Cardiac Rehabilitation

Cardiac rehabilitation (rehab) is a medically supervised program to help people who have:

• A heart attack
• Angioplasty or coronary artery bypass grafting for coronary heart disease
• A heart valve repair or replacement
• A heart transplant or a lung transplant
• Angina
• Heart failure

The goal is to help you return to an active life, and to reduce the risk of further heart problems. A team of specialists will create a plan for you that includes exercise training, education on heart healthy living, and counseling to reduce stress. You will learn how to reduce your risk factors, such as high blood pressure, high blood cholesterol, depression, and diabetes. Being overweight, having obesity, smoking, and not exercising are other risk factors.

NIH: National Heart, Lung, and Blood Institute

Coronary Artery Disease

What is coronary artery disease?

Coronary artery disease (CAD) is the most common type of heart disease in the United States and a leading cause of death for both men and women.

CAD affects the coronary arteries, which are the blood vessels that carry blood and oxygen to your heart muscle. When these arteries are damaged or diseased, your heart does not get the blood it needs.

What causes coronary artery disease?

CAD develops slowly over time when plaque builds up inside your coronary arteries. Plaque is a waxy, sticky substance made of fat, cholesterol, calcium, and other materials found in your blood. This buildup is called atherosclerosis.

As plaque grows, it narrows the arteries and reduces blood flow to your heart muscle. Over time, this can partly or fully block the flow of blood and oxygen your heart needs to work properly.

What are the types of coronary artery disease?

• Obstructive CAD is when a large coronary artery is narrowed by 50% or more, significantly reducing blood flow.
• Nonobstructive CAD is when a large coronary artery is narrowed by less than 50%.
• Coronary microvascular disease affects the heart's tiny blood vessels. Damage to the walls of these small vessels reduces blood flow to your heart. This type is more common in women.

Who is more likely to have coronary artery disease?

You may be more likely to develop CAD if you:

• Eat a diet high in saturated fat
• Smoke or use tobacco products
• Are not physically active
• Are overweight or have obesity
• Have high blood pressure, high cholesterol, or high blood glucose (diabetes)
• Have a family history of heart disease, especially in a parent or sibling who had it before age 50
• Are getting older, especially men, who tend to develop CAD earlier in life than women

Your health care provider may use a risk calculator to estimate your chance of having a heart attack or stroke in the next 10 years. Talk with your provider about your personal risk.

What are symptoms of coronary artery disease?

Symptoms of CAD vary from person to person. Some people have no symptoms at all. Others do not know they have CAD until they have a heart attack or their heart suddenly stops beating (cardiac arrest).

When symptoms do occur, they may include:

• Chest pain, pressure, tightness, or discomfort that may spread to your neck, jaw, shoulder or arm
• Shortness of breath
• Feeling unusually fatigued

These symptoms may start or get worse when you are active or under stress and may go away with rest. They can also get worse over time as plaque continues to build up.

Get emergency help right away if you have chest pain or discomfort that does not go away or happens while you are resting. This may be a sign of a heart attack. Call 911.

What other problems does coronary artery disease cause?

Over time, reduced blood flow from CAD can lead to serious heart problems, including:

• Angina, which is chest pain or discomfort caused by reduced blood flow to your heart
• Heart attack, which occurs when a blood clot suddenly blocks blood flow to part of your heart, causing permanent damage to your heart muscle
• Heart failure, which occurs when your heart can't pump enough blood to meet your body's needs
• Arrhythmia, which is a problem with the rate or rhythm of your heartbeat

How is coronary artery disease diagnosed?

To find out if you have CAD, your provider may:

• Ask about your symptoms
• Ask about your personal and family health history
• Review your risk factors and lifestyle habits
• Do a physical exam, including checking your blood pressure
• Order blood tests, including checking your cholesterol and blood glucose
• Order heart health tests

What are the treatments for coronary artery disease?

If you have CAD, your provider will work with you to create a treatment plan based on which arteries are affected, how much blood flow is blocked, and what other health conditions you have. Treatments may include:

• Heart-healthy lifestyle changes, such as eating a heart-healthy diet, being more active, and quitting smoking
• Medicines to lower blood pressure, reduce cholesterol, control blood glucose, or prevent blood clots
• Procedures or surgery, such as angioplasty, or coronary artery bypass grafting (CABG), to open or bypass blocked arteries
• Cardiac rehabilitation, to improve your quality of life and help prevent future heart problems

Can coronary artery disease be prevented?

You may be able to lower your risk of CAD or slow its progress by managing risk factors and making healthy lifestyle choices. Steps that may help include:

• Choosing heart-healthy foods
• Being physically active on a regular basis
• Reaching or maintaining a healthy weight
• Not smoking and avoiding secondhand smoke
• Limiting alcohol
• Managing stress
• Getting enough good-quality sleep

NIH: National Heart, Lung, and Blood Institute

Heart Attack

Each year almost 800,000 Americans have a heart attack. A heart attack happens when blood flow to the heart suddenly becomes blocked. Without the blood coming in, the heart can't get oxygen. If not treated quickly, the heart muscle begins to die. But if you do get quick treatment, you may be able to prevent or limit damage to the heart muscle. That's why it's important to know the symptoms of a heart attack and call 911 if you or someone else is having them. You should call, even if you are not sure that it is a heart attack.

