How the heart works

To understand heart disease, it helps to know how the heart works. Your heart is a
pump. It's a muscular organ about the size of your fist and located slightly left of center
in your chest. Your heart is divided into the right and the left side. The division protects
oxygen-rich blood from mixing with oxygen-poor blood. Oxygen-poor blood returns to
the heart after circulating through your body.
The right side of the heart, composed of the right atrium and ventricle, collects and
pumps blood to the lungs through the pulmonary arteries. The lungs refresh the blood
with a new supply of oxygen, making it turn red. Oxygen-rich blood then enters the left
side of the heart, composed of the left atrium and ventricle, and is pumped through the
aorta to supply tissues throughout the body with oxygen and nutrients.
Four valves within your heart keep your blood moving the right way. The tricuspid,
mitral, pulmonary and aortic valves open only one way and only when pushed on. Each
valve opens and closes once per heartbeat or about once every second while you're
at rest.
A beating heart contracts and relaxes. Contraction is called systole, and relaxation is
called diastole. During systole, your ventricles contract, forcing blood into the vessels
going to your lungs and body much like ketchup being forced out of a squeeze bottle.
The right ventricle contracts a little bit before the left ventricle does. Your ventricles then
relax during diastole and are filled with blood coming from the upper chambers, the left
and right atria. The cycle then starts over again.
Your heart also has electrical wiring, which keeps it beating. Electrical impulses begin
high in the right atrium and travel through specialized pathways to the ventricles,
delivering the signal to pump. The conduction system keeps your heart beating in a
coordinated and normal rhythm, which in turn keeps blood circulating. The continuous
exchange of oxygen-rich blood with oxygen-poor blood is what keeps you alive.
The causes of heart disease vary by type of heart disease.
Causes of cardiovascular disease
While cardiovascular disease can refer to many different types of heart or blood vessel
problems, the term is often used to mean damage caused to your heart or blood vessels
by atherosclerosis (ath-ur-oh-skluh-ROW-sis), a buildup of fatty plaques in your arteries.
This is a disease that affects your arteries. Arteries are blood vessels that carry oxygen
and nutrients from your heart to the rest of your body. Healthy arteries are flexible and
strong.
Over time, however, too much pressure in your arteries can make the walls thick and
stiff sometimes restricting blood flow to your organs and tissues. This process is
called hardening of the arteries (arteriosclerosis). Atherosclerosis is the most common
form of this disorder. Atherosclerosis is also the most common cause of cardiovascular
disease, and it's often caused by an unhealthy diet, lack of exercise, being overweight
and smoking. All of these are major risk factors for developing atherosclerosis and, in
turn, cardiovascular disease.
Symptoms of heart disease in your blood vessels
(cardiovascular disease)
Cardiovascular disease is caused by narrowed, blocked or stiffened blood vessels that
prevent your heart, brain or other parts of your body from receiving enough blood.
Cardiovascular disease symptoms can include:
Chest pain (angina)
Shortness of breath
Pain, numbness, weakness or coldness in your legs or arms, if the blood vessels in
those parts of your body are narrowed
Causes of heart arrhythmia
Common causes of abnormal heart rhythms (arrhythmias), or conditions that can lead to
arrhythmias include:
Heart defects you're born with (congenital heart defects)
Coronary artery disease
High blood pressure
Diabetes
Smoking
Excessive use of alcohol or caffeine
Drug abuse
Stress
Some over-the-counter medications, prescription medications, dietary supplements
and herbal remedies
Valvular heart disease
In a healthy person with a normal, healthy heart, it's unlikely for a fatal arrhythmia to
develop without some outside trigger, such as an electrical shock or the use of illegal
drugs. That's primarily because a healthy person's heart is free from any abnormal
conditions that cause an arrhythmia, such as an area of scarred tissue.
However, in a heart that's diseased or deformed, the heart's electrical impulses may not
properly start or travel through the heart, making arrhythmias more likely to develop.
Heart disease symptoms caused by abnormal heartbeats
(heart arrhythmias)
A heart arrhythmia is an abnormal heartbeat. Your heart may beat too quickly, too
slowly or irregularly if you have an arrhythmia. Heart arrhythmia symptoms can include:
A fluttering in your chest
A racing heartbeat (tachycardia)
A slow heartbeat (bradycardia)
Chest pain
Shortness of breath
Lightheadedness
Dizziness
Fainting (syncope) or near fainting

