Coronary Artery Disease | Diseases Of The Aortic And Mitral Valves
Congenital Defects Of The Adult Heart | Aneurysms Of The Thoracic Aorta
Tumors Of The Heart | Risk Factors

The heart is a muscle. It is supplied with blood by three main arteries called the coronary arteries. Coronary Artery disease is caused by narrowing or blockage of these arteries with cholesterol and calcium build-up or plaque.

As the arteries become narrower, less blood is able to get to the heart. At first, this may happen only when the heart is working harder than normal and requires more blood. For example, the heart works harder when a person exercises. If the heart does not receive enough blood, individuals may experience chest pain, shortness of breath, arm, neck or jaw pain. These symptoms are referred to as angina. Some people, such as diabetics, may have no symptoms at all.

Several tests may be used to find if a patient's symptoms are actually angina. EKG's and stress tests are often the first tests given. If further testing is needed, a cardiac catheterization is done. With this test, dye is injected directly into the coronary arteries under the guidance of an x-ray. A picture is taken of the inside of the arteries to find the location of the blockages.

To treat coronary artery disease some may only need careful medical management along with proper diet, exercise and medication to control blood pressure, heart rate and cholesterol.

Others with more blockages may require angioplasty - a procedure in which a balloon is inflated inside the blocked artery to open it further. A metal stent may be placed after the artery is opened to keep it from narrowing again.

Bypass surgery may be required if multiple arteries are blocked or if there are multiple blockages in the arteries which make angioplasty difficult or impossible.

The heart has 4 one way valves that keep the blood moving in the proper direction as the heart pumps blood.

In adults, one or more of the valves may not function properly as the result of a disease (such as rheumatic fever) or thickening and calcium build up due to age. The aortic and mitral valves in the adult are the most likely ones to need attention from a cardiac surgeon. Values that don't work normally often create a noise or a heart murmur.

The Aortic Valve

The aortic valve prevents blood that has been pumped out of the heart from returning to the pumping chamber after each heart beat. If the valve leaks (or is "insufficient") it allows blood to leak back into the heart after each beat. This causes the heart to enlarge as it needs to pump larger volumes of blood. If the valve is too tight (or is "stenotic") the heart must work extra hard to empty itself with each beat as it forces blood through a tight valve.

Once the valve leaks enough or becomes so tight that it causes symptoms such as fainting, shortness of breath or even chest pain, it must be replaced with valve surgery. A new aortic valve may be made of metal and plastic, tissue from a cow or pig, or it may be a human valve. Each of these types of valves has advantages and disadvantages over the others. You and your surgeon can discuss the best valve choice for you.

The Mitral Valve

The mitral valve keeps blood from washing back into the lungs as the heart beats. This valve looks like the sail on a ship with cords that hold it in place. If these cords become too long or break, the valve billows outward ("prolapses") and allows blood to leak back into the lungs with the heart beat. Many people, particularly women, have a small amount of mitral valve prolapse. This condition is usually quite benign and does not necessarily require surgery if the valve leaks only a small amount. If the valve does leak substantially, it can sometimes be repaired instead of replaced.

If the mitral valve is too tight ("stenotic"), it can cause the blood pressure in the lungs to become elevated as blood must be forced through a too small valve. During valve surgery these stenotic valves are replaced with a valve made of metal and plastic or one of pig tissue.

The most common congenital defect (a condition present since birth) is an atrial septal defect or ASD. This is a small hole between the 2 collecting chambers of the heart. With surgery it can be repaired to prevent blood from travelling from the left to the right side of the heart or vice versa. An ASD may also allow small blood clots which would normally be filtered by the lungs to pass directly to the left side of the heart where they can be pumped to the brain and cause a stroke.

An aneurysm is a ballooning out of a portion of a blood vessel, usually due to a weakened area in the wall of the blood vessel.

A small aneurysm can be treated by carefully controlling blood pressure to help keep it from expanding. As the aneurysm becomes large, there is a risk of rupture. Aneurysm surgery may be needed to remove the weakened area and replace it with an artificial blood vessel.

If the aneurysm involves the aortic valve (the valve which keeps blood from flowing back into the heart once it has been pumped out to the body), the ballooning out of the vessel may cause the valve to leak and valve surgery may be needed to replaced the valve.

The most common tumor in the adult heart is called a myxoma. It is usually located in one of the collecting chambers of the heart. It usually looks like a mushroom, with a stalk attaching it to the heart and a cap that waves in the collecting chamber with each heart beat. These may be found accidentally when an echocardiogram or ultrasound study of the heart is done for some other reason. They may cause symptoms such as dizziness or palpitations, especially if the tumor interferes with the function of one of the valves. They also may cause a stroke if part of the tumor breaks off and goes to the brain. These tumors are usually benign, but because they can interfere with the function of the heart or occasionally cause a stroke, they should be removed with surgery soon after they are discovered.

Family history of heart disease

If a close relative (brother, sister, parent) has had coronary artery disease, there may be a genetic tendency for other family members to also have coronary artery disease.

Smoking

Chemicals in cigarette smoke increase stress on the heart and cause high blood pressure. They also cause cholesterol plaque to build up faster in the arteries of the heart and the rest of the body. For tips on how to quit smoking see our How To Survive Without Cigarettes Guide or participate in our Smoking Cessation programs in our Healthy Living Guide.

Hypertension

High blood pressure causes the heart to work harder to pump blood. The heart muscle becomes thickened and requires even more blood to work well. For programs to help you control hypertension see sections Stress Management, Exercise, Nutrition Education and Weight Management in our Healthy Living Guide, or to learn more about the numbers in your blood pressure reading and how to control it see our Blood Pressure brochure.

High cholesterol

Cholesterol is the basis for atherosclerosis or "hardening of the arteries". Cholesterol plaque builds up inside the arteries and narrows or even blocks them. For programs to help you reduce your cholesterol see sections Nutrition Education, Weight Management and Exercise in our Healthy Living Guide.

Diabetes

Poor control of blood sugar may cause cholesterol plaque to build up faster in the arteries. Diabetics often do not have the typical symptoms of heart disease. This means that they may not have chest pain as a symptom of angina. They may only have neck or arm pain or even no pain at all. A poor diet and lack of exercise may increase your risk of diabetes. For programs to help you reduce your risk see sections Nutrition Education, Weight Management and Exercise in our Healthy Living Guide.

Obesity

Obesity contributes to hypertension and to the beginnings of diabetes in an adult. Because of this, it is also a risk for heart disease. We offer many programs to help you either lose weight or control your weight. See sections on Weight Management, Nutrition Education and Exercise in our Healthy Living Guide.