if your mother or a sister was diagnosed with heart disease before 65 years of age.
  • Preeclampsia (pre-e-KLAMP-se-ah). This condition can develop during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine. Preeclampsia is linked to an increased lifetime risk of CHD, heart attack, heart failure, and high blood pressure.
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What Are the Signs and Symptoms of Diabetic Heart Disease?

Some people who have diabetic heart disease (DHD) may have no signs or symptoms of heart disease. This is called “silent” heart disease. Diabetes-related nerve damage that blunts heart pain may explain why symptoms aren't noticed.

Thus, people who have diabetes should have regular medical checkups. Tests may reveal a problem before they're aware of it. Early treatment can reduce or delay related problems.

Some people who have DHD will have some or all of the typical symptoms of heart disease. Be aware of the symptoms described below and seek medical care if you have them.

If you think you're having a heart attack, call 9–1–1 right away for emergency care. Treatment for a heart attack works best when it's given right after symptoms occur.

Coronary Heart Disease

A common symptom of coronary heart disease (CHD) is angina. Angina is chest pain or discomfort that occurs if your heart muscle doesn't get enough oxygen-rich blood.

Angina may feel like pressure or squeezing in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. The pain tends to get worse with activity and go away with rest. Emotional stress also can trigger the pain.

See your doctor if you think you have angina. He or she may recommend tests to check your coronary arteries and to see whether you have CHD risk factors.

Other CHD signs and symptoms include nausea (feeling sick to your stomach), fatigue (tiredness), shortness of breath, sweating, light-headedness, and weakness.

Some people don't realize they have CHD until they have a heart attack. A heart attack occurs if a blood clot forms in a coronary artery and blocks blood flow to part of the heart muscle.

The most common heart attack symptom is chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest that often lasts for more than a few minutes or goes away and comes back.

The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. The feeling can be mild or severe. Heart attack pain sometimes feels like indigestion or heartburn. Shortness of breath may occur with or before chest discomfort.

Heart attacks also can cause upper body discomfort in one or both arms, the back, neck, jaw, or upper part of the stomach. Other heart attack symptoms include nausea, vomiting, light-headedness or sudden dizziness, breaking out in a cold sweat, sleep problems, fatigue, and lack of energy.

Some heart attack symptoms are similar to angina symptoms. Angina pain usually lasts for only a few minutes and goes away with rest. Chest pain or discomfort that doesn't go away or changes from its usual pattern (for example, occurs more often or while you're resting) can be a sign of a heart attack.

If you don't know whether your chest pain is angina or a heart attack, call 9–1–1 right away for emergency care.

Not everyone who has a heart attack has typical symptoms. If you've already had a heart attack, your symptoms may not be the same for another one. Also, diabetes-related nerve damage can interfere with pain signals in the body. As a result, some people who have diabetes may have heart attacks without symptoms.

Heart Failure

The most common symptoms of heart failure are shortness of breath or trouble breathing, fatigue, and swelling in the ankles, feet, legs, abdomen, and veins in your neck. As the heart weakens, heart failure symptoms worsen.

People who have heart failure can live longer and more active lives if the condition is diagnosed early and they follow their treatment plans. If you have any form of DHD, talk with your doctor about your risk of heart failure.

Diabetic Cardiomyopathy

Diabetic cardiomyopathy may not cause symptoms in its early stages. Later, you may have weakness, shortness of breath, a severe cough, fatigue, and swelling of the legs and feet.

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How Is Diabetic Heart Disease Diagnosed?

Your doctor will diagnose diabetic heart disease (DHD) based on your signs and symptoms, medical and family histories, a physical exam, and the results from tests and procedures.

Doctors and researchers are still trying to find out whether routine testing for DHD will benefit people who have diabetes but no heart disease symptoms.

Initial Tests

No single test can diagnose DHD, which may involve coronary heart disease (CHD), heart failure, and/or diabetic cardiomyopathy. Initially, your doctor may recommend one or more of the following tests.

Blood Pressure Measurement

To measure your blood pressure, your doctor or nurse will use some type of a gauge, a stethoscope (or electronic sensor), and a blood pressure cuff.

Most often, you'll sit or lie down with the cuff around your arm as your doctor or nurse checks your blood pressure. If he or she doesn't tell you what your blood pressure numbers are, you should ask.

Blood Tests

Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels of these substances may show that you're at risk for DHD.

A blood test also can check the level of a hormone called BNP (brain natriuretic peptide) in your blood. The heart makes BNP, and the level of BNP rises during heart failure.

Chest X Ray

A chest x ray takes pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels. A chest x ray can reveal signs of heart failure.

EKG (Electrocardiogram)

An EKG is a simple, painless test that detects and records your heart's electrical activity. The test shows how fast your heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through your heart.

An EKG can show signs of heart damage due to CHD and signs of a previous or current heart attack.

Stress Test

Some heart problems are easier to diagnose when your heart is working hard and beating fast. Stress testing gives your doctor information about how your heart works during physical stress.

During a stress test, you exercise (walk or run on a treadmill or pedal a bicycle) to make your heart work hard and beat fast. Tests are done on your heart while you exercise. If you can’t exercise, you may be given medicine to raise your heart rate.

Urinalysis

For this test, you'll give a sample of urine for analysis. The sample is checked for abnormal levels of protein or blood cells. In people who have diabetes, protein in the urine is a risk factor for DHD.

Other Tests and Procedures

Your doctor may refer you to a cardiologist if your initial test results suggest that you have a form of DHD. A cardiologist is a doctor who specializes in diagnosing and treating heart diseases and conditions.

The cardiologist may recommend other tests or procedures to get more detailed information about the nature and extent of your DHD.

For more information about other tests and procedures, go to the diagnosis sections of the Health Topics Coronary Heart Disease, Heart Failure, and Cardiomyopathy articles.

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How Is Diabetic Heart Disease Treated?

Diabetic heart disease (DHD) is treated with lifestyle", "diseases_conditions.last_update": "June 11, 2014.", "diseases_conditions.category_1_x_diseases_conditions_id": { "29": { "category_1_x_diseases_conditions.id": 29, "category_1.id": 4, "category_1.ts": "2018-02-02 04:25:06", "category_1.title": "d" } } }, "30": { "diseases_conditions.id": 30, "diseases_conditions.ts": "2018-02-02 05:10:58", "diseases_conditions.title": "Disseminated Intravascular Coagulation", "diseases_conditions.diseases_conditions_detail": "

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What Is Disseminated Intravascular Coagulation?

Disseminated intravascular coagulation (ko-ag-u-LA-shun), or DIC, is a condition in which blood clots form throughout the body's small blood vessels. These blood clots can reduce or block blood flow through the blood vessels, which can damage the body's organs.

In DIC, the increased clotting uses up platelets (PLATE-lets) and clotting factors in the blood. Platelets are blood cell fragments that stick together to seal small cuts and breaks on blood vessel walls and stop bleeding. Clotting factors are proteins needed for normal blood clotting.

With fewer platelets and clotting factors in the blood, serious bleeding can occur. DIC can cause internal and external bleeding.

Internal bleeding occurs inside the body. External bleeding occurs underneath or from the skin or mucosa. (The mucosa is the tissue that lines some organs and body cavities, such as your nose and mouth.)

DIC can cause life-threatening bleeding.

Overview

To understand DIC, it helps to understand the body's normal blood clotting process. Your body has a system to control bleeding. When small cuts or breaks occur on blood vessel walls, your body activates clotting factors. These clotting factors, such as thrombin and fibrin, work with platelets to form blood clots.

Blood clots seal the small cuts or breaks on the blood vessel walls. After bleeding stops and the vessels heal, your body breaks down and removes the clots.

Some diseases and conditions can cause clotting factors to become overactive, leading to DIC. These diseases and conditions include:

Examples of less common causes of DIC are bites from poisonous snakes (such as rattlesnakes and other vipers), frostbite, and burns.

The two types of DIC are acute and chronic. Acute DIC develops quickly (over hours or days) and must be treated right away. The condition begins with excessive blood clotting in the small blood vessels and quickly leads to serious bleeding.

Chronic DIC develops slowly (over weeks or months). It lasts longer and usually isn't recognized as quickly as acute DIC. Chronic DIC causes excessive blood clotting, but it usually doesn't lead to bleeding. Cancer is the most common cause of chronic DIC.

Treatment for DIC involves treating the clotting and bleeding problems and the underlying cause of the condition.

People who have acute DIC may need blood transfusions, medicines, and other life-saving measures. People who have chronic DIC may need medicines to help prevent blood clots from forming in their small blood vessels.

Outlook

The outlook for DIC depends on its severity and underlying cause. Acute DIC can damage the body's organs and even cause death if it's not treated right away. Chronic DIC also can damage the body's organs.

Researchers are looking for ways to prevent DIC or diagnose it early. They're also studying the use of various clotting proteins and medicines to treat the condition.

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Other Names for Disseminated Intravascular Coagulation

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What Causes Disseminated Intravascular Coagulation?

Some diseases and conditions can disrupt the body's normal blood clotting process and lead to disseminated intravascular coagulation (DIC). These diseases and conditions include:

Examples of less common causes of DIC are bites from poisonous snakes (such as rattlesnakes and other vipers), frostbite, and burns.

The two types of DIC are acute and chronic. Acute DIC begins with clotting in the small blood vessels and quickly leads to serious bleeding. Chronic DIC causes blood clotting, but it usually doesn't lead to bleeding. Cancer is the most common cause of chronic DIC.

Similar Clotting Conditions

Two other conditions cause blood clotting in the small blood vessels. However, their causes and treatments differ from those of DIC.

These conditions are thrombotic thrombocytopenic purpura (throm-BOT-ik throm-bo-cy-toe-PEE-nick PURR-purr-ah), or TTP, and hemolytic-uremic syndrome (HUS). HUS is more common in children than adults. It's also more likely to cause kidney damage than TTP.

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Who Is at Risk for Disseminated Intravascular Coagulation?

Disseminated intravascular coagulation (DIC) is the result of an underlying disease or condition. People who have one or more of the following conditions are most likely to develop DIC:

People who are bitten by poisonous snakes (such as rattlesnakes and other vipers), or those who have frostbite or burns, also are at risk for DIC.

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What Are the Signs and Symptoms of Disseminated Intravascular Coagulation?

Signs and symptoms of disseminated intravascular coagulation (DIC) depend on its cause and whether the condition is acute or chronic.

Acute DIC develops quickly (over hours or days) and is very serious. Chronic DIC develops more slowly (over weeks or months). It lasts longer and usually isn't recognized as quickly as acute DIC.

With acute DIC, blood clotting in the blood vessels usually occurs first, followed by bleeding. However, bleeding may be the first obvious sign. Serious bleeding can occur very quickly after developing acute DIC. Thus, emergency treatment in a hospital is needed.

Blood clotting also occurs with chronic DIC, but it usually doesn't lead to bleeding. Sometimes chronic DIC has no signs or symptoms.

Signs and Symptoms of Excessive Blood Clotting

In DIC, blood clots form throughout the body's small blood vessels. These blood clots can reduce or block blood flow through the blood vessels. This can cause the following signs and symptoms:

Signs and Symptoms of Bleeding

In DIC, the increased clotting activity uses up the platelets and clotting factors in the blood. As a result, serious bleeding can occur. DIC can cause internal and external bleeding.

Internal Bleeding

Internal bleeding can occur in your body's organs, such as the kidneys, intestines, and brain. This bleeding can be life threatening. Signs and symptoms of internal bleeding include:

External Bleeding

External bleeding can occur underneath or from the skin, such as at the site of cuts or an intravenous (IV) needle. External bleeding also can occur from the mucosa. (The mucosa is the tissue that lines some organs and body cavities, such as your nose and mouth.)

External bleeding may cause purpura (PURR-purr-ah) or petechiae (peh-TEE-key-ay). Purpura are purple, brown, and red bruises. This bruising may happen easily and often. Petechiae are small red or purple dots on your skin.

\"Purpura

Figure

Purpura and Petechiae. The photograph shows purpura (bruises) and petechiae (dots) on the skin. Bleeding under the skin causes the purple, brown, and red colors of the purpura and petechiae.

Other signs of external bleeding include:

  • Prolonged bleeding, even from minor cuts.
  • Bleeding or oozing from your gums or nose, especially nosebleeds or bleeding from brushing your teeth.
  • Heavy or extended menstrual bleeding in women.
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How Is Disseminated Intravascular Coagulation Diagnosed?

Your doctor will diagnose disseminated intravascular coagulation (DIC) based on your medical history, a physical exam, and test results. Your doctor also will look for the cause of DIC.

Acute DIC requires emergency treatment. The condition can be life threatening if it's not treated right away. If you have signs or symptoms of severe bleeding or blood clots, call 9–1–1 right away.

Medical History and Physical Exam

Your doctor will ask whether you have or have had any diseases or conditions that can trigger DIC. For more information about these diseases and conditions, go to \"What Causes Disseminated Intravascular Coagulation?\"

Your doctor will ask about signs and symptoms of blood clots and bleeding. He or she also will do a physical exam to look for signs and symptoms of blood clots and internal and external bleeding. For example, your doctor may look for bleeding from your gums.

Diagnostic Tests

To diagnose DIC, your doctor may recommend blood tests to look at your blood cells and the clotting process. For these tests, a small amount of blood is drawn from a blood vessel, usually in your arm.

Complete Blood Count and Blood Smear

A complete blood count (CBC) measures the number of red blood cells, white blood cells, and platelets in your blood.

Platelets are blood cell fragments that help with blood clotting. Abnormal platelet numbers may be a sign of a bleeding disorder (not enough clotting) or a thrombotic disorder (too much clotting).

A blood smear is a test that may reveal whether your red blood cells are damaged.

Tests for Clotting Factors and Clotting Time

The following tests examine the proteins active in the blood clotting process and how long it takes them to form a blood clot.

  • PT and PTT tests. These tests measure how long it takes blood clots to form.
  • Serum fibrinogen. Fibrinogen is a protein that helps the blood clot. This test measures how much fibrinogen is in your blood.
  • Fibrin degradation. After blood clots dissolve, substances called fibrin degradation products are left behind in the blood. This test measures the amount of these substances in the blood.
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How Is Disseminated Intravascular Coagulation Treated?

Treatment for disseminated intravascular coagulation (DIC) depends on its severity and cause. The main goals of treating DIC are to control bleeding and clotting problems and treat the underlying cause.

Acute Disseminated Intravascular Coagulation

People who have acute DIC may have severe bleeding that requires emergency treatment in a hospital. Treatment may include blood transfusions, medicines, and oxygen therapy. (Oxygen is given through nasal prongs, a mask, or a breathing tube.)

A blood transfusion is a safe, common procedure. You receive blood through an intravenous (IV) line in one of your blood vessels. Blood transfusions are done to replace blood loss due to an injury, surgery, or illness.

Blood is made up of various parts, including red blood cells, white blood cells, platelets, and plasma. Some blood transfusions involve whole blood (blood with all of its parts). More often though, only some parts of blood are transfused.

If you have DIC, you may be given platelets and clotting factors, red blood cells, and plasma (the liquid part of blood).

Chronic Disseminated Intravascular Coagulation

People who have chronic DIC are more likely to have blood clotting problems than bleeding. If you have chronic DIC, your doctor may treat you with medicines called anticoagulants, or blood thinners.

Blood thinners help prevent blood clots from forming. They also keep existing blood clots from getting larger.

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Living With Disseminated Intravascular Coagulation

If you have disseminated intravascular coagulation (DIC), ask your doctor how often you should schedule followup care and blood tests. Blood tests help track how well your blood is clotting.

You may need to take blood-thinning medicines (blood thinners) to help prevent blood clots or to keep existing clots from getting larger. If you take blood thinners, let everyone on your health care team know.

Blood thinners may thin your blood too much and cause bleeding. A lot of bleeding after a fall or injury or easy bruising or bleeding may mean that your blood is too thin.

Call your doctor right away if you have any signs of bleeding. If you have severe bleeding, call 9–1–1 right away.

Also, you should talk with your doctor before using any over-the-counter medicines or products, such as vitamins, supplements, or herbal remedies. Some of these products also can affect blood clotting and bleeding. For example, aspirin and ibuprofen may thin your blood too much. This can increase your risk of bleeding.

If you need surgery, your doctor may adjust the amount of medicine you take before, during, and after the surgery to prevent bleeding. This also may happen for dental work, but it's less common.

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Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.

NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.

Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.

By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.

If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.

If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.

For more information about clinical trials related to disseminated intravascular coagulation, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:

For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.

", "diseases_conditions.last_update": "June 11, 2014.", "diseases_conditions.category_1_x_diseases_conditions_id": { "30": { "category_1_x_diseases_conditions.id": 30, "category_1.id": 4, "category_1.ts": "2018-02-02 04:25:06", "category_1.title": "d" } } }, "31": { "diseases_conditions.id": 31, "diseases_conditions.ts": "2018-02-02 05:11:18", "diseases_conditions.title": "Endocarditis", "diseases_conditions.diseases_conditions_detail": "
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What Is Endocarditis?

Endocarditis (EN-do-kar-DI-tis) is an infection of the inner lining of the heart chambers and valves. This lining is called the endocardium (en-do-KAR-de-um). The condition also is called infective endocarditis (IE).

The term \"endocarditis\" also is used to describe an inflammation of the endocardium due to other conditions. This article only discusses endocarditis related to infection.

IE occurs if bacteria, fungi, or other germs invade your bloodstream and attach to abnormal areas of your heart. The infection can damage your heart and cause serious and sometimes fatal complications.

IE can develop quickly or slowly; it depends on what type of germ is causing it and whether you have an underlying heart problem. When IE develops quickly, it's called acute infective endocarditis. When it develops slowly, it's called subacute infective endocarditis.

Overview

IE mainly affects people who have:

People who have normal heart valves also can have IE. However, the condition is much more common in people who have abnormal hearts.

Certain factors make it easier for bacteria to enter your bloodstream. These factors put you at higher risk for IE. For example, poor dental hygiene and unhealthy teeth and gums increase your risk for the infection.

Other risk factors include using intravenous (IV) drugs, having a catheter (tube) or another medical device in your body for long periods, and having a history of IE.

Common symptoms of IE are fever and other flu-like symptoms. Because the infection can affect people in different ways, the signs and symptoms vary. IE also can cause problems in many other parts of the body besides the heart.

If you're at high risk for IE, seek medical care if you have signs or symptoms of the infection, especially a fever that persists or unexplained fatigue (tiredness).

Outlook

IE is treated with antibiotics for several weeks. You also may need heart surgery to repair or replace heart valves or remove infected heart tissue.

Most people who are treated with the proper antibiotics recover. But if the infection isn't treated, or if it persists despite treatment (for example, if the bacteria are resistant to antibiotics), it's usually fatal.

If you have signs or symptoms of IE, see your doctor as soon as you can, especially if you have abnormal heart valves.

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What Causes Endocarditis?

Infective endocarditis (IE) occurs if bacteria, fungi, or other germs invade your bloodstream and attach to abnormal areas of your heart. Certain factors increase the risk of this happening.

A common underlying factor in IE is a structural heart defect, especially f aulty heart valves. Usually your immune system will kill germs in your bloodstream. However, if your heart has a rough lining or abnormal valves, the invading germs can attach and multiply in the heart.

Other factors also can play a role in causing IE. Common activities, such as brushing your teeth or having certain dental procedures, can allow bacteria to enter your bloodstream. This is even more likely to happen if your teeth and gums are in poor condition.

Having a catheter (tube) or another medical device inserted through your skin, especially for long periods, also can allow bacteria to enter your bloodstream. People who use intravenous (IV) drugs also are at risk for IE because of the germs on needles and syringes.

Bacteria also may spread to the blood and heart from infections in other parts of the body, such as the gut, skin, or genitals.

Endocarditis Complications

As the bacteria or other germs multiply in your heart, they form clumps with other cells and matter found in the blood. These clumps are called vegetations (vej-eh-TA-shuns).

As IE worsens, pieces of the vegetations can break off and travel to almost any other organ or tissue in the body. There, the pieces can block blood flow or cause a new infection. As a result, IE can cause a range of complications.

