Mitral Valve Prolapse

What Is Mitral Valve Prolapse?

Mitral (MI-tral) valve prolapse (MVP) is a condition in which one of the valves of the heart, the mitral valve, doesn’t work properly. The flaps of the valve are “floppy” and don’t close tightly. Much of the time, MVP doesn’t cause any problems. Rarely, blood can leak the wrong way through the floppy valve, which may cause shortness of breath, palpitations, chest pain, and other symptoms.

Normal Mitral Valve

The mitral valve controls the flow of blood between the two chambers on the left side of the heart. The two chambers are the left atrium (AY-tree-um) and the left ventricle (VEN-trih-kul). The mitral valve allows blood to flow from the left atrium to the left ventricle, but not back the other way. (The heart also has a right atrium and ventricle, separated by the tricuspid (tri-CUSS-pid) valve.)

At the beginning of a heartbeat, the atria contract and push blood through to the ventricles. The flaps of the mitral and tricuspid valves swing open to let the blood through. Then, the ventricles contract to pump the blood out of the heart. When the ventricles contract, the flaps of the mitral and tricuspid valves swing shut and form a tight seal that prevents blood from flowing back into the atria.

For more information, see the How the Heart Works section.

Mitral Valve Prolapse

In MVP, when the left ventricle contracts, one or both flaps of the mitral valve flop or bulge back (prolapse) into the left atrium. This can prevent the valve from forming a tight seal, which allows blood to flow backward from the ventricle into the atrium. The backward flow of blood is called regurgitation (re-GUR-ji-TA-shun), and it can lead to symptoms and complications.

Regurgitation doesn’t occur in all cases of MVP. In fact, the majority of people with MVP don’t have regurgitation and never have any symptoms or complications. In these people, even though the valve flaps prolapse, the valve is still able to form a tight seal.

When regurgitation does occur, it can cause complications and troublesome symptoms such as shortness of breath, arrhythmias (ah-RITH-me-ahs), or chest pain. Arrhythmias are problems with the rate or rhythm of the heartbeat.

Regurgitation can get worse over time and lead to changes in the heart’s size and higher pressures in the left atrium and lungs. Regurgitation increases the risk for heart valve infections.

Medicines can treat MVP symptoms that cause people to worry or have discomfort. Medicines are also used to prevent complications. Sometimes a person will need surgery to repair or replace the mitral valve.

Figure A shows the normal mitral valve separating the left atrium from the left ventricle. Figure B shows the heart with mitral valve prolapse. Figure C shows the detail of mitral valve prolapse. Figure D shows a mitral valve that allows blood to flow backward into the left atrium.

MVP was once thought to affect as much as 5 to 15 percent of the population. It’s now believed that many people who were diagnosed with MVP in the past didn’t actually have an abnormal mitral valve. They may have had a slight bulging of the valve flaps due to other conditions such as dehydration or a small heart. However, their valve was normal and there was little or no regurgitation through the valve.

Now, more precise rules for diagnosing MVP with a test called an echocardiogram make it easier to identify true MVP and to detect troublesome regurgitation. Based on these new rules, it’s now believed that less than 3 percent of the population actually have true MVP, and an even smaller percentage has serious complications from it.

Outlook

Most people who have MVP have no symptoms or medical problems and don’t need treatment. These people are able to lead normal, active lives; they may not even know they have the condition. A small number of people who have MVP may need medicines to relieve their symptoms. Very few people who have MVP need heart valve surgery to repair their mitral valve.

Rarely, MVP can cause complications, such as arrhythmias (irregular heartbeats) or infective endocarditis (EN-do-kar-DI-tis). Infective endocarditis is a heart valve infection caused by bacteria that enter the bloodstream and attach to the heart valves.

How the Heart Works

The heart is a muscle about the size of your fist. It works like a pump and beats 100,000 times a day.

The heart has two sides, separated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to pick up oxygen. Then, oxygen-rich blood returns from the lungs to the left side of the heart, and the left side pumps it to the body.

The heart has four chambers and four valves and is connected to various blood vessels. Veins are the blood vessels that carry blood from the body to the heart. Arteries are the blood vessels that carry blood away from the heart to the body.

A Healthy Heart Cross-Section

The illustration shows a cross-section of a healthy heart and its inside structures. The blue arrow shows the direction in which oxygen-poor blood flows from the body to the lungs. The red arrow shows the direction in which oxygen-rich blood flows from the lungs to the rest of the body.

Heart Chambers

The heart has four chambers or "rooms."

• The atria are the two upper chambers that collect blood as it comes into the heart.
• The ventricles are the two lower chambers that pump blood out of the heart to the lungs or other parts of the body.

Heart Valves

Four valves control the flow of blood from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart.

• The tricuspid valve is in the right side of the heart, between the right atrium and the right ventricle.
• The pulmonary (PULL-mun-ary) valve is in the right side of the heart, between the right ventricle and the entrance to the pulmonary artery, which carries blood to the lungs.
• The mitral valve is in the left side of the heart, between the left atrium and the left ventricle.
• The aortic valve is in the left side of the heart, between the left ventricle and the entrance to the aorta, the artery that carries blood to the body.

Valves are like doors that open and close. They open to allow blood to flow through to the next chamber or to one of the arteries, and then they shut to keep blood from flowing backward.

When the heart's valves open and close, they make a "lub-DUB" sound that a doctor can hear using a stethoscope.

• The first sound-the "lub"-is made by the mitral and tricuspid valves closing at the beginning of systole (SIS-toe-lee). Systole is when the ventricles contract, or squeeze, and pump blood out of the heart.
• The second sound-the "DUB"-is made by the aortic and pulmonary valves closing at beginning of diastole (di-AS-toe-lee). Diastole is when the ventricles relax and fill with blood pumped into them by the atria.

Arteries

The arteries are major blood vessels connected to your heart.

• The pulmonary artery carries blood pumped from the right side of the heart to the lungs to pick up a fresh supply of oxygen.
• The aorta is the main artery that carries oxygen-rich blood pumped from the left side of the heart out to the body.
• The coronary arteries are the other important arteries attached to the heart. They carry oxygen-rich blood from the aorta to the heart muscle, which must have its own blood supply to function.

Veins

The veins are also major blood vessels connected to your heart.

• The pulmonary veins carry oxygen-rich blood from the lungs to the left side of the heart so it can be pumped out to the body.
• The vena cava is a large vein that carries oxygen-poor blood from the body back to the heart.

For more information on how a healthy heart works, see the Diseases and Conditions Index article on How the Heart Works. This article contains animations that show how your heart pumps blood and how your heart's electrical system works.

Other Names for Mitral Valve Prolapse

• Balloon mitral valve
• Barlow's syndrome
• Billowing mitral valve
• Click-murmur syndrome
• Floppy valve syndrome
• Myxomatous mitral valve
• Prolapsing mitral valve syndrome

What Causes Mitral Valve Prolapse?

The exact cause of mitral valve prolapse (MVP) isn't known. Most people with the condition are born with it. It tends to run in families and is more common in people who were born with connective tissue disorders, such as Marfan syndrome.

The mitral valve can be abnormal in two ways. First, the valve flaps may be oversized and thickened. Second, the valve flaps may be "floppy." The tissue of the flaps and their supporting "strings" are too stretchy, and parts of the valve flop or bulge back into the atrium. Some people's valves are abnormal in both ways. Either way can keep the valve from making a tight seal.

Who Is At Risk for Mitral Valve Prolapse?

Mitral valve prolapse (MVP) occurs in all age groups and in men and women. MVP with complications or severe symptoms is seen most often in men older than 50.

Certain conditions increase the risk for MVP, including:

• Connective tissue disorders, such as Marfan syndrome
• Scoliosis and other skeletal abnormalities
• Some types of muscular dystrophy
• Graves' disease

What Are the Signs and Symptoms of Mitral Valve Prolapse?

The majority of people with mitral valve prolapse (MVP) aren’t affected by the condition because they don’t have any symptoms or significant mitral valve regurgitation. Among those who do have symptoms, heart palpitations (strong or rapid heartbeats) are reported most often.

Other symptoms include shortness of breath, cough, dizziness, fatigue (tiredness), anxiety, migraine headaches, and chest discomfort.

Symptoms can vary widely from one person to another. They tend to be mild but can worsen over time, mainly when there are complications of MVP.

Complications of Mitral Valve Prolapse

Complications of MVP are rare, but when present, they’re most often due to regurgitation of blood through the valve. Mitral valve regurgitation is most common among men and people with high blood pressure. People with severe cases of mitral valve regurgitation may need valve surgery to prevent complications.

In mitral valve regurgitation, blood flows backward from the left ventricle into the left atrium. It can even back up from the atrium into the lungs, causing shortness of breath. The backward flow of blood puts a strain on the muscles of both the atrium and the ventricle. Over time, the strain can lead to arrhythmias (irregular heartbeats). Regurgitation also increases the risk of infective endocarditis, an infection of the lining of the valves.

Arrhythmias

Mitral valve regurgitation can cause arrhythmia, an abnormal rate or rhythm of the heartbeat.

There are many different types of arrhythmia. The most common arrhythmias are harmless. Others can be serious or even life threatening. When the heart rate is too slow, too fast, or irregular, the heart may not be able to pump enough blood to the body. Lack of blood flow can damage the brain, heart, and other organs.

One troublesome arrhythmia that may be seen with MVP and regurgitation is atrial fibrillation. In atrial fibrillation, the walls of the atria quiver instead of beating normally. As a result, the atria aren’t able to pump blood into the ventricles the way they should.