Causes of heart infection
Heart infections, such as pericarditis, endocarditis and myocarditis, are caused when an
irritant, such as a bacterium, virus or chemical, reaches your heart muscle. The most
common causes of heart infections include:
Bacteria. Endocarditis can be caused by a number of bacteria entering your
bloodstream. The bacteria can enter your bloodstream through everyday activities,
such as eating or brushing your teeth, especially if you have poor oral health.
Myocarditis can also be caused by a tick-borne bacterium that is responsible for
Lyme disease.
Viruses. Heart infections can be caused by viruses, including some that cause
influenza (coxsackievirus B and adenovirus), a rash called fifth disease (human
parvovirus B19), gastrointestinal infections (echovirus), mononucleosis (Epstein-Barr
virus) and German measles (rubella). Viruses associated with sexually transmitted
infections also can travel to the heart muscle and cause an infection.
Parasites. Among the parasites that can cause heart infections are Trypanosoma
cruzi, toxoplasma, and some that are transmitted by insects and can cause a
condition called Chagas' disease.
Medications that may cause an allergic or toxic reaction. These include
antibiotics, such as penicillin and sulfonamide drugs, as well as some illegal
substances, such as cocaine. The needles used to administer medications or illegal
drugs also can transmit viruses or bacteria that can cause heart infections.
Other diseases. These include lupus, connective tissue disorders, inflammation of
blood vessels (vasculitis) and rare inflammatory conditions, such as Wegener's
granulomatosis
Heart disease symptoms caused by heart infections
There are three types of heart infections:
Pericarditis, which affects the tissue surrounding the heart (pericardium)
Myocarditis, which affects the muscular middle layer of the walls of the heart
(myocardium)
Endocarditis, which affects the inner membrane that separates the chambers and
valves of the heart (endocardium)
Varying slightly with each type of infection, heart infection symptoms can include:
Fever
Shortness of breath
Weakness or fatigue
Swelling in your legs or abdomen
Changes in your heart rhythm
Dry or persistent cough
Skin rashes or unusual spots
Causes of cardiomyopathy
The exact cause of cardiomyopathy, a thickening or enlarging of the heart muscle, is
unknown. There are three types of cardiomyopathy:
Dilated cardiomyopathy. This is the most common type of cardiomyopathy. In this
disorder, your heart's main pumping chamber the left ventricle becomes
enlarged (dilated), its pumping ability becomes less forceful, and blood doesn't flow
as easily through the heart.
Hypertrophic cardiomyopathy. This type involves abnormal growth or thickening
of your heart muscle, particularly affecting the muscle of your heart's main pumping
chamber. As thickening occurs, the heart tends to stiffen and the size of the pumping
chamber may shrink, interfering with your heart's ability to deliver blood to your body.
Restrictive cardiomyopathy. The heart muscle in people with restrictive
cardiomyopathy becomes stiff and less elastic, meaning the heart can't properly
expand and fill with blood between heartbeats. It's the least common type of
cardiomyopathy and can occur for no known reason
Heart disease symptoms caused by thick heart muscle
(cardiomyopathy)
Cardiomyopathy is the thickening and stiffening of heart muscle. In early stages of
cardiomyopathy, you may have no symptoms. As the condition worsens,
cardiomyopathy symptoms include:
Breathlessness with exertion or even at rest
Swelling of the legs, ankles and feet
Bloating (distention) of the abdomen with fluid
Fatigue
Irregular heartbeats that feel rapid, pounding or fluttering
Dizziness, lightheadedness and fainting

Prevention

Certain types of heart disease, such as heart defects, can't be prevented. However, you
can help prevent many other types of heart disease by making the same lifestyle
changes that can improve your heart disease, such as:
Quit smoking
Control other health conditions, such as high blood pressure, high cholesterol and
diabetes
Exercise at least 30 minutes a day on most days of the week
Eat a diet that's low in salt and saturated fat
Maintain a healthy weight
Reduce and manage stress
Practice good hygiene
Heart disease prevention and risk reduction is possible by living a healthy lifestyle. Basic components of a healthy
lifestyle are as follows:
Never smoke or stop smoking cigarettes
Eat a nutritious diet (many vegetables and fruits, less fats, sugars, and meats)
Get at least 30 minutes of exercise almost every day
Avoid alcohol or consume no more than 1 drink per day for women and no more than 2 drinks per day for men
If needed, achieve medical control of diabetes, high blood pressure, and cholesterol
Encourage friends and family to help you do the above (maybe they could benefit from your good example)
Strategies to prevent heart disease
You can prevent heart disease by following a heart-healthy lifestyle. Here are
strategies to help you protect your heart.

Heart disease may be a leading cause of death, but that doesn't mean you have to
accept it as your fate. Although you lack the power to change some risk factors such
as family history, sex or age there are some key heart disease prevention steps you
can take.
You can avoid heart problems in the future by adopting a healthy lifestyle today. Here
are six heart disease prevention tips to get you started.

1. Don't smoke or use tobacco
Smoking or using tobacco of any kind is one of the most significant risk factors for
developing heart disease. Chemicals in tobacco can damage your heart and blood
vessels, leading to narrowing of the arteries (atherosclerosis). Atherosclerosis can
ultimately lead to a heart attack.
Carbon monoxide in cigarette smoke replaces some of the oxygen in your blood. This
increases your blood pressure and heart rate by forcing your heart to work harder to
supply enough oxygen. Women who smoke and take birth control pills are at greater
risk of having a heart attack or stroke than are those who don't do either because both
smoking and taking birth control pills increase the risk of blood clots.
When it comes to heart disease prevention, no amount of smoking is safe. But, the
more you smoke, the greater your risk. Smokeless tobacco and low-tar and low-nicotine
cigarettes also are risky, as is exposure to secondhand smoke. Even so-called "social
smoking" smoking only while at a bar or restaurant with friends is dangerous and
increases the risk of heart disease.
The good news, though, is that when you quit smoking, your risk of heart disease drops
almost to that of a nonsmoker in about five years. And no matter how long or how much
you smoked, you'll start reaping rewards as soon as you quit.

2. Exercise for 30 minutes on most days of the week
Getting some regular, daily exercise can reduce your risk of fatal heart disease. And
when you combine physical activity with other lifestyle measures, such as maintaining a
healthy weight, the payoff is even greater.
Physical activity helps you control your weight and can reduce your chances of
developing other conditions that may put a strain on your heart, such as high blood
pressure, high cholesterol and diabetes.
Try getting at least 30 to 60 minutes of moderately intense physical activity most days of
the week. However, even shorter amounts of exercise offer heart benefits, so if you
can't meet those guidelines, don't give up. You can even get the same health benefits if
you break up your workout time into three 10-minute sessions most days of the week.
And remember that activities, such as gardening, housekeeping, taking the stairs and
walking the dog all count toward your total. You don't have to exercise strenuously to
achieve benefits, but you can see bigger benefits by increasing the intensity, duration
and frequency of your workouts.