Heart Complications

Heart problems are the most common complication of IE. They occur in one-third to one-half of all people who have the infection. These problems may include a new heart murmur, heart failure, heart valve damage, heart block, or, rarely, a heart attack.

Central Nervous System Complications

These complications occur in as many as 20 to 40 percent of people who have IE. Central nervous system complications most often occur when bits of the vegetation, called emboli (EM-bo-li), break away and lodge in the brain.

The emboli can cause local infections called brain abscesses. Or, they can cause a more widespread brain infection called meningitis (men-in-JI-tis).

Emboli also can cause strokes or seizures. This happens if they block blood vessels or affect the brain's electrical signals. These complications can cause long-term damage to the brain and may even be fatal.

Complications in Other Organs

IE also can affect other organs in the body, such as the lungs, kidneys, and spleen.

Lungs. The lungs are especially at risk when IE affects the right side of the heart. This is called right-sided infective endocarditis.

A vegetation or blood clot going to the lungs can cause a pulmonary embolism (PE) and lung damage. A PE is a sudden blockage in a lung artery.

Other lung complications include pneumonia and a buildup of fluid or pus around the lungs.

Kidneys. IE can cause kidney abscesses and kidney damage. The infection also can inflame the internal filtering structures of the kidneys.

Signs and symptoms of kidney complications include back or side pain, blood in the urine, or a change in the color or amount of urine. In some cases, IE can cause kidney failure.

Spleen. The spleen is an organ located in the left upper part of the abdomen near the stomach. In some people who have IE, the spleen enlarges (especially in people who have long-term IE). Sometimes emboli also can damage the spleen.

Signs and symptoms of spleen problems include pain or discomfort in the upper left abdomen and/or left shoulder, a feeling of fullness or the inability to eat large meals, and hiccups.

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Who Is At Risk for Endocarditis?

Infective endocarditis (IE) is an uncommon condition that can affect both children and adults. It's more common in men than women.

IE typically affects people who have abnormal hearts or other conditions that put them at risk for the infection. Sometimes IE does affect people who were healthy before the infection.

Major Risk Factors

The germs that cause IE tend to attach and multiply on damaged, malformed, or artificial (man-made) heart valves and implanted medical devices. Certain conditions put you at higher risk for IE. These include:

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What Are the Signs and Symptoms of Endocarditis?

Infective endocarditis (IE) can cause a range of signs and symptoms that can vary from person to person. Signs and symptoms also can vary over time in the same person.

Signs and symptoms differ depending on whether you have an underlying heart problem, the type of germ causing the infection, and whether you have acute or subacute IE.

Signs and symptoms of IE may include:

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How Is Endocarditis Diagnosed?

Your doctor will diagnose infective endocarditis (IE) based on your risk factors, your medical history and signs and symptoms, and test results.

Diagnosis of IE often is based on many factors, rather than a single positive test result, sign, or symptom.

Diagnostic Tests

Blood Tests

Blood cultures are the most important blood tests used to diagnose IE. Blood is drawn several times over a 24-hour period. It's put in special culture bottles that allow bacteria to grow.

Doctors then identify and test the bacteria to see which antibiotics will kill them. Sometimes the blood cultures don't grow any bacteria, even if a person has IE. This is called culture-negative endocarditis, and it requires antibiotic treatment.

Other blood tests also are used to diagnose IE. For example, a complete blood count may be used to check the number of red and white blood cells in your blood. Blood tests also may be used to check your immune system and to check for inflammation.

Echocardiography

Echocardiography (echo) is a painless test that uses sound waves to create pictures of your heart. Two types of echo are useful in diagnosing IE.

Transthoracic (tranz-thor-AS-ik) echo. For this painless test, gel is applied to the skin on your chest. A device called a transducer is moved around on the outside of your chest.

This device sends sound waves called ultrasound through your chest. As the ultrasound waves bounce off your heart, a computer converts them into pictures on a screen.

Your doctor uses the pictures to look for vegetations, areas of infected tissue (such as an abscess), and signs of heart damage.

Because the sound waves have to pass through skin, muscle, tissue, bone, and lungs, the pictures may not have enough detail. Thus, your doctor may recommend transesophageal (tranz-ih-sof-uh-JEE-ul) echo (TEE).

Transesophageal echo. For TEE, a much smaller transducer is attached to the end of a long, narrow, flexible tube. The tube is passed down your throat. Before the procedure, you're given medicine to help you relax, and your throat is sprayed with numbing medicine.

The doctor then passes the transducer down your esophagus (the passage from your mouth to your stomach). Because this passage is right behind the heart, the transducer can get detailed pictures of the heart's structures.

EKG

An EKG is a simple, painless test that detects your heart's electrical activity. The test shows how fast your heart is beating, whether your heart rhythm is steady or irregular, and the strength and timing of electrical signals as they pass through your heart.

An EKG typically isn't used to diagnose IE. However, it may be done to see whether IE is affecting your heart's electrical activity.

For this test, soft, sticky patches called electrodes are attached to your chest, arms, and legs. You lie still while the electrodes detect your heart's electrical signals. A machine records these signals on graph paper or shows them on a computer screen. The entire test usually takes about 10 minutes.

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How Is Endocarditis Treated?

Infective endocarditis (IE) is treated with antibiotics and sometimes with heart surgery.

Antibiotics

Antibiotics usually are given for 2 to 6 weeks through an intravenous (IV) line inserted into a vein. You're often in a hospital for at least the first week or more of treatment. This allows your doctor to make sure the medicine is helping.

If you're allowed to go home before the treatment is done, the antibiotics are almost always continued by vein at home. You'll need special care if you get IV antibiotic treatment at home. Before you leave the hospital, your medical team will arrange for you to receive home-based care so you can continue your treatment.

You also will need close medical followup, usually by a team of doctors. This team often includes a doctor who specializes in infectious diseases, a cardiologist (heart specialist), and a heart surgeon.

Surgery

Sometimes surgery is needed to repair or replace a damaged heart valve or to help clear up IE. For example, IE caused by fungi often requires surgery. This is because this type of IE is harder to treat than IE caused by bacteria.

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How Can Endocarditis Be Prevented?

If you're at risk for infective endocarditis (IE), you can take steps to prevent the infection and its complications.

Research shows that not everyone at risk for IE needs to take antibiotics before routine dental exams and certain other dental and medical procedures.

Let your health care providers, including your dentist, know if you're at risk for IE. They can tell you whether you need antibiotics before exams and procedures.

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Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.

NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.

Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.

By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.

If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.

If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.

For more information about clinical trials related to infective endocarditis, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:

For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.

", "diseases_conditions.last_update": "June 11, 2014.", "diseases_conditions.category_1_x_diseases_conditions_id": { "31": { "category_1_x_diseases_conditions.id": 31, "category_1.id": 5, "category_1.ts": "2018-02-02 04:25:06", "category_1.title": "e" } } }, "32": { "diseases_conditions.id": 32, "diseases_conditions.ts": "2018-02-02 05:11:31", "diseases_conditions.title": "Excessive Blood Clotting", "diseases_conditions.diseases_conditions_detail": "
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What Is Excessive Blood Clotting?

Excessive blood clotting is a condition in which blood clots form too easily or don't dissolve properly. Normally, blood clots form to seal small cuts or breaks on blood vessel walls and stop bleeding.

Slow blood flow in the blood vessels also can cause blood clots to form. For example, if a blood vessel narrows, blood may slow down as it moves through the vessel.

Excessive blood clotting has many causes. Problems with the blood, blood vessel defects, or other factors can cause the condition. Regardless of the cause, blood clots can limit or block blood flow. This can damage the body's organs and may even cause death.

Overview

Excessive blood clotting can be acquired or genetic. Acquired causes of excessive blood clotting are more common than genetic causes.

\"Acquired\" means that another disease, condition, or factor triggers the condition. For example, atherosclerosis (ath-er-o-skler-O-sis) can damage the blood vessels, which can cause blood clots to form. Atherosclerosis is a disease in which a fatty substance called plaque (plak) builds up inside the arteries.

Other acquired causes of excessive blood clotting include smoking, overweight and obesity, and being unable to move around much (for example, if you're in the hospital).

If excessive blood clotting is genetic, it’s caused by a faulty gene. Most genetic defects that cause excessive blood clotting occur in the proteins needed for blood clotting. Defects also can occur with the substances that delay or dissolve blood clots.

Although the acquired and genetic causes of the condition aren't related, a person can have both. People at highest risk for excessive blood clotting have both causes.

Outlook

The outlook and treatment for excessive blood clotting depend on the cause of the blood clots, how severe they are, and how well they can be controlled.

Life-threatening blood clots are treated as emergencies. Medicines that thin the blood are used as routine treatment for blood clotting problems. Some people must take these medicines for the rest of their lives.

With medicines and ongoing care, many people who have excessive blood clotting can successfully manage it.

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Other Names for Excessive Blood Clotting

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What Causes Excessive Blood Clotting?

To understand what causes excessive blood clotting, it helps to understand the body's normal blood clotting process.

Normally, blood clots form to seal small cuts or breaks on blood vessel walls and stop bleeding. After the bleeding has stopped and healing has occurred, the body breaks down and removes the clots.

Blood clotting is a complex process, but it mainly involves:

Excessive blood clotting can occur if the body's clotting process is altered or wrongly triggered. Blood clots can form in, or travel to, the arteries or veins in the brain, heart, kidneys, lungs, and limbs. (Arteries and veins are the blood vessels that carry blood to your heart and body.)

Certain diseases and conditions, genetic mutations, medicines, and other factors can cause excessive blood clotting.

Diseases and Conditions

Many diseases and conditions can cause the blood to clot too much or prevent blood clots from dissolving properly. Certain diseases and conditions are more likely to cause clots to form in certain areas of the body.

Antiphospholipid Antibody Syndrome

This condition, also called APS, is an autoimmune disorder. If you have APS, your body makes antibodies (proteins) that attack phospholipids (fos-fo-LIP-ids)—a type of fat. Phospholipids are found in all living cells and cell membranes, including blood cells and the lining of blood vessels.

In APS, the antibodies trigger blood clots to form in the body's arteries and veins. These blood clots can lead to many health problems, including frequent miscarriages.

APS is more common in women and people who have other autoimmune or rheumatic disorders, such as lupus. (\"Rheumatic\" refers to disorders that affect the joints, bones, or muscles.)

Bone Marrow Disorders

Some bone marrow disorders can cause your body to make too many blood cells that can lead to blood clots. Examples include polycythemia vera (POL-e-si-THE-me-ah VE-ra), or PV, and thrombocythemia (THROM-bo-si-THE-me-ah).

PV is a rare blood disease in which your body makes too many red blood cells. These extra red blood cells make your blood thicker than normal. This slows the flow of blood through your small blood vessels, which can cause blood clots to form.

Thrombocythemia is a condition in which your body makes too many platelets. The platelets can stick together to form blood clots.

Thrombotic Thrombocytopenic Purpura and Disseminated Intravascular Coagulation

Two rare, but serious conditions that can cause blood clots are thrombotic thrombocytopenic purpura (throm-BOT-ik throm-bo-cy-toe-PEE-nick PURR-purr-ah), or TTP, and disseminated intravascular coagulation (ko-ag-u-LA-shun), or DIC.

TTP causes blood clots to form in the body's small blood vessels, including vessels in the brain, kidneys, and heart.

DIC is a rare complication of pregnancy, severe infections, or severe trauma. DIC causes tiny blood clots to form suddenly throughout the body.

Problems With Blood Clot Breakdown

After a blood clot has done its job, the body normally breaks down the fibrin that holds the clot together.

Several rare genetic and acquired conditions affect the fibrin network that holds blood clots together. Thus, the clots don't break down properly, and they remain in the body longer than needed.

In one condition, for example, the body's fibrin is abnormal and resists being broken down. In another condition, the body has a decreased amount of plasmin. This protein helps break down fibrin.

Excessive Blood Clotting That Mainly Affects the Heart and Brain

Any condition that damages the smooth inner surface of the blood vessels can trigger blood clotting. Many of these conditions are acquired. However, some genetic problems also can damage the inner surface of the blood vessels.

Certain diseases, conditions, or factors can trigger excessive blood clotting mainly in the arteries and veins of the heart and brain.

Atherosclerosis. Atherosclerosis is a disease in which a waxy substance called plaque builds up inside your arteries. Over time, the plaque may rupture (break open). Platelets clump together to form blood clots at the site of the damage. Atherosclerosis is a major cause of damage to the blood vessel walls.

Vasculitis. Vasculitis (vas-kyu-LI-tis) is a disorder that causes the body's blood vessels to become inflamed. Platelets may stick to areas where the blood vessels are damaged and form blood clots. Vasculitis also is a major cause of damage to the blood vessel walls.

Diabetes. Diabetes increases the risk of plaque buildup in the arteries, which can cause dangerous blood clots. Nearly 80 percent of people who have diabetes will eventually die of clot-related causes. Many of these deaths are related to complications with the heart and blood vessels.

Heart failure. Heart failure is a condition in which the heart is damaged or weakened. As a result, it can't pump enough blood to meet the body's needs. Heart failure slows blood flow, which can cause blood clots to form.

Atrial fibrillation. Atrial fibrillation (A-tre-al fih-brih-LA-shun), or AF, is the most common type of arrhythmia (ah-RITH-me-ah). An arrhythmia is a problem with the rate or rhythm of the heartbeat. AF can cause blood to pool in the upper chambers of the heart. This can cause blood clots to form.

Overweight and obesity. Overweight and obesity refer to body weight that's greater than what is considered healthy for a certain height. These conditions can lead to atherosclerosis, which increases the risk of blood clots.

Metabolic syndrome. Some research shows that people who have metabolic syndrome are at increased risk for excessive blood clotting. Metabolic syndrome is the name for a group of risk factors that increases your chance of having heart disease and other health problems.

Excessive Blood Clotting That Mainly Affects the Limbs

Blood clots can form in the veins deep in the limbs. This condition is called deep vein thrombosis (DVT). DVT usually affects the deep veins of the legs.

A blood clot in a deep vein can break off and travel through the bloodstream. If the clot travels to the lungs and blocks blood flow, the condition is called pulmonary embolism (PULL-mun-ary EM-bo-lizm), or PE.

Certain diseases, conditions, or factors can trigger excessive blood clotting mainly in the deep veins of the limbs. Examples include:

  • Hospitalization for major surgery, a serious medical illness, trauma, or broken bones. If you're not able to be active for long periods, blood flow in your veins slows down. As a result, blood clots may form in your legs.
  • \"Coach class.\" This term refers to a situation in which you must stay in one position for a long time, such as in a car or plane. Staying in one position can slow blood flow and lead to blood clots in the legs.
  • Cancer growth and cancer treatment.

Genetic Mutations

Genetic causes of excessive blood clotting most often are due to gene mutations (changes to a normal gene).

Common mutations include Factor V Leiden and Prothrombin G20210A mutations. Fairly rare genetic mutations include proteins C and S deficiencies and antithrombin III deficiency.

Medicines

Some medicines can disrupt the body's normal blood clotting process. Medicines containing the female hormone estrogen are linked to an increased risk of blood clots. Examples of medicines that may contain estrogen include birth control pills and hormone therapy.

Heparin is a medicine commonly used to prevent blood clots. But, in some people, the medicine can cause blood clots and a low platelet count. This condition is called heparin-induced thrombocytopenia (HIT).

HIT rarely occurs outside of a hospital because heparin usually is given in hospitals. In HIT, the body's immune system attacks the heparin and a protein on the surface of the platelets. This attack prompts the platelets to start forming blood clots.

Other Factors That Can Alter the Blood Clotting Process

Many other factors also can alter the clotting process and lead to excessive blood clotting. Common examples include:

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Who Is at Risk for Excessive Blood Clotting?

People at highest risk for excessive blood clotting have both acquired and genetic risk factors. For example, if you smoke and have the Factor V Leiden mutation and atherosclerosis, you're at higher risk than someone who has only one of these risk factors.

For more information about the diseases, conditions, and other factors that can lead to excessive blood clotting, go to \"What Causes Excessive Blood Clotting?\"

Genetic Risk Factors

You're more likely to have a genetic cause of excessive blood clotting if you have:

Factor V Leiden is one of the most common genetic mutations that can alter the blood clotting process. This mutation accounts for 40–50 percent of genetic blood clotting disorders in Caucasians.

Other Risk Factors

Another risk factor for excessive blood clotting is antiphospholipid antibody syndrome. APS is an autoimmune disorder that can trigger blood clots to form in the body's arteries and veins. These blood clots can lead to many health problems, including frequent miscarriages.

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What Are the Signs and Symptoms of Excessive Blood Clotting?

Signs and symptoms of excessive blood clotting depend on where the clots form. For example, symptoms of a blood clot in the heart or lungs may include chest pain, shortness of breath, and upper body discomfort in the arms, back, neck, or jaw. These symptoms may suggest a heart attack or pulmonary embolism (PE).

Signs and symptoms of a blood clot in the deep veins of the leg may include pain, redness, warmth, and swelling in the lower leg. These signs and symptoms may suggest deep vein thrombosis (DVT).

Signs and symptoms of a blood clot in the brain may include headaches, speech changes, paralysis (an inability to move), dizziness, and trouble speaking or understanding speech. These signs and symptoms may suggest a stroke.

If you have signs or symptoms of a heart attack, PE, or stroke, call 9–1–1 right away. If you have signs or symptoms of DVT, call your doctor right away. The cause of the blood clot needs to be found and treated as soon as possible.

Complications of Blood Clots

Blood clots can form in, or travel to, the arteries or veins in the brain, heart, kidneys, lungs, and limbs. Blood clots can limit or block blood flow. This can damage the body's organs and cause many problems. Sometimes blood clots can be fatal.

Stroke

A stroke can occur if blood flow to your brain is cut off. If blood flow is cut off for more than a few minutes, the cells in your brain start to die. This impairs the parts of the body that the brain cells control.

A stroke can cause lasting brain damage, long-term disability, paralysis (an inability to move), or death.

For more information, go to the Health Topics Stroke article and the National Institute of Neurological Disorders and Stroke's Stroke Information Page.

Heart Attack

A blood clot in a coronary artery can lead to a heart attack. A heart attack occurs if blood flow to a section of heart muscle becomes blocked. If blood flow isn't restored quickly, the section of heart muscle becomes damaged from lack of oxygen and begins to die.

This heart damage may not be obvious, or it may cause severe or long-lasting problems such as heart failure or arrhythmias (irregular heartbeats).

For more information, go to the Health Topics Heart Attack article.

Kidney Problems and Kidney Failure

A blood clot in the kidneys can lead to kidney problems or kidney failure. Kidney failure occurs if the kidneys can no longer remove fluids and waste from your body. This causes a buildup of these fluids and waste in your body, high blood pressure, and other health problems.

Pulmonary Embolism

If a blood clot travels from a deep vein in the body to the lungs, it's called a pulmonary embolism, or PE. PE is a serious condition that can damage your lungs and other organs and cause low oxygen levels in your blood.

For more information, go to the Health Topics Pulmonary Embolism article.

Deep Vein Thrombosis

A blood clot in a vein deep in your arm or leg can cause pain, swelling, redness, or increased warmth in the affected limb. This type of clot is called deep vein thrombosis, or DVT. Deep vein clots can break off, travel to the lungs, and cause PE.

For more information, go to the Health Topics Deep Vein Thrombosis article.

Pregnancy-Related Problems

Blood clots can cause miscarriages, stillbirths, and other pregnancy-related problems, such as preeclampsia (pre-e-KLAMP-se-ah). Preeclampsia is high blood pressure that occurs during pregnancy.

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How Is Excessive Blood Clotting Diagnosed?

If your doctor thinks that you have excessive blood clotting based on your signs and symptoms, he or she will look for the cause of the condition.

Your doctor will ask about your medical and family histories, do a physical exam, and review the results from tests.

Your primary care doctor may refer you to a hematologist. This is a doctor who specializes in diagnosing and treating blood diseases and disorders.

Medical and Family Histories

Your doctor may ask you detailed questions about your medical history and your family's medical history. He or she may ask whether you or a blood relative:

Physical Exam

Your doctor will do a physical exam to see how severe your blood clotting problem is and to look for a possible cause.

Diagnostic Tests

Your doctor may recommend blood tests to look at your blood cells and the clotting process. If he or she thinks you have a genetic condition, you may need more blood tests.

Tests to find the cause of excessive blood clotting might be delayed for weeks or even months while you receive treatment for a blood clot.

Complete Blood Count and Platelet Count

Initial blood tests will include a complete blood count and a platelet count. These tests measure the number of red blood cells, white blood cells, and platelets in your blood.

In this situation, your doctor will want to know the number of platelets in your blood. Platelets are blood cell fragments that stick together to form clots.

Tests for Clotting Factors and Clotting Time

You also may need blood tests that look at the proteins active in the blood clotting process and how long it takes them to form a blood clot.

Clotting proteins or factors react with each other along two pathways called the intrinsic and extrinsic pathways. (A pathway is a string of chemical reactions that always occur in a certain order.) The two pathways join in a common pathway to make a fibrin network that holds blood clots together.

  • PT test. This test looks at the extrinsic and common pathways to measure how long it takes blood clots to form. People who have excessive blood clotting may take the medicine warfarin to prolong their clotting times.
  • A PTT test. This test looks at the intrinsic and common pathways to measure how long it takes blood clots to form. People also may take blood thinners, like heparin, to slow their clotting times.

Followup Tests

If your doctor thinks your blood clotting condition is genetic, you may need other blood tests. For example, you might need tests to check:

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How Is Excessive Blood Clotting Treated?

Excessive blood clotting is treated with medicines. Depending on the size and location of the clot(s), you may need emergency treatment or routine treatment.

Emergency Treatmentdiseases_conditions.last_update": "June 11, 2014.", "diseases_conditions.category_1_x_diseases_conditions_id": { "32": { "category_1_x_diseases_conditions.id": 32, "category_1.id": 5, "category_1.ts": "2018-02-02 04:25:06", "category_1.title": "e" } } }, "33": { "diseases_conditions.id": 33, "diseases_conditions.ts": "2018-02-02 05:11:50", "diseases_conditions.title": "Fanconi Anemia", "diseases_conditions.diseases_conditions_detail": "
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What Is Fanconi Anemia?

Fanconi anemia (fan-KO-nee uh-NEE-me-uh), or FA, is a rare, inherited blood disorder that leads to bone marrow failure. The disorder also is called Fanconi’s anemia.

FA prevents your bone marrow from making enough new blood cells for your body to work normally. FA also can cause your bone marrow to make many faulty blood cells. This can lead to serious health problems, such as leukemia (a type of blood cancer).

Although FA is a blood disorder, it also can affect many of your body's organs, tissues, and systems. Children who inherit FA are at higher risk of being born with birth defects. FA also increases the risk of some cancers and other serious health problems.

FA is different from Fanconi syndrome. Fanconi syndrome affects the kidneys. It's a rare and serious condition that mostly affects children.

Children who have Fanconi syndrome pass large amounts of key nutrients and chemicals through their urine. These children may have serious health and developmental problems.

Bone Marrow and Blood

Bone marrow is the spongy tissue inside the large bones of your body. Healthy bone marrow contains stem cells that develop into the three types of blood cells that the body needs:

It's normal for blood cells to die. The lifespan of red blood cells is about 120 days. White blood cells live less than 1 day. Platelets live about 6 days. As a result, your bone marrow must constantly make new blood cells.

If your bone marrow can't make enough new blood cells to replace the ones that die, serious health problems can occur.

Fanconi Anemia and Your Body

FA is one of many types of anemia. The term \"anemia\" usually refers to a condition in which the blood has a lower than normal number of red blood cells.

FA is a type of aplastic anemia. In aplastic anemia, the bone marrow stops making or doesn't make enough of all three types of blood cells. Low levels of the three types of blood cells can harm many of the body's organs, tissues, and systems.

With too few red blood cells, your body's tissues won't get enough oxygen to work well. With too few white blood cells, your body may have problems fighting infections. This can make you sick more often and make infections worse. With too few platelets, your blood can’t clot normally. As a result, you may have bleeding problems.

Outlook

People who have FA have a greater risk than other people for some cancers. About 10 percent of people who have FA develop leukemia.

People who have FA and survive to adulthood are much more likely than others to develop cancerous solid tumors.

The risk of solid tumors increases with age in people who have FA. These tumors can develop in the mouth, tongue, throat, or esophagus (eh-SOF-ah-gus). (The esophagus is the passage leading from the mouth to the stomach.)

Women who have FA are at much greater risk than other women of developing tumors in the reproductive organs.

FA is an unpredictable disease. The average lifespan for people who have FA is between 20 and 30 years. The most common causes of death related to FA are bone marrow failure, leukemia, and solid tumors.

Advances in care and treatment have improved the chances of surviving longer with FA. Blood and marrow stem cell transplant is the major advance in treatment. However, even with this treatment, the risk of some cancers is greater in people who have FA.

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What Causes Fanconi Anemia?

Fanconi anemia (FA) is an inherited disease. The term “inherited” means that the disease is passed from parents to children through genes. At least 13 faulty genes are associated with FA. FA occurs when both parents pass the same faulty FA gene to their child.

People who have only one faulty FA gene are FA \"carriers.\" Carriers don't have FA, but they can pass the faulty gene to their children.

If both of your parents have a faulty FA gene, you have:

If only one of your parents has a faulty FA gene, you won't have the disorder. However, you have a 50 percent chance of being an FA carrier and passing the gene to any children you have.

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Who Is at Risk for Fanconi Anemia?

Fanconi anemia (FA) occurs in all racial and ethnic groups and affects men and women equally.

In the United States, about 1 out of every 181 people is an FA carrier. This carrier rate leads to about 1 in 130,000 people being born with FA.

Two ethnic groups, Ashkenazi Jews and Afrikaners, are more likely than other groups to have FA or be FA carriers.

Ashkenazi Jews are people who are descended from the Jewish population of Eastern Europe. Afrikaners are White natives of South Africa who speak a language called Afrikaans. This ethnic group is descended from early Dutch, French, and German settlers.

In the United States, 1 out of 90 Ashkenazi Jews is an FA carrier, and 1 out of 30,000 is born with FA.

Major Risk Factors

FA is an inherited disease—that is, it's passed from parents to children through genes. At least 13 faulty genes are associated with FA. FA occurs if both parents pass the same faulty FA gene to their child.

Children born into families with histories of FA are at risk of inheriting the disorder. Children whose mothers and fathers both have family histories of FA are at even greater risk. A family history of FA means that it's possible that a parent carries a faulty gene associated with the disorder.

Children whose parents both carry the same faulty gene are at greatest risk of inheriting FA. Even if these children aren't born with FA, they're still at risk of being FA carriers.

Children who have only one parent who carries a faulty FA gene also are at risk of being carriers. However, they're not at risk of having FA.

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What Are the Signs and Symptoms of Fanconi Anemia?

Major Signs and Symptoms

Your doctor may suspect you or your child has Fanconi anemia (FA) if you have signs and symptoms of:

FA is an inherited disorder—that is, it's passed from parents to children through genes. If a child has FA, his or her brothers and sisters also should be tested for the disorder.

Anemia

The most common symptom of all types of anemia is fatigue (tiredness). Fatigue occurs because your body doesn't have enough red blood cells to carry oxygen to its various parts. If you have anemia, you may not have the energy to do normal activities.

A low red blood cell count also can cause shortness of breath, dizziness, headaches, coldness in your hands and feet, pale skin, and chest pain.

Bone Marrow Failure

When your bone marrow fails, it can't make enough red blood cells, white blood cells, and platelets. This can cause many problems that have various signs and symptoms.

With too few red blood cells, you can develop anemia. In FA, the size of your red blood cells also can be much larger than normal. This makes it harder for the cells to work well.

With too few white blood cells, you're at risk for infections. Infections also may last longer and be more serious than normal.

With too few platelets, you may bleed and bruise easily, suffer from internal bleeding, or have petechiae (pe-TEE-kee-ay). Petechiae are tiny red or purple spots on the skin. Bleeding in small blood vessels just below your skin causes these spots.

In some people who have FA, the bone marrow makes a lot of harmful, immature white blood cells called blasts. Blasts don't work like normal blood cells. As they build up, they prevent the bone marrow from making enough normal blood cells.

A large number of blasts in the bone marrow can lead to a type of blood cancer called acute myeloid leukemia (AML).

Birth Defects

Many birth defects can be signs of FA. These include:

  • Bone or skeletal defects. FA can cause missing, oddly shaped, or three or more thumbs. Arm bones, hips, legs, hands, and toes may not form fully or normally. People who have FA may have a curved spine, a condition called scoliosis (sco-le-O-sis).
  • Eye and ear defects. The eyes, eyelids, and ears may not have a normal shape. Children who have FA also might be born deaf.
  • Skin discoloration. This includes coffee-colored areas or odd-looking patches of lighter skin.
  • Kidney problems. A child who has FA might be born with a missing kidney or kidneys that aren't shaped normally.
  • Congenital heart defects. The most common congenital heart defect linked to FA is a ventricular septal defect (VSD). A VSD is a hole or defect in the lower part of the wall that separates the heart’s left and right chambers.

Developmental Problems

Other signs and symptoms of FA are related to physical and mental development. They include:

  • Low birth weight
  • Poor appetite
  • Delayed growth
  • Below-average height
  • Small head size
  • Mental retardation or learning disabilities

Signs and Symptoms of Fanconi Anemia in Adults

Some signs and symptoms of FA may develop as you or your child gets older. Women who have FA may have some or all of the following:

  • Sex organs that are less developed than normal
  • Menstruating later than women who don't have FA
  • Starting menopause earlier than women who don't have FA
  • Problems getting pregnant and carrying a pregnancy to full term

Men who have FA may have sex organs that are less developed than normal. They also may be less fertile than men who don't have the disease.

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How Is Fanconi Anemia Diagnosed?

People who have Fanconi anemia (FA) are born with the disorder. They may or may not show signs or symptoms of it at birth. For this reason, FA isn't always diagnosed when a person is born. In fact, most people who have the disorder are diagnosed between the ages of 2 and 15 years.

The tests used to diagnose FA depend on a person's age and symptoms. In all cases, medical and family histories are an important part of diagnosing FA. However, because FA has many of the same signs and symptoms as other diseases, only genetic testing can confirm its diagnosis.

Specialists Involved

A geneticist is a doctor or scientist who studies how genes work and how diseases and traits are passed from parents to children through genes.

Geneticists do genetic testing for FA. They also can provide counseling about how FA is inherited and the types of prenatal (before birth) testing used to diagnose it.

An obstetrician may detect birth defects linked to FA before your child is born. An obstetrician is a doctor who specializes in providing care for pregnant women.

After your child is born, a pediatrician also can help find out whether your child has FA. A pediatrician is a doctor who specializes in treating children and teens.

A hematologist (blood disease specialist) also may help diagnose FA.

Family and Medical Histories

FA is an inherited disease. Some parents are aware that their family has a medical history of FA, even if they don't have the disease.

Other parents, especially if they're FA carriers, may not be aware of a family history of FA. Many parents may not know that FA can be passed from parents to children.

Knowing your family medical history can help your doctor diagnose whether you or your child has FA or another condition with similar symptoms.

If your doctor thinks that you, your siblings, or your children have FA, he or she may ask you detailed questions about:

If you know your family has a history of FA, or if your answers to your doctor's questions suggest a possible diagnosis of FA, your doctor will recommend further testing.

Diagnostic Tests and Procedures

The signs and symptoms of FA aren't unique to the disease. They're also linked to many other diseases and conditions, such as aplastic anemia. For this reason, genetic testing is needed to confirm a diagnosis of FA. Genetic tests for FA include the following.

Chromosome Breakage Test

This is the most common test for FA. It's available only in special laboratories (labs). It shows whether your chromosomes (long chains of genes) break more easily than normal.

Skin cells sometimes are used for the test. Usually, though, a small amount of blood is taken from a vein in your arm using a needle. A technician combines some of the blood cells with certain chemicals.

If you have FA, the chromosomes in your blood sample break and rearrange when mixed with the test chemicals. This doesn't happen in the cells of people who don't have FA.

Cytometric Flow Analysis

Cytometric flow analysis, or CFA, is done in a lab. This test examines how chemicals affect your chromosomes as your cells grow and divide. Skin cells are used for this test.

A technician mixes the skin cells with chemicals that can cause the chromosomes in the cells to act abnormally. If you have FA, your cells are much more sensitive to these chemicals.

The chromosomes in your skin cells will break at a high rate during the test. This doesn't happen in the cells of people who don't have FA.

Mutation Screening

A mutation is an abnormal change in a gene or genes. Geneticists and other specialists can examine your genes, usually using a sample of your skin cells. With special equipment and lab processes, they can look for gene mutations that are linked to FA.

Diagnosing Different Age Groups

Before Birth (Prenatal)

If your family has a history of FA and you get pregnant, your doctor may want to test you or your fetus for FA.

Two tests can be used to diagnose FA in a developing fetus: amniocentesis (AM-ne-o-sen-TE-sis) and chorionic villus (ko-re-ON-ik VIL-us) sampling (CVS). Both tests are done in a doctor's office or hospital.

Amniocentesis is done 15 to 18 weeks after a pregnant woman's last period. A doctor uses a needle to remove a small amount of fluid from the sac around the fetus. A technician tests chromosomes (chains of genes) from the fluid sample to see whether they have faulty genes associated with FA.

CVS is done 10 to 12 weeks after a pregnant woman's last period. A doctor inserts a thin tube through the vagina and cervix to the placenta (the temporary organ that connects the fetus to the mother).

The doctor removes a tissue sample from the placenta using gentle suction. The tissue sample is sent to a lab to be tested for genetic defects associated with FA.

At Birth

Three out of four people who inherit FA are born with birth defects. If your baby is born with certain birth defects, your doctor may recommend genetic testing to confirm a diagnosis of FA.

For more information about these defects, go to “What Are the Signs and Symptoms of Fanconi Anemia?”

Childhood and Later

Some people who have FA are not born with birth defects. Doctors may not diagnose them with the disorder until signs of bone marrow failure or cancer occur. This usually happens within the first 10 years of life.

Signs of bone marrow failure most often begin between the ages of 3 and 12 years, with 7 to 8 years as the most common ages. However, 10 percent of children who have FA aren't diagnosed until after 16 years of age.

If your bone marrow is failing, you may have signs of aplastic anemia. FA is one type of aplastic anemia.

In aplastic anemia, your bone marrow stops making or doesn't make enough of all three types of blood cells: red blood cells, white blood cells, and platelets.

Aplastic anemia can be inherited or acquired after birth through exposure to chemicals, radiation, or medicines.

Doctors diagnose aplastic anemia using:

If you or your child is diagnosed with aplastic anemia, your doctor will want to find the cause. If your doctor suspects you have FA, he or she may recommend genetic testing.

For more information, go to the Health Topics Aplastic Anemia article.

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How Is Fanconi Anemia Treated?

Doctors decide how to treat Fanconi anemia (FA) based on a person's age and how well the person's bone marrow is making new blood cells.

Goals of Treatment

Long-term treatments for FA can:

  • Cure the anemia. Damaged bone marrow cells are replaced with healthy ones that can make enough of all three types of blood cells on their own.

—Or—

  • Treat the symptoms without curing the cause. This is done using medicines and other substances that can help your body make more blood cells for a limited time.

Screening and Short-Term Treatment

Even if you or your child has FA, your bone marrow might still be able to make enough new blood cells. If so, your doctor might suggest frequent blood count checks so he or she can watch your condition.

Your doctor will probably want you to have bone marrow tests once a year. He or she also will screen you for any signs of cancer or tumors.

If your blood counts begin to drop sharply and stay low, your bone marrow might be failing. Your doctor may prescribe antibiotics to help your body fight infections. In the short term, he or she also may want to give you blood transfusions to increase your blood cell counts to normal levels.

However, long-term use of blood transfusions can reduce the chance that other treatments will work.

Long-Term Treatment

The four main types of long-term treatment for FA are:

Blood and Marrow Stem Cell Transplant

A blood and marrow stem cell transplant is the current standard treatment for patients who have FA that's causing major bone marrow failure. Healthy stem cells from another person, called a donor, are used to replace the faulty cells in your bone marrow.

If you're going to receive stem cells from another person, your doctor will want to find a donor whose stem cells match yours as closely as possible.

Stem cell transplants are most successful in younger people who:

  • Have few or no serious health problems
  • Receive stem cells from a brother or sister who is a good donor match
  • Have had few or no previous blood transfusions

During the transplant, you'll get donated stem cells in a procedure that's like a blood transfusion. Once the new stem cells are in your body, they travel to your bone marrow and begin making new blood cells.

A successful stem cell transplant will allow your body to make enough of all three types of blood cells.

Even if you've had a stem cell transplant to treat FA, you’re still at risk for some types of blood cancer and cancerous solid tumors. Your doctor will check your health regularly after the procedure.

For more information about stem cell transplants—including finding a donor, having the procedure, and learning about the risks—go to the Health Topics Blood and Marrow Stem Cell Transplant article.

Androgen Therapy

Before improvements made stem cell transplants more effective, androgen therapy was the standard treatment for people who had FA. Androgens are man-made male hormones that can help your body make more blood cells for long periods.

Androgens increase your red blood cell and platelet counts. They don't work as well at raising your white blood cell count.

Unlike a stem cell transplant, androgens don't allow your bone marrow to make enough of all three types of blood cells on its own. You may need ongoing treatment with androgens to control the effects of FA.

Also, over time, androgens lose their ability to help your body make more blood cells, which means you'll need other treatments.

Androgen therapy can have serious side effects, such as liver disease. This treatment also can't prevent you from developing leukemia (a type of blood cancer).

Synthetic Growth Factors

Your doctor may choose to treat your FA with growth factors. These are substances found in your body, but they also can be man-made.

Growth factors help your body make more red and white blood cells. Growth factors that help your body make more platelets still are being studied.

More research is needed on growth factor treatment for FA. Early results suggest that growth factors may have fewer and less serious side effects than androgens.

Gene Therapy

Researchers are looking for ways to replace faulty FA genes with normal, healthy genes. They hope these genes will make proteins that can repair and protect your bone marrow cells. Early results of this therapy hold promise, but more research is needed.

Surgery

FA can cause birth defects that affect the arms, thumbs, hips, legs, and other parts of the body. Doctors may recommend surgery to repair some defects.

For example, your child might be born with a ventricular septal defect—a hole or defect in the wall that separates the lower chambers of the heart. His or her doctor may recommend surgery to close the hole so the heart can work properly.

Children who have FA also may need surgery to correct digestive system problems that can harm their nutrition, growth, and survival.

One of the most common problems is an FA-related birth defect in which the trachea (windpipe), which carries air to the lungs, is connected to the esophagus, which carries food to the stomach.

This can cause serious breathing, swallowing, and eating problems and can lead to lung infections. Surgery is needed to separate the two organs and allow normal eating and breathing.

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diseases_conditions.last_update": "June 11, 2014.", "diseases_conditions.category_1_x_diseases_conditions_id": { "33": { "category_1_x_diseases_conditions.id": 33, "category_1.id": 6, "category_1.ts": "2018-02-02 04:25:06", "category_1.title": "f" } } }, "34": { "diseases_conditions.id": 34, "diseases_conditions.ts": "2018-02-02 05:12:09", "diseases_conditions.title": "Heart Attack", "diseases_conditions.diseases_conditions_detail": "
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What Is a Heart Attack?

A heart attack happens when the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart can't get oxygen. If blood flow isn't restored quickly, the section of heart muscle begins to die.

Heart attacks are a leading killer of both men and women in the United States. The good news is that excellent treatments are available for heart attacks. These treatments can save lives and prevent disabilities.

Heart attack treatment works best when it's given right after symptoms occur. If you think you or someone else is having a heart attack (even if you're not fully sure), call 9–1–1 right away.

Overview

Heart attacks most often occur as a result of coronary heart disease (CHD), also called coronary artery disease. CHD is a condition in which a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart.

When plaque builds up in the arteries, the condition is called atherosclerosis (ath-er-o-skler-O-sis). The buildup of plaque occurs over many years.