Atrial fibrillation is bothersome but rarely life threatening unless it’s very fast or unless it causes blood clots to form in the atria. Blood clots can form in the atria because some of the blood “pools” there instead of flowing into the ventricles. If a blood clot breaks off and goes into the bloodstream, it can reach the brain and cause a stroke.

Infection of the Mitral Valve

A deformed mitral valve flap attracts bacteria that may be found in the bloodstream. The bacteria attach to the valve and can cause a serious infection called infective endocarditis. Signs and symptoms of a bacterial infection include fever, chills, body aches, or headaches.

Infective endocarditis doesn’t happen often, but when it does, it’s serious. MVP is the most common heart condition that puts people at risk for this infection.

Floss and brush your teeth regularly. Gum infections and tooth decay can cause endocarditis.

How Is Mitral Valve Prolapse Diagnosed?

Mitral valve prolapse (MVP) is most often found during a routine physical exam when your doctor uses a stethoscope to listen to your heart. Your doctor listens for a certain "click" and/or murmur. Stretched valve flaps, as seen in MVP, can make a clicking sound as they shut. If the valve is leaking blood back into the atrium, a murmur or whooshing sound can often be heard. However, these abnormal heart sounds may come and go, so they may not be heard at the time of an exam, even if you have MVP. As a result, diagnostic tests and procedures may also be needed to diagnose MVP.

Diagnostic Tests and Procedures

Echocardiogram

An echocardiogram is the most useful test for diagnosing MVP. This test uses sound waves to create a moving picture of your heart. An echocardiogram provides information about the size and shape of your heart and how well your heart chambers and valves are functioning. The test also can identify areas of poor blood flow to the heart, areas of heart muscle that are not contracting normally, and previous injury to the heart muscle caused by poor blood flow. The echocardiogram is a painless test that's used to look for prolapse of the mitral valve flaps and for backflow (regurgitation) of blood through the leaky valve.

There are several different types of echocardiograms, including a stress echocardiogram. During this test, an echocardiogram is done both before and after your heart is stressed either by having you exercise or by injecting a medicine into your bloodstream that makes your heart beat faster and work harder. A stress echocardiogram is usually done to find out if you have decreased blood flow to your heart (coronary artery disease).

Echocardiography also can be performed through your esophagus (the tube leading from your mouth to your stomach) to get a closer look at the mitral valve. A tiny probe in your esophagus takes sound wave pictures of your heart. This form of echocardiogram is called a transesophageal echocardiogram, or TEE.

Doppler Ultrasound

A Doppler ultrasound is part of the echocardiogram test. The Doppler ultrasound is used to show the speed and direction of blood flow through the mitral valve.

Other Tests

Other tests that can help diagnose MVP are:

• A chest x ray, which is used to look for fluid in your lungs or to see if your heart is enlarged.
• An EKG (electrocardiogram), which charts the electrical activity of your heart. The EKG can show abnormal heartbeats, damage to the heart muscle, and enlargement of the heart.

How Is Mitral Valve Prolapse Treated?

Goals of Treatment

The goals of treating mitral valve prolapse (MVP) are to:

• Prevent infective endocarditis, arrhythmias, and other complications
• Relieve symptoms
• Correct the underlying mitral valve problem when necessary

Who Needs Treatment

Most people with MVP don't need treatment because they don't have significant regurgitation of blood through the valve, and they have few or no symptoms. Even people who do have symptoms may not require treatment. The presence of symptoms doesn't necessarily mean that there is significant regurgitation through the valve. People with MVP and troublesome mitral valve regurgitation usually need treatment.

Specific Types of Treatment

MVP can be treated with medicine, surgery, or both.

Medicine

For people with MVP who have little or no regurgitation, medicines called beta blockers have been used to treat symptoms such as palpitations (strong or rapid heartbeats) and chest discomfort.

For people with MVP who have significant regurgitation and symptoms, the following medicines may be used to prevent complications:

• Vasodilators to widen the blood vessels and reduce the workload of the heart. Examples of vasodilators are isosorbide dinitrate and hydralazine.
• Digoxin to strengthen the heartbeat.
• Diuretics (water pills) to remove excess fluid in the lungs.
• Drugs such as flecainide and procainamide to regulate heart rhythms.
• Anticoagulants (blood thinners) to reduce the risk of blood clots forming in people with atrial fibrillation. Examples include aspirin or warfarin.

Surgery

Surgery on the mitral valve is done only when the valve is very abnormal and blood is regurgitating into the atrium. The main goal of surgery is to improve symptoms and reduce the risk for heart failure.

The timing of the surgery is very important. If it's done too early and your leaking valve is working fairly well, you may be put at needless risk from surgery. If it's done too late, irreversible heart damage may have already occurred.

Surgical approaches. The traditional surgical approach for mitral valve repair and replacement is through an incision in the breastbone to expose the heart. A small but growing number of heart surgeons are using another approach that uses one or more smaller incisions through the side of the chest wall. This approach can result in less cutting, reduced blood loss, and a shorter hospital stay, but it isn't available yet in all hospitals.

Valve repair versus valve replacement. In mitral valve surgery, the valve may either be repaired or replaced completely. Valve repair is preferred when possible. It's less likely to weaken the heart, lowers the risk of infection, and decreases the need for lifelong use of blood-thinning medicines.

If repair isn't an option, then the valve can be replaced. Two types of substitute valves are available: a mechanical valve or a biological valve.

Mechanical valves are made of man-made materials and can last a lifetime. Patients with mechanical valves must take blood-thinning medicines for life. Biological valves are valves taken from cows or pigs or made from human tissue. Many patients with biological valves don't need to take blood-thinning medicines for life. The major drawback of biological valves is that they weaken and often only last about 10 years.

After surgery, a patient usually stays in the intensive care unit in the hospital for 2 to 3 days. Most people spend about 1 to 2 weeks in the hospital. Complete recovery takes a few weeks to several months, depending on the person's health before surgery.

If you've had valve repair or replacement, you may need antibiotics before dental work and surgery that can allow bacteria into the bloodstream. These medicines can help prevent infective endocarditis, a serious heart valve infection. Talk to your doctor about whether you need to take antibiotics before such procedures.

Experimental approaches. Some researchers are testing the repair of leaky valves using a catheter inserted through a large blood vessel. While this approach is less invasive and can save the patient from having open heart surgery, it's only being done in a few medical centers. In addition, because it's a new procedure, it hasn't yet been shown in large studies to be better than traditional approaches.

How Can Mitral Valve Prolapse Be Prevented?

You can't prevent mitral valve prolapse (MVP). Most people who have the condition are born with it. However, complications from MVP, such as arrhythmias (irregular heartbeats) and infective endocarditis, are rare.

In the past, some people who had MVP were given antibiotics before dental work and surgeries to prevent infective endocarditis. New research suggests that people who have MVP don't need antibiotics before such procedures.

However, if you've had valve repair or replacement, you may still need antibiotics before dental work and surgeries. Talk to your doctor about whether you need these medicines.

Living With Mitral Valve Prolapse

Most people with mitral valve prolapse (MVP) have no symptoms or problems, need no treatment, and are able to lead normal, active lives. Symptoms and complications, when present, most often can be controlled with medicines.

Some people may need heart valve surgery to relieve their symptoms and prevent complications. Rarely, MVP can result in heart failure, arrhythmias (irregular heartbeats), or stroke.

Ongoing Health Care Needs

If you have MVP, you should:

• Check with your doctor if your symptoms get worse.
• Try to prevent infective endocarditis (an infection of the surface of the mitral valve flaps).
  • Tell your doctors and dentists that you have MVP. Floss and brush your teeth regularly. Gum infections and tooth decay can cause endocarditis.
  • Call your doctor if you have any signs of infection, such as sore throat, general body aches, and fever.
• Take all medicines as prescribed, including blood-thinning and high blood pressure medicines.
• Make healthy lifestyle choices.
  • Avoid smoking and taking birth control pills, which increase the risk for blood clots.
  • Talk with your health care provider about how much and what kind of exercise is right for you.
  • Ask about any changes you need to make to your diet.

Key Points

• Mitral valve prolapse (MVP) is a heart condition in which one or both flaps of the mitral valve are floppy or thickened. These abnormal valve flaps prolapse (bulge back) into the left atrium as the left ventricle contracts. This prevents the valve from closing tightly and can allow blood to flow backward through the valve. The backward flow of blood through the valve is called mitral valve regurgitation.
• MVP is one of the more common heart valve conditions. Most often, it’s a lifelong condition that a person is born with. Most people with MVP have no symptoms or problems, need no treatment, and are able to lead normal, active lives.
• Rarely, MVP can cause complications, such as mitral valve regurgitation, arrhythmias (irregular heartbeats), and infective endocarditis, a serious heart valve infection.
• The most useful test for diagnosing MVP is an echocardiogram with Doppler ultrasound.
• Complications and severe symptoms of MVP are treated with medicines and sometimes with heart valve surgery. The preferred surgery is mitral valve repair, but the mitral valve may need to be replaced with a mechanical or biological valve.
• You can't prevent MVP. However, complications from this condition are rare.
• If you have MVP, you should check with your doctor if your symptoms get worse, get ongoing care, and take all your medicines as prescribed.

Source : http://www.nhlbi.nih.gov/health/dci/Diseases/mvp/mvp_summary.html

Aneurysm

What Is an Aneurysm?

An aneurysm (AN-u-rism) is an abnormal bulge or “ballooning” in the wall of an artery. Arteries are blood vessels that carry oxygen-rich blood from the heart to other parts of the body. An aneurysm that grows and becomes large enough can burst, causing dangerous, often fatal, bleeding inside the body.

Most aneurysms occur in the aorta. The aorta is the main artery that carries blood from the heart to the rest of the body. The aorta comes out from the left ventricle (VEN-trih-kul) of the heart and travels through the chest and abdomen. An aneurysm that occurs in the aorta in the chest is called a thoracic (tho-RAS-ik) aortic aneurysm. An aneurysm that occurs in the aorta in the abdomen is called an abdominal aortic aneurysm.

Aneurysms also can occur in arteries in the brain, heart, intestine, neck, spleen, back of the knees and thighs, and in other parts of the body. If an aneurysm in the brain bursts, it causes a stroke.

About 15,000 Americans die each year from ruptured aortic aneurysms. Ruptured aortic aneurysm is the 10th leading cause of death in men over age 50 in the United States.

Many cases of ruptured aneurysm can be prevented with early diagnosis and medical treatment. Because aneurysms can develop and become large before causing any symptoms, it is important to look for them in people who are at the highest risk. Experts recommend that men who are 65 to 75 years old and have ever smoked (at least 100 cigarettes in their lifetime) should be checked for abdominal aortic aneurysms.

When found in time, aneurysms can usually be treated successfully with medicines or surgery. If an aortic aneurysm is found, the doctor may prescribe medicine to reduce the heart rate and blood pressure. This can reduce the risk of rupture.

Large aortic aneurysms, if found in time, can often be repaired with surgery to replace the diseased portion of the aorta. The outlook is usually excellent.

Types of Aneurysm

Types of aneurysm include aortic aneurysms, cerebral aneurysms, and peripheral aneurysms.

Aortic Aneurysm

Most aneurysms occur in the aorta. The aorta is the main artery that carries blood from the heart to the rest of the body. The aorta comes out from the left ventricle of the heart and travels through the chest and abdomen. The two types of aortic aneurysm are thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA).

Thoracic Aortic Aneurysm

An aortic aneurysm that occurs in the part of the aorta running through the thorax (chest) is a thoracic aortic aneurysm. One in four aortic aneurysms is a TAA.

Most TAAs do not produce symptoms, even when they are large. Only half of all people with TAAs notice any symptoms. TAAs are identified more often now than in the past because of chest computed tomography (CT) scans performed for other medical problems.

In a common type of TAA, the walls of the aorta become weak and a section nearest to the heart enlarges. Then the valve between the heart and the aorta cannot close properly and blood leaks backward into the heart. Less commonly, a TAA can develop in the upper back away from the heart. A TAA in this location can result from and injury to the chest such as from an auto crash.

Abdominal Aortic Aneurysm

An aortic aneurysm that occurs in the part of the aorta running through the abdomen is an abdominal aortic aneurysm. Three in four aortic aneurysms are AAAs.

An AAA can grow very large without producing symptoms. About 1 in 5 AAAs rupture.

Figure A shows a normal aorta. Figure B shows a thoracic aortic aneurysm located behind the heart. Figure C shows an abdominal aortic aneurysm located below the arteries that supply the kidneys.

Cerebral Aneurysm

Aneurysms that occur in an artery in the brain are called cerebral aneurysms. They are sometimes called berry aneurysms because they are often the size of a small berry. Most cerebral aneurysms produce no symptoms until they become large, begin to leak blood, or rupture.

The illustration shows a typical location of a cerebral (berry) aneurysm in the arteries supplying blood to the brain. The inset image shows a closeup of the sac-like aneurysm.

A ruptured cerebral aneurysm causes a stroke. Signs and symptoms can include a sudden, extremely severe headache, nausea, vomiting, stiff neck, sudden weakness in an area of the body, sudden difficulty speaking, and even loss of consciousness, coma, or death. The danger of a cerebral aneurysm depends on its size and location in the brain, whether it leaks or ruptures, and the person’s age and overall health.

Peripheral Aneurysm

Aneurysms that occur in arteries other than the aorta (and not in the brain) are called peripheral aneurysms. Common locations for peripheral aneurysms include the artery that runs down the back of the thigh behind the knee (popliteal artery), the main artery in the groin (femoral artery), and the main artery in the neck (carotid artery).

Peripheral aneurysms are not as likely to rupture as aortic aneurysms, but blood clots can form in peripheral aneurysms. If a blood clot breaks away from the aneurysm, it can block blood flow through the artery. If a peripheral aneurysm is large, it can press on a nearby nerve or vein and cause pain, numbness, or swelling.

Other Names for Aneurysm

• Aortic aneurysm
  • Abdominal aortic aneurysm, or AAA
  • Thoracic aortic aneurysm, or TAA
• Cerebral aneurysm
• Peripheral aneurysm

What Causes an Aneurysm?

An aneurysm can result from atherosclerosis (hardening and narrowing of the inside of arteries). As atherosclerosis develops, the artery walls become thick and damaged and lose their normal inner lining. This damaged area of artery can stretch or "balloon" from the pressure of blood flow inside the artery, resulting in an aneurysm.

An aneurysm also can develop from constant high blood pressure inside an artery.

A thoracic aortic aneurysm can result from an injury to the chest (for example, an injury that occurs from an auto crash). Certain medical conditions, such as Marfan syndrome, that weaken the body's connective tissues, also can cause aneurysms.

In rare cases, infections such as untreated syphilis (a sexually transmitted infection) can cause aortic aneurysms. Aortic aneurysms also can occur as a result of diseases that cause inflammation of blood vessels, such as vasculitis.

Who Is At Risk for an Aneurysm?

Populations Affected

Men are 5 to 10 times more likely than women to have an abdominal aortic aneurysm (AAA)-the most common type of aneurysm.

The risk of AAA increases as you get older, and it is more likely to occur in people between the ages of 60 to 80. A peripheral aneurysm also is more likely to affect people ages 60 to 80. Cerebral (brain) aneurysms, though rare, are more likely to occur in people ages 35 to 60.

Risk Factors

Factors that increase your risk for aneurysm include:

• Atherosclerosis, a buildup of fatty deposits in the arteries.
• Smoking. You are eight times more likely to develop an aneurysm if you smoke.
• Overweight or obesity.
• A family history of aortic aneurysm, heart disease, or other diseases of the arteries.
• Certain diseases that can weaken the wall of the aorta, such as:
  • Marfan syndrome (an inherited disease in which tissues don't develop normally)
  • Untreated syphilis (a very rare cause today)
  • Tuberculosis (also a very rare cause today)
• Trauma such as a blow to the chest in a car accident.
• Severe and persistent high blood pressure between the ages of 35 and 60. This increases the risk for a cerebral aneurysm.
• Use of stimulant drugs such as cocaine.

What Are the Signs and Symptoms of an Aneurysm?

The signs and symptoms of an aneurysm depend on its type, location, and whether it has ruptured or is interfering with other structures in the body. Aneurysms can develop and grow for years without causing any signs or symptoms. It is often not until an aneurysm ruptures or grows large enough to press on nearby parts of the body or block blood flow that it produces any signs or symptoms.

Abdominal Aortic Aneurysm

Most abdominal aortic aneurysms (AAAs) develop slowly over years and have no signs or symptoms until (or if) they rupture. Sometimes, a doctor can feel a pulsating mass while examining a patient's abdomen. When symptoms are present, they can include:

• Deep penetrating pain in your back or the side of your abdomen
• Steady gnawing pain in your abdomen that lasts for hours or days at a time
• Coldness, numbness, or tingling in your feet due to blocked blood flow in your legs

If an AAA ruptures, symptoms can include sudden, severe pain in your lower abdomen and back; nausea and vomiting; clammy, sweaty skin; lightheadedness; and a rapid heart rate when standing up. Internal bleeding from a ruptured AAA can send you into shock. Shock is a life-threatening condition in which the organs of the body do not get enough blood flow.

Thoracic Aortic Aneurysm

A thoracic (chest) aortic aneurysm may have no symptoms until the aneurysm begins to leak or grow. Signs or symptoms may include:

• Pain in your jaw, neck, upper back (or other part of your back), or chest
• Coughing, hoarseness, or trouble breathing

Cerebral Aneurysm

If a cerebral (brain) aneurysm presses on nerves in your brain, it can cause signs and symptoms. These can include:

• A droopy eyelid
• Double vision or other changes in vision
• Pain above or behind the eye
• A dilated pupil
• Numbness or weakness on one side of the face or body

If a cerebral aneurysm ruptures, symptoms can include a sudden, severe headache, nausea and vomiting, stiff neck, loss of consciousness, and signs of a stroke. Signs of a stroke are similar to those listed above for cerebral aneurysm, but they usually come on suddenly and are more severe. Any of these symptoms require immediate medical attention.

Peripheral Aneurysm

Signs and symptoms of peripheral aneurysm may include:

• A pulsating lump that can be felt in your neck, arm, or leg
• Leg or arm pain, or cramping with exercise
• Painful sores on toes or fingers
• Gangrene (tissue death) from severely blocked blood flow in your limbs

An aneurysm in the popliteal artery (behind the knee) can compress nerves and cause pain, weakness, and numbness in your knee and leg.

Blood clots can form in peripheral aneurysms. If a clot breaks loose and travels through the bloodstream, it can lodge in your arm, leg, or brain and block the artery. An aneurysm in your neck can block the artery to the brain and cause a stroke.

How Is an Aneurysm Diagnosed?

An aneurysm may be found by chance during a routine physical exam. More often, an aneurysm is found by chance during an x ray, ultrasound, or computed tomography (CT) scan performed for another reason, such as chest or abdominal pain.

If you have an abdominal aortic aneurysm (AAA), the doctor may feel a pulsating mass in your abdomen. A rapidly growing aneurysm about to rupture can be tender and very painful when pressed. If you are overweight or obese, it may be difficult for your doctor to feel even a large abdominal aneurysm.

