Patient Frequently Asked Questions:

Q: What is Angina?
A: Angina is a symptom of coronary artery disease (CAD), the most common type of heart disease. CAD occurs when plaque builds up in the coronary arteries. This buildup of plaque is called atherosclerosis. As plaque builds up, the coronary arteries become narrow and stiff. Blood flow to the heart is reduced. This decreases the oxygen supply to the heart muscle.

Types of Angina :
The three types of angina are stable, unstable, and variant (Prinzmetal's). It is very important to know the differences among the types.

• Stable angina :
     Stable angina is the most common type. It occurs when the heart is working harder than      usual.
    » There is a regular pattern to stable angina. After several episodes, you learn to         recognize the pattern and can predict when it will occur.
    » The pain usually goes away in a few minutes after you rest or take your angina         medicine.
    » Stable angina is not a heart attack but makes it more likely that you will have a heart         attack in the future.
• Unstable angina :
     Unstable angina is a very dangerous condition that requires emergency treatment. It is a      sign that a heart attack could occur soon. Unlike stable angina, it does not follow a pattern.      It can occur without physical exertion and is not relieved by rest or medicine.

• Variant angina :
     Variant angina is rare. It usually occurs at rest. The pain can be severe and usually occurs      between midnight and early morning. It is relieved by medicine.
     
Not all chest pain or discomfort is angina. Chest pain or discomfort can be caused by a heart attack, lung problems (such as an infection or a blood clot), heartburn, or a panic attack. However, all chest pain should be checked by a doctor.

Q: What is High Blood Cholesterol?
A: Too much cholesterol (ko-LES-ter-ol) in the blood, or high blood cholesterol, can be serious. People with high blood cholesterol have a greater chance of getting heart disease. High blood cholesterol on its own does not cause symptoms, so many people are unaware that their cholesterol level is too high.

What Is Cholesterol?
A: To understand high blood cholesterol, it is important to know more about cholesterol.

• Cholesterol is a waxy, fat-like substance that is found in all cells of the body. Your body      needs some cholesterol to work the right way. Your body makes all the cholesterol it      needs.
• Cholesterol is also found in some of the foods you eat.
• Your body uses cholesterol to make hormones, vitamin D, and substances that help you      digest foods.

Blood is watery, and cholesterol is fatty. Just like oil and water, the two do not mix. To travel in the bloodstream, cholesterol is carried in small packages called lipoproteins (lip-o-PRO-teens). The small packages are made of fat (lipid) on the inside and proteins on the outside. Two kinds of lipoproteins carry cholesterol throughout your body. It is important to have healthy levels of both:

• Low-density lipoprotein (LDL) cholesterol is sometimes called bad cholesterol.
   » High LDL cholesterol leads to a buildup of cholesterol in arteries. The higher the LDL level         in your blood, the greater chance you have of getting heart disease.
• High-density lipoprotein (HDL) cholesterol is sometimes called good cholesterol.
   » HDL carries cholesterol from other parts of your body back to your liver. The liver         removes the cholesterol from your body. The higher your HDL cholesterol level, the lower         your chance of getting heart disease.

What Is High Blood Cholesterol?
A: Too much cholesterol in your blood can build up on the walls of your arteries (blood vessels that carry blood from the heart to other parts of the body). This buildup of cholesterol is called plaque (plak). Over time, plaque can cause narrowing of the arteries. This is called atherosclerosis (ath-er-o-skler-O-sis), or hardening of the arteries.

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Special arteries, called coronary arteries, bring blood to the heart. Narrowing of your coronary arteries due to plaque can stop or slow down the flow of blood to your heart. When the arteries narrow, the amount of oxygen-rich blood is decreased. This is called coronary artery disease (CAD). Large plaque areas can lead to chest pain called angina (an-JI-nuh or AN-juh-nuh). Angina happens when the heart does not receive enough oxygen-rich blood. Angina is a common symptom of CAD.

Some plaques have a thin covering and burst (rupture), releasing fat and cholesterol into the bloodstream. The release of fat and cholesterol may cause your blood to clot. A clot can block the flow of blood. This blockage can cause angina or a heart attack.

Lowering your cholesterol level decreases your chance for having a plaque burst and cause a heart attack. Lowering cholesterol may also slow down, reduce, or even stop plaque from building up.

Plaque and resulting health problems can also occur in arteries elsewhere in the body.

Q: What Is Heart Failure?
A: Heart failure is a condition where the heart cannot pump enough blood throughout the body. Heart failure does not mean that your heart has stopped or is about to stop working. It means that your heart is not able to pump blood the way that it should. The heart cannot fill with enough blood or pump with enough force or both. Go to the section on How the Heart Works for details.