Eventually, an area of plaque can rupture (break open) inside of an artery. This causes a blood clot to form on the plaque's surface. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.

If the blockage isn't treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.

\"Heart

Figure

Heart With Muscle Damage and a Blocked Artery. Figure A shows a heart with dead heart muscle caused by a heart attack. Figure B is a cross-section of a coronary artery with plaque buildup and a blood clot.

A less common cause of heart attack is a severe spasm (tightening) of a coronary artery. The spasm cuts off blood flow through the artery. Spasms can occur in coronary arteries that aren't affected by atherosclerosis.

Heart attacks can be associated with or lead to severe health problems, such as heart failure and life-threatening arrhythmias (ah-RITH-me-ahs).

Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. Arrhythmias are irregular heartbeats. Ventricular fibrillation is a life-threatening arrhythmia that can cause death if not treated right away.

Don't Wait—Get Help Quickly

Acting fast at the first sign of heart attack symptoms can save your life and limit damage to your heart. Treatment works best when it's given right after symptoms occur.

Many people aren't sure what's wrong when they are having symptoms of a heart attack. Some of the most common warning symptoms of a heart attack for both men and women are:

  • Chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion.
  • Upper body discomfort. You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach (above the belly button).
  • Shortness of breath. This may be your only symptom, or it may occur before or along with chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity.

Other possible symptoms of a heart attack include:

  • Breaking out in a cold sweat
  • Feeling unusually tired for no reason, sometimes for days (especially if you are a woman)
  • Nausea (feeling sick to the stomach) and vomiting
  • Light-headedness or sudden dizziness
  • Any sudden, new symptom or a change in the pattern of symptoms you already have (for example, if your symptoms become stronger or last longer than usual)

Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies, or other common symptoms such as chest discomfort. The symptoms of a heart attack can vary from person to person. Some people can have few symptoms and are surprised to learn they've had a heart attack. If you've already had a heart attack, your symptoms may not be the same for another one.

Quick Action Can Save Your Life: Call 9–1–1

If you think you or someone else may be having heart attack symptoms or a heart attack, don't ignore it or feel embarrassed to call for help. Call 9–1–1 for emergency medical care. Acting fast can save your life.

Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. Take a nitroglycerin pill if your doctor has prescribed this type of treatment.

Outlook

Each year, close to 1 million people in the United States have heart attacks, and many of them die. CHD, which often results in heart attacks, is the leading killer of both men and women in the United States.

Many more people could survive or recover better from heart attacks if they got help faster. Of the people who die from heart attacks, about half die within an hour of the first symptoms and before they reach the hospital.

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Other Names for a Heart Attack

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What Causes a Heart Attack?

Coronary Heart Disease

A heart attack happens if the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart can't get oxygen. Most heart attacks occur as a result of coronary heart disease (CHD).

CHD is a condition in which a waxy substance called plaque builds up inside of the coronary arteries. These arteries supply oxygen-rich blood to your heart.

When plaque builds up in the arteries, the condition is called atherosclerosis. The buildup of plaque occurs over many years.

Eventually, an area of plaque can rupture (break open) inside of an artery. This causes a blood clot to form on the plaque's surface. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.

If the blockage isn't treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.

Coronary Artery Spasm

A less common cause of heart attack is a severe spasm (tightening) of a coronary artery. The spasm cuts off blood flow through the artery. Spasms can occur in coronary arteries that aren't affected by atherosclerosis.

What causes a coronary artery to spasm isn't always clear. A spasm may be related to:

  • Taking certain drugs, such as cocaine
  • Emotional stress or pain
  • Exposure to extreme cold
  • Cigarette smoking

The animation below shows how plaque buildup or a coronary artery spasm can lead to a heart attack. Click the \"start\" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.

\"Figure

Figure

The animation shows how blocked blood flow in a coronary artery can lead to a heart attack.

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Who Is at Risk for a Heart Attack?

Certain risk factors make it more likely that you'll develop coronary heart disease (CHD) and have a heart attack. You can control many of these risk factors.

Risk Factors You Can Control

The major risk factors for a heart attack that you can control include:

Some of these risk factors—such as obesity, high blood pressure, and high blood sugar—tend to occur together. When they do, it's called metabolic syndrome.

In general, a person who has metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as someone who doesn't have metabolic syndrome.

For more information about the risk factors that are part of metabolic syndrome, go to the Health Topics Metabolic Syndrome article.

Risk Factors You Can't Control

Risk factors that you can't control include:

  • Age. The risk of heart disease increases for men after age 45 and for women after age 55 (or after menopause).
  • Family history of early heart disease. Your risk increases if your father or a brother was diagnosed with heart disease before 55 years of age, or if your mother or a sister was diagnosed with heart disease before 65 years of age.
  • Preeclampsia (pre-e-KLAMP-se-ah). This condition can develop during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine. Preeclampsia is linked to an increased lifetime risk of heart disease, including CHD, heart attack, heart failure, and high blood pressure.
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What Are the Symptoms of a Heart Attack?

Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies. In one study, for example, one-third of the patients who had heart attacks had no chest pain. These patients were more likely to be older, female, or diabetic.

The symptoms of a heart attack can vary from person to person. Some people can have few symptoms and are surprised to learn they've had a heart attack. If you've already had a heart attack, your symptoms may not be the same for another one. It is important for you to know the most common symptoms of a heart attack and also remember these facts:

Some people don't have symptoms at all. Heart attacks that occur without any symptoms or with very mild symptoms are called silent heart attacks.

Most Common Symptoms

The most common warning symptoms of a heart attack for both men and women are:

  • Chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion. The feeling can be mild or severe.
  • Upper body discomfort. You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach (above the belly button).
  • Shortness of breath. This may be your only symptom, or it may occur before or along with chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity.

The symptoms of angina (an-JI-nuh or AN-juh-nuh) can be similar to the symptoms of a heart attack. Angina is chest pain that occurs in people who have coronary heart disease, usually when they're active. Angina pain usually lasts for only a few minutes and goes away with rest.

Chest pain or discomfort that doesn't go away or changes from its usual pattern (for example, occurs more often or while you're resting) can be a sign of a heart attack.

All chest pain should be checked by a doctor.

Other Common Symptoms

Pay attention to these other possible symptoms of a heart attack:

  • Breaking out in a cold sweat
  • Feeling unusually tired for no reason, sometimes for days (especially if you are a woman)
  • Nausea (feeling sick to the stomach) and vomiting
  • Light-headedness or sudden dizziness
  • Any sudden, new symptoms or a change in the pattern of symptoms you already have (for example, if your symptoms become stronger or last longer than usual)

Not everyone having a heart attack has typical symptoms. If you've already had a heart attack, your symptoms may not be the same for another one. However, some people may have a pattern of symptoms that recur.

The more signs and symptoms you have, the more likely it is that you're having a heart attack.

Quick Action Can Save Your Life: Call 9–1–1

The signs and symptoms of a heart attack can develop suddenly. However, they also can develop slowly—sometimes within hours, days, or weeks of a heart attack.

Any time you think you might be having heart attack symptoms or a heart attack, don't ignore it or feel embarrassed to call for help. Call 9–1–1 for emergency medical care, even if you are not sure whether you're having a heart attack. Here's why:

  • Acting fast can save your life.
  • An ambulance is the best and safest way to get to the hospital. Emergency medical services (EMS) personnel can check how you are doing and start life-saving medicines and other treatments right away. People who arrive by ambulance often receive faster treatment at the hospital.
  • The 9–1–1 operator or EMS technician can give you advice. You might be told to crush or chew an aspirin if you're not allergic, unless there is a medical reason for you not to take one. Aspirin taken during a heart attack can limit the damage to your heart and save your life.

Every minute matters. Never delay calling 9–1–1 to take aspirin or do anything else you think might help.

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How Is a Heart Attack Diagnosed?

Your doctor will diagnose a heart attack based on your signs and symptoms, your medical and family histories, and test results.

Diagnostic Tests

EKG (Electrocardiogram)

An EKG is a simple, painless test that detects and records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through each part of the heart.

An EKG can show signs of heart damage due to coronary heart disease (CHD) and signs of a previous or current heart attack.

Blood Tests

During a heart attack, heart muscle cells die and release proteins into the bloodstream. Blood tests can measure the amount of these proteins in the bloodstream. Higher than normal levels of these proteins suggest a heart attack.

Commonly used blood tests include troponin tests, CK or CK–MB tests, and serum myoglobin tests. Blood tests often are repeated to check for changes over time.

Coronary Angiography

Coronary angiography (an-jee-OG-ra-fee) is a test that uses dye and special x rays to show the insides of your coronary arteries. This test often is done during a heart attack to help find blockages in the coronary arteries.

To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization (KATH-e-ter-ih-ZA-shun).

A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream.

Special x rays are taken while the dye is flowing through the coronary arteries. The dye lets your doctor study the flow of blood through the heart and blood vessels.

If your doctor finds a blockage, he or she may recommend a procedure called percutaneous (per-ku-TA-ne-us) coronary intervention (PCI), sometimes referred to as coronary angioplasty (AN-jee-oh-plas-tee). This procedure can help restore blood flow through a blocked artery. Sometimes a small mesh tube called a stent is placed in the artery to help prevent blockages after the procedure.

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How Is a Heart Attack Treated?

Early treatment for a heart attack can prevent or limit damage to the heart muscle. Acting fast, at the first symptoms of a heart attack, can save your life. Medical personnel can begin diagnosis and treatment even before you get to the hospital.

Certain treatments usually are started right away if a heart attack is suspected, even before the diagnosis is confirmed. These include:

Once the diagnosis of a heart attack is confirmed or strongly suspected, doctors start treatments to try to promptly restore blood flow to the heart. The two main treatments are \"clot-busting\" medicines and percutaneous coronary intervention (PCI), sometimes referred to as coronary angioplasty, a procedure used to open blocked coronary arteries.

Clot-Busting Medicines

Thrombolytic medicines, also called \"clot busters,\" are used to dissolve blood clots that are blocking the coronary arteries. To work best, these medicines must be given within several hours of the start of heart attack symptoms. Ideally, the medicine should be given as soon as possible.

Percutaneous Coronary Intervention

PCI is a nonsurgical procedure that opens blocked or narrowed coronary arteries. This procedure also is called coronary angioplasty.

A thin, flexible tube with a balloon or other device on the end is threaded through a blood vessel, usually in the groin (upper thigh), to the narrowed or blocked coronary artery.

Once in place, the balloon is inflated to compress the plaque against the wall of the artery. This restores blood flow through the artery.

During the procedure, the doctor may put a small mesh tube called a stent in the artery. The stent helps prevent blockages in the artery in the months or years after the procedure.

For more information, go to the Health Topics Coronary Angioplasty article.

Other Treatments for Heart Attack

Medicines

  • Beta blockers. Beta blockers decrease your heart's workload. These medicines also are used to relieve chest pain and discomfort and to help prevent repeat heart attacks. Beta blockers also are used to treat arrhythmias (irregular heartbeats).
  • ACE inhibitors. ACE inhibitors lower blood pressure and reduce strain on your heart. They also help slow down further weakening of the heart muscle.
  • Anticoagulants. Anticoagulants, or \"blood thinners,\" prevent blood clots from forming in your arteries. These medicines also keep existing clots from getting larger.
  • Anticlotting medicines. Anticlotting medicines stop platelets from clumping together and forming unwanted blood clots. Examples of anticlotting medicines include aspirin and clopidogrel.

You also may be given medicines to relieve pain and anxiety, treat arrhythmias (which often occur during a heart attack), or lower your cholesterol (these medicines are called statins).

Medical Procedures

Coronary artery bypass grafting (CABG) also may be used to treat a heart attack. During CABG, a surgeon removes a healthy artery or vein from your body. The artery or vein is then connected, or grafted, to the blocked coronary artery.

The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This provides a new route for blood to flow to the heart muscle.

For more information, go to the Health Topics Coronary Artery Bypass Grafting article.

Treatment After You Leave the Hospital

Most people spend several days in the hospital after a heart attack. When you leave the hospital, treatment doesn't stop. At home, your treatment may include daily medicines and cardiac rehabilitation (rehab). Your doctor may want you to have a flu shot and pneumococcal vaccine each year.

Your doctor also may recommend lifestyle changes, including following a heart healthy diet, being physically active, maintaining a healthy weight, and quitting smoking. Taking these steps can lower your chances of having another heart attack.

Cardiac Rehabilitation

Your doctor may recommend cardiac rehab to help you recover from a heart attack and to help prevent another heart attack. Almost everyone who has had a heart attack can benefit from rehab.

Cardiac rehab is a medically supervised program that may help improve the health and well-being of people who have heart problems.

The cardiac rehab team may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians or nutritionists, and psychologists or other mental health specialists.

Rehab has two parts:

  • Exercise training. This part helps you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your personal abilities, needs, and interests.
  • Education, counseling, and training. This part of rehab helps you understand your heart condition and find ways to reduce your risk of future heart problems. The rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and deal with your fears about the future.

For more information, go to the Health Topics Cardiac Rehabilitation article.

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How Can a Heart Attack Be Prevented?

Lowering your risk factors for coronary heart disease (CHD) can help you prevent a heart attack. (For more information about risk factors, go to \"Who Is at Risk for a Heart Attack?\")

Even if you already have CHD, you can still take steps to lower your risk for a heart attack. These steps involve following a heart healthy lifestyle and getting ongoing care.

Heart Healthy Lifestyle

Following a healthy diet is an important part of a heart healthy lifestyle. A healthy diet includes a variety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish, beans, and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugars.

For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute's (NHLBI's) Aim for a Healthy Weight Web site, \"Your Guide to a Healthy Heart,\" and \"Your Guide to Lowering Your Blood Pressure With DASH.\" All of these resources provide general information about healthy eating.

If you're overweight or obese, work with your doctor to create a reasonable weight-loss plan that involves diet and physical activity. Controlling your weight helps you control risk factors for CHD and heart attack.

Be as physically active as you can. Physical activity can improve your fitness level and your health. Talk with your doctor about what types of activity are safe for you.

For more information about physical activity, go to the Health Topics Physical Activity and Your Heart article and the NHLBI's \"Your Guide to Physical Activity and Your Heart.\"

If you smoke, quit. Smoking can raise your risk of CHD and diseases_conditions.last_update": "June 11, 2014.", "diseases_conditions.category_1_x_diseases_conditions_id": { "34": { "category_1_x_diseases_conditions.id": 34, "category_1.id": 7, "category_1.ts": "2018-02-02 04:25:06", "category_1.title": "h" } } }, "35": { "diseases_conditions.id": 35, "diseases_conditions.ts": "2018-02-02 05:12:29", "diseases_conditions.title": "Heart Block", "diseases_conditions.diseases_conditions_detail": "

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What Is Heart Block?

Heart block is a problem that occurs with the heart's electrical system. This system controls the rate and rhythm of heartbeats. (\"Rate\" refers to the number of times your heart beats per minute. \"Rhythm\" refers to the pattern of regular or irregular pulses produced as the heart beats.)

With each heartbeat, an electrical signal spreads across the heart from the upper to the lower chambers. As it travels, the signal causes the heart to contract and pump blood.

Heart block occurs if the electrical signal is slowed or disrupted as it moves through the heart.

Overview

Heart block is a type of arrhythmia (ah-RITH-me-ah). An arrhythmia is any problem with the rate or rhythm of the heartbeat.

Some people are born with heart block, while others develop it during their lifetimes. If you're born with the condition, it's called congenital (kon-JEN-ih-tal) heart block. If the condition develops after birth, it's called acquired heart block.

Doctors might detect congenital heart block before or after a baby is born. Certain diseases that may occur during pregnancy can cause heart block in a baby. Some congenital heart defects also can cause heart block. Congenital heart defects are problems with the heart's structure that are present at birth. Often, doctors don't know what causes these defects.

Acquired heart block is more common than congenital heart block. Damage to the heart muscle or its electrical system causes acquired heart block. Diseases, surgery, or medicines can cause this damage.

The three types of heart block are first degree, second degree, and third degree. First degree is the least severe, and third degree is the most severe. This is true for both congenital and acquired heart block.

Doctors use a test called an EKG (electrocardiogram) to help diagnose heart block. This test detects and records the heart's electrical activity. It maps the data on a graph for the doctor to review.

Outlook

The symptoms and severity of heart block depend on which type you have. First-degree heart block may not cause any severe symptoms.

Second-degree heart block may result in the heart skipping a beat or beats. This type of heart block also can make you feel dizzy or faint.

Third-degree heart block limits the heart's ability to pump blood to the rest of the body. This type of heart block may cause fatigue (tiredness), dizziness, and fainting. Third-degree heart block requires prompt treatment because it can be fatal.

A medical device called a pacemaker is used to treat third-degree heart block and some cases of second-degree heart block. This device uses electrical pulses to prompt the heart to beat at a normal rate. Pacemakers typically are not used to treat first-degree heart block.

All types of heart block may increase your risk for other arrhythmias, such as atrial fibrillation (A-tre-al fih-brih-LA-shun). Talk with your doctor to learn more about the signs and symptoms of arrhythmias.

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Understanding the Heart's Electrical System and EKG Results

Doctors use a test called an EKG (electrocardiogram) to help diagnose heart block. This test detects and records the heart's electrical activity. An EKG records the strength and timing of electrical signals as they pass through the heart.

The data are recorded on a graph so your doctor can study your heart's electrical activity. Different parts of the graph show each step of an electrical signal's journey through the heart.

\"EKG.\"

Figure

EKG. The image shows the standard setup for an EKG. In figure A, a normal heart rhythm recording shows the electrical pattern of a regular heartbeat. In figure B, a patient lies in a bed with EKG electrodes attached to his chest, upper arms, and legs. (more...)

Each electrical signal begins in a group of cells called the sinus node or sinoatrial (SA) node. The SA node is located in the right atrium (AY-tree-um), which is the upper right chamber of the heart. (Your heart has two upper chambers and two lower chambers.)

In a healthy adult heart at rest, the SA node sends an electrical signal to begin a new heartbeat 60 to 100 times a minute.

From the SA node, the signal travels through the right and left atria. This causes the atria to contract, which helps move blood into the heart's lower chambers, the ventricles (VEN-trih-kuls). The electrical signal moving through the atria is recorded as the P wave on the EKG.

The electrical signal passes between the atria and ventricles through a group of cells called the atrioventricular (AV) node. The signal slows down as it passes through the AV node. This slowing allows the ventricles enough time to finish filling with blood. On the EKG, this part of the process is the flat line between the end of the P wave and the beginning of the Q wave.

The electrical signal then leaves the AV node and travels along a pathway called the bundle of His. From there, the signal travels into the right and left bundle branches. The signal spreads quickly across your heart's ventricles, causing them to contract and pump blood to your lungs and the rest of your body. This process is recorded as the QRS waves on the EKG.

The ventricles then recover their normal electrical state (shown as the T wave on the EKG). The muscle stops contracting to allow the heart to refill with blood. This entire process continues over and over with each new heartbeat.

The animation below shows how your heart's electrical system works and how an EKG records your heart's electrical activity. Click the \"start\" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.

\"Figure

Figure

The animation shows how an electrical signal moves through your heart and how an EKG records your heart's electrical activity.

For more information about the heart's electrical system, go to the Health Topics How the Heart Works article.

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Types of Heart Block

Some people are born with heart block (congenital), while others develop it during their lifetimes (acquired). Acquired heart block is more common than congenital heart block.

The three types of heart block are first degree, second degree, and third degree. First degree is the least severe, and third degree is the most severe. This is true for both congenital and acquired heart block.

First-Degree Heart Block

In first-degree heart block, the heart's electrical signals are slowed as they move from the atria to the ventricles (the heart's upper and lower chambers, respectively). This results in a longer, flatter line between the P and the R waves on the EKG (electrocardiogram).

First-degree heart block may not cause any symptoms or require treatment.

Second-Degree Heart Block

In this type of heart block, electrical signals between the atria and ventricles are slowed to a large degree. Some signals don't reach the ventricles. On an EKG, the pattern of QRS waves doesn't follow each P wave as it normally would.

If an electrical signal is blocked before it reaches the ventricles, they won't contract and pump blood to the lungs and the rest of the body.