If you have an AAA, your doctor may hear rushing blood flow instead of the normal whooshing sound when listening to your abdomen with a stethoscope.

Specialists Involved

You may be referred to a cardiothoracic surgeon, vascular surgeon, or neurosurgeon for diagnosis and treatment of an aneurysm. A cardiothoracic surgeon performs surgery on the heart, lungs, and other organs and structures in the chest, including the aorta. A vascular surgeon performs surgery on the abdominal aorta and on the peripheral arteries. A neurosurgeon performs surgery on the brain, including the arteries in the head, and on the spine and nerves.

Diagnostic Tests and Procedures

To diagnose and evaluate an aneurysm, one or more of the following tests or procedures may be performed:

• Chest x ray. A chest x ray provides a picture of the organs and structures inside the chest, including the heart, lungs, and blood vessels.
• Ultrasound. This simple and painless test uses sound waves to create a picture of the inside of the body. It shows the size of an aneurysm, if one is detected. The ultrasound scan may be repeated every few months to see how quickly an aneurysm is growing.
• CT scan. A CT scan provides computer-generated, x-ray images of the internal organs. A CT scan may be performed if the doctor suspects a TAA or AAA. A liquid dye that can be seen on an x ray is injected into an arm vein to outline the aorta or artery on the CT scan. The CT scan images can be used to determine the size and shape of an abdominal aneurysm more accurately than an ultrasound.
• MRI. MRI uses magnets and radio waves to create images of the inside of the body. It is very accurate in detecting aneurysms and determining their size and exact location.
• Angiography. Angiography also uses a special dye injected into the blood stream to make the insides of arteries show up on x-ray pictures. An angiogram shows the amount of damage and blockage in blood vessels.
• Aortogram. An aortogram is an angiogram of the aorta. It may show the location and size of an aortic aneurysm, and the arteries of the aorta that are involved.

How Is an Aneurysm Treated?

Goals of Treatment

Some aneurysms, mainly small ones that are not causing pain, can be treated with "watchful waiting." Others need to be treated to prevent growth and complications. The goals of treatment are to prevent the aneurysm from growing, prevent or reverse damage to other body structures, prevent or treat a rupture, and to allow you to continue to participate in normal daily activities.

Treatment Options

Medicine and surgery are the two types of treatment for an aneurysm. Medicines may be prescribed before surgery or instead of surgery. Medicines are used to reduce pressure, relax blood vessels, and reduce the risk of rupture. Beta blockers and calcium channel blockers are the medicines most commonly used.

Surgery may be recommended if an aneurysm is large and likely to rupture.

Treatment by Type of Aneurysm

Aortic Aneurysm

Experts recommend that men who have ever smoked (at least 100 cigarettes in their lifetime) and are between the ages of 65 and 75 should have an ultrasound screening to check for abdominal aortic aneurysms.

Treatment recommendations for aortic aneurysms are based on the size of the aneurysm. Small aneurysms found early can be treated with "watchful waiting."

• If the diameter of the aorta is small-less than 3 centimeters (cm)-and there are no symptoms, "watchful waiting" and a followup screening in 5 to 10 years may be all that is needed, as determined by the doctor.
• If the aorta is between 3 and 4 cm in diameter, the patient should return to the doctor every year for an ultrasound to see if the aneurysm has grown.
• If the aorta is between 4 and 4.5 cm, testing should be repeated every 6 months.
• If the aorta is larger than 5 cm (2 inches around or about the size of a lemon) or growing more than 1 cm per year, surgery should be considered as soon as possible.

Two main types of surgery to repair aortic aneurysms are open abdominal or open chest repair and endovascular repair.

The traditional and most common type of surgery for aortic aneurysms is open abdominal or open chest repair. It involves a major incision in the abdomen or chest. General anesthesia is needed with this procedure.

The aneurysm is removed and the section of aorta is replaced with an artificial graft made of material such as Dacron® or Teflon®. The surgery takes 3 to 6 hours, and the patient remains in the hospital for 5 to 8 days. It often takes a month to recover from open abdominal or open chest surgery and return to full activity. Open abdominal and chest surgeries have been performed for 50 years. More than 90 percent of patients make a full recovery.

In endovascular repair, the aneurysm is not removed, but a graft is inserted into the aorta to strengthen it. This type of surgery is performed through catheters (tubes) inserted into the arteries; it does not require surgically opening the chest or abdomen.

To perform endovascular repair, the doctor first inserts a catheter into an artery in the groin (upper thigh) and threads it up to the area of the aneurysm. Then, watching on x ray, the surgeon threads the graft (also called a stent graft) into the aorta to the aneurysm. The graft is then expanded inside the aorta and fastened in place to form a stable channel for blood flow. The graft reinforces the weakened section of the aorta to prevent the aneurysm from rupturing.

The illustration shows the placement of an endovascular stent graft in an aortic aneurysm. In figure A, a catheter is inserted into an artery in the groin (upper thigh). It is then threaded up to the abdominal aorta, and the stent graft is released from the catheter. In figure B, the stent graft allows blood to flow through the aneurysm.

Endovascular repair surgery reduces recovery time to a few days and greatly reduces time in the hospital. The procedure has been used since 1999. Not all aortic aneurysms can be repaired with this procedure. The exact location or size of the aneurysm may prevent the stent graft from being safely or reliably positioned inside the aneurysm.

Cerebral Aneurysm

Treatment for cerebral (brain) aneurysms depends on the size and location of the aneurysm, whether it is infected, and whether it has ruptured. A small cerebral aneurysm that hasn't burst may not need treatment. A large cerebral aneurysm may press against brain tissue, causing a severe headache or impaired vision, and is likely to burst. If the aneurysm ruptures, there will be bleeding into the brain which will cause a stroke. If a cerebral aneurysm becomes infected, it requires immediate medical treatment. Treatment of many cerebral aneurysms, especially large or growing ones, involves surgery, which can be risky depending on the location of the aneurysm.

Peripheral Aneurysm

Most peripheral aneurysms have no symptoms, especially if they are small. They seldom rupture.

Treatment of peripheral aneurysms depends on the presence of symptoms, the location of the aneurysm, and whether the blood flow through the artery is blocked. Blood clots can form in a peripheral aneurysm, break loose, and block the artery.

An aneurysm in the back of the knee that is larger than 1 inch in diameter usually requires surgery. An aneurysm in the thigh also is usually repaired with surgery.

How Can an Aneurysm Be Prevented?

The best way to prevent an aneurysm is to avoid the risk factors that increase the changes of developing one. To do this, you can:

• Quit smoking.
• Eat a low-fat, low-cholesterol diet to reduce the buildup of plaque in the arteries. Plaque is a fatty buildup that narrows the arteries.
• Control high blood pressure (eating a low-salt diet helps).
• Control high cholesterol.
• Get regular physical activity.

Key Points

• An aneurysm is an abnormal bulge or "ballooning" in the wall of an artery. Arteries are blood vessels that carry oxygen-rich blood from the heart to other parts of the body.
• An aneurysm that grows and becomes large enough can rupture, causing dangerous bleeding inside the body.
• Most aneurysms occur in the aorta. The aorta is the main artery that carries blood from the heart to the rest of the body.
• Most aneurysms (3 out of 4) are found by chance when a diagnostic test, such as x ray or ultrasound, is performed for a different reason.
• Many cases of ruptured aneurysm can be prevented with early diagnosis and medical treatment.
• Because aneurysms can develop and become large before causing any symptoms, it is important to look for them in people who are at the highest risk. Ultrasound screening for abdominal aortic aneurysms is recommended for men who have ever smoked and are between the ages of 65 and 75.
• Medicines and surgery are the two main treatments for aneurysms. Medicines may be prescribed before surgery or instead of surgery.
• To prevent an aneurysm and keep blood vessels healthy, quit smoking, eat a low-fat, low-cholesterol diet, get regular physical activity, and control high blood pressure and high cholesterol.

Source : http://www.nhlbi.nih.gov/health/dci/Diseases/arm/arm_summary.html

Angina

What Is Angina?

Angina (an-JI-nuh or AN-juh-nuh) is chest pain or discomfort that occurs when an area of your heart muscle doesn't get enough oxygen-rich blood. Angina may feel like pressure or squeezing in your chest. The pain also may occur in your shoulders, arms, neck, jaw, or back. It can feel like indigestion.

Angina itself isn't a disease. Rather, it's a symptom of an underlying heart problem. Angina is usually a symptom of coronary artery disease (CAD), the most common type of heart disease.

CAD occurs when a fatty material called plaque (plak) builds up on the inner walls of the coronary arteries. These arteries carry oxygen-rich blood to your heart. When plaque builds up in the arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis).

Atherosclerosis

Figure A shows a normal artery with normal blood flow. Figure B shows an artery containing plaque buildup.

Plaque causes the coronary arteries to become narrow and stiff. The flow of oxygen-rich blood to the heart muscle is reduced. This causes pain and can lead to a heart attack.

Types of Angina

The three types of angina are stable, unstable, and variant (Prinzmetal's). Knowing how the types are different is important. This is because they have different symptoms and require different treatment.

Stable Angina

Stable angina is the most common type. It occurs when the heart is working harder than usual. Stable angina has a regular pattern. If you know you have stable angina, you can learn to recognize the pattern and predict when the pain will occur.

The pain usually goes away in a few minutes after you rest or take your angina medicine.

Stable angina isn't a heart attack, but it makes a heart attack more likely in the future.

Unstable Angina

Unstable angina doesn't follow a pattern. It can occur with or without physical exertion and isn't relieved by rest or medicine.