3. Eat a heart-healthy diet
Eating a healthy diet can reduce your risk of heart disease. Two examples of heart-
healthy food plans include the Dietary Approaches to Stop Hypertension (DASH) eating
plan and the Mediterranean diet.
A diet rich in fruits, vegetables and whole grains can help protect your heart. Beans,
other low-fat sources of protein and certain types of fish also can reduce your risk of
heart disease.
Limiting certain fats you eat also is important. Of the types of fat saturated,
polyunsaturated, monounsaturated and trans fat saturated fat and trans fat are the
ones to try to limit or avoid. Try to keep saturated fat to no more than 10 percent of your
daily calories. And, try to keep trans fat out of your diet altogether.
Major sources of saturated fat include:
Red meat
Dairy products
Coconut and palm oils
Sources of trans fat include:
Deep-fried fast foods
Bakery products
Packaged snack foods
Margarines
Crackers
If the nutrition label has the term "partially hydrogenated," it means that product
contains trans fat.
Heart-healthy eating isn't all about cutting back, though. Healthy fats from plant-based
sources, such as avocado, nuts, olives and olive oil, help your heart by lowering the bad
type of cholesterol.
Most people need to add more fruits and vegetables to their diet with a goal of five to
10 servings a day. Eating that many fruits and vegetables can not only help prevent
heart disease but also may help prevent cancer and improve diabetes.
Eating several servings a week of certain fish, such as salmon and mackerel, may
decrease your risk of heart attack.
Following a heart-healthy diet also means keeping an eye on how much alcohol you
drink. If you choose to drink alcohol, it's better for your heart to do so in moderation. For
healthy adults, that means up to one drink a day for women of all ages and men older
than age 65, and up to two drinks a day for men age 65 and younger. At that moderate
level, alcohol can have a protective effect on your heart. More than that becomes a
health hazard.
4. Maintain a healthy weight
Being overweight, especially if you carry excess weight around your middle, ups your
risk of heart disease. Excess weight can lead to conditions that increase your chances
of heart disease high blood pressure, high cholesterol and diabetes.
One way to see if your weight is healthy is to calculate your body mass index (BMI),
which considers your height and weight in determining whether you have a healthy or
unhealthy percentage of body fat. BMI numbers 25 and higher are associated with
higher blood fats, higher blood pressure, and an increased risk of heart disease and
stroke.
The BMI is a good, but imperfect guide. Muscle weighs more than fat, for instance, and
women and men who are very muscular and physically fit can have high BMIs without
added health risks. Because of that, waist circumference also is a useful tool to
measure how much abdominal fat you have:
Men are considered overweight if their waist measurement is greater than 40 inches (101.6
centimeters, or cm).
Women are overweight if their waist measurement is greater than 35 inches (88.9 cm).
Even a small weight loss can be beneficial. Reducing your weight by just 5 to 10
percent can help decrease your blood pressure, lower your blood cholesterol level and
reduce your risk of diabetes.

5. Get enough quality sleep
Sleep deprivation can do more than leave you yawning throughout the day; it can harm
your health. People who don't get enough sleep have a higher risk of obesity, high blood
pressure, heart attack, diabetes and depression.
Most adults need seven to nine hours of sleep each night. If you wake up without your
alarm clock and you feel refreshed, you're getting enough sleep. But, if you're constantly
reaching for the snooze button and it's a struggle to get out of bed, you need more sleep
each night.
Make sleep a priority in your life. Set a sleep schedule and stick to it by going to bed
and waking up at the same times each day. Keep your bedroom dark and quiet, so it's
easier to sleep.
If you feel like you've been getting enough sleep, but you're still tired throughout the
day, ask your doctor if you need to be evaluated for sleep apnea. Obstructive sleep
apnea blocks the airflow through your windpipe and causes you to stop breathing
temporarily. Signs and symptoms of sleep apnea include snoring loudly; gasping for air
during sleep; waking up several times during the night; waking up with a headache, sore
throat or dry mouth; and memory or learning problems.
Treatments for obstructive sleep apnea include losing weight or using a continuous
positive airway pressure (CPAP) device that keeps your airway open while you sleep.
CPAP treatment appears to lower the risk of heart disease from sleep apnea.

6. Get regular health screenings
High blood pressure and high cholesterol can damage your heart and blood vessels.
But without testing for them, you probably won't know whether you have these
conditions. Regular screening can tell you what your numbers are and whether you
need to take action.
Blood pressure. Regular blood pressure screenings usually start in childhood. Adults
should have their blood pressure checked at least every two years. You may need more-
frequent checks if your numbers aren't ideal or if you have other risk factors for heart
disease. Optimal blood pressure is less than 120/80 millimeters of mercury.
Cholesterol levels. Adults should have their cholesterol measured at least once every five
years starting at age 20 if they have risk factors for heart disease, such as obesity or high
blood pressure. If you're healthy, you can start having your cholesterol screened at age 35
for men and 45 for women. Some children may need their blood cholesterol tested if they
have a strong family history of heart disease.
Diabetes screening. Since diabetes is a risk factor for developing heart disease, you may
want to consider being screened for diabetes. Talk to your doctor about when you should
have a fasting blood sugar test to check for diabetes. Depending on your risk factors, such
as being overweight or having a family history of diabetes, your doctor may recommend
early screening for diabetes. If your weight is normal and you don't have other risk factors
for type 2 diabetes, the American Diabetes Association recommends starting screening at
age 45, and then retesting every three years.