Second-degree heart block is divided into two types: Mobitz type I and Mobitz type II.

Mobitz Type I

In this type (also known as Wenckebach's block), the electrical signals are delayed more and more with each heartbeat, until the heart skips a beat. On the EKG, the delay is shown as a line (called the PR interval) between the P and QRS waves. The line gets longer and longer until the QRS waves don't follow the next P wave.

Sometimes people who have Mobitz type I feel dizzy or have other symptoms. This type of second-degree heart block is less serious than Mobitz type II.

The animation below shows how your heart's electrical system works. It also shows what happens during second-degree Mobitz type I heart block. Click the \"start\" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.

The first part of this animation is the same as the animation in the section on understanding the heart's electrical system and EKG results. If you want to skip directly to the frames on Mobitz type I heart block, click the \"skip intro\" link above the start, pause, and replay buttons.

\"Figure

Figure

The first part of the animation shows how an electrical signal moves through your heart and how an EKG records your heart's electrical activity. The second part of the animation shows how a pause in the heart's electrical signal can delay or block the (more...)

Mobitz Type II

In second-degree Mobitz type II heart block, some of the electrical signals don't reach the ventricles. However, the pattern is less regular than it is in Mobitz type I. Some signals move between the atria and ventricles normally, while others are blocked.

On an EKG, the QRS wave follows the P wave at a normal speed. Sometimes, though, the QRS wave is missing (when a signal is blocked).

Mobitz type II is less common than type I, but it's usually more severe. Some people who have type II need medical devices called pacemakers to maintain their heart rates.

Third-Degree Heart Block

In this type of heart block, none of the electrical signals reach the ventricles. This type also is called complete heart block or complete AV block.

When complete heart block occurs, special areas in the ventricles may create electrical signals to cause the ventricles to contract. This natural backup system is slower than the normal heart rate and isn't coordinated with the contraction of the atria. On an EKG, the normal pattern is disrupted. The P waves occur at a faster rate, and it isn't coordinated with the QRS waves.

Complete heart block can result in sudden cardiac arrest and death. This type of heart block often requires emergency treatment. A temporary pacemaker might be used to keep the heart beating until you get a long-term pacemaker.

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What Causes Heart Block?

Heart block has many causes. Some people are born with the disorder (congenital), while others develop it during their lifetimes (acquired).

Congenital Heart Block

One form of congenital heart block occurs in babies whose mothers have autoimmune diseases, such as lupus. With autoimmune diseases, the body makes proteins called antibodies that attack and damage tissues or cells.

In pregnant women, antibodies can cross the placenta. (The placenta is the organ that attaches the umbilical cord to the mother's womb.) These proteins can damage the baby's heart and lead to congenital heart block.

Congenital heart defects also can cause congenital heart block. These defects are problems with the heart's structure that are present at birth. Often, doctors don't know what causes congenital heart defects.

Acquired Heart Block

Many factors can cause acquired heart block. Examples include:

Other diseases may increase the risk of heart block. Examples include sarcoidosis (sar-koy-DOE-sis) and the degenerative muscle disorders Lev's disease and Lenegre's disease.

Certain types of surgery also may damage the heart's electrical system and lead to heart block.

Exposure to toxic substances and taking certain medicines—including digitalis, beta blockers, and calcium channel blockers—also may cause heart block. Doctors closely watch people who are taking these medicines for signs of problems.

Some types of heart block have been linked to genetic mutations (changes in the genes).

An overly active vagus nerve also can cause heart block. You have one vagus nerve on each side of your body. These nerves run from your brain stem all the way to your abdomen. Activity in the vagus nerve slows the heart rate.

Sometimes acquired heart block will go away if the factor causing it is treated or resolved. For example, heart block that occurs after a heart attack or surgery may go away during recovery.

If medicine is causing heart block, the disorder may go away if the medicine is stopped or the dosage is lowered. (Always talk with your doctor before you change the way you take your medicines.)

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Who Is at Risk for Heart Block?

The risk factors for congenital and acquired heart block are different.

Congenital Heart Block

If a pregnant woman has an autoimmune disease, such as lupus, her fetus is at risk for heart block.

Autoimmune diseases can cause the body to make proteins called antibodies that can cross the placenta. (The placenta is the organ that attaches the umbilical cord to the mother's womb.) These antibodies may damage the baby's heart and lead to congenital heart block.

Congenital heart defects also can cause heart block. These defects are problems with the heart's structure that are present at birth. Most of the time, doctors don't know what causes congenital heart defects.

Heredity may play a role in certain heart defects. For example, a parent who has a congenital heart defect might be more likely than other people to have a child with the condition.

Acquired Heart Block

Acquired heart block can occur in people of any age. However, most types of the condition are more common in older people. This is because many of the risk factors are more common in older people.

People who have a history of heart disease or heart attacks are at increased risk for heart block. Examples of heart disease that can lead to heart block include heart failure, coronary heart disease, and cardiomyopathy (heart muscle diseases).

Other diseases also may raise the risk of heart block, such as sarcoidosis and the degenerative muscle disorders Lev's disease and Lenegre's disease.

Exposure to toxic substances or taking certain medicines, such as digitalis, also can raise your risk for heart block.

Well-trained athletes and young people are at higher risk for first-degree heart block caused by an overly active vagus nerve. You have one vagus nerve on each side of your body. These nerves run from your brain stem all the way to your abdomen. Activity in the vagus nerve slows the heart rate.

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What Are the Signs and Symptoms of Heart Block?

Signs and symptoms depend on the type of heart block you have. First-degree heart block may not cause any symptoms.

Signs and symptoms of second- and third-degree heart block include:

These symptoms may suggest other health problems as well. If these symptoms are new or severe, call 9–1–1 or have someone drive you to the hospital emergency room. If you have milder symptoms, talk with your doctor right away to find out whether you need prompt treatment.

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How Is Heart Block Diagnosed?

Heart block might be diagnosed as part of a routine doctor's visit or during an emergency situation. (Third-degree heart block often is an emergency.)

Your doctor will diagnose heart block based on your family and medical histories, a physical exam, and test results.

Specialists Involved

Your primary care doctor might be involved in diagnosing heart block. However, if you have the condition, you might need to see a heart specialist. Heart specialists include:

  • Cardiologists (doctors who diagnose and treat adults who have heart problems)
  • Pediatric cardiologists (doctors who diagnose and treat babies and children who have heart problems)
  • Electrophysiologists (cardiologists or pediatric cardiologists who specialize in the heart's electrical system)

Family and Medical Histories

Your doctor may ask whether:

  • You have any health problems, such as heart disease
  • Any of your family members have been diagnosed with heart block or other health problems
  • You're taking any medicines, including herbal products and prescription and over-the-counter medicines
  • You smoke or use alcohol or drugs

Your doctor also may ask about other health habits, such as how physically active you are.

Physical Exam

During the physical exam, your doctor will listen to your heart. He or she will listen carefully for abnormal rhythms or heart murmurs (extra or unusual sounds heard during heartbeats).

Your doctor also may:

Diagnostic Tests and Procedures

EKG (Electrocardiogram)

Doctors usually use an EKG (electrocardiogram) to help diagnose heart block. This simple test detects and records the heart's electrical activity.

An EKG shows how fast the heart is beating and its rhythm (steady or irregular). The test also records the strength and timing of electrical signals as they pass through the heart.

The data are recorded on a graph. Different types of heart block have different patterns on the graph. (For more information, go to \"Types of Heart Block.\")

A standard EKG only records the heart's activity for a few seconds. To diagnose heart rhythm problems that come and go, your doctor may have you wear a portable EKG monitor.

The most common types of portable EKGs are Holter and event monitors. Your doctor may have you use one of these monitors to diagnose first- or second-degree heart block.

Holter and Event Monitors

A Holter monitor records the heart's electrical signals for a full 24- or 48-hour period. You wear one while you do your normal daily activities. This allows the monitor to record your heart for a longer time than a standard EKG.

An event monitor is similar to a Holter monitor. You wear an event monitor while doing your normal activities. However, an event monitor only records your heart's electrical activity at certain times while you're wearing it.

You may wear an event monitor for 1 to 2 months, or as long as it takes to get a recording of your heart during symptoms.

Electrophysiology Study

For some cases of heart block, doctors may do electrophysiology studies (EPS). During this test, a thin, flexible wire is passed through a vein in your groin (upper thigh) or arm to your heart. The wire records your heart's electrical signals.

Other Tests

To diagnose heart block, your doctor may recommend tests to rule out other types of arrhythmias (irregular heartbeats). For more information, go to \"How Are Arrhythmias Diagnosed?\"

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How Is Heart Block Treated?

Treatment depends on the type of heart block you have. If you have first-degree heart block, you may not need treatment.

If you have second-degree heart block, you may need a pacemaker. A pacemaker is a small device that's placed under the skin of your chest or abdomen. This device uses electrical pulses to prompt the heart to beat at a normal rate.

If you have third-degree heart block, you will need a pacemaker. In an emergency, a temporary pacemaker might be used until you can get a long-term device. Most people who have third-degree heart block need pacemakers for the rest of their lives.

Some people who have third-degree congenital heart block don't need pacemakers for many years. Others may need pacemakers at a young age or during infancy.

If a pregnant woman has an autoimmune disease, such as lupus, her fetus is at risk for heart block. If heart block is detected in a fetus, the mother might be given medicine to reduce the fetus' risk of developing serious heart block.

Sometimes acquired heart block goes away if the factor causing it is treated or resolved. For example, heart block that occurs after a heart attack or surgery may go away during recovery.

Also, if a medicine is causing heart block, the condition may go away if the medicine is stopped or the dosage is lowered. (Always talk with your doctor before you change the way you take your medicines.)

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Living With Heart Block

First-degree heart block may not cause any symptoms or require treatment. However, some research has shown that people who have first-degree heart block might be at higher risk for atrial fibrillation (AF) in the future.

AF is a type of arrhythmia. It occurs if rapid, disorganized electrical signals cause the heart's upper chambers to contract very fast and irregularly.

If you've been diagnosed with first-degree heart block, ask your doctor whether you need to take any special steps to control it.

Your doctor can tell you whether you need ongoing care or whether you need to change the way you take certain medicines.

If you have second-degree heart block that doesn't require a pacemaker, talk with your doctor about keeping your heart healthy. Your doctor will tell you whether you need ongoing care for your condition.

Living With a Pacemaker

People who have third-degree heart block and some people who have second-degree heart block need pacemakers. These devices use electrical pulses to prompt the heart to beat at a normal rate.

If you have a pacemaker, you should take special care to avoid things that may interfere with it. Avoid close or prolonged contact with electrical devices and devices that have strong magnetic fields. These objects can keep your pacemaker from working properly.

Let all of your doctors, dentists, and medical technicians know that you have a pacemaker. You also should notify airport screeners.

Your doctor can give you a card that states what kind of pacemaker you have. Carry this card in your wallet. You may want to wear a medical ID bracelet or necklace that states that you have a pacemaker.

Certain medical procedures can disrupt pacemakers. Examples include MRI (magnetic resonance imaging), electrocauterization during surgery, and shock-wave lithotripsy to get rid of kidney stones.

Your doctor may need to check your pacemaker several times a year to make sure it's working well. Some pacemakers must be checked in the doctor's office, but others can be checked over the phone.

Ask your doctor about what types of physical activity are safe for you. A pacemaker usually won't limit you from doing sports and physical activity. But you may need to avoid full-contact sports, such as football, that can damage the pacemaker.

For more information about living with a pacemaker, go to the Health Topics Pacemaker article.

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Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.

NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.

Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.

By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.

If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.

If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.

For more information about clinical trials related to heart block, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:

  • http://clinicalresearch.nih.gov
  • diseases_conditions.last_update": "June 11, 2014.", "diseases_conditions.category_1_x_diseases_conditions_id": { "35": { "category_1_x_diseases_conditions.id": 35, "category_1.id": 7, "category_1.ts": "2018-02-02 04:25:06", "category_1.title": "h" } } }, "36": { "diseases_conditions.id": 36, "diseases_conditions.ts": "2018-02-02 05:12:49", "diseases_conditions.title": "Heart Disease in Women", "diseases_conditions.diseases_conditions_detail": "
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    How Does Heart Disease Affect Women?

    In the United States, 1 in 4 women dies from heart disease. In fact, coronary heart disease (CHD)—the most common type of heart disease—is the #1 killer of both men and women in the United States.

    Other types of heart disease, such as coronary microvascular disease (MVD) and broken heart syndrome, also pose a risk for women. These disorders, which mainly affect women, are not as well understood as CHD. However, research is ongoing to learn more about coronary MVD and broken heart syndrome.

    This article focuses on CHD and its complications. However, it also includes general information about coronary MVD and broken heart syndrome.

    Coronary Heart Disease

    CHD is a disease in which plaque (plak) builds up on the inner walls of your coronary arteries. These arteries carry oxygen-rich blood to your heart. When plaque builds up in the arteries, the condition is called atherosclerosis (ath-er-o-skler-O-sis).

    Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque can harden or rupture (break open).

    Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina (an-JI-nuh or AN-juh-nuh).

    If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries.

    \"Heart

    Figure

    Heart With Muscle Damage and a Blocked Artery. Figure A is an overview of a heart and coronary artery showing damage (dead heart muscle) caused by a heart attack. Figure B is a cross-section of the coronary artery with plaque buildup and a blood clot (more...)

    Plaque also can develop within the walls of the coronary arteries. Tests that show the insides of the coronary arteries may look normal in people who have this pattern of plaque. Studies are under way to see whether this type of plaque buildup occurs more often in women than in men and why.

    In addition to angina and heart attack, CHD can cause other serious heart problems. The disease may lead to heart failure, irregular heartbeats called arrhythmias (ah-RITH-me-ahs), and sudden cardiac arrest (SCA).

    Coronary Microvascular Disease

    Coronary MVD is heart disease that affects the heart's tiny arteries. This disease is also called cardiac syndrome X or nonobstructive CHD. In coronary MVD, the walls of the heart's tiny arteries are damaged or diseased.

    \"Heart

    Figure

    Heart With Muscle Damage and a Blocked Artery Coronary Microvascular Disease. Figure A shows the small coronary artery network (microvasculature), containing a normal artery and an artery with coronary MVD. Figure B shows a large coronary artery with (more...)

    Women are more likely than men to have coronary MVD. Many researchers think that a drop in estrogen levels during menopause combined with other heart disease risk factors causes coronary MVD.

    Although death rates from heart disease have dropped in the last 30 years, they haven't dropped as much in women as in men. This may be the result of coronary MVD.

    Standard tests for CHD are not designed to detect coronary MVD. Thus, test results for women who have coronary MVD may show that they are at low risk for heart disease.

    Research is ongoing to learn more about coronary MVD and its causes.

    Broken Heart Syndrome

    Women are also more likely than men to have a condition called broken heart syndrome. In this recently recognized heart problem, extreme emotional stress can lead to severe (but often short-term) heart muscle failure.

    Broken heart syndrome is also called stress-induced cardiomyopathy (KAR-de-o-mi-OP-ah-thee) or takotsubo cardiomyopathy.

    Doctors may misdiagnose broken heart syndrome as a heart attack because it has similar symptoms and test results. However, there's no evidence of blocked heart arteries in broken heart syndrome, and most people have a full and quick recovery.

    Researchers are just starting to explore what causes this disorder and how to diagnose and treat it. Often, patients who have broken heart syndrome have previously been healthy.

    Outlook

    Women tend to have CHD about 10 years later than men. However, CHD remains the #1 killer of women in the United States.

    The good news is that you can control many CHD risk factors. CHD risk factors are conditions or habits that raise your risk for CHD and heart attack. These risk factors also can increase the chance that existing CHD will worsen.

    Lifestyle changes, medicines, and medical or surgical procedures can help women lower their risk for CHD. Thus, early and ongoing CHD prevention is important.

    More information about heart disease in women is available through the National Heart, Lung, and Blood Institute's The Heart Truth® campaign.

    ____________

    ®The Heart Truth and its logo are registered trademarks of the U.S. Department of Health and Human Services (HHS).

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Other Names for Heart Disease

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What Causes Heart Disease?

Research suggests that coronary heart disease (CHD) begins with damage to the lining and inner layers of the coronary (heart) arteries. Several factors contribute to this damage. They include:

Plaque may begin to build up where the arteries are damaged. The buildup of plaque in the coronary arteries may start in childhood.

Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina.

If the plaque ruptures, blood cell fragments called platelets (PLATE-lets) stick to the site of the injury. They may clump together to form blood clots.

Blood clots can further narrow the coronary arteries and worsen angina. If a clot becomes large enough, it can mostly or completely block a coronary artery and cause a heart attack.

In addition to the factors above, low estrogen levels before or after menopause may play a role in causing coronary microvascular disease (MVD). Coronary MVD is heart disease that affects the heart's tiny arteries.

The cause of broken heart syndrome isn't yet known. However, a sudden release of stress hormones may play a role in causing the disorder. Most cases of broken heart syndrome occur in women who have gone through menopause.

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Who Is at Risk for Heart Disease?

Certain traits, conditions, or habits may raise your risk for coronary heart disease (CHD). These conditions are known as risk factors. Risk factors also increase the chance that existing CHD will worsen.

Women generally have the same CHD risk factors as men. However, some risk factors may affect women differently than men. For example, diabetes raises the risk of CHD more in women. Also, some risk factors, such as birth control pills and menopause, only affect women.

There are many known CHD risk factors. Your risk for CHD and heart attack rises with the number of risk factors you have and their severity. Risk factors tend to \"gang up\" and worsen each other's effects.

Having just one risk factor doubles your risk for CHD. Having two risk factors increases your risk for CHD fourfold. Having three or more risk factors increases your risk for CHD more than tenfold.

Also, some risk factors, such as smoking and diabetes, put you at greater risk for CHD and heart attack than others.

More than 75 percent of women aged 40 to 60 have one or more risk factors for CHD. Many risk factors start during childhood; some even develop within the first 10 years of life. You can control most risk factors, but some you can't.

For more information about CHD risk factors, go to the Health Topics Coronary Heart Disease Risk Factors article. To find out whether you're at risk for CHD, talk with your doctor or health care provider.

Risk Factors You Can Control

Smoking

Smoking is the most powerful risk factor that women can control. Smoking tobacco or long-term exposure to secondhand smoke raises your risk for CHD and heart attack.

Smoking exposes you to carbon monoxide. This chemical robs your blood of oxygen and triggers a buildup of plaque in your arteries.

Smoking also increases the risk of blood clots forming in your arteries. Blood clots can block plaque-narrowed arteries and cause a heart attack. The more you smoke, the greater your risk for a heart attack.

Even women who smoke fewer than two cigarettes a day are at increased risk for CHD.

High Blood Cholesterol and High Triglyceride Levels

Cholesterol travels in the bloodstream in small packages called lipoproteins (LI-po-pro-teens). The two major kinds of lipoproteins are low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol.

LDL cholesterol is sometimes called \"bad\" cholesterol. This is because it carries cholesterol to tissues, including your heart arteries. HDL cholesterol is sometimes called \"good\" cholesterol. This is because it helps remove cholesterol from your arteries.

A blood test called a lipoprotein panel is used to measure cholesterol levels. This test gives information about your total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides (a type of fat found in the blood).

Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood. A woman's risk for CHD increases if she has a total cholesterol level greater than 200 mg/dL, an LDL cholesterol level greater than 100 mg/dL, or an HDL cholesterol level less than 50 mg/dL.

A triglyceride level greater than 150 mg/dL also increases a woman's risk for CHD. A woman's HDL cholesterol and triglyceride levels predict her risk for CHD better than her total cholesterol or LDL cholesterol levels.

High Blood Pressure

Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps blood. If this pressure rises and stays high over time, it can damage the body in many ways.

Women who have blood pressure greater than 120/80 mmHg are at increased risk for CHD. (The mmHg is millimeters of mercury—the units used to measure blood pressure.)

High blood pressure is defined differently for people who have diabetes or chronic kidney disease. If you have one of these diseases, work with your doctor to set a healthy blood pressure goal.

Diabetes and Prediabetes

Diabetes is a disease in which the body's blood sugar level is too high. This is because the body doesn't make enough insulin or doesn't use its insulin properly.