Unstable angina is very dangerous and needs emergency treatment. It's a sign that a heart attack may happen soon.

Variant (Prinzmetal's) Angina

Variant angina is rare. It usually occurs while you're at rest. The pain can be severe. It usually happens between midnight and early morning. This type of angina is relieved by medicine.

Overview

It's thought that nearly 7 million people in the United States suffer from angina. About 400,000 patients go to their doctors with new cases of angina every year.

Angina occurs equally in men and women. It can be a sign of heart disease, even when initial tests don't show evidence of CAD.

Not all chest pain or discomfort is angina. A heart attack, lung problems (such as an infection or a blood clot), heartburn, or a panic attack also can cause chest pain or discomfort. All chest pain should be checked by a doctor.

Other Names for Angina

• Angina pectoris
• Acute coronary syndrome
• Chest pain
• Coronary artery spasms
• Prinzmetal's angina
• Stable or common angina
• Unstable angina
• Variant angina

What Causes Angina?

Underlying Causes

Angina is a symptom of an underlying heart condition. Angina pain is the result of reduced blood flow to an area of heart muscle. Coronary artery disease (CAD) usually causes the reduced blood flow.

This means that the underlying causes of angina are generally the same as the underlying causes of CAD.

Research suggests that damage to the inner layers of the coronary arteries causes CAD. Smoking, high levels of fat and cholesterol in the blood, high blood pressure, and a high level of sugar in the blood (due to insulin resistance or diabetes) can damage the coronary arteries.

When damage occurs, your body starts a healing process. Excess fatty tissues release compounds that promote this process. This healing causes plaque to build up where the arteries are damaged. Plaque narrows or blocks the arteries, reducing blood flow to the heart muscle.

Some plaque is hard and stable and leads to narrowed and hardened arteries. Other plaque is soft and is more likely to break open and cause blood clots.

The buildup of plaque on the arteries' inner walls can cause angina in two ways. It can:

• Narrow the arteries and greatly reduce blood flow to the heart
• Form blood clots that partially or totally block the arteries

Immediate Causes

There are different triggers for angina pain, depending on the type of angina you have.

Stable Angina

Physical exertion is the most common trigger of stable angina. Severely narrowed arteries may allow enough blood to reach the heart when the demand for oxygen is low (such as when you're sitting). But with exertion, like walking up a hill or climbing stairs, the heart works harder and needs more oxygen.

Other triggers of stable angina include:

• Emotional stress
• Exposure to very hot or cold temperatures
• Heavy meals
• Smoking

Unstable Angina

Blood clots that partially or totally block an artery cause unstable angina. If plaque in an artery ruptures or breaks open, blood clots may form. This creates a larger blockage. A clot may grow large enough to completely block the artery and cause a heart attack. For more information, see the animation in "What Causes a Heart Attack?"

Blood clots may form, partly dissolve, and later form again. Angina can occur each time a clot blocks an artery.

Variant Angina

A spasm in a coronary artery causes variant angina. The spasm causes the walls of the artery to tighten and narrow. Blood flow to the heart slows or stops. Variant angina may occur in people with or without CAD.

Other causes of spasms in the coronary arteries are:

• Exposure to cold
• Emotional stress
• Medicines that tighten or narrow blood vessels
• Smoking
• Cocaine use

Who Is At Risk for Angina?

Angina is a symptom of an underlying heart condition, usually coronary artery disease (CAD). So if you're at risk for CAD, you're also at risk for angina.

Risk factors for CAD include:

• Unhealthy cholesterol levels.
• High blood pressure.
• Cigarette smoking.
• Insulin resistance or diabetes.
• Overweight or obesity.
• Metabolic syndrome.
• Lack of physical activity.
• Age. (The risk increases for men after 45 years of age and for women after 55 years of age.)
• Family history of early heart disease.

You can read more about CAD risk factors in "Who Is At Risk for Coronary Artery Disease?"

Populations Affected

People sometimes think that because men have more heart attacks than women, men also suffer from angina more often. In fact, angina occurs equally among women and men. It can be a sign of heart disease, even when initial tests don't show evidence of CAD.

Unstable angina occurs more often in older adults.

Variant angina is rare. It accounts for only about 2 out of 100 cases of angina. People who have variant angina are often younger than those who have other forms of angina.

What Are the Signs and Symptoms of Angina?

Pain and discomfort are the main symptoms of angina. Angina is often described as pressure, squeezing, burning, or tightness in the chest. It usually starts in the chest behind the breastbone.

Pain from angina also can occur in the arms, shoulders, neck, jaw, throat, or back. It may feel like indigestion.

Some people say that angina discomfort is hard to describe or that they can't tell exactly where the pain is coming from.

Symptoms such as nausea (feeling sick to your stomach), fatigue (tiredness), shortness of breath, sweating, light-headedness, or weakness also may occur. Women are more likely to feel discomfort in their back, shoulders, and abdomen.

Symptoms vary based on the type of angina.

Stable Angina

The pain or discomfort:

• Occurs when the heart must work harder, usually during physical exertion
• Doesn't come as a surprise, and episodes of pain tend to be alike
• Usually lasts a short time (5 minutes or less)
• Is relieved by rest or medicine
• May feel like gas or indigestion
• May feel like chest pain that spreads to the arms, back, or other areas

Unstable Angina

The pain or discomfort:

• Often occurs at rest, while sleeping at night, or with little physical exertion
• Comes as a surprise
• Is more severe and lasts longer (as long as 30 minutes) than episodes of stable angina
• Is usually not relieved with rest or medicine
• May get continually worse
• May mean that a heart attack will happen soon

Variant Angina

The pain or discomfort:

• Usually occurs at rest and during the night or early morning hours
• Tends to be severe
• Is relieved by medicine

Lasting Chest Pain

Chest pain that lasts longer than a few minutes and isn't relieved by rest or angina medicine may mean you're having (or are about to have) a heart attack. Call 9–1–1 right away.

How Is Angina Diagnosed?

The most important issues to address when you go to the doctor with chest pain are:

• What's causing the chest pain
• Whether you're having or are about to have a heart attack

Angina is a symptom of an underlying heart problem, usually coronary artery disease (CAD). The type of angina pain you have can be a sign of how severe the CAD is and whether it's likely to cause a heart attack.

If you have chest pain, your doctor will want to find out whether it's angina. He or she also will want to know whether the angina is stable or unstable. If it's unstable, you may need emergency medical attention to try to prevent a heart attack.

To diagnose chest pain as stable or unstable angina, your doctor will do a physical exam, ask about your symptoms, and ask about your risk factors and your family history of CAD or other heart disease.

He or she may also ask questions about your symptoms, such as:

• What brings on the pain or discomfort and what relieves it?
• What does the pain or discomfort feel like (for example, heaviness or tightness)?
• How often does the pain occur?
• Where do you feel the pain or discomfort?
• How severe is the pain or discomfort?
• How long does the pain or discomfort last?

Diagnostic Tests and Procedures

If your doctor suspects that you have unstable angina or that your angina is related to a serious heart condition, he or she may order one or more tests.

EKG (Electrocardiogram)

An EKG is a simple test that detects and records the electrical activity of your heart. An EKG shows how fast your heart is beating and whether it has a regular rhythm. It also shows the strength and timing of electrical signals as they pass through each part of your heart.

Certain electrical patterns that the EKG detects can suggest whether CAD is likely. An EKG also can show signs of a previous or current heart attack.

However, some people with angina have a normal EKG.

Stress Testing

During stress testing, you exercise to make your heart work hard and beat fast while heart tests are performed. If you can't exercise, you're given medicine to speed up your heart rate.

During exercise stress testing, your blood pressure and EKG readings are checked while you walk or run on a treadmill or pedal a bicycle. Other heart tests, such as nuclear heart scanning or echocardiography, also can be done at the same time.

If you're unable to exercise, a medicine can be injected into your bloodstream to make your heart work hard and beat fast. Nuclear heart scanning or echocardiography is then usually done.

When your heart is beating fast and working hard, it needs more blood and oxygen. Arteries narrowed by plaque can't supply enough oxygen-rich blood to meet your heart's needs.

A stress test can show possible signs of CAD, such as:

• Abnormal changes in your heart rate or blood pressure
• Symptoms such as shortness of breath or chest pain
• Abnormal changes in your heart rhythm or your heart's electrical activity

Chest X Ray

A chest x ray takes a picture of the organs and structures inside the chest, including your heart, lungs, and blood vessels. A chest x ray can reveal signs of heart failure, as well as lung disorders and other causes of symptoms that aren't due to CAD.

Coronary Angiography and Cardiac Catheterization

Your doctor may ask you to have coronary angiography (an-jee-OG-ra-fee) if other tests or factors show that you're likely to have CAD. This test uses dye and special x rays to show the insides of your coronary arteries.

To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization (KATH-e-ter-i-ZA-shun). A long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is then threaded into your coronary arteries, and the dye is released into your bloodstream. Special x rays are taken while the dye is flowing through the coronary arteries.

Cardiac catheterization is usually done in a hospital. You're awake during the procedure. It usually causes little to no pain, although you may feel some soreness in the blood vessel where your doctor put the catheter.

Blood Tests

Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels may show that you have risk factors for CAD.

Your doctor may order a blood test to check the level of C-reactive protein (CRP) in your blood. Some studies suggest that high levels of CRP in the blood may increase the risk for CAD and heart attack.

Your doctor also may order a blood test to check for low hemoglobin (HEE-muh-glow-bin) in your blood. Hemoglobin is an iron-rich protein in the red blood cells that carries oxygen from the lungs to all parts of your body. If you have low hemoglobin, you may have a condition called anemia (uh-NEE-me-eh).