Heart failure develops over time as the pumping action of the heart grows weaker. It can affect the left side, the right side, or both sides of the heart. Most cases involve the left side where the heart cannot pump enough oxygen-rich blood to the rest of the body. With right-sided failure, the heart cannot effectively pump blood to the lungs where the blood picks up oxygen.

The weakening of the pumping ability of the heart causes:
       » Blood and fluid to "back up" into the lungs
       » The buildup of fluid in the feet, ankles, and legs
       » Tiredness and shortness of breath

Heart failure is a serious condition. About 5 million people in the U. S. have heart failure and the number is growing. Each year, another 550,000 people are diagnosed for the first time. It contributes to or causes about 300,000 deaths each year.

Q: What Is Heart Failure?
A: Heart failure is a condition where the heart cannot pump enough blood throughout the body. Heart failure does not mean that your heart has stopped or is about to stop working. It means that your heart is not able to pump blood the way that it should. The heart cannot fill with enough blood or pump with enough force or both. Go to the section on How the Heart Works for details.

Heart failure develops over time as the pumping action of the heart grows weaker. It can affect the left side, the right side, or both sides of the heart. Most cases involve the left side where the heart cannot pump enough oxygen-rich blood to the rest of the body. With right-sided failure, the heart cannot effectively pump blood to the lungs where the blood picks up oxygen.

The weakening of the pumping ability of the heart causes:
       » Blood and fluid to "back up" into the lungs
       » The buildup of fluid in the feet, ankles, and legs
       » Tiredness and shortness of breath

Heart failure is a serious condition. About 5 million people in the U. S. have heart failure and the number is growing. Each year, another 550,000 people are diagnosed for the first time. It contributes to or causes about 300,000 deaths each year.

Q: What Is a Heart Attack?
A: A heart attack occurs when the supply of blood and oxygen to an area of heart muscle is blocked, usually by a clot in a coronary artery. Often, this blockage leads to arrhythmias (irregular heartbeat or rhythm) that cause a severe decrease in the pumping function of the heart and may bring about sudden death. If the blockage is not treated within a few hours, the affected heart muscle will die and be replaced by scar tissue.

A heart attack is a life-threatening event. Everyone should know the warning signs of a heart attack and how to get emergency help. Many people suffer permanent damage to their hearts or die because they do not get help immediately.

Each year, more than a million persons in the U.S. have a heart attack and about half (515,000) of them die. About one-half of those who die do so within 1 hour of the start of symptoms and before reaching the hospital.

Emergency personnel can often stop arrhythmias with emergency CPR (cardiopulmonary resuscitation), defibrillation (electrical shock), and prompt advanced cardiac life support procedures. If care is sought soon enough, blood flow in the blocked artery can be restored in time to prevent permanent damage to the heart. Yet, most people do not seek medical care for 2 hours or more after symptoms begin. Many people wait 12 hours or longer.

A heart attack is an emergency. Call 9-1-1 if you think you (or someone else) may be having a heart attack. Prompt treatment of a heart attack can help prevent or limit lasting damage to the heart and can prevent sudden death.

Q: What Is Coronary Angioplasty?
A: Coronary angioplasty (AN-jee-oh-plas-tee) is a medical procedure used to restore blood flow through a narrowed or blocked artery in the heart. The arteries of the heart (the coronary arteries) can become narrowed and blocked due to buildup of a material called plaque on their inner walls. This narrowing reduces the flow of blood through the artery and can lead, over time, to coronary artery disease and heart attack. In angioplasty, a thin tube with a balloon or other device on the end is first threaded through a blood vessel in the arm or groin (upper thigh) up to the site of a narrowing or blockage in a coronary artery. Once in place, the balloon is then inflated to push the plaque outward against the wall of the artery, widening the artery and restoring the flow of blood through it.

Angioplasty is used to:
       » Relieve chest pain caused by reduced blood flow to the heart.
       » Minimize damage to the heart muscle during a heart attack. This damage occurs when               blood flow is totally cut off to an area of the heart.