Insulin is a hormone that helps move blood sugar into cells, where it's used for energy. Over time, a high blood sugar level can lead to increased plaque buildup in your arteries.

Prediabetes is a condition in which your blood sugar level is higher than normal, but not as high as it is in diabetes. Prediabetes puts you at higher risk for both diabetes and CHD.

Diabetes and prediabetes raise the risk of CHD more in women than in men. In fact, having diabetes doubles a woman's risk of developing CHD.

Before menopause, estrogen provides women some protection against CHD. However, in women who have diabetes, the disease counters the protective effects of estrogen.

Overweight and Obesity

The terms \"overweight\" and \"obesity\" refer to body weight that's greater than what is considered healthy for a certain height.

The most useful measure of overweight and obesity is body mass index (BMI). BMI is calculated from your height and weight. In adults, a BMI of 18.5 to 24.9 is considered normal. A BMI of 25 to 29.9 is considered overweight. A BMI of 30 or more is considered obese.

You can use the National Heart, Lung, and Blood Institute's (NHLBI's) online BMI calculator to figure out your BMI, or your doctor can help you.

Studies suggest that where extra weight occurs on the body may predict CHD risk better than BMI. Women who carry much of their fat around the waist are at greatest risk for CHD. These women have \"apple-shaped\" figures.

Women who carry most of their fat on their hips and thighs—that is, those who have \"pear-shaped\" figures—are at lower risk for CHD.

To fully know how excess weight affects your CHD risk, you should know your BMI and waist measurement. If you have a BMI greater than 24.9 and a waist measurement greater than 35 inches, you're at increased risk for CHD.

If your waist measurement divided by your hip measurement is greater than 0.9, you're also at increased risk for CHD.

Studies also suggest that women whose weight goes up and down dramatically (typically due to unhealthy dieting) are at increased risk for CHD. These swings in weight can lower HDL cholesterol levels.

Metabolic Syndrome

Metabolic syndrome is the name for a group of risk factors that raises your risk for CHD and other health problems, such as diabetes and stroke. A diagnosis of metabolic syndrome is made if you have at least three of the following risk factors:

  • A large waistline. Having extra fat in the waist area is a greater risk factor for CHD than having extra fat in other parts of the body, such as on the hips.
  • A higher than normal triglyceride level (or you're on medicine to treat high triglycerides).
  • A lower than normal HDL cholesterol level (or you're on medicine to treat low HDL cholesterol).
  • Higher than normal blood pressure (or you're on medicine to treat high blood pressure).
  • Higher than normal fasting blood sugar (or you're on medicine to treat diabetes)

Metabolic syndrome is more common in African American women and Mexican American women than in men of the same racial groups. The condition affects White women and men about equally.

Birth Control Pills

Women who smoke and take birth control pills are at very high risk for CHD, especially if they're older than 35. For women who take birth control pills but don't smoke, the risk of CHD isn't fully known.

Lack of Physical Activity

Inactive people are nearly twice as likely to develop CHD as those who are physically active. A lack of physical activity can worsen other CHD risk factors, such as high blood cholesterol and triglyceride levels, high blood pressure, diabetes and prediabetes, and overweight and obesity.

Unhealthy Diet

An unhealthy diet can raise your risk for CHD. For example, foods that are high in saturated and trans fats and cholesterol raise your LDL cholesterol level. A high-sodium (salt) diet can raise your risk for high blood pressure.

Foods with added sugars will give you extra calories without nutrients, such as vitamins and minerals. This can cause you to gain weight, which raises your risk for CHD.

Too much alcohol also can cause you to gain weight, and it will raise your blood pressure.

Stress or Depression

Stress may play a role in causing CHD. Stress can trigger your arteries to narrow. This can raise your blood pressure and your risk for a heart attack.

Getting upset or angry also can trigger a heart attack. Stress also may indirectly raise your risk for CHD if it makes you more likely to smoke or overeat foods high in fat and sugar.

People who are depressed are two to three times more likely to develop CHD than people who are not. Depression is twice as common in women as in men.

Anemia

Anemia (uh-NEE-me-eh) is a condition in which your blood has a lower than normal number of red blood cells.

The condition also can occur if your red blood cells don't contain enough hemoglobin (HEE-muh-glow-bin). Hemoglobin is an iron-rich protein that carries oxygen from your lungs to the rest of your organs.

If you have anemia, your organs don't get enough oxygen-rich blood. This causes your heart to work harder, which may raise your risk for CHD.

Anemia has many causes. For more information, go to the Health Topics Anemia article.

Sleep Apnea

Sleep apnea is a common disorder that causes pauses in breathing or shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an hour.

Typically, normal breathing starts again after the pause, sometimes with a loud snort or choking sound. Major signs of sleep apnea are snoring and daytime sleepiness.

When you stop breathing, the lack of oxygen triggers your body's stress hormones. This causes blood pressure to rise and makes the blood more likely to clot.

Untreated sleep apnea can raise your risk for high blood pressure, diabetes, and even a heart attack or stroke.

Women are more likely to develop sleep apnea after menopause.

Risk Factors You Can't Control

Age and Menopause

As you get older, your risk for CHD and heart attack rises. This is due in part to the slow buildup of plaque inside your heart arteries, which can start during childhood.

Before age 55, women have a lower risk for CHD than men. Estrogen provides women with some protection against CHD before menopause. After age 55, however, the risk of CHD increases in both women and men.

You may have gone through early menopause, either naturally or because you had your ovaries removed. If so, you're twice as likely to develop CHD as women of the same age who aren't yet menopausal.

Another reason why women are at increased risk for CHD after age 55 is that middle age is when you tend to develop other CHD risk factors.

Women who have gone through menopause also are at increased risk for broken heart syndrome. (For more information, go to the section on emerging risk factors below.)

Family History

Family history plays a role in CHD risk. Your risk increases if your father or a brother was diagnosed with CHD before 55 years of age, or if your mother or a sister was diagnosed with CHD before 65 years of age.

Also, a family history of stroke—especially a mother's stroke history—can help predict the risk of heart attack in women.

Having a family history of CHD or stroke doesn't mean that you'll develop heart disease. This is especially true if your affected family member smoked or had other risk factors that were not well treated.

Making lifestyle changes and taking medicines to treat risk factors often can lessen genetic influences and prevent or delay heart problems.

Preeclampsia

Preeclampsia (pre-e-KLAMP-se-ah) is a condition that develops during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine.

These signs usually occur during the second half of pregnancy and go away after delivery. However, your risk of developing high blood pressure later in life increases after having preeclampsia.

Preeclampsia also is linked to an increased lifetime risk of heart disease, including CHD, heart attack, and heart failure. (Likewise, having heart disease risk factors, such as diabetes or obesity, increases your risk for preeclampsia.)

If you had preeclampsia during pregnancy, you're twice as likely to develop heart disease as women who haven't had the condition. You're also more likely to develop heart disease earlier in life.

Preeclampsia is a heart disease risk factor that you can't control. However, if you've had the condition, you should take extra care to try and control other heart disease risk factors.

The more severe your preeclampsia was, the greater your risk for heart disease. Let your doctor know that you had preeclampsia so he or she can assess your heart disease risk and how to reduce it.

Emerging Risk Factors

Research suggests that inflammation plays a role in causing CHD. Inflammation is the body's response to injury or infection. Damage to the arteries' inner walls seems to trigger inflammation and help plaque grow.

High blood levels of a protein called C-reactive protein (CRP) are a sign of inflammation in the body. Research suggests that women who have high blood levels of CRP are at increased risk for heart attack.

Also, some inflammatory diseases, such as lupus and rheumatoid arthritis, may increase the risk for CHD.

Some studies suggest that women who have migraine headaches may be at greater risk for CHD. This is especially true for women who have migraines with auras (visual disturbances), such as flashes of light or zig-zag lines.

Low bone density and low intake of folate and vitamin B6 also may raise a woman's risk for CHD.

More research is needed to find out whether calcium supplements with or without vitamin D affect CHD risk. You may want to talk with your doctor to find out whether these types of supplements are right for you.

Researchers are just starting to learn about broken heart syndrome risk factors. Most women who have this disorder are White and have gone through menopause.

Many of these women have other heart disease risk factors, such as high blood pressure, high blood cholesterol, diabetes, and smoking. However, these risk factors tend to be less common in women who have broken heart syndrome than in women who have CHD.

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What Are the Signs and Symptoms of Heart Disease?

The signs and symptoms of coronary heart disease (CHD) may differ between women and men. Some women who have CHD have no signs or symptoms. This is called silent CHD.

Silent CHD may not be diagnosed until a woman has signs and symptoms of a heart attack, heart failure, or an arrhythmia (irregular heartbeat).

Other women who have CHD will have signs and symptoms of the disease.

\"Heart

Figure

Heart Disease Signs and Symptoms. The illustration shows the major signs and symptoms of coronary heart disease.

A common symptom of CHD is angina. Angina is chest pain or discomfort that occurs when your heart muscle doesn't get enough oxygen-rich blood.

In men, angina often feels like pressure or squeezing in the chest. This feeling may extend to the arms. Women can also have these angina symptoms. But women also tend to describe a", "diseases_conditions.last_update": "June 11, 2014.", "diseases_conditions.category_1_x_diseases_conditions_id": { "36": { "category_1_x_diseases_conditions.id": 36, "category_1.id": 7, "category_1.ts": "2018-02-02 04:25:06", "category_1.title": "h" } } }, "37": { "diseases_conditions.id": 37, "diseases_conditions.ts": "2018-02-02 05:13:09", "diseases_conditions.title": "Heart Failure", "diseases_conditions.diseases_conditions_detail": "

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What Is Heart Failure?

Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. In some cases, the heart can't fill with enough blood. In other cases, the heart can't pump blood to the rest of the body with enough force. Some people have both problems.

The term \"heart failure\" doesn't mean that your heart has stopped or is about to stop working. However, heart failure is a serious condition that requires medical care.

Overview

Heart failure develops over time as the heart's pumping action grows weaker. The condition can affect the right side of the heart only, or it can affect both sides of the heart. Most cases involve both sides of the heart.

Right-side heart failure occurs if the heart can't pump enough blood to the lungs to pick up oxygen. Left-side heart failure occurs if the heart can't pump enough oxygen-rich blood to the rest of the body.

Right-side heart failure may cause fluid to build up in the feet, ankles, legs, liver, abdomen, and the veins in the neck. Right-side and left-side heart failure also may cause shortness of breath and fatigue (tiredness).

The leading causes of heart failure are diseases that damage the heart. Examples include coronary heart disease (CHD), high blood pressure, and diabetes.

Outlook

Heart failure is a very common condition. About 5.1 million people in the United States have heart failure.

Both children and adults can have the condition, although the symptoms and treatments differ. This article focuses on heart failure in adults.

Currently, heart failure has no cure. However, treatments—such as medicines and lifestyle changes—can help people who have the condition live longer and more active lives. Researchers continue to study new ways to treat heart failure and its complications.

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Other Names for Heart Failure

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What Causes Heart Failure?

Conditions that damage or overwork the heart muscle can cause heart failure. Over time, the heart weakens. It isn't able to fill with and/or pump blood as well as it should.

As the heart weakens, certain proteins and substances might be released into the blood. These substances have a toxic effect on the heart and blood flow, and they worsen heart failure.

Common Causes of Heart Failure

The most common causes of heart failure are coronary heart disease (CHD), high blood pressure, and diabetes. Treating these problems can prevent or improve heart failure.

Coronary Heart Disease

CHD is a condition in which a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle.

Plaque narrows the arteries and reduces blood flow to your heart muscle. The buildup of plaque also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow.

CHD can lead to chest pain or discomfort called angina (an-JI-nuh or AN-juh-nuh), a heart attack, heart damage, or even death.

High Blood Pressure

Blood pressure is the force of blood pushing against the walls of the arteries. If this pressure rises and stays high over time, it can weaken your heart and lead to plaque buildup.

Blood pressure is considered high if it stays at or above 140/90 mmHg over time. (The mmHg is millimeters of mercury—the units used to measure blood pressure.) If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher.

Diabetes

Diabetes is a disease in which the body's blood glucose (sugar) level is too high. The body normally breaks down food into glucose and then carries it to cells throughout the body. The cells use a hormone called insulin to turn the glucose into energy.

In diabetes, the body doesn't make enough insulin or doesn't use its insulin properly. Over time, high blood sugar levels can damage and weaken the heart muscle and the blood vessels around the heart, leading to heart failure.

Other Causes

Other diseases and conditions also can lead to heart failure, such as:

Other factors also can injure the heart muscle and lead to heart failure. Examples include:

Heart damage from obstructive sleep apnea may worsen heart failure. Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.

Sleep apnea can deprive your heart of oxygen and increase its workload. Treating this sleep disorder might improve heart failure.

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Who Is at Risk for Heart Failure?

About 5.8 million people in the United States have heart failure. The number of people who have this condition is growing.

Heart failure is more common in:

  • People who are 65 years old or older. Aging can weaken the heart muscle. Older people also may have had diseases for many years that led to heart failure. Heart failure is a leading cause of hospital stays among people on Medicare.
  • African Americans. African Americans are more likely to have heart failure than people of other races. They're also more likely to have symptoms at a younger age, have more hospital visits due to heart failure, and die from heart failure.
  • People who are overweight. Excess weight puts strain on the heart. Being overweight also increases your risk of heart disease and type 2 diabetes. These diseases can lead to heart failure.
  • People who have had a heart attack.
  • Men. Men have a higher rate of heart failure than women.

Children who have congenital heart defects also can develop heart failure. These defects occur if the heart, heart valves, or blood vessels near the heart don't form correctly while a baby is in the womb.

Congenital heart defects can make the heart work harder. This weakens the heart muscle, which can lead to heart failure.

Children don't have the same symptoms of heart failure or get the same treatments as adults. This article focuses on heart failure in adults.

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What Are the Signs and Symptoms of Heart Failure?

The most common signs and symptoms of heart failure are:

All of these symptoms are the result of fluid buildup in your body. When symptoms start, you may feel tired and short of breath after routine physical effort, like climbing stairs.

As your heart grows weaker, symptoms get worse. You may begin to feel tired and short of breath after getting dressed or walking across the room. Some people have shortness of breath while lying flat.

Fluid buildup from heart failure also causes weight gain, frequent urination, and a cough that's worse at night and when you're lying down. This cough may be a sign of acute pulmonary edema (e-DE-ma). This is a condition in which too much fluid builds up in your lungs. The condition requires emergency treatment.

\"Heart

Figure

Heart Failure Signs and Symptoms. The image shows the major signs and symptoms of heart failure.

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How Is Heart Failure Diagnosed?

Your doctor will diagnose heart failure based on your medical and family histories, a physical exam, and test results. The signs and symptoms of heart failure also are common in other conditions. Thus, your doctor will:

Early diagnosis and treatment can help people who have heart failure live longer, more active lives.

Medical and Family Histories

Your doctor will ask whether you or others in your family have or have had a disease or condition that can cause heart failure.

Your doctor also will ask about your symptoms. He or she will want to know which symptoms you have, when they occur, how long you've had them, and how severe they are. Your answers will help show whether and how much your symptoms limit your daily routine.

Physical Exam

During the physical exam, your doctor will:

  • Listen to your heart for sounds that aren't normal
  • Listen to your lungs for the sounds of extra fluid buildup
  • Look for swelling in your ankles, feet, legs, abdomen, and the veins in your neck

Diagnostic Tests

No single test can diagnose heart failure. If you have signs and symptoms of heart failure, your doctor may recommend one or more tests.

Your doctor also may refer you to a cardiologist. A cardiologist is a doctor who specializes in diagnosing and treating heart diseases and conditions.

EKG (Electrocardiogram)

An EKG is a simple, painless test that detects and records the heart's electrical activity. The test shows how fast your heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through your heart.

An EKG may show whether the walls in your heart's pumping chambers are thicker than normal. Thicker walls can make it harder for your heart to pump blood. An EKG also can show signs of a previous or current heart attack.

Chest X Ray

A chest x ray takes pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. This test can show whether your heart is enlarged, you have fluid in your lungs, or you have lung disease.

BNP Blood Test

This test checks the level of a hormone in your blood called BNP. The level of this hormone rises during heart failure.

Echocardiography

Echocardiography (echo) uses sound waves to create a moving picture of your heart. The test shows the size and shape of your heart and how well your heart chambers and valves work.

Echo also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and heart muscle damage caused by lack of blood flow.

Echo might be done before and after a stress test (see below). A stress echo can show how well blood is flowing through your heart. The test also can show how well your heart pumps blood when it beats.

Doppler Ultrasound

A Doppler ultrasound uses sound waves to measure the speed and direction of blood flow. This test often is done with echo to give a more complete picture of blood flow to the heart and lungs.

Doctors often use Doppler ultrasound to help diagnose right-side heart failure.

Holter Monitor

A Holter monitor records your heart's electrical activity for a full 24- or 48-hour period, while you go about your normal daily routine.

You wear small patches called electrodes on your chest. Wires connect the patches to a small, portable recorder. The recorder can be clipped to a belt, kept in a pocket, or hung around your neck.

Nuclear Heart Scan

A nuclear heart scan shows how well blood is flowing through your heart and how much blood is reaching your heart muscle.

During a nuclear heart scan, a safe, radioactive substance called a tracer is injected into your bloodstream through a vein. The tracer travels to your heart and releases energy. Special cameras outside of your body detect the energy and use it to create pictures of your heart.

A nuclear heart scan can show where the heart muscle is healthy and where it's damaged.

A positron emission tomography (PET) scan is a type of nuclear heart scan. It shows the level of chemical activity in areas of your heart. This test can help your doctor see whether enough blood is flowing to these areas. A PET scan can show blood flow problems that other tests might not detect.

Cardiac Catheterization

During cardiac catheterization (KATH-eh-ter-ih-ZA-shun), a long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck and threaded to your heart. This allows your doctor to look inside your coronary (heart) arteries.

During this procedure, your doctor can check the pressure and blood flow in your heart chambers, collect blood samples, and use x rays to look at your coronary arteries.

Coronary Angiography

Coronary angiography (an-jee-OG-rah-fee) usually is done with cardiac catheterization. A dye that can be seen on x ray is injected into your bloodstream through the tip of the catheter.

The dye allows your doctor to see the flow of blood to your heart muscle. Angiography also shows how well your heart is pumping.

Stress Test

Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise to make your heart work hard and beat fast.

You may walk or run on a treadmill or pedal a bicycle. If you can't exercise, you may be given medicine to raise your heart rate.

Heart tests, such as nuclear heart scanning and echo, often are done during stress testing.

Cardiac MRI

Cardiac MRI (magnetic resonance imaging) uses radio waves, magnets, and a computer to create pictures of your heart as it's beating. The test produces both still and moving pictures of your heart and major blood vessels.

A cardiac MRI can show whether parts of your heart are damaged. Doctors also have used MRI in research studies to find early signs of heart failure, even before symptoms appear.

Thyroid Function Tests

Thyroid function tests show how well your thyroid gland is working. These tests include blood tests, imaging tests, and tests to stimulate the thyroid. Having too much or too little thyroid hormone in the blood can lead to heart failure.

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How Is Heart Failure Treated?

Early diagnosis and treatment can help people who have heart failure live longer, more active lives. Treatment for heart failure will depend on the type and stage of heart failure (the severity of the condition).

The goals of treatment for all stages of heart failure include:

Treatments usually include lifestyle changes, medicines, and ongoing care. If you have severe heart failure, you also may need medical procedures or surgery.

Lifestyle Changes

Simple changes can help you feel better and control heart failure. The sooner you make these changes, the better off you'll likely be.

A Heart Healthy Diet

Following a heart healthy diet is an important part of managing heart failure. In fact, not having a proper diet can make heart failure worse. Ask your doctor and health care team to create an eating plan that works for you.

A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, eggs, poultry without skin, seafood, nuts, seeds, beans, and peas.

A healthy diet is low in sodium (salt) and solid fats (saturated fat and trans fatty acids). Too much salt can cause extra fluid to build up in your body, making heart failure worse. Saturated fat and trans fatty acids can cause unhealthy blood cholesterol levels, which are a risk factor for heart disease.