How Is Angina Treated?

Treatments for angina include lifestyle changes, medicines, medical procedures, and cardiac rehabilitation (rehab). The main goals of treatment are to:

• Reduce pain and discomfort and how often it occurs
• Prevent or lower the risk of heart attack and death by treating the underlying heart condition

Lifestyle changes and medicines may be the only treatments needed if your symptoms are mild and aren't getting worse. When lifestyle changes and medicines don't control angina, you may need medical procedures or cardiac rehab.

Unstable angina is an emergency condition that requires treatment in the hospital.

Lifestyle Changes

Making lifestyle changes can help prevent episodes of angina. You can:

• Slow down or take rest breaks if angina comes on with exertion.
• Avoid large meals and rich foods that leave you feeling stuffed if angina comes on after a heavy meal.
• Try to avoid situations that make you upset or stressed if angina comes on with stress. Learn ways to handle stress that can't be avoided.

You also can make lifestyle changes that help lower your risk of heart disease. An important lifestyle change is adopting a healthy diet. This will help prevent or reduce high blood pressure, high blood cholesterol, and obesity.

Follow a heart healthy eating plan that focuses on fruits, vegetables, whole grains, low-fat or no-fat diary products, and lean meat and fish. The plan also should be low in salt, fat, saturated fat, trans fat, and cholesterol.

Examples of healthy eating plans are the National Heart, Lung, and Blood Institute's Therapeutic Lifestyle Changes (TLC) diet and the Dietary Approaches to Stop Hypertension (DASH) eating plan.

Your doctor may recommend TLC if you have high cholesterol or the DASH eating plan if you have high blood pressure. Even if you don't have these conditions, you can still benefit from these heart healthy plans.

Other important lifestyle changes include:

• Quitting smoking, if you smoke. Avoid secondhand smoke.
• Being physically active. Check with your doctor to find out how much and what kinds of activity are safe for you.
• Losing weight, if you're overweight or obese.
• Taking all medicines as your doctor prescribes, especially if you have diabetes.

Medicines

Nitrates are the most commonly used medicines to treat angina. They relax and widen blood vessels. This allows more blood to flow to the heart while reducing its workload.

Nitroglycerin is the most commonly used nitrate for angina. Nitroglycerin that dissolves under your tongue or between your cheeks and gum is used to relieve an angina episode. Nitroglycerin in the form of pills and skin patches is used to prevent attacks of angina. These forms of nitroglycerin act too slowly to relieve pain during an angina attack.

You also may need other medicines to treat angina. These medicines may include beta blockers, calcium channel blockers, ACE inhibitors, oral antiplatelet (an-ty-PLAYT-lit) medicines, and anticoagulants (AN-te-ko-AG-u-lants). These medicines can help:

• Lower blood pressure and cholesterol levels
• Slow the heart rate
• Relax blood vessels
• Reduce strain on the heart
• Prevent blood clots from forming

Medical Procedures

When medicines and other treatments don't control angina, you may need a medical procedure to treat the underlying heart disease. Angioplasty (AN-jee-oh-plas-tee) and coronary artery bypass grafting (CABG) are both commonly used to treat angina.

Angioplasty opens blocked or narrowed coronary arteries. During angioplasty, a thin tube with a balloon or other device on the end is threaded through a blood vessel to the narrowed or blocked coronary artery. Once in place, the balloon is inflated to push the plaque outward against the wall of the artery. This widens the artery and restores blood flow.

Angioplasty can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. Sometimes a small mesh tube called a stent is placed in the artery to keep it open after the procedure.

During CABG, healthy arteries or veins taken from other areas in your body are used to bypass (that is, go around) your narrowed coronary arteries. Bypass surgery can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack.

Your doctor will help decide which treatment is right for you.

Cardiac Rehabilitation

Your doctor may prescribe cardiac rehab for angina or after angioplasty, CABG, or a heart attack.

The cardiac rehab team may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians, and psychologists or other behavioral therapists.

Rehab has two parts:

• Exercise training. This part helps you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your individual abilities, needs, and interests.
• Education, counseling, and training. This part of rehab helps you understand your heart condition and find ways to reduce your risk of future heart problems. The cardiac rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and to deal with your fears about the future.

For more information on cardiac rehab, see the Diseases and Conditions Index Cardiac Rehabilitation article.

How Can Angina Be Prevented?

You can prevent or lower your risk for angina and coronary artery disease (CAD) by making lifestyle changes and treating related conditions.

Making Lifestyle Changes

Healthy lifestyle choices can help prevent or delay angina and CAD. To make lifestyle changes, you can:

• Follow a healthy eating plan. (See "How Is Angina Treated" for more information.)
• Quit smoking, if you smoke. Avoid secondhand smoke.
• Be physically active. Check with your doctor to find out how much and what kinds of activity are safe for you.
• Learn ways to handle stress and relax.

Treating Related Conditions

You also can help prevent or delay angina and CAD by treating related conditions, such as:

• High blood cholesterol. If you have high cholesterol, follow your doctor's advice about lowering it. Take medicines as directed to lower your cholesterol.
• High blood pressure. If you have high blood pressure, follow your doctor's advice about keeping your blood pressure under control. Take blood pressure medicines as directed.
• Diabetes. If you have diabetes, follow your doctor's advice about keeping your blood sugar level under control. Take medicines as directed.
• Overweight or obesity. If you're overweight or obese, talk to your doctor about how to lose weight safely.

Living With Angina

Angina isn't a heart attack, but it does mean that you're at greater risk of having a heart attack than someone who doesn't have angina. The risk is even higher if you have unstable angina. For these reasons, it's important that you know:

• The usual pattern of your angina, if you have it regularly.
• What medicines you take (keep a list) and how to take them. Make sure you're medicines are readily available.
• How to control your angina.
• The limits of your physical activity.
• How and when to seek medical attention.

Know the Pattern of Your Angina

Stable angina usually occurs in a pattern. You should know:

• What causes the pain to occur
• What angina pain feels like
• How long the pain usually lasts
• Whether rest or medicine relieves the pain

After several episodes, you will learn to recognize when you're having angina. It's important for you to notice if the pattern starts to change. Pattern changes may include angina that occurs more often, lasts longer, is more severe, occurs without exertion, or doesn't go away with rest or medicines.

These changes may be a sign that your symptoms are getting worse or becoming unstable. You should seek medical help. Unstable angina suggests that you're at high risk for a heart attack very soon.

Know Your Medicines

You should know what medicines you're taking, the purpose of each, how and when to take them, and possible side effects. It's very important that you know exactly when and how to take fast-acting nitroglycerin or other nitrates to relieve chest pain.

It's also important to know how to correctly store your angina medicines and when to replace them. Your doctor can advise you on this.

If you have side effects from your medicines, let your doctor know. You should never stop taking your medicines without your doctor's approval.

Talk to your doctor if you have any questions or concerns about taking your angina medicines. Tell him or her about any other medicines you might be taking. Some medicines can cause serious problems if they're taken with nitrates or other angina medicines.

Know How To Control Your Angina

After several episodes, you will know the level of activity, stress, and other factors that can bring on your angina. By knowing this, you can take steps to prevent or lessen the severity of episodes.

Physical Activity

Know what level of activity brings on your angina and try to stop and rest before chest pain starts. For example, if walking up a flight of stairs leads to chest pain, then stop halfway and rest before continuing.

When chest pain occurs during exertion, stop and rest or take your angina medicine. The pain should go away in a few minutes. If the pain doesn't go away or lasts longer than usual, call 9–1–1 for emergency care.

Emotional Stress

Anger, arguing, and worrying are examples of emotional stress that can bring on an angina episode. Try to avoid or limit situations that cause these emotions.

Exercise and relaxation can help relieve stress. Alcohol and drug use play a part in causing stress and don't relieve it. If stress is a problem for you, talk with your doctor about getting help for it.

Eating Large Meals

If this leads to chest pain, eat smaller meals. Also, avoid eating rich foods.

Know the Limits of Your Physical Activity

Most people with stable angina can continue their normal activities. This includes work, hobbies, and sexual relations. However, if you do very strenuous activities or have a stressful job, talk to your doctor.

Know How and When To Seek Medical Attention

If you have angina, you're at a higher risk for a heart attack than someone who doesn't have angina. So it's very important that you and your family know how and when to seek medical attention.

Talk to your doctor about making an emergency action plan. The plan should include making sure you and your family members know:

• The signs and symptoms of a heart attack
• How to use aspirin and nitroglycerin when needed
• How to access emergency medical services in your community
• The location of the nearest hospital that offers 24-hour emergency heart care

Be sure to discuss your emergency plan with your family members. Take action quickly if your chest pain becomes severe, lasts longer than a few minutes, or isn't relieved by rest or medicine.

Sometimes, it may be difficult to tell the difference between unstable angina and a heart attack. Either way, it's an emergency situation, and you should call 9–1–1 right away.

Key Points

• Angina is chest pain or discomfort that occurs when your heart muscle doesn't get enough oxygen-rich blood. Angina is the symptom of an underlying heart condition, usually coronary artery disease (CAD).
• CAD occurs when a fatty material called plaque builds up on the inner walls of the coronary arteries. Plaque causes the coronary arteries to become narrow and stiff. The flow of oxygen-rich blood to the heart muscle is reduced.
• Angina may feel like pressure or a squeezing pain in your chest. The pain also may occur in your shoulders, arms, neck, jaw, or back.
• The most common types of angina are stable angina and unstable angina. A rare type of angina is called variant angina.
  • Stable angina occurs when the heart is working harder than usual. Pain from stable angina goes away when you rest or take your angina medicine. Angina medicine, such as nitroglycerin, helps widen and relax the arteries so that more blood can flow to the heart.
  • Unstable angina is a very dangerous condition and needs emergency treatment. Unstable angina is a sign that a heart attack may happen soon. Unstable angina can occur with or without physical exertion. It isn't relieved by rest or medicine.
  • Variant angina is caused by a spasm (tightening) in a coronary artery. This narrowing of the artery slows or stops blood flow to the heart muscle. The pain may be severe. This type of angina is relieved by medicine.
• Nearly 7 million people in the United States have angina. It occurs equally in men and women.
• Because angina is usually a symptom of CAD, its risk factors are usually the same as those for CAD.
• Pain and discomfort are the main symptoms of angina. Nausea (feeling sick to your stomach), fatigue (tiredness), shortness of breath, sweating, light-headedness, or weakness also may occur.
• If you have chest pain, your doctor will want to find out whether it's angina. To diagnose angina, your doctor will do a physical exam and ask about your symptoms, risk factors, and family history of heart disease. He or she also may order tests to confirm the diagnosis.
• Treatments for angina include lifestyle changes, medicines, medical procedures, and cardiac rehabilitation. Lifestyle changes include following a healthy eating plan, quitting smoking, being physically active, losing weight, and learning how to handle stress and relax.
• You can prevent or lower your risk for angina and CAD by making lifestyle changes and treating related conditions.
• If you have angina, it's important to know the pattern of your angina, what medicines you take (keep a list) and how often you should take then, how to control your angina, and the limits on your physical activity. You should know how and when to seek medical help.

Source : http://www.nhlbi.nih.gov/health/dci/Diseases/Angina/Angina_Summary.html

Cardiogenic Shock

What Is Cardiogenic Shock?

Cardiogenic (kar-dee-oh-JE-nik) shock is a state in which a weakened heart isn't able to pump enough blood to meet the body's needs. It is a medical emergency and is fatal if not treated right away. The most common cause of cardiogenic shock is damage to the heart muscle from a severe heart attack.

Not everyone who has a heart attack develops cardiogenic shock. In fact, less than 10 percent of people who have a heart attack develop it. But when cardiogenic shock does occur, it's very dangerous. For people who die from a heart attack in a hospital, cardiogenic shock is the most common cause.

What Is Shock?

The medical term "shock" refers to a state in which not enough blood and oxygen reach important organs in the body, such as the brain and kidneys. In a state of shock, a person's blood pressure is very low.

Shock can have a number of different causes. Cardiogenic shock is only one cause of shock. Other causes of shock include:

• Hypovolemic (hy-poe-voe-LEE-mik) shock. This is shock due to not enough blood in the body. The most common cause is severe bleeding.
• Vasodilatory (VAZ-oh-DILE-ah-tor-ee) shock. In this type of shock, the blood vessels relax too much and cause very low blood pressure. When the blood vessels are too relaxed, there isn't enough pressure to push the blood through them. Without enough pressure, blood doesn't reach the organs. A bacterial infection in the bloodstream, a severe allergic reaction, or damage to the nervous system (brain and nerves) may cause vasodilatory shock.

When a person is in shock (from any cause), not enough blood or oxygen is reaching the body's organs. If shock lasts more than several minutes, the lack of oxygen to the organs starts to damage them. If shock isn't treated quickly, the organ damage can become permanent, and the person can die.

Some of the signs and symptoms of shock include:

• Confusion or lack of alertness
• Loss of consciousness
• A sudden, rapid heartbeat
• Sweating
• Pale skin
• Weak pulse
• Rapid breathing
• Decreased or no urine output
• Cool hands and feet

If you suspect that you or someone with you is in shock, call 9–1–1 and get emergency treatment right away. Prompt treatment can help prevent or limit lasting damage to the brain and other organs and can prevent death.

Outlook

In the past, almost no one survived cardiogenic shock. Now, thanks to improved treatments, around 50 percent of people who go into cardiogenic shock survive.

The reason more people are able to survive cardiogenic shock is because of treatments (medicines and devices) that restore blood flow to the heart and help the heart pump better. In some cases, devices that take over the pumping function of the heart are used. Implanting these devices requires major surgery.

How the Heart Works

To understand cardiogenic shock, it's helpful to understand how a normal heart works.

The heart is a muscle about the size of your fist. It works like a pump and beats 100,000 times a day.

The heart has two sides, separated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to pick up oxygen. Then, oxygen-rich blood returns from the lungs to the left side of the heart, and the left side pumps it to the body.

The heart has four chambers and four valves and is connected to various blood vessels. Veins are the blood vessels that carry blood from the body to the heart. Arteries are the blood vessels that carry blood away from the heart to the body.

A Healthy Heart Cross-Section

The illustration shows a cross-section of a healthy heart and its inside structures. The blue arrow shows the direction in which oxygen-poor blood flows from the body to the lungs. The red arrow shows the direction in which oxygen-rich blood flows from the lungs to the rest of the body.

Heart Chambers

The heart has four chambers or "rooms."

• The atria (AY-tree-uh) are the two upper chambers that collect blood as it comes into the heart.
• The ventricles (VEN-trih-kuls) are the two lower chambers that pump blood out of the heart to the lungs or other parts of the body.

Heart Valves

Four valves control the flow of blood from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart.

• The tricuspid (tri-CUSS-pid) valve is in the right side of the heart, between the right atrium and the right ventricle.
• The pulmonary (PULL-mun-ary) valve is in the right side of the heart, between the right ventricle and the entrance to the pulmonary artery, which carries blood to the lungs.
• The mitral (MI-trul) valve is in the left side of the heart, between the left atrium and the left ventricle.
• The aortic (ay-OR-tik) valve is in the left side of the heart, between the left ventricle and the entrance to the aorta, the artery that carries blood to the body.

Valves are like doors that open and close. They open to allow blood to flow through to the next chamber or to one of the arteries, and then they shut to keep blood from flowing backward.

When the heart's valves open and close, they make a "lub-DUB" sound that a doctor can hear using a stethoscope.

• The first sound—the "lub"—is made by the mitral and tricuspid valves closing at the beginning of systole (SIS-toe-lee). Systole is when the ventricles contract, or squeeze, and pump blood out of the heart.
• The second sound—the "DUB"—is made by the aortic and pulmonary valves closing at beginning of diastole (di-AS-toe-lee). Diastole is when the ventricles relax and fill with blood pumped into them by the atria.

Arteries

The arteries are major blood vessels connected to your heart.

• The pulmonary artery carries blood pumped from the right side of the heart to the lungs to pick up a fresh supply of oxygen.
• The aorta is the main artery that carries oxygen-rich blood pumped from the left side of the heart out to the body.
• The coronary arteries are the other important arteries attached to the heart. They carry oxygen-rich blood from the aorta to the heart muscle, which must have its own blood supply to function.

Veins

The veins are also major blood vessels connected to your heart.

• The pulmonary veins carry oxygen-rich blood from the lungs to the left side of the heart so it can be pumped out to the body.
• The vena cava is a large vein that carries oxygen-poor blood from the body back to the heart.

For more information on how a healthy heart works, see the Diseases and Conditions Index article on How the Heart Works. This article contains animations that show how your heart pumps blood and how your heart’s electrical system works.

What Causes Cardiogenic Shock?

Immediate Causes

Cardiogenic shock happens when the heart can't pump enough blood to the body. This mostly occurs when the left ventricle isn't working because the muscle isn't getting enough blood or oxygen due to an ongoing heart attack. The weakened heart muscle can't pump enough oxygen-rich blood to the rest of the body.

In about 3 percent of the cases of cardiogenic shock, the right ventricle isn't working. This means the heart can't effectively pump blood to the lungs, where the blood picks up oxygen to bring back to the heart and the rest of the body.

When the heart isn't pumping enough blood to the rest of the body, organs (such as the brain and kidneys) don't get enough oxygen and can be damaged. Some of the things that might happen include the following.

• Cardiogenic shock may result in death if the flow of blood and oxygen to the organs isn't restored quickly. This is why emergency medical treatment is essential.
• When organs don't get enough blood or oxygen and stop working, cells in the organs die, and the organs may never go back to working normally.
• As some organs stop working, they may cause problems with other bodily functions. This, in turn, can make the shock worse. For example:
  • When the kidneys aren't working right, the levels of important chemicals in the body change. This may cause the heart and other muscles to become even weaker, limiting blood flow even more.
  • When the liver isn't working right, the body stops making proteins that cause the blood to clot. This can lead to more bleeding if the shock is due to blood loss.
• How well the brain, kidneys, and other organs recover depends on how long a person is in shock. The shorter the time in shock, the less damage to the organs. This is another reason why it's so important to get emergency treatment right away.

Underlying Causes

The underlying causes of cardiogenic shock are conditions that weaken the heart and make it unable to pump enough blood and oxygen to the body.

These conditions include:

• Heart attack. Coronary artery disease (CAD) usually causes heart attack. CAD is a condition in which a material called plaque (plak) narrows or blocks the coronary arteries.
• Serious heart conditions that may cause a heart attack and lead to cardiogenic shock, such as:
  • Ventricular septal rupture. This is when the wall between the two ventricles breaks down because cells in part of the wall have died due to a heart attack. If the ventricles aren't separated, they can't pump properly.
  • Papillary muscle infarction or rupture. This is when the muscles that help anchor the heart valves stop working or break because their blood supply is cut off due to a heart attack. When this happens, blood doesn't flow in the right way between the different chambers of the heart, and they can't pump properly.
• Serious heart conditions that may happen with or without a heart attack, including:
  • Myocarditis, or inflammation of the heart muscle.
  • Endocarditis, or infection of the heart valves.
  • Arrhythmias, or problems with the speed or rhythm of the heartbeat.
  • Pericardial tamponade, or too much fluid or blood around the heart. The fluid squeezes the heart muscle so it can't pump properly.
• Pulmonary embolism. This is a sudden blockage in a lung artery, usually due to a blood clot that traveled to the lung from a vein in the leg.

Who Is At Risk for Cardiogenic Shock?

The most common risk factor for cardiogenic shock is having a heart attack.

If you've had a heart attack, the following factors can further increase your risk for cardiogenic shock:

• Older age
• Having a history of heart attacks or heart failure
• Having coronary artery disease in all the major heart blood vessels

What Are the Signs and Symptoms of Cardiogenic Shock?

A lack of blood and oxygen reaching the brain, kidneys, skin, and other parts of the body causes the symptoms of cardiogenic shock.

The signs and symptoms of cardiogenic shock include:

• Confusion or lack of alertness
• Loss of consciousness
• A sudden, rapid heartbeat
• Sweating
• Pale skin
• Weak pulse
• Rapid breathing
• Decreased or no urine output
• Cool hands and feet

If you or someone with you is having these signs and symptoms, call 9–1–1 right away for emergency treatment. Prompt treatment can help prevent or limit lasting damage to the heart and other organs and can prevent sudden death.

How Is Cardiogenic Shock Diagnosed?

The first step in diagnosing cardiogenic shock is to identify that a person is in shock. At that point, emergency treatment should be started.

Once emergency treatment is started, doctors can look for the specific cause of the shock. If the reason for the shock is that the heart isn't pumping strongly enough, then the diagnosis is cardiogenic shock.

Tests that are useful in diagnosing cardiogenic shock include:

• Blood pressure. Using a simple blood pressure sleeve and stethoscope, doctors can check to see if a person has very low blood pressure, the most common sign of shock. This can easily be done before the patient goes to the hospital. Very low blood pressure also can have less serious causes, including simple fainting and side effects of medicines, such as medicines that treat high blood pressure.
• EKG (electrocardiogram). This test detects and records the electrical activity of the heart, measuring the rate and regularity of the heartbeat. Doctors use EKG to diagnose severe heart attack and monitor your heart's condition.
• Chest x ray. This test takes pictures of organs and structures inside your chest, including the heart, lungs, and blood vessels. A chest x ray shows whether the heart is enlarged or whether there is fluid in the lungs, which can be signs of cardiogenic shock.
• Echocardiography. This test uses sound waves to create a moving picture of your heart. Echocardiography provides information about the size and shape of your heart and how well your heart chambers and valves are working. The test also can identify areas of heart muscle that aren't contracting normally. Not enough blood is flowing to these areas.
• Coronary angiography. This test is an x-ray exam of the heart and blood vessels. The doctor passes a catheter (a thin, flexible tube) through an artery in your leg or arm to your heart. The catheter can measure the pressure inside the various chambers of your heart. A dye that can be seen on x ray is injected into the blood through the tip of the catheter. The dye lets the doctor study the flow of blood through the heart and blood vessels and see any blockages that exist.

Certain blood tests also are used to diagnose cardiogenic shock, including:

• Arterial blood gas measurement. In this test, a blood sample is taken from an artery to measure oxygen, carbon dioxide, and pH (acidity) in the blood. Doctors look for abnormalities in these levels that are associated with shock.
• Cardiac enzymes. When cells in the heart die, they release enzymes into the blood called markers or biomarkers. Measuring these markers can show whether the heart is damaged and the extent of the damage.
• Tests that measure the function of various organs, such as the kidneys and liver. If these organs aren't working right, it could be a sign that they aren't getting enough blood and oxygen, which could be a sign of cardiogenic shock.

How Is Cardiogenic Shock Treated?

Cardiogenic shock is life threatening and requires emergency medical treatment. In most cases, cardiogenic shock is diagnosed after a person has been admitted to the hospital for a heart attack. If the person isn't already in the hospital, emergency treatment can start as soon as medical personnel arrive.

The goals of emergency treatment for cardiogenic shock are first to treat the shock and then to treat the underlying cause or causes of the shock.

Sometimes both the shock and its cause are treated at the same time. For example, doctors may quickly open a blocked blood vessel that's causing damage to the heart. Often, opening the blood vessel can get the patient out of shock with little or no additional treatment.

Emergency Life Support

Emergency life support treatment is required for any type of shock. This treatment helps get blood and oxygen flowing to the brain, kidneys, and other organs. Restoring blood flow to the organs is essential to keep the patient alive and to try to prevent long-term damage to the organs. Emergency life support treatment includes:

• Giving the patient extra oxygen to breathe so that more oxygen reaches the lungs, the heart, and the rest of the body.
• Giving the patient fluids, including blood and blood products, through a needle inserted in a vein (when the shock is due to blood loss). Putting more blood into the bloodstream can help get more blood to important organs and to the rest of the body. This is usually not done for cardiogenic shock because the heart can't pump the blood that's already in the body and too much fluid is in the lungs, making it difficult to breathe.

Medicines

During and after emergency life support treatment, doctors try to find out what is causing the shock. If the reason for the shock is that the heart isn't pumping strongly enough, then the diagnosis is cardiogenic shock.

Depending on what is causing the cardiogenic shock, treatment may include medicines to:

• Increase the force with which the heart muscle contracts
• Treat the heart attack that may have caused the shock

Medical Devices and Procedures

In addition to medicines, there are medical devices that can help the heart pump and improve blood flow. The devices most commonly used to treat cardiogenic shock include:

• Intra-aortic balloon pump. This device is placed in the aorta (the main blood vessel that carries blood from the heart to the body). A large balloon at the tip of the device is inflated and deflated in a rhythm that exactly matches the rhythm of the heart's pumping action. This helps the weakened heart muscle pump as much blood as it can, and gets more blood to vital organs such as the brain and kidneys.
• Angioplasty and stents. Angioplasty is a procedure used to restore blood flow through blocked coronary arteries and to treat an ongoing heart attack. A stent is a small device that's placed in a coronary artery during angioplasty to help keep it open.

Surgery

Sometimes medicine and medical devices aren't enough to treat cardiogenic shock. Surgery can restore blood flow to the heart and the rest of the body and repair damage to the heart. Surgery can help keep a patient alive while recovering from shock and improve the chances for long-term survival.

The types of surgery used to treat underlying causes of cardiogenic shock include:

• Coronary artery bypass grafting. In this surgery, arteries or veins from other parts of the body are used to bypass (that is, go around) narrowed coronary arteries.
• Surgery to repair damaged heart valves.
• Surgery to repair a break in the wall between two chambers of the heart. This break is called a septal rupture.
• Surgery to implant a device to help the heart pump blood to the body. This device is called a left ventricular assist device (LVAD) or mechanical circulatory assist. This surgery may be done if damage to the left ventricle is causing the shock. The implanted device is a battery-operated pump that takes over part of the pumping action of the heart.
• Heart transplant. This is rarely done during an emergency situation like cardiogenic shock due to the other available devices and surgery options. Also, doctors need to do very careful tests to make sure a patient will benefit from a heart transplant and to find a matching heart from a donor. Still, in some cases, doctors may recommend a transplant if they feel it's the best way to improve the patient's chances of long-term survival.

How Can Cardiogenic Shock Be Prevented?

The best way to prevent cardiogenic shock is to do as much as you can to lower your risk for heart disease and prevent a heart attack. (See the National Heart, Lung, and Blood Institute's "Your Guide to a Healthy Heart.")

If you have a heart attack, you should get immediate treatment to try to prevent cardiogenic shock and other possible complications.

• Act in time. Know the warning signs of a heart attack so you can act fast to get treatment. Many heart attack victims wait 2 hours or more after their symptoms begin before they seek medical help. Delay in seeking treatment increases the chances of complications and death.
• If you think you're having a heart attack, or if you have angina (chest pain or discomfort) that doesn't go away as usual when you take your angina medicine as directed, call 9–1–1 for help. You can begin to receive life-saving treatment as soon as medical personnel arrive.

Key Points

• Cardiogenic shock is a state in which a weakened heart isn't able to pump enough blood to meet the body's needs. It is a medical emergency and is fatal if not treated right away.
• The medical term "shock" refers to a state in which not enough blood and oxygen reach important organs in the body, such as the brain and kidneys.
• The most common cause of cardiogenic shock is damage to the heart muscle from a severe heart attack. However, less than 10 percent of people who have a heart attack develop cardiogenic shock.
• Common signs and symptoms of cardiogenic shock include:
  • Confusion or lack of alertness
  • Loss of consciousness
  • A sudden, rapid heartbeat
  • Sweating
  • Pale skin
  • Weak pulse
  • Rapid breathing
  • Decreased or no urine output
  • Cool hands and feet
• If you or someone with you is having these signs and symptoms, call 9–1–1 right away for emergency treatment. Prompt treatment can help prevent or limit lasting damage to the heart and other organs and can prevent sudden death.
• Blood pressure tests, EKG (electrocardiogram), chest x ray, echocardiography, coronary angiography, and blood tests are used to diagnose cardiogenic shock.
• Treatment for cardiogenic shock starts with emergency life support to keep the patient alive. Once doctors know that a person is in cardiogenic shock, they can use medicines, medical devices, and different types of surgery to treat the underlying causes of the shock.
• The best way to prevent cardiogenic shock is to do as much as you can to lower your risk for heart disease and prevent a heart attack. (See the National Heart, Lung, and Blood Institute's "Your Guide to a Healthy Heart.")

Source : http://www.nhlbi.nih.gov/health/dci/Diseases/shock/shock_summary.html