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Heart disease is a generic term that describes many different problems affecting the heart. Heart disease can affect your coronary arteries, heart valves, heart rate and rhythm, or heart muscle. The most common heart problems are discussed in the following sections. As you read, keep in mind that the various conditions and disease processes that affect the heart are often related.
Coronary artery disease (CAD)/atherosclerosis
Coronary artery disease (CAD) is a narrowing of the coronary arteries that supply blood and oxygen to the heart. CAD is usually caused by a process called atherosclerosis. Atherosclerosis means that fat, cholesterol, and other substances have built up in the coronary arteries. This buildup, often called plaque, irritates and scars the arteries, causing them to become hard and thickened. Over time, atherosclerosis narrows the opening that blood passes through, limiting the amount of blood delivered to your heart. When this happens, you have CAD.
Risk factors for CAD include anything that damages your arteries. Some of these risk factors are beyond your control, such as your family medical history or your age. Yet other risk factors can be changed, and include your lifestyle choices such as smoking, diet, and your activity level.
Tests used to diagnose CAD include electrocardiograms (EKGs), stress testing, echocardiography, cardiac MRI, and nuclear imaging. Treatments for CAD include angioplasty, stent placement, and coronary artery bypass grafting (CABG).
How do you know if you have CAD? Unfortunately, many people don’t know they have it until the disease is fairly advanced. At this point, they may experience angina or a heart attack.
Heart valve disease
Heart valves control blood flow through your heart. When valves are damaged, they often don’t open and close properly. This leads to backflow of blood or limits the forward flow of blood, and makes your heart work harder to move the same amount of blood. In time, this extra work can weaken your heart muscle and may lead to heart failure (described below). Heart valve disease can also cause heart rate and rhythm problems and other complications.
Heart valve disease has several possible causes. You may have been born with a valve defect. Your valves may have been damaged by coronary artery disease or by an illness such as rheumatic fever. Or, your heart valves may simply be wearing out as you grow older. Three common types of valve problems are:
- Insufficiency. The valve fails to close completely and permits blood backflow.
- Stenosis. Thickened tissue narrows the valve opening and limits the amount of blood that can pass through.
- Prolapse. Mitral valve leaflets (flaps) protrude backward into the left atrium whenever the heart contracts — causing some blood to flow backwards inside the heart.
Heart failure and cardiomyopathy
Heart failure is a condition in which your heart can’t pump enough blood to meet your body’s needs. It frequently involves congestion (blood and fluids backing up in your system). Key symptoms may include shortness of breath, a dry and hacking cough, weight gain, swelling, and fatigue.
Heart failure develops because the heart muscle becomes weak or loses the ability to pump correctly. If the heart is not “squeezing” well to get enough blood to your body, you have systolic heart failure. If the heart can’t “relax” to fill with enough blood between contractions, you have diastolic heart failure.
Heart failure is often caused by other conditions, such as atherosclerosis, heart attack, high blood pressure, heart valve problems, and alcohol or drug abuse. Heart muscle weakening and damage is often called cardiomyopathy, which literally means “heart muscle disease.” Sometimes the damage occurs for no known reason. This is called idiopathic cardiomyopathy (idiopathic means “no known cause”).
Arrhythmias, also called dysrhythmias, are heart rhythm problems. They occur when the heart’s natural pacemaker, the SA node, is no longer in control of the electrical impulses that cause your heart to pump. Instead, impulses may be blocked — or may start elsewhere in the heart muscle. This disrupts the heart’s normal rhythm and makes it work less efficiently.
Arrhythmias can result from a number of different conditions. Some of these are lack of oxygen to the heart (often caused by atherosclerosis), heart valve disease, or damage to the heart muscle.
People may experience arrhythmias as palpitations, a “fluttering” or “racing” heart, or skipped heartbeats.
Atrial fibrillation is the most common type of irregular heartbeat. It is caused by an abnormal rhythm in the upper chambers of the heart (the atria). Normally, an electrical pulse travels through the heart about 60 to 100 times per minute while you’re at rest. But with atrial fibrillation, the electrical pulses come too fast. The pulses in the upper chambers then compete for a chance to travel to the lower chambers of the heart. The result is a rapid, irregular heartbeat.
Congenital heart defects
Although the term “heart defect” can refer to many different heart problems, it’s often used to talk about defects affecting the wall (septum) that divides the two upper or two lower chambers of the heart. Three of the more common defects are the following:
- Atrial septal defect (ASD). This congenital defect is fairly common. With ASD, there is a hole in the wall between the two upper chambers of the heart (the atria). The hole allows oxygen-rich and oxygendepleted blood to mix, and overfills the (lower-pressure) right atrium with blood. As a result, too much blood flows into the right ventricle and lungs. Your heart has to work harder, and your lungs can be damaged.
- Patent foramen ovale (PFO). Fetuses have a normal opening (called a foramen ovale) between the left and right atria of the heart. But if this opening fails to close naturally soon after birth, the result is an open (patent) foramen ovale, or PFO. Most of the time, this defect doesn’t cause significant health problems, and doesn’t require treatment. When a PFO is serious enough to cause problems, healthcare providers may recommend a procedure to close the hole.
- Ventricular septal defect (VSD). This defect — which may be congenital or a result of damage to the heart — is a hole in the wall between the two lower chambers of the heart (the ventricles). With a VSD, oxygen-rich blood from the heart’s left ventricle is forced through the hole into the right ventricle. The blood is then pumped back to the lungs — even though it’s already been refreshed with oxygen. This is inefficient, and makes your heart work harder.
If you would like more information about Heart Disease and other Heart related illnesses, please read our Heart Care Handbook.
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The content presented here is for your information only. It is not a substitute for professional medical advice, and it should not be used to diagnose or treat a health problem or disease. Please consult your healthcare provider if you have any questions or concerns. More health information is available at www.intermountainhealthcare.org.