A healthy diet also is low in added sugars and refined grains. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber). Examples of refined grains include white rice and white bread.

A balanced, nutrient-rich diet can help your heart work better. Getting enough potassium is important for people who have heart failure. Some heart failure medicines deplete the potassium in your body. Lack of potassium can cause very rapid heart rhythms that can lead to sudden death.

Potassium is found in foods like white potatoes and sweet potatoes, greens (such as spinach), bananas, many dried fruits, and white beans and soybeans.

Talk with your health care team about getting the correct amount of potassium. Too much potassium also can be harmful.

For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute's \"Your Guide to Lowering Your Blood Pressure With DASH\" and the U.S. Department of Agriculture's ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating.

Fluid Intake

It's important for people who have heart failure to drink the correct amounts and types of fluid. Drinking too much fluid can worsen heart failure. Also, if you have heart failure, you shouldn't drink alcohol.

Talk with your doctor about what amounts and types of fluid you should have each day.

Other Lifestyle Changes

Taking steps to control risk factors for CHD, high blood pressure, and diabetes will help control heart failure. For example:

  • Lose weight if you're overweight or obese. Work with your health care team to lose weight safely.
  • Be physically active (as your doctor advises) to become more fit and stay as active as possible.
  • Quit smoking and avoid using illegal drugs. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke. Smoking and drugs can worsen heart failure and harm your health.
  • Get enough rest.

Medicines

Your doctor will prescribe medicines based on the type of heart failure you have, how severe it is, and your response to certain medicines. The following medicines are commonly used to treat heart failure:

Ongoing Care

You should watch for signs that heart failure is getting worse. For example, weight gain may mean that fluids are building up in your body. Ask your doctor how often you should check your weight and when to report weight changes.

Getting medical care for other related conditions is important. If you have diabetes or high blood pressure, work with your health care team to control these conditions. Have your blood sugar level and blood pressure checked. Talk with your doctor about when you should have tests and how often to take measurements at home.

Try to avoid respiratory infections like the flu and pneumonia. Talk with your doctor or nurse about getting flu and pneumonia vaccines.

Many people who have severe heart failure may need treatment in a hospital from time to time. Your doctor may recommend oxygen therapy (oxygen given through nasal prongs or a mask). Oxygen therapy can be given in a hospital or at home.

Medical Procedures and Surgery

As heart failure worsens, lifestyle changes and medicines may no longer control your symptoms. You may need a medical procedure or surgery.

If you have heart damage and severe heart failure symptoms, your doctor might recommend a cardiac resynchronization therapy (CRT) device or an implantable cardioverter defibrillator (ICD).

In heart failure, the right and left sides of the heart may no longer contract at the same time. This disrupts the heart's pumping. To correct this problem, your doctor might implant a CRT device (a type of pacemaker) near your heart.

This device helps both sides of your heart contract at the same time, which can decrease heart failure symptoms.

Some people who have heart failure have very rapid, irregular heartbeats. Without treatment, these heartbeats can cause sudden cardiac arrest. Your doctor might implant an ICD near your heart to solve this problem. An ICD checks your heart rate and uses electrical pulses to correct irregular heart rhythms.

People who have severe", "diseases_conditions.last_update": "June 11, 2014.", "diseases_conditions.category_1_x_diseases_conditions_id": { "37": { "category_1_x_diseases_conditions.id": 37, "category_1.id": 7, "category_1.ts": "2018-02-02 04:25:06", "category_1.title": "h" } } }, "38": { "diseases_conditions.id": 38, "diseases_conditions.ts": "2018-02-02 05:13:28", "diseases_conditions.title": "Heart Murmur", "diseases_conditions.diseases_conditions_detail": "

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What Is a Heart Murmur?

A heart murmur is an extra or unusual sound heard during a heartbeat. Murmurs range from very faint to very loud. Sometimes they sound like a whooshing or swishing noise.

Normal heartbeats make a \"lub-DUPP\" or \"lub-DUB\" sound. This is the sound of the heart valves closing as blood moves through the heart. Doctors can hear these sounds and heart murmurs using a stethoscope.

Overview

The two types of heart murmurs are innocent (harmless) and abnormal.

Innocent heart murmurs aren't caused by heart problems. These murmurs are common in healthy children. Many children will have heart murmurs heard by their doctors at some point in their lives.

People who have abnormal heart murmurs may have signs or symptoms of heart problems. Most abnormal murmurs in children are caused by congenital (kon-JEN-ih-tal) heart defects. These defects are problems with the heart's structure that are present at birth.

In adults, abnormal heart murmurs most often are caused by acquired heart valve disease. This is heart valve disease that develops as the result of another condition. Infections, diseases, and aging can cause heart valve disease.

Outlook

A heart murmur isn't a disease, and most murmurs are harmless. Innocent murmurs don't cause symptoms. Having one doesn't require you to limit your physical activity or do anything else special. Although you may have an innocent murmur throughout your life, you won't need treatment for it.

The outlook and treatment for abnormal heart murmurs depend on the type and severity of the heart problem causing them.

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How the Heart Works

The heart is a muscle about the size of your fist. It works like a pump and beats 100,000 times a day.

The heart has two sides, separated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to pick up oxygen. The left side of the heart receives the oxygen-rich blood from the lungs and pumps it to the body.

The heart has four chambers and four valves and is connected to various blood vessels. Veins are blood vessels that carry blood from the body to the heart. Arteries are blood vessels that carry blood away from the heart to the body.

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Figure

A Healthy Heart Cross-Section. Figure 1 shows the location of the heart in the body. Figure B shows a cross-section of a healthy heart and its inside structures. The blue arrow shows the direction in which oxygen-poor blood flows through the heart to (more...)

Heart Chambers

The heart has four chambers or \"rooms.\"

Heart Valves

Four valves control the flow of blood from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart.

  • The tricuspid (tri-CUSS-pid) valve is in the right side of the heart, between the right atrium and the right ventricle.
  • The pulmonary (PULL-mun-ary) valve is in the right side of the heart, between the right ventricle and the entrance to the pulmonary artery. The artery carries blood from the heart to the lungs.
  • The mitral (MI-trul) valve is in the left side of the heart, between the left atrium and the left ventricle.
  • The aortic (ay-OR-tik) valve is in the left side of the heart, between the left ventricle and the entrance to the aorta. This artery carries blood from the heart to the body.

Valves are like doors that open and close. They open to allow blood to flow through to the next chamber or to one of the arteries. Then they shut to keep blood from flowing backward.

When the heart's valves open and close, they make a \"lub-DUB\" sound that a doctor can hear using a stethoscope.

  • The first sound—the \"lub\"—is made by the mitral and tricuspid valves closing at the beginning of systole (SIS-toe-lee). Systole is when the ventricles contract, or squeeze, and pump blood out of the heart.
  • The second sound—the \"DUB\"—is made by the aortic and pulmonary valves closing at the beginning of diastole (di-AS-toe-lee). Diastole is when the ventricles relax and fill with blood pumped into them by the atria.

Arteries

The arteries are major blood vessels connected to your heart.

Veins

The veins also are major blood vessels connected to your heart.

For more information about how a healthy heart works, go to the Health Topics How the Heart Works article. This article contains animations that show how your heart pumps blood and how your heart's electrical system works.

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Other Names for a Heart Murmur

Innocent Heart Murmurs

Abnormal Heart Murmurs

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What Causes Heart Murmurs?

Innocent Heart Murmurs

Why some people have innocent heart murmurs and others do not isn't known. Innocent murmurs are simply sounds made by blood flowing through the heart's chambers and valves, or through blood vessels near the heart.

Extra blood flow through the heart also may cause innocent heart murmurs. After childhood, the most common cause of extra blood flow through the heart is pregnancy. This is because during pregnancy, women's bodies make extra blood. Most heart murmurs that occur in pregnant women are innocent.

Abnormal Heart Murmurs

Congenital heart defects or acquired heart valve disease often are the cause of abnormal heart murmurs.

Congenital Heart Defects

Congenital heart defects are the most common cause of abnormal heart murmurs in children. These defects are problems with the heart's structure that are present at birth. They change the normal flow of blood through the heart.

Congenital heart defects can involve the interior walls of the heart, the valves inside the heart, or the arteries and veins that carry blood to and from the heart. Some babies are born with more than one heart defect.

Heart valve problems, septal defects (also called holes in the heart), and diseases of the heart muscle such as hypertrophic cardiomyopathy are common heart defects that cause abnormal heart murmurs.

Examples of valve problems are narrow valves that limit blood flow or leaky valves that don't close properly. Septal defects are holes in the wall that separates the right and left sides of the heart. This wall is called the septum.

A hole in the septum between the heart's two upper chambers is called an atrial septal defect. A hole in the septum between the heart's two lower chambers is called a ventricular septal defect.

Hypertrophic (hi-per-TROF-ik) cardiomyopathy (kar-de-o-mi-OP-ah-thee) (HCM) occurs if heart muscle cells enlarge and cause the walls of the ventricles (usually the left ventricle) to thicken. The thickening may block blood flow out of the ventricle. If a blockage occurs, the ventricle must work hard to pump blood to the body. HCM also can affect the heart’s mitral valve, causing blood to leak backward through the valve.

\"Heart

Figure

Heart Defects That Can Cause Abnormal Heart Murmurs. Figure A shows the structure and blood flow inside a normal heart. Figure B shows a heart with leaking and narrowed valves. Figure C shows a heart with a ventricular septal defect.

For more information, go to the Health Topics Congenital Heart Defects article.

Acquired Heart Valve Disease

Acquired heart valve disease often is the cause of abnormal heart murmurs in adults. This is heart valve disease that develops as the result of another condition.

Many conditions can cause heart valve disease. Examples include heart conditions and other disorders, age-related changes, rheumatic (ru-MAT-ik) fever, and infections.

Heart conditions and other disorders. Certain conditions can stretch and distort the heart valves, such as:

Damage and scar tissue from a heart attack or injury to the heart.

Advanced high blood pressure and heart failure. These conditions can enlarge the heart or its main arteries.

Age-related changes. As you get older, calcium deposits or other deposits may form on your heart valves. These deposits stiffen and thicken the valve flaps and limit blood flow. This stiffening and thickening of the valve is called sclerosis (skle-RO-sis).

Rheumatic fever. The bacteria that cause strep throat, scarlet fever, and, in some cases, impetigo (im-peh-TI-go) also can cause rheumatic fever. This serious illness can develop if you have an untreated or not fully treated streptococcal (strep infection.

Rheumatic fever can damage and scar the heart valves. The symptoms of this heart valve damage often don't occur until many years after recovery from rheumatic fever.

Today, most people who have strep infections are treated with antibiotics before rheumatic fever develops. It's very important to take all of the antibiotics your doctor prescribes for strep throat, even if you feel better before the medicine is gone.

Infections. Common germs that enter the bloodstream and get carried to the heart can sometimes infect the inner surface of the heart, including the heart valves. This rare but sometimes life-threatening infection is called infective endocarditis (EN-do-kar-DI-tis), or IE.

IE is more likely to develop in people who already have abnormal blood flow through a heart valve because of heart valve disease. The abnormal blood flow causes blood clots to form on the surface of the valve. The blood clots make it easier for germs to attach to and infect the valve.

IE can worsen existing heart valve disease.

Other Causes

Some heart murmurs occur because of an illness outside of the heart. The heart is normal, but an illness or condition can cause blood flow that's faster than normal. Examples of this type of illness include fever, anemia (uh-NEE-me-eh), and hyperthyroidism.

Anemia is a condition in which the body has a lower than normal number of red blood cells. Hyperthyroidism is a condition in which the body has too much thyroid hormone.

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What Are the Signs and Symptoms of a Heart Murmur?

People who have innocent (harmless) heart murmurs don't have any signs or symptoms other than the murmur itself. This is because innocent heart murmurs aren't caused by heart problems.

People who have abnormal heart murmurs may have signs or symptoms of the heart problems causing the murmurs. These signs and symptoms may include:

  • Poor eating and failure to grow normally (in infants)
  • Shortness of breath, which may occur only with physical exertion
  • Excessive sweating with minimal or no exertion
  • Chest pain
  • A bluish color on the skin, especially on the fingertips and lips
  • Swelling or sudden weight gain
  • Enlarged liver
  • Enlarged neck veins

Signs and symptoms depend on the problem causing the heart murmur and its severity.

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How Is a Heart Murmur Diagnosed?

Doctors use a stethoscope to listen to heart sounds and hear heart murmurs. They may detect heart murmurs during routine checkups or while checking for another condition.

If a congenital heart defect causes a murmur, it's often heard at birth or during infancy. Abnormal heart murmurs caused by other heart problems can be heard in patients of any age.

Specialists Involved

Primary care doctors usually refer people who have abnormal heart murmurs to cardiologists or pediatric cardiologists for further care and testing.

Cardiologists are doctors who specialize in diagnosing and treating heart problems in adults. Pediatric cardiologists specialize in diagnosing and treating heart problems in children.

Physical Exam

Your doctor will carefully listen to your heart or your child's heart with a stethoscope to find out whether a murmur is innocent or abnormal. He or she will listen to the loudness, location, and timing of the murmur. This will help your doctor diagnose the cause of the murmur.

Your doctor also may:

  • Ask about your medical and family histories.
  • Do a complete physical exam. He or she will look for signs of illness or physical problems. For example, your doctor may look for a bluish color on your skin. In infants, doctors may look for delayed growth and feeding problems.
  • Ask about your symptoms, such as chest pain, shortness of breath (especially with physical exertion), dizziness, or fainting.

Evaluating Heart Murmurs

When evaluating a heart murmur, your doctor will pay attention to many things, such as:

  • How faint or loud the sound is. Your doctor will grade the murmur on a scale of 1 to 6 (1 is very faint and 6 is very loud).
  • When the sound occurs in the cycle of the heartbeat.
  • Where the sound is heard in the chest and whether it also can be heard in the neck or back.
  • Whether the sound has a high, medium, or low pitch.
  • How long the sound lasts.
  • How breathing, physical activity, or a change in body position affects the sound.

Diagnostic Tests and Procedures

If your doctor thinks you or your child has an abnormal heart murmur, he or she may recommend one or more of the following tests.

Chest X Ray

A chest x ray is a painless test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. This test is done to find the cause of symptoms, such as shortness of breath and chest pain.

EKG

An EKG (electrocardiogram) is a simple test that detects and records the heart's electrical activity. An EKG shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through each part of the heart.

This test is used to detect and locate the source of heart problems. The results from an EKG also may be used to rule out certain heart problems.

Echocardiography

Echocardiography (EK-o-kar-de-OG-ra-fee), or echo, is a painless test that uses sound waves to create pictures of your heart. The test shows the size and shape of your heart and how well your heart's chambers and valves are working.

Echo also can show areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.

There are several types of echo, including a stress echo. This test is done both before and after a stress test. During this test, you exercise to make your heart work hard and beat fast. If you can’t exercise, you may be given medicine to make your heart work hard and beat fast. Echo is used to take pictures of your heart before you exercise and as soon as you finish.

Stress echo shows whether you have decreased blood flow to your heart (a sign of coronary heart disease).

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How Is a Heart Murmur Treated?

A heart murmur isn't a disease. It's an extra or unusual sound heard during the heartbeat. Thus, murmurs themselves don't require treatment. However, if an underlying condition is causing a heart murmur, your doctor may recommend treatment for that condition.

Innocent (Harmless) Heart Murmurs

Healthy children who have innocent (harmless) heart murmurs don't need treatment. Their heart murmurs aren't caused by heart problems or other conditions.

Pregnant women who have innocent heart murmurs due to extra blood volume also don't need treatment. Their heart murmurs should go away after pregnancy.

Abnormal Heart Murmurs

If you or your child has an abnormal heart murmur, your doctor will recommend treatment for the disease or condition causing the murmur.

Some medical conditions, such as anemia or hyperthyroidism, can cause heart murmurs that aren't related to heart disease. Treating these conditions should make the heart murmur go away.

If a congenital heart defect is causing a heart murmur, treatment will depend on the type and severity of the defect. Treatment may include medicines or surgery. For more information about treatments for congenital heart defects, go to the Health Topics Congenital Heart Defects article.

If acquired heart valve disease is causing a heart murmur, treatment usually will depend on the type, amount, and severity of the disease.

Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines can treat symptoms and help delay complications. Eventually, though, you may need surgery to repair or replace a faulty heart valve.

For more information about treatments for heart valve disease, go to the Health Topics Heart Valve Disease article.

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Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.

NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.

Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.

By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.

If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.

If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.

For more information about clinical trials related to heart murmurs or other heart diseases or conditions, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:

For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.

", "diseases_conditions.last_update": "June 11, 2014.", "diseases_conditions.category_1_x_diseases_conditions_id": { "38": { "category_1_x_diseases_conditions.id": 38, "category_1.id": 7, "category_1.ts": "2018-02-02 04:25:06", "category_1.title": "h" } } }, "39": { "diseases_conditions.id": 39, "diseases_conditions.ts": "2018-02-02 05:13:46", "diseases_conditions.title": "Heart Palpitations", "diseases_conditions.diseases_conditions_detail": "
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What Are Palpitations?

Palpitations (pal-pi-TA-shuns) are feelings that your heart is skipping a beat, fluttering, or beating too hard or too fast. You may have these feelings in your chest, throat, or neck. They can occur during activity or even when you're sitting still or lying down.

Overview

Many things can trigger palpitations, including:

These factors can make the heart beat faster or stronger than usual, or they can cause premature (extra) heartbeats. In these situations, the heart is still working normally. Thus, these palpitations usually are harmless.

Some palpitations are symptoms of arrhythmias (ah-RITH-me-ahs). Arrhythmias are problems with the rate or rhythm of the heartbeat.

Some arrhythmias are signs of heart conditions, such as heart attack, heart failure, heart valve disease, or heart muscle disease. However, less than half of the people who have palpitations have arrhythmias.

You can take steps to reduce or prevent palpitations. Try to avoid things that trigger them (such as stress and stimulants) and treat related medical conditions.

Outlook

Palpitations are very common. They usually aren't serious or harmful, but they can be bothersome. If you have them, your doctor can decide whether you need treatment or ongoing care.

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What Causes Palpitations?

Many things can cause palpitations. You may have these feelings even when your heart is beating normally or somewhat faster than normal.

Most palpitations are harmless and often go away on their own. However, some palpitations are signs of a heart problem. Sometimes the cause of palpitations can't be found.

If you start having palpitations, see your doctor to have them checked.

Causes Not Related to Heart Problems

Strong Emotions

You may feel your heart pounding or racing during anxiety, fear, or stress. You also may have these feelings if you're having a panic attack.

Vigorous Physical Activity

Intense activity can make your heart feel like it’s beating too hard or too fast, even though it's working normally. Intense activity also can cause occasional premature (extra) heartbeats.

Medical Conditions

Some medical conditions can cause palpitations. These conditions can make the heart beat faster or stronger than usual. They also can cause premature (extra) heartbeats.

Examples of these medical conditions include:

Hormonal Changes

The hormonal changes that happen during pregnancy, menstruation, and the perimenopausal period may cause palpitations. The palpitations will likely improve or go away as these conditions go away or change.

Some palpitations that occur during pregnancy may be due to anemia.

Medicines and Stimulants

Many medicines can trigger palpitations because they can make the heart beat faster or stronger than usual. Medicines also can cause premature (extra) heartbeats.

Examples of these medicines include:

Over-the-counter medicines that act as stimulants also may cause palpitations. These include decongestants (found in cough and cold medicines) and some herbal and nutritional supplements.

Caffeine, nicotine (found in tobacco), alcohol, and illegal drugs (such as cocaine and amphetamines) also can cause palpitations.

Causes Related to Heart Problems

Some palpitations are symptoms of arrhythmias. Arrhythmias are problems with the rate or rhythm of the heartbeat. However, less than half of the people who have palpitations have arrhythmias.

During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. An arrhythmia happens if some part of the heart's electrical system doesn't work as it should.

Palpitations are more likely to be related to an arrhythmia if you:

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Who Is at Risk for Palpitations?

