Your heart is a powerful pump. The muscular organ sends oxygen and nutrients coursing through your bloodstream to keep organs, tissues and cells humming.
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What happens when disease disrupts this process? Repercussions are felt throughout the body.
Heart disease can manifest as a problem with plumbing, wiring, structure and/or muscle. You can have more than one of these problems at a time.
Coronary artery disease: Clogged plumbing
The problem: Plaque — composed of fats (lipids), calcium and other materials — can collect on the walls of your blood vessels.
It may build up in the coronary arteries that nourish your heart. “The clogged, narrowed artery can’t deliver enough oxygen or nutrients to the heart muscle,” says coronary artery disease specialist Samir Kapadia, MD. “Painful cramps, called angina, develop.”
When plaque completely clogs the coronary arteries or they can’t deliver enough oxygen to fuel the heart, a heart attack occurs. Part of the heart muscle dies.
The fix: Medications can help to reduce fats in the blood and lower blood pressure, reducing the risk of heart attack.
A balloon-tipped catheter, threaded into the narrowed coronary artery, can open it up and restore blood flow. “Often, a tiny metal scaffold (stent) is used to hold the vessel open,” he notes.
Bypass surgery can bridge diseased coronary vessels using artery grafts from the chest, leg or arm, delivering oxygen and nutrients once again to starved heart tissue.
Arrhythmias: Bad wiring
The problem: Electricity powers your heart. Impulses synchronize each heartbeat to move blood from your heart’s filling chambers (atria) to its pumping chambers (ventricles), then out to your lungs and body, and back again.
When this electrical pathway is disturbed, impulses can misfire or travel the wrong route. Your heart can beat too fast (tachycardia) or too slow (bradycardia), or quiver (fibrillation).
Bradycardia makes you feel dizzy and lightheaded. Tachycardia causes these symptoms plus palpitations and fatigue.
More importantly, “untreated arrhythmias raise your risks of stroke and sudden cardiac death,” says arrhythmia specialist Oussama Wazni, MD.
The fix: For bradycardia, implanting a pacemaker sends electrical impulses to speed up the slow heart.
For atrial fibrillation and supraventricular tachycardia, medications help control heart rhythm and prevent risky blood clots. “We can also do ablation, delivering energy through a catheter to disconnect abnormal electrical pathways,” says Dr. Wazni.
Life-threatening ventricular arrhythmias are treated with medication or ablation as long as the heart isn’t failing. “If the heart is failing, we implant a defibrillator to restore rhythm whenever ventricular arrhythmia occurs,” he says.
Valve disease: Faulty mechanics
The problem: Valves keep blood moving in one direction through your atria and ventricles. As each chamber fills with blood, a valve opens; as each chamber empties, it closes.
Damage from infection, structural changes or congenital defects can narrow a valve or make it leak, causing the heart to pump less blood and to work harder to meet the body’s needs.
“Shortness of breath, chest pain, swelling, fatigue and dizziness can compromise day-to-day life,” says valve disease specialist Brian Griffin MD.
The fix: Medications may ease symptoms but don’t cure the problem. “Valve disease doesn’t go away,” cautions Dr. Griffin. “As it progresses, faulty valves must be repaired or replaced.”
This can be done using minimally invasive “keyhole” surgery or robotic surgery in properly selected patients.
Repair is ideal. It preserves the heart muscle’s strength and is less likely to cause infection or require lifelong blood-thinners (Coumadin®). If that’s not possible, faulty valves can be swapped for mechanical or biological (animal or human tissue) valves.
When surgery is too risky, doctors use a catheter-based approach to repair, replace or “clip” leaky valves from within the heart.
Heart failure: A weak pump
The problem: Over time, coronary artery disease, other heart diseases, diabetes and high blood pressure can weaken the heart.
The heart’s ability to move blood through your body can also deteriorate suddenly after heart attack or infection.
“In heart failure, either or both ventricles can become severely weakened, stiffened or both, causing them to contract poorly and fill poorly,” explains heart failure specialist David Taylor, MD.
Symptoms like breathlessness on exertion, swelling, fatigue and mental dulling can compromise your quality of life.
The fix: Doctors first treat any underlying disease with medications or bypass surgery, valve surgery or catheter treatments to improve blood flow.
Medications can boost heart function by dilating blood vessels and lowering blood pressure, and help the kidneys to eliminate excess fluid. Pacemakers help to improve the electrical function of faltering ventricles. Implanted defibrillators prevent ventricular arrhythmia and sudden death.
“When all else fails to improve the situation, implantable left ventricular assist devices and heart transplants are possible options for selected patients,” says Dr. Taylor.
Whether you have a plumbing, wiring, structural or muscle problem, a heart-healthy diet, exercise, quitting smoking and drinking moderately (if at all) will help you feel your best.
To avoid complications, see your doctor regularly and take medications as prescribed. Follow through with cardiac rehabilitation if recommended. And manage any high blood pressure or diabetes well.