Angioplasty was first used in 1977. A tiny balloon was used to open or widen narrowed arteries. Since then, new devices and medicines have improved the procedure and made it appropriate for more people. The improvements include:

       » Stents : A stent is a tiny mesh tube that looks like a small spring. The stent is inserted               in the area where the artery is narrowed to keep it open. Some stents are coated               with medication to help prevent the artery from closing again. Stents are used in most               angioplasties except when an artery is too small for a stent to fit.
       » When a stent is used, in 2 out of 10 people the artery will close again within the first 6               months.
       » When a stent is not used, in 4 out of 10 people the artery will close again within the               first 6 months.
       » Plaque removers : Many kinds of plaque removers exist. They are used to cut away               plaque that narrows the inside of the arteries.
       » Laser : A laser is used to dissolve or vaporize plaque. First approved in 1992, laser               devices are used in many major U.S. medical centers.

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Today, angioplasty is performed on more than 1 million people a year in the United States. The procedure is best done:

By doctors who do at least 75 angioplasties a year
       » In hospitals that do at least 400 angioplasties a year
       » Research on angioplasty continues to:

Increase its safety
       » Prevent the artery from closing again
       » Make it an option for more people

Q: What Is High Blood Pressure?
A: High blood pressure is a blood pressure reading of 140/90 mmHg or higher. Both numbers are important.

Nearly one in three American adults has high blood pressure. Once high blood pressure develops, it usually lasts a lifetime. The good news is that it can be treated and controlled.

High blood pressure is called "the silent killer" because it usually has no symptoms. Some people may not find out they have it until they have trouble with their heart, brain, or kidneys. When high blood pressure is not found and treated, it can cause:

       » The heart to get larger, which may lead to heart failure.
       » Small bulges (aneurysms) to form in blood vessels. Common locations are the main               artery from the heart (aorta), arteries in the brain, legs, and intestines, and the artery               leading to the spleen.
       » Blood vessels in the kidney to narrow, which may cause kidney failure.
       » Arteries throughout the body to "harden" faster, especially those in the heart, brain,               kidneys, and legs. This can cause a heart attack, stroke, kidney failure, or amputation               of part of the leg.
       » Blood vessels in the eyes to burst or bleed, which may cause vision changes and can               result in blindness.

Q: What is blood pressure?
A: Blood is carried from the heart to all parts of your body in vessels called arteries. Blood pressure is the force of the blood pushing against the walls of the arteries. Each time the heart beats (about 60-70 times a minute at rest), it pumps out blood into the arteries. Your blood pressure is at its highest when the heart beats, pumping the blood. This is called systolic pressure. When the heart is at rest, between beats, your blood pressure falls. This is the diastolic pressure.

Blood pressure is always given as these two numbers, the systolic and diastolic pressures. Both are important. Usually they are written one above or before the other, such as 120/80 mmHg. The top number is the systolic and the bottom the diastolic. When the two measurements are written down, the systolic pressure is the first or top number, and the diastolic pressure is the second or bottom number (for example, 120/80). If your blood pressure is 120/80, you say that it is "120 over 80."

Blood pressure changes during the day. It is lowest as you sleep and rises when you get up. It also can rise when you are excited, nervous, or active.

Still, for most of your waking hours, your blood pressure stays pretty much the same when you are sitting or standing still. That level should be lower than 120/80. When the level stays high, 140/90 or higher, you have high blood pressure. With high blood pressure, the heart works harder, your arteries take a beating, and your chances of a stroke, heart attack, and kidney problems are greater.

Q: What is normal blood pressure?
A: A blood pressure reading below 120/80 is considered normal. In general, lower is better. However, very low blood pressures can sometimes be a cause for concern and should be checked out by a doctor.

Doctors classify blood pressures under 140/90 as either "normal," or "prehypertension."
       » "Normal" blood pressures are lower than 120/80.
       » "Prehypertension" is blood pressure between 120 and 139 for the top number, or               between 80 and 89 for the bottom number. For example, blood pressure readings of               138/82, 128/89, or 130/86 are all in the "prehypertension" range. If your blood               pressure is in the prehypertension range, it is more likely that you will end up with               high blood pressure unless you take action to prevent it.

Q: What is high blood pressure?
A: A blood pressure of 140/90 or higher is considered high blood pressure. Both numbers are important. If one or both numbers are usually high, you have high blood pressure. If you are being treated for high blood pressure, you still have high blood pressure even if you have repeated readings in the normal range

There are two levels of high blood pressure: Stage 1 and Stage 2 (see the chart below).