The most common symptoms in men and women are:

• Chest discomfort. It is often in center or left side of the chest. It usually lasts more than a few minutes. It may go away and come back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion.
• Shortness of breath. Sometimes this is your only symptom. You may get it before or during the chest discomfort. It can happen when you are resting or doing a little bit of physical activity.
• Discomfort in the upper body. You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach.

You may also have other symptoms, such as nausea, vomiting, dizziness, and lightheadedness. You may break out in a cold sweat. Sometimes women will have different symptoms then men. For example, they are more likely to feel tired for no reason.

The most common cause of heart attacks is coronary artery disease (CAD). With CAD, there is a buildup of cholesterol and other material, called plaque, on their inner walls or the arteries. This is atherosclerosis. It can build up for years. Eventually an area of plaque can rupture (break open). A blood clot can form around the plaque and block the artery.

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.

At the hospital, health care providers make a diagnosis based on your symptoms, blood tests, and different heart health tests. Treatments may include medicines and medical procedures such as coronary angioplasty. After a heart attack, cardiac rehabilitation and lifestyle changes can help you recover.

NIH: National Heart, Lung, and Blood Institute

Heart Diseases

What is heart disease?

Heart disease is a general term that includes many types of heart problems. It's a type of cardiovascular disease, which means heart and blood vessel disease.

Heart disease is the leading cause of death in the United States, but there are ways to prevent and manage many types of heart disease.

What are the types of heart disease?

There are many different types of heart disease. Some you may be born with, called congenital heart disease. Other types develop during your lifetime.

Coronary artery disease (also called coronary heart disease) is the most common type of heart disease. It happens slowly over time when a sticky substance called plaque builds up in the arteries that supply your heart muscle with blood. The plaque narrows or blocks blood flow to the heart muscle and can lead to other heart problems:

• Angina - chest pain from lack of blood flow
• Heart attacks - when part of the heart muscle dies from loss of blood flow
• Heart failure - when your heart can't pump enough blood to meet your body's needs
• Arrhythmia - a problem with the rate or rhythm of your heartbeat

Other types of heart diseases may affect your heart valves or heart muscle (cardiomyopathy).

What causes heart diseases?

The causes of heart disease depend on the type of disease. Some possible causes include lifestyle, genetics, infections, medicines, and other diseases.

Who is more likely to develop heart diseases?

There are many different factors that can make you more likely to develop heart disease. Some of these factors you can change, but others you cannot.

• Age. Your risk of heart disease goes up as you get older.
• Sex. Some factors may affect heart disease risk differently in women than in men.
• Family history and genetics. A family history of early heart disease raises your risk. And research has shown that some genes are linked to a higher risk of certain heart diseases.
• Race/ethnicity. Heart disease is the leading cause of death in most racial and ethnic groups in the United States. However, certain groups have higher risks than others. This includes Black people, White people, and American Indian/Alaska Native people.
• Lifestyle habits. Over time, unhealthy lifestyle habits can raise your risk of heart disease. These can include:
  • Eating a diet high in saturated fats, refined carbohydrates, and salt.
  • Not getting enough physical activity.
  • Drinking too much alcohol.
  • Smoking and exposure to secondhand smoke.
  • Too much stress.
• Having other medical conditions can raise your risk of heart diseases. These conditions include:
  • High blood pressure.
  • High cholesterol levels.
  • Diabetes.
  • Obesity.
  • Autoimmune and inflammatory diseases.
  • Chronic kidney disease.
  • Metabolic syndrome.

What are the symptoms of heart disease?

Your symptoms will depend on the type of heart disease you have. You may not have symptoms at first. In some cases, you may not know you have heart disease until you have a complication such as a heart attack.

How are heart diseases diagnosed?

To find out if you have heart disease, your health care provider will:

• Ask about your medical history, including your symptoms
• Ask about your family health history, including relatives who have had heart disease
• Do a physical exam
• Likely run heart tests and blood tests

In some cases, your provider may refer you to a cardiologist (a doctor who specializes in heart diseases) for tests, diagnosis, and care.

What are the treatments for heart disease?

Treatment plans for heart disease depend on the type of heart disease you have, how serious your symptoms are, and what other health conditions you have. Possible treatments may include:

• Heart-healthy lifestyle changes
• Medicines
• Procedures or surgeries
• Cardiac rehabilitation

Can heart diseases be prevented?

You may be able to lower your risk of certain heart diseases by making heart-healthy lifestyle changes and managing any other medical conditions you have.

NIH: National Heart, Lung, and Blood Institute

Atherosclerosis

What is atherosclerosis?

Atherosclerosis is a condition in which plaque builds up inside your arteries. Plaque is a sticky substance made up of cholesterol, fat, blood cells, calcium, and other substances found in the blood. Over time, plaque hardens and causes your arteries to narrow. That limits the flow of oxygen-rich blood to your body.

Some people may confuse atherosclerosis and arteriosclerosis, but they are not the same thing:

• Arteriosclerosis is hardening of the arteries, which means that the arteries thicken and become less flexible. It can have several different causes.
• Atherosclerosis, which develops from plaque buildup, is a common type of arteriosclerosis.

Atherosclerosis can affect most of the arteries in the body. It has different names, based on which arteries are affected:

• Coronary artery disease (CAD) is plaque buildup in the arteries of your heart.
• Peripheral artery disease (PAD) is plaque buildup in the arteries that carry blood away from the heart to other parts of the body. It most often affects the arteries of your legs, but it can also affect the arteries of your arms or pelvis.
• Carotid artery disease is plaque buildup in the neck arteries. It reduces blood flow to the brain.
• Renal artery stenosis is plaque buildup in the arteries that supply blood to your kidneys.
• Vertebral artery disease is plaque buildup in the arteries that supply blood to the back of your brain.
• Mesenteric artery ischemia is plaque buildup in the arteries that supply your intestines with blood.

What causes atherosclerosis?

Plaque often starts to build up during childhood and gets worse with age. The exact cause is unknown, but researchers believe that this buildup happens when there is damage to the arteries. This damage may be caused by unhealthy lifestyle habits, medical conditions, and your genes.

Who is more likely to develop atherosclerosis?

You may be more likely to develop atherosclerosis if you:

• Have certain medical conditions, including:
  • High blood pressure
  • High blood cholesterol
  • Diabetes
  • Metabolic syndrome
  • Inflammatory diseases such as rheumatoid arthritis and psoriasis
• Have a family history of high blood cholesterol
• Eat a lot of foods high in saturated fats
• Smoke or chew tobacco
• Are older - the risk increases after age 45 men and age 55 in women

What are the symptoms of atherosclerosis?

In the early stages, atherosclerosis often does not cause any symptoms. You may first notice some symptoms at times when your body needs more oxygen. For example, this could be when you are having physical or emotional stress.

Your symptoms will depend on which arteries are affected and how much blood flow is blocked:

• With coronary artery disease, the symptoms may include angina (a type of chest pain), palpitations (racing or pounding heart), and shortness of breath.
• With carotid artery disease, you may have a bruit. This is a whooshing sound that your health care provider hears when using a stethoscope. You could also have a transient ischemic attack (TIA), sometimes called a mini-stroke.
• With peripheral artery disease, you may have pain, aching, heaviness, or cramping in the legs when walking or climbing stairs.
• With vertebral artery disease, you may have problems with thinking and memory, weakness or numbness on one side of the body or face, and vision trouble. You could also have a transient ischemic attack.
• With mesenteric artery ischemia, the symptoms can include severe pain after meals, weight loss, and diarrhea.

For men, erectile dysfunction (ED) is an early warning sign that you may be at higher risk for atherosclerosis and its complications. If you have ED, talk with your provider about your risk of plaque buildup.

What other problems can atherosclerosis cause?

Atherosclerosis can cause other health problems, or complications. For example, if a plaque bursts, a blood clot may form. The clot could block the artery completely or travel to another part of the body. Other possible complications can vary, depending on which arteries are affected. For example, blockages in different parts of the body can lead to complications such as a heart attack, stroke, vascular dementia, or limb loss.

How is atherosclerosis diagnosed?

To find out if you have atherosclerosis, your provider:

• Will ask about your medical and family health history
• Will ask about your lifestyle and risk factors for plaque buildup in the arteries
• Will do a physical exam, which will include listening to your heart and the blood flow in your arteries
• Will likely order tests, such as blood tests and heart health tests

What are the treatments for atherosclerosis?

If you have atherosclerosis, your provider will work with you to create a treatment plan that works for you. Your plan will depend on which arteries are affected, how much the blood flow is blocked, and what other medical conditions you have. Possible treatments may include:

• Heart-healthy lifestyle changes.
• Medicines to:
  • Manage your risk factors.
  • Treat atherosclerosis or its complications.
  • Treat any medical conditions you have that can worsen plaque buildup.
• Procedures or surgeries to treat diseases or complications that were caused by plaque buildup. The specific type of procedure or surgery will depend on which arteries are affected.
• Cardiac rehabilitation, if you have had certain complications from atherosclerosis.

Can atherosclerosis be prevented?

There are steps you can take to try to prevent atherosclerosis:

• Choose heart-healthy foods, such fruits, vegetables, and whole grains. Limit foods that are high in saturated fats, salt, and added sugars.
• Do regular physical activity. But before you start an exercise program, ask your provider what level of physical activity is right for you.
• Aim for a healthy weight.
• Limit how much alcohol you drink. Drinking less is better for health than drinking more. Men should limit their intake to 2 drinks or less in a day. Women should drink 1 drink or less per day.
• Manage stress.
• If you smoke, quit smoking.
• Avoid secondhand smoke.
• Get enough good-quality sleep.

NIH: National Heart, Lung, and Blood Institute