Some people may be more likely than others to have palpitations. People at increased risk include those who:

Women who are pregnant, menstruating, or perimenopausal also may be at higher risk for palpitations because of hormonal changes. Some palpitations that occur during pregnancy may be due to anemia.

For more information about these risk factors, go to \"What Causes Palpitations?\"

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What Are the Signs and Symptoms of Palpitations?

Symptoms of palpitations include feelings that your heart is:

You may have these feelings in your chest, throat, or neck. They can occur during activity or even when you're sitting still or lying down.

Palpitations often are harmless, and your heart is working normally. However, these feelings can be a sign of a more serious problem if you also:

Your doctor may have already told you that your palpitations are harmless. Even so, see your doctor again if your palpitations:

Your doctor will want to check whether your palpitations are the symptom of a heart problem, such as an arrhythmia (irregular heartbeat).

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How Are Palpitations Diagnosed?

First, your doctor will want to find out whether your palpitations are harmless or related to a heart problem. He or she will ask about your symptoms and medical history, do a physical exam, and recommend several basic tests.

This information may point to a heart problem as the cause of your palpitations. If so, your doctor may recommend more tests. These tests will help show what the problem is, so your doctor can decide how to treat it.

The cause of palpitations may be hard to diagnose, especially if symptoms don't occur regularly.

Specialists Involved

Several types of doctors may work with you to diagnose and treat your palpitations. These include a:

Medical History

Your doctor will ask questions about your palpitations, such as:

Your doctor also may ask about your use of caffeine, alcohol, supplements, and illegal drugs.

Physical Exam

Your doctor will take your pulse to find out how fast your heart is beating and whether its rhythm is normal. He or she also will use a stethoscope to listen to your heartbeat.

Your doctor may look for signs of conditions that can cause palpitations, such as an overactive thyroid.

Diagnostic Tests

Often, the first test that's done is an EKG (electrocardiogram). This simple test records your heart's electrical activity.

An EKG shows how fast your heart is beating and its rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through your heart.

Even if your EKG results are normal, you may still have a medical condition that's causing palpitations. If your doctor suspects this is the case, you may have blood tests to gather more information about your heart's structure, function, and electrical system.

Holter or Event Monitor

A standard EKG only records the heartbeat for a few seconds. It won't detect heart rhythm problems that don't happen during the test. To diagnose problems that come and go, your doctor may have you wear a Holter or event monitor.

A Holter monitor records the heart’s electrical activity for a full 24- or 48-hour period. You wear patches called electrodes on your chest. Wires connect the patches to a small, portable recorder. The recorder can be clipped to a belt, kept in a pocket, or hung around your neck.

During the 24- or 48-hour period, you do your usual daily activities. You use a notebook to record any symptoms you have and the time they occur. You then return both the recorder and the notebook to your doctor to read the results. Your doctor can see how your heart was beating at the time you had symptoms.

An event monitor is similar to a Holter monitor. You wear an event monitor while doing your normal activities. However, an event monitor only records your heart's electrical activity at certain times while you're wearing it.

For many event monitors, you push a button to start the monitor when you feel symptoms. Other event monitors start automatically when they sense abnormal heart rhythms.

You can wear an event monitor for weeks or until symptoms occur.

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Echocardiography

Echocardiography uses sound waves to create a moving picture of your heart. The picture shows the size and shape of your heart and how well your heart chambers and valves are working.

The test also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.

Stress Test

Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can’t exercise, you may be given medicine to make your heart work hard and beat fast.

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How Are Palpitations Treated?

Treatment for palpitations depends on their cause. Most palpitations are harmless and often go away on their own. In these cases, no treatment is needed.

Avoiding Triggers

Your palpitations may be harmless but bothersome. If so, your doctor may suggest avoiding things that trigger them. For examples, your doctor may advise you to:

Treating Medical Conditions That May Cause Palpitations

Work with your doctor to control medical conditions that can cause palpitations, such as an overactive thyroid. If you're taking medicine that's causing palpitations, your doctor will try to find a different medicine for you.

If your palpitations are caused by an arrhythmia (irregular heartbeat), your doctor may recommend medicines or procedures to treat the problem. For more information, go to the Health Topics Arrhythmia article.

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How Can Palpitations Be Prevented?

You can take steps to prevent palpitations. Try to avoid things that trigger them. For example:

Also, work with your doctor to treat medical conditions that can cause palpitations.

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Living With Palpitations

Most palpitations are harmless and often go away on their own. Treatment usually isn’t needed in these cases. Your doctor may advise you to avoid triggers for palpitations. (For more information, go to \"How Are Palpitations Treated?\")

Your doctor may have already told you that your palpitations are harmless. Even so, see your doctor again if they get worse, start to occur more often, become more noticeable or bothersome, or occur with other symptoms.

Your doctor will tell you about other signs and symptoms to be aware of and when to seek emergency care.

A medical condition or heart problem might be the cause of your palpitations. If so, your doctor will give you advice and treatment for your condition.

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Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.

NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.

Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.

By taking part in a clinical trial, you can gain access to new treatments before they’re widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don’t directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.

If you volunteer for a clinical trial, the research will be explained to you in detail. You’ll learn about treatments and tests you may receive, and the benefits and risks they may pose. You’ll also be given a chance to ask questions about the research. This process is called informed consent.

If you agree to take part in the trial, you’ll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.

For more information about clinical trials related to palpitations, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:

For more information about clinical trials for children, visit the NHLBI’s Children and Clinical Studies Web page.

", "diseases_conditions.last_update": "June 11, 2014.", "diseases_conditions.category_1_x_diseases_conditions_id": { "39": { "category_1_x_diseases_conditions.id": 39, "category_1.id": 7, "category_1.ts": "2018-02-02 04:25:06", "category_1.title": "h" } } }, "40": { "diseases_conditions.id": 40, "diseases_conditions.ts": "2018-02-02 05:13:58", "diseases_conditions.title": "Heart Valve Disease", "diseases_conditions.diseases_conditions_detail": "
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What Is Heart Valve Disease?

Heart valve disease occurs if one or more of your heart valves don't work well. The heart has four valves: the tricuspid (tri-CUSS-pid), pulmonary (PULL-mun-ary), mitral (MI-trul), and aortic (ay-OR-tik) valves.

These valves have tissue flaps that open and close with each heartbeat. The flaps make sure blood flows in the right direction through your heart's four chambers and to the rest of your body.

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Figure

Healthy Heart Cross-Section. Figure A shows the location of the heart in the body. Figure B shows a cross-section of a healthy heart and its inside structures. The blue arrow shows the direction in which oxygen-poor blood flows through the heart to the (more...)

Birth defects, age-related changes, infections, or other conditions can cause one or more of your heart valves to not open fully or to let blood leak back into the heart chambers. This can make your heart work harder and affect its ability to pump blood.

Overview

How the Heart Valves Work

At the start of each heartbeat, blood returning from the body and lungs fills the atria (the heart's two upper chambers). The mitral and tricuspid valves are located at the bottom of these chambers. As the blood builds up in the atria, these valves open to allow blood to flow into the ventricles (the heart's two lower chambers).

After a brief delay, as the ventricles begin to contract, the mitral and tricuspid valves shut tightly. This prevents blood from flowing back into the atria.

As the ventricles contract, they pump blood through the pulmonary and aortic valves. The pulmonary valve opens to allow blood to flow from the right ventricle into the pulmonary artery. This artery carries blood to the lungs to get oxygen.

At the same time, the aortic valve opens to allow blood to flow from the left ventricle into the aorta. The aorta carries oxygen-rich blood to the body. As the ventricles relax, the pulmonary and aortic valves shut tightly. This prevents blood from flowing back into the ventricles.

For more information about how the heart pumps blood and detailed animations, go to the Health Topics How the Heart Works article.

Heart Valve Problems

Heart valves can have three basic kinds of problems: regurgitation (re-GUR-jih-TA-shun), stenosis (ste-NO-sis), and atresia (a-TRE-ze-ah).

Regurgitation, or backflow, occurs if a valve doesn't close tightly. Blood leaks back into the chambers rather than flowing forward through the heart or into an artery.

In the United States, backflow most often is due to prolapse. \"Prolapse\" is when the flaps of the valve flop or bulge back into an upper heart chamber during a heartbeat. Prolapse mainly affects the mitral valve.

Stenosis occurs if the flaps of a valve thicken, stiffen, or fuse together. This prevents the heart valve from fully opening. As a result, not enough blood flows through the valve. Some valves can have both stenosis and backflow problems.

Atresia occurs if a heart valve lacks an opening for blood to pass through.

Some people are born with heart valve disease, while others acquire it later in life. Heart valve disease that develops before birth is called congenital (kon-JEN-ih-tal) heart valve disease. Congenital heart valve disease can occur alone or with other congenital heart defects.

Congenital heart valve disease often involves pulmonary or aortic valves that don't form properly. These valves may not have enough tissue flaps, they may be the wrong size or shape, or they may lack an opening through which blood can flow properly.

Acquired heart valve disease usually involves aortic or mitral valves. Although the valves are normal at first, problems develop over time.

Both congenital and acquired heart valve disease can cause stenosis or backflow.

Outlook

Many people have heart valve defects or disease but don't have symptoms. For some people, the condition mostly stays the same throughout their lives and doesn't cause any problems.

For other people, heart valve disease slowly worsens until symptoms develop. If not treated, advanced heart valve disease can cause heart failure, stroke, blood clots, or death due to sudden cardiac arrest (SCA).

Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines can relieve many of its symptoms and complications.

These treatments also can lower your risk of developing a life-threatening condition, such as stroke or SCA. Eventually, you may need to have your faulty heart valve repaired or replaced.

Some types of congenital heart valve disease are so severe that the valve is repaired or replaced during infancy, childhood, or even before birth. Other types may not cause problems until middle-age or older, if at all.

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Other Names for Heart Valve Disease

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What Causes Heart Valve Disease?

Heart conditions and other disorders, age-related changes, rheumatic fever, or infections can cause acquired heart valve disease. These factors change the shape or flexibility of once-normal valves.

The cause of congenital heart valve disease isn't known. It occurs before birth as the heart is forming. Congenital heart valve disease can occur alone or with other types of congenital heart defects.

Heart Conditions and Other Disorders

Certain conditions can stretch and distort the heart valves, such as:

Age-Related Changes

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

The aortic valve is especially prone to this problem. The deposits look similar to the plaque deposits seen in people who have atherosclerosis. Some of the same processes may cause both atherosclerosis and heart valve disease.

Rheumatic Fever

Untreated strep throat or other infections with strep bacteria that progress to rheumatic fever can cause heart valve disease.

When the body tries to fight the strep infection, one or more heart valves may be damaged or scarred in the process. The aortic and mitral valves most often are affected. Symptoms of heart valve damage often don't appear until many years after recovery from rheumatic fever.

Today, most people who have strep infections are treated with antibiotics before rheumatic fever occurs. If you have strep throat, take all of the antibiotics your doctor prescribes, even if you feel better before the medicine is gone.

Heart valve disease caused by rheumatic fever mainly affects older adults who had strep infections before antibiotics were available. It also affects people from developing countries, where rheumatic fever is more common.

Infections

Common germs that enter the bloodstream and get carried to the heart can sometimes infect the inner surface of the heart, including the heart valves. This rare but serious infection is called infective endocarditis (EN-do-kar-DI-tis), or IE.

The germs can enter the bloodstream through needles, syringes, or other medical devices and through breaks in the skin or gums. Often, the body's defenses fight off the germs and no infection occurs. Sometimes these defenses fail, which leads to IE.

IE can develop in people who already have abnormal blood flow through a heart valve as the result of congenital or acquired heart valve disease. The abnormal blood flow causes blood clots to form on the surface of the valve. The blood clots make it easier for germs to attach to and infect the valve.

IE can worsen existing heart valve disease.

Other Conditions and Factors Linked To Heart Valve Disease

Many other conditions and factors are linked to heart valve disease. However, the role they play in causing heart valve disease often isn't clear.

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Who Is at Risk for Heart Valve Disease?

Older age is a risk factor for heart valve disease. As you age, your heart valves thicken and become stiffer. Also, people are living longer now than in the past. As a result, heart valve disease has become an increasing problem.

People who have a history of infective endocarditis (IE), rheumatic fever, heart attack, or heart failure—or previous heart valve disease—also are at higher risk for heart valve disease. In addition, having risk factors for IE, such as intravenous drug use, increases the risk of heart valve disease.

You're also at higher risk for heart valve disease if you have risk factors for coronary heart disease. These risk factors include high blood cholesterol, high blood pressure, smoking, insulin resistance, diabetes, overweight or obesity, lack of physical activity, and a family history of early heart disease.

Some people are born with an aortic valve that has two flaps instead of three. Sometimes an aortic valve may have three flaps, but two flaps are fused together and act as one flap. This is called a bicuspid or bicommissural aortic valve. People who have this congenital condition are more likely to develop aortic heart valve disease.

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What Are the Signs and Symptoms of Heart Valve Disease?

Major Signs and Symptoms

The main sign of heart valve disease is an unusual heartbeat sound called a heart murmur. Your doctor can hear a heart murmur with a stethoscope.

However, many people have heart murmurs without having heart valve disease or any other heart problems. Others may have heart murmurs due to heart valve disease, but have no other signs or symptoms.

Heart valve disease often worsens over time, so signs and symptoms may occur years after a heart murmur is first heard. Many people who have heart valve disease don't have any symptoms until they're middle-aged or older.

Other common signs and symptoms of heart valve disease relate to heart failure, which heart valve disease can cause. These signs and symptoms include:

Other Signs and Symptoms

Heart valve disease can cause chest pain that may happen only when you exert yourself. You also may notice a fluttering, racing, or irregular heartbeat. Some types of heart valve disease, such as aortic or mitral valve stenosis, can cause dizziness or fainting.

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How Is Heart Valve Disease Diagnosed?

Your primary care doctor may detect a heart murmur or other signs of heart valve disease. However, a cardiologist usually will diagnose the condition. A cardiologist is a doctor who specializes in diagnosing and treating heart problems.

To diagnose heart valve disease, your doctor will ask about your signs and symptoms. He or she also will do a physical exam and look at the results from tests and procedures.

Physical Exam

Your doctor will listen to your heart with a stethoscope. He or she will want to find out whether you have a heart murmur that's likely caused by a heart valve problem.

Your doctor also will listen to your lungs as you breathe to check for fluid buildup. He or she will check for swollen ankles and other signs that your body is retaining water.

Tests and Procedures

Echocardiography (echo) is the main test for diagnosing heart valve disease. But an EKG (electrocardiogram) or chest x ray commonly is used to reveal certain signs of the condition. If these signs are present, echo usually is done to confirm the diagnosis.

Your doctor also may recommend other tests and procedures if you're diagnosed with heart valve disease. For example, you may have cardiac catheterization, (KATH-eh-ter-ih-ZA-shun), stress testing, or cardiac MRI (magnetic resonance imaging). These tests and procedures help your doctor assess how severe your condition is so he or she can plan your treatment.

EKG

This simple test detects and records the heart's electrical activity. An EKG can detect an irregular heartbeat and signs of a previous heart attack. It also can show whether your heart chambers are enlarged.

An EKG usually is done in a doctor's office.

Chest X Ray

This test can show whether certain sections of your heart are enlarged, whether you have fluid in your lungs, or whether calcium deposits are present in your heart.

A chest x ray helps your doctor learn which type of valve defect you have, how severe it is, and whether you have any other heart problems.

Echocardiography

Echo uses sound waves to create a moving picture of your heart as it beats. A device called a transducer is placed on the surface of your chest.

The transducer sends sound waves through your chest wall to your heart. Echoes from the sound waves are converted into pictures of your heart on a computer screen.

Echo can show:

Your doctor may recommend transesophageal (tranz-ih-sof-uh-JEE-ul) echo, or TEE, to get a better image of your heart.

During TEE, the transducer is attached to the end of a flexible tube. The tube is guided down your throat and into your esophagus (the passage leading from your mouth to your stomach). From there, your doctor can get detailed pictures of your heart.

You'll likely be given medicine to help you relax during this procedure.

Cardiac Catheterization

For this procedure, a long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck and threaded to your heart. Your doctor uses x-ray images to guide the catheter.

Through the catheter, your doctor does diagnostic tests and imaging that show whether backflow is occurring through a valve and how fully the valve opens. You'll be given medicine to help you relax, but you will be awake during the procedure.

Your doctor may recommend cardiac catheterization if your signs and symptoms of heart valve disease aren't in line with your echo results.

The procedure also can help your doctor assess whether your symptoms are due to specific valve problems or coronary heart disease. All of this information helps your doctor decide the best way to treat you.

Stress Test

During stress testing, you exercise to make your heart work hard and beat fast while heart tests and imaging are done. If you can't exercise, you may be given medicine to raise your heart rate.

A stress test can show whether you have signs and symptoms of heart valve disease when your heart is working hard. It can help your doctor assess the severity of your heart valve disease.

Cardiac MRI

Cardiac MRI uses a powerful magnet and radio waves to make detailed images of your heart. A cardiac MRI image can confirm information about valve defects or provide more detailed information.

This information can help your doctor plan your treatment. An MRI also may be done before heart valve surgery to help your surgeon plan for the surgery.

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How Is Heart Valve Disease Treated?

Currently, no medicines can cure heart valve disease. However, lifestyle changes and medicines often can successfully treat symptoms and delay problems for many years. Eventually, though, you may need surgery to repair or replace a faulty heart valve.

The goals of treating heart valve disease might include:

Preventing, Treating, or Relieving the Symptoms of Other Related Heart Conditions

To relieve the symptoms of heart conditions related to heart valve disease, your doctor may advise you to quit smoking and follow a healthy diet.

A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas.

A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).

For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute's \"Your Guide to Lowering Your Blood Pressure With DASH\" and the U.S. Department of Agriculture's ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating.

Your doctor may ask you to limit physical activities that make you short of breath and tired. He or she also may ask that you limit competitive athletic activity, even if the activity doesn't leave you unusually short of breath or tired.

Your doctor may prescribe medicines to:

Protecting Heart Valves From Further Damage

If you've had previous heart valve disease and now have a man-made valve, you may be at risk for a heart infection called infective endocarditis (IE). This infection can worsen your heart valve disease.

One of the most common causes of IE is poor dental hygiene. To prevent this serious infection, floss and brush your teeth and regularly see a dentist. Gum infections and tooth decay can increase the risk of IE.

Let your doctors and dentists know if you have a man-made valve or if you've had IE before. They may give you antibiotics before dental procedures (such as dental cleanings) that could allow bacteria to enter your bloodstream. Talk to your doctor about whether you need to take antibiotics before such procedures.

Repairing or Replacing Heart Valves

Your doctor may recommend repairing or replacing your heart valve(s), even if your heart valve disease isn't causing symptoms. Repairing or replacing a valve can prevent lasting damage to your heart and sudden death.

Having heart valve repair or replacement depends on many factors, including:

When possible, heart valve repair is preferred over heart valve replacement. Valve repair preserves the strength and function of the heart muscle. People who have valve repair also have a lower risk of IE after the surgery, and they don't need to take blood-thinning medicines for the rest of their lives.

However, heart valve repair surgery is harder to do than valve replacement. Also, not all valves can be repaired. Mitral valves often can be repaired. Aortic and pulmonary valves often have to be replaced.

Repairing Heart Valves

Heart surgeons can repair heart valves by:

  • Separating fused valve flaps
  • Removing or reshaping tissue so the valve can close tighter
  • Adding tissue to patch holes or tears or to increase the support at the base of the valve

Sometimes cardiologists repair heart valves using cardiac catheterization. Although catheter procedures are less invasive than surgery, they may not work as well for some patients.

Work with your doctor to decide whether repair is appropriate. If so, your doctor can advise you on the best procedure for doing it.

Balloon valvuloplasty. Heart valves that don't fully open (stenosis) can be repaired with surgery or with a less invasive catheter procedure called balloon valvuloplasty (VAL-vyu-lo-plas-tee). This procedure also is called balloon valvotomy (val-VOT-o-me).

During the procedure, a catheter (thin tube) with a balloon at its tip is threaded through a blood vessel to the faulty valve in your heart. The balloon is inflated to help widen the opening of the valve. Your doctor then deflates the balloon and removes both it and the tube.

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