Categories for Blood Pressure Levels in Adults*
(In mmHg, millimeters of mercury) Category Systolic

* For adults 18 and older who:
Are not on medicine for high blood pressure
Are not having a short-term serious illness
Do not have other conditions such as diabetes and kidney disease

Note:
1.	When systolic and diastolic blood pressures fall into different categories, the higher category should be used to classify blood pressure level. For example, 160/80 would be stage 2 high blood pressure.
2.	There is an exception to the above definition of high blood pressure. A blood pressure of 130/80 or higher is considered high blood pressure in persons with diabetes and chronic kidney disease.
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Q: What Is a Congenital Heart Defect? A: A congenital heart defect is a structural problem (or defect) in the heart that is present at birth. A baby's heart begins to develop shortly after conception. During development, structural defects can occur. These defects can involve the walls of the heart, the valves of the heart, and the arteries and veins near the heart. Congenital heart defects can disrupt the normal flow of blood through the heart. The blood flow can:
»	Slow down
»	Go in the wrong direction or to the wrong place
»	Be blocked completely
Congenital heart defect is the most common type of major birth defect. Each year, more than 30,000 babies in the United States are born with congenital heart defects. Types of Congenital Heart Defects There are many types of congenital heart defects. They include:
»	Abnormal passages in the heart or between blood vessels
»	Problems with the heart valves
»	Problems with the placement or development of blood vessels near the heart
»	Problems with development of the heart itself
To better understand the effects of these problems, see "How the Heart Works." Some of these problems are described below. Abnormal passages in the heart or between blood vessels
»	Atrial septal defect (ASD) is a hole in the wall that separates the upper chambers (atria (AY-tree-uh)) of the heart. This causes blood to leak from one atrium to the other.
»	Ventricular septal defect (VSD) is a hole in the wall that separates the lower chambers (ventricles (VEN-trih-kuls)) of the heart. This causes blood to leak from one ventricle to the other.
»	Atrioventricular septal defect (AVSD) includes an ASD, VSD, and abnormal development of the atrioventricular valves (tricuspid (tri-CUSS-pid) and mitral (MI-trul)). This causes blood to flow abnormally inside the heart. An AVSD is also known as an atrioventricular canal defect.
»	Patent ductus arteriosus (PDA) is a persistent connection between the aorta and the pulmonary (PULL-mun-ary) artery. This connection is called the ductus arteriosus and is normally present before birth. In most babies, the vessel closes within a few hours or days after birth. In some children, the vessel fails to close, resulting in PDA
Problems with the heart valves Congenital heart defects can involve any of the valves and include the following types of problems:
»	Stenosis. The valve opening is narrow and does not open completely.
»	Atresia. The valve does not form, so there is no opening for blood to pass from one chamber to another.
»	Regurgitation. The valve does not close completely, so blood can leak back through the valve.
Examples of particular heart valve problems include:
»	Aortic valve stenosis is a narrowing of the aortic (ay-OR-tik) valve in the heart that causes it to open incompletely. This can reduce blood flow to the body.
»	Pulmonary valve atresia is a defect in which a solid sheet of tissue forms in place of the pulmonary valve. This prevents blood in the right side of the heart from traveling normally to the lungs to pick up oxygen.
»	Pulmonary valve stenosis is a narrowing of the pulmonary valve. The narrowing slows the flow of blood from the right side of the heart to the lungs. The heart must pump harder to push blood through the smaller opening.
»	Tricuspid valve atresia is a defect in which a solid sheet of tissue forms in place of the tricuspid valve. Without the tricuspid valve, blood entering the right atrium cannot travel normally to the right ventricle and then to the lungs to pick up oxygen.
»	Ebstein's anomaly is a defect in which the tricuspid valve is both displaced and abnormally formed. The valve leaks and allows blood to flow back into the right atrium instead of to the lungs to pick up oxygen.
Problems with placement or development of blood vessels near the heart
»	Transposition of the great vessels is a defect in which the location of the "great vessels" (the aorta and pulmonary artery) coming off the heart is switched. The aorta comes off the right ventricle instead of the left ventricle. The pulmonary artery comes off the left ventricle instead of the right ventricle. Therefore, blood without oxygen is continually pumped to the body, instead of blood with oxygen.
»	Tetralogy of Fallot is a combination of four defects: Pulmonary valve stenosis is the narrowing of the pulmonary valve. The narrowing slows the flow of blood from the right ventricle to the lungs. VSD is a hole in the wall that separates the left and right ventricles. Overriding aorta is a defect in which the aorta is positioned between the left and right ventricles, over the VSD. Right ventricular hypertrophy is the thickening of the right ventricle. The thickening is caused by the heart having to work harder because of the other defects.
»	Truncus arteriosus is a defect of the great vessels. The aorta and pulmonary artery do not form as separate arteries. Instead, a large artery, called the truncus, comes from the heart. As the truncus leaves the heart, it may branch into arteries that carry blood to the body and to the lungs.
»	Coarctation of the aorta is a narrowing of the aorta. It slows or blocks the flow of blood from the heart to the body.
»	Anomalous pulmonary venous return is a defect in which one or more of the four pulmonary veins, which normally return oxygen-rich blood from the lungs to the heart, return to the wrong chamber in the heart.
Problems with development of the heart
»	Hypoplastic left heart syndrome is a combination of defects in which the left side of the heart does not develop properly. Defects usually include mitral atresia, aortic atresia, and a tiny left ventricle. Mitral atresia occurs when a solid sheet of tissue forms instead of the mitral valve, which separates the left atrium and the left ventricle. Aortic atresia occurs when a solid sheet of tissue forms instead of the aortic valve, which separates the left ventricle from the aorta.
»	Single ventricle describes a group of heart defects in which only one ventricle is present instead of two. It can be a single right or a single left ventricle. The other ventricle is usually absent or very tiny. Hypoplastic left heart syndrome is an example of a single ventricle defect.
Today, the outlook for an infant born with a heart defect is much better than it was 30 years ago. Rapid advances in infant and childhood surgery, better tests, and new medicines help most children with congenital heart defects. Many children born with more complex or severe heart defects now reach adulthood. Today, there are more than 1 million adults living with congenital heart defects.
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Q: What Is Coronary Artery Disease? A: Coronary artery disease (CAD) occurs when the arteries that supply blood to the heart muscle (the coronary arteries) become hardened and narrowed. The arteries harden and narrow due to buildup of a material called plaque (plak) on their inner walls. The buildup of plaque is known as atherosclerosis (ATH-er-o-skler-O-sis). As the plaque increases in size, the insides of the coronary arteries get narrower and less blood can flow through them. Eventually, blood flow to the heart muscle is reduced, and, because blood carries much-needed oxygen, the heart muscle is not able to receive the amount of oxygen it needs. Reduced or cutoff blood flow and oxygen supply to the heart muscle can result in: Angina (AN-ji-na or an-JI-na) : Angina is chest pain or discomfort that occurs when the heart does not get enough blood. Heart attack : A heart attack happens when a blood clot develops at the site of plaque in a coronary artery and suddenly cuts off most or all blood supply to that part of the heart muscle. Cells in the heart muscle begin to die if they do not receive enough oxygen-rich blood. This can cause permanent damage to the heart muscle. Over time, CAD can weaken the heart muscle and contribute to: Heart failure. In heart failure, the heart can’t pump blood effectively to the rest of the body. Heart failure does not mean that the heart has stopped or is about to stop. Instead, it means that the heart is failing to pump blood the way that it should. Arrhythmias (a-RITH-me-as). Arrhythmias are changes in the normal beating rhythm of the heart. Some can be quite serious. CAD is the most common type of heart disease. It is the leading cause of death in the United States in both men and women.

Q: What is the Normal Heart?
A: The heart is a muscular pump, about the size of a man's clenched fist. It is located in the mid left chest, behind the rib cage and above the diaphragm. The heart is divided into four distinct chambers by a wall of tissue called the septum, which separates the heart into right and left sides, and two valves between the upper and lower chambers. The upper chambers are called atria and receive blood from the body. The lower chambers are called the ventricles, and send blood out to the body.

A loose sac surrounds the heart, absorbing any friction, which might be caused by the movement of the heart. This sac, called the pericardium, normally contains a very small amount of fluid. The muscle, which forms the chambers of the heart and pumps blood, is called the myocardium. The inner portion of the heart chambers and valves is lined with a slick surface called the endocardium. It is similar to the lining of the inside of the mouth, and functions to reduce turbulence of blood flow through the heart.

The heart pumps blood through the body and lungs allowing the exchange of nutrients and oxygen. The heart has four valves, which keep the blood flowing in the right direction. The valves help prevent the back flow of blood. The four valves in the heart are: tricuspid, pulmonic, mitral, and aortic.

Blood is transported throughout the body in vessels called veins and arteries. Veins are vessels that carry blood to the heart. Arteries are vessels that take blood away from the heart. They have a muscular wall that is able to expand and relax with each pulsation of blood out of the heart.

Circulation of the blood through the heart accomplishes two major tasks:
	The right side of the heart receives oxygen-poor blood from the body and sends that blood to the lungs to be replenished with oxygen.
	The left side of the heart receives blood now rich with oxygen from the lungs and sends it to all the body tissues.

The chambers, electrical pathways and the blood vessels work together to ensure the heart pumps an adequate amount of blood rich in oxygen and nutrients throughout the body and carry away the waste products.