Various causes and risk factor associated with

heart disease

You might be headed down the road to either your

first heart attack, or possibly your second or

third, then you are very much willing to know the

various causes of the heart diseases. So, what

the number one cause for heart disease actually

is? And the truth is no singular cause is

responsible for heart diseases, several risk

factors that you really need to be aware of, if you

are to have any chance of beating the odds. Heart

disease may come in any form like high blood

pressure, coronary artery disease, stroke,

rheumatic fever/rheumatic heart disease or

valvular heart disease, to name but a few. Here

are the various common reasons of heart

diseases, have a look:

High cholesterol: Cholesterol is considered as a

major cause of heart disease and if you dont

recognize it as a common cause of heart disease,

then you must have been in a comma for the last

20 years or so, and I would like to take this

opportunity to welcome you back to the real world.

Cholesterol is always being produced by liver to

supply the body with its essential needs. When

the production is more than enough, then it is

deposited in the arteries, including those in the

heart. Finally it will leads to leads to a narrowing

of the arteries, heart disease, as well as other

conditions.

Smoking: Smoking always promotes

atherosclerosis and increases the levels of blood

clotting factors, such as fibrinogen. The

dangerous chemicals used in the production of

cigarettes that facilitate the buildup of arterial

deposits, as a result of which it leads to severe

heart complications. Hence smokers be aware!!!

Diet: Certainly diet has a vast role in promoting

the heart disease. If your diet is enriched with

high saturated fat and cholesterol and high

sodium, then you are more prone towards the

heart disease.

Obesity: Obesity directly linked to high bad

cholesterol levels and other blood fats, reduces

the number of helpful HDL molecules, and

increases the risks of diabetes.

Stress: It always poses a high threat in promoting

the heart diseases. Always try to be happy and

active.

Lifestyle: It has a high contribution towards the

risk of heart disease. Hence it is highly

recommended to start eating more fruits,

vegetables and to have regular exercise.

In addition to this, there are also several

contributing risk factor associated with the heart

disease. These are Sex hormone, birth control

pill, diabetes sufferer and lack of mobility. In fact

there is no real agreement on the list of

determinants. Just try to follow the above steps

and ensure a secured and heart disease free life.

Various heart disease and its Symptoms

In todays date after cancer if any disease poses a

threat to human being, then it is heart diseases.

More than 75% population of the whole globe is

affected by heart diseases. In fat its a very

broad term, it is a very simple exercise to give a

glimpse of various type of heart diseases.

I. Causes of Heart Diseases

There are numerous reasons for heart disease,

out of which one is High levels of bad cholesterol

(LDL) build up in the arteries as a result of

uncontrolled diet with high levels of saturated fat

and trans fat. The deposited fat causes an

arterial blockage or anything that serves to

damage the inner lining of blood vessels and

impedes the transportation of oxygen and

nutrition to the heart can be defined as a risk of

heart disease.

2) Symptoms:

Leg cramps during walking: Leg cramps during

walking are the common associated with every

heart disease and it is advised to take lot of

water. The leg pain appear due to cramps during

walking might be an indication of heart disease

caused by arteries in your leg being clogged up by

cholesterol in result of not enough oxygen being

delivered to the cells in your leg.

Chest pain: This common symptom appears due to

blood vessels in the heart temporarily being

blocked up. In fact inadequate oxygen supply to

the heart muscle or coronary is also another

reason of the symptom.

Shortness of breath: This measure symptom

appears due to left ventricular insufficiency and

people feel restless ness.

Dizziness: This symptom appears due to low blood

count, low iron in the blood stream and other

blood disorders, dehydration, and viral

illnesses. So it is advised to concern a doctor

whenever you are having such syndrome.

Loss of consciousness: this is the most common

symptoms of every heart patients. However

sometimes this condition indicates a dangerous or

even life-threatening condition such as heart

disease so when loss of consciousness occurs it is

important to figure out the cause.

Types:

Congestive heart failure: This condition appear

when the heart does not pump as much blood as it

should and so the body does not get as much blood

and oxygen that it needs. In todays date a major

population are facing this problem.

Pulmonary heart disease: This form of disease

appears due to an enlarged right ventricle where

the blood flowing into the lungs is slowed or

blocked causing increased lung pressure.

Hypertrophic cardiomyopathy: This disease is

characterized with shortness of breath,

dizziness, fainting and angina pectoris.

Angina Pectoris: Basically there are two types of

angina pectoris, i.e stable and unstable. However

in both the case it is characterized by a stabbing

type of pain in the chest.

The list of heart disease is endless; to keep you

update keep visiting this place.

Myocardial infarction (MI ) or acute myocardial

infarction (AMI), is the medical term for an

event commonly known as a heart attack. It

happens when blood stops flowing properly to

part of the heart and the heart muscle is

injured due to not enough oxygen. Usually this

is because one of the coronary arteries that

supplies blood to the heart develops a blockage

due to an unstable buildup of white blood cells ,

cholesterol and fat . The event is called "acute"

if it is sudden and serious.

A person having an acute myocardial infarction

usually has sudden chest pain that is felt

behind the breast bone and sometimes travels

to the left arm or the left side of the neck.

Additionally, the person may have shortness of

breath , sweating , nausea, vomiting , abnormal

heartbeats , and anxiety . The anxiety is often

described as a "sense of impending doom." [1]

Women experience fewer of these symptoms

than men, but usually have shortness of

breath, weakness, a feeling of indigestion, and

fatigue . [2] In many cases, in some estimates

as high as 64 percent, the person does not

have chest pain or other symptoms. [3] These

are called "silent" myocardial infarctions.

Important risk factors are previous

cardiovascular disease, old age, tobacco

smoking , high blood levels of certain lipids

(low-density lipoprotein cholesterol,

triglycerides) and low levels of high density

lipoprotein (HDL) cholesterol, diabetes , high

blood pressure , lack of physical activity,

obesity , chronic kidney disease, excessive

alcohol consumption , the use of illicit drugs

(such as cocaine and amphetamines), and

chronic high stress levels. [4][5][6] The two

main ways to determine if a person has had a

myocardial infarction are electrocardiograms

(ECGs) that trace the electrical signals in the

heart and testing the blood for substances

associated with damage to the heart muscle.

Common blood tests are creatine kinase (CK-

MB) and troponin . ECG testing is used to

differentiate between two types of myocardial

infarctions based on the shape of the tracing.

When the ST section of the tracing is higher

than the baseline it is called an ST-elevation

myocardial infarction (STEMI) which usually

requires more aggressive treatment.

Immediate treatments for a suspected

myocardial infarction include aspirin, which

prevents further blood from clotting, and

sometimes nitroglycerin to treat chest pain

and oxygen . [7] STEMI is treated by restoring

circulation to the heart, called reperfusion

therapy, and typical methods are angioplasty ,

where the arteries are pushed open, and

thrombolysis, where the blockage is removed

using medications. [8] Non-ST elevation

myocardial infarction (NSTEMI) may be

managed with medication, although angioplasty

may be required if the person is considered to

be at high risk. [9] People who have multiple

blockages of their coronary arteries,

particularly if they also have diabetes , may

also be treated with bypass surgery (CABG).

[10][11] Ischemic heart disease, which includes

myocardial infarction, angina and heart failure

when it happens after myocardial infarction,

was the leading cause of death for both men

and women worldwide in 2011. [12][13]

Classification

There are two basic types of acute myocardial

infarction based on pathology:

Transmural: associated with atherosclerosis

involving a major coronary artery. It can be

subclassified into anterior, posterior, inferior,

lateral or septal. Transmural infarcts extend

through the whole thickness of the heart

muscle and are usually a result of complete

occlusion of the area's blood supply. [14] In

addition, on ECG, ST elevation and Q waves are

seen.

Subendocardial: involving a small area in the

subendocardial wall of the left ventricle,

ventricular septum, or papillary muscles. The

subendocardial area is particularly susceptible

to ischemia. [14] In addition, ST depression is

seen on ECG.

In the clinical context, a myocardial infarction

can be further subclassified into a ST elevation

MI (STEMI) versus a non-ST elevation MI (non-

STEMI) based on ECG changes. [15] The phrase

heart attack is sometimes used incorrectly to

describe sudden cardiac death , which may or

may not be the result of acute myocardial

infarction. A heart attack is different from,

but can be the cause of cardiac arrest , which

is the stopping of the heartbeat, and cardiac

arrhythmia , an abnormal heartbeat. It is also

distinct from heart failure , in which the

pumping action of the heart is impaired;

however severe myocardial infarction may lead

to heart failure. [10] A 2007 consensus

document classifies myocardial infarction into

five main types: [16]

Type 1 Spontaneous myocardial infarction

related to ischemia due to a primary coronary

event such as plaque erosion and/or rupture,

fissuring, or dissection

Type 2 Myocardial infarction secondary to

ischemia due to either increased oxygen

demand or decreased supply, e.g. coronary

artery spasm, coronary embolism, anaemia,

arrhythmias, hypertension, or hypotension

Type 3 Sudden unexpected cardiac death,

including cardiac arrest, often with symptoms

suggestive of myocardial ischaemia,

accompanied by new ST elevation, or new LBBB,

or evidence of fresh thrombus in a coronary

artery by angiography and/or at autopsy, but

death occurring before blood samples could be

obtained, or at a time before the appearance

of cardiac biomarkers in the blood

Type 4 Associated with coronary angioplasty

or stents:

Type 4a Myocardial infarction associated

with PCI

Type 4b Myocardial infarction associated

with stent thrombosis as documented by

angiography or at autopsy

Type 5 Myocardial infarction associated with

CABG

sign and symptoms

The onset of symptoms in myocardial infarction

(MI) is usually gradual, over several minutes,

and rarely instantaneous. [17] Chest pain is

the most common symptom of acute myocardial

infarction and is often described as a

sensation of tightness, pressure, or

squeezing. Chest pain due to ischemia (a lack

of blood and hence oxygen supply) of the heart

muscle is termed angina pectoris . Pain radiates

most often to the left arm , but may also

radiate to the lower jaw , neck , right arm,

back, and epigastrium, [10][18] where it may

mimic heartburn. Levine's sign , in which the

patient localizes the chest pain by clenching

their fist over the sternum , has classically

been thought to be predictive of cardiac chest

pain, although a prospective observational

study showed that it had a poor positive

predictive value. [19]

Shortness of breath (dyspnea) occurs when the

damage to the heart limits the output of the

left ventricle , causing left ventricular failure

and consequent pulmonary edema . Other

symptoms include diaphoresis (an excessive

form of sweating ), [1] weakness, light-

headedness, nausea, vomiting , and

palpitations. These symptoms are likely induced

by a massive surge of catecholamines from the

sympathetic nervous system [20] which occurs

in response to pain and the hemodynamic

abnormalities that result from cardiac

dysfunction. Loss of consciousness (due to

inadequate cerebral perfusion and cardiogenic

shock) and sudden death (frequently due to the

development of ventricular fibrillation) can

occur in myocardial infarctions. [10]

Female, elderly, and diabetic patients report

atypical symptoms more frequently than their

male and younger counterparts. [21][22]

Women also report more numerous symptoms

compared with men (2.6 on average vs 1.8

symptoms in men). [21] The most common

symptoms of MI in women include dyspnea

(shortness of breath), weakness, and fatigue .

Fatigue, sleep disturbances, and dyspnea have

been reported as frequently occurring

symptoms that may manifest as long as one

month before the actual clinically manifested

ischemic event. In women, chest pain may be

less predictive of coronary ischemia than in

men. [23] Women may also experience back or

jaw pain during an episode. [24]

At least one-fourth of all myocardial

infarctions are silent, without chest pain or

other symptoms. [3][25] These cases can be

discovered later on electrocardiograms, using

blood enzyme tests or at autopsy without a

prior history of related complaints. Estimates

of the prevalence of silent myocardial

infarctions vary between 22 and 64%. [3] A

silent course is more common in the elderly , [3]

in patients with diabetes mellitus [26] and

after heart transplantation, probably because

the donor heart is not fully innervated by the

nervous system of the recipient. [27] In people

with diabetes, differences in pain threshold ,

autonomic neuropathy , and psychological

factors have been cited as possible

explanations for the lack of symptoms. [26]

Any group of symptoms compatible with a

sudden interruption of the blood flow to the

heart are called an acute coronary syndrome .

[28]

The differential diagnosis includes other

catastrophic causes of chest pain, such as

pulmonary embolism , aortic dissection ,

pericardial effusion causing cardiac

tamponade , tension pneumothorax , and

esophageal rupture. Other non-catastrophic

differentials include gastroesophageal reflux

and Tietze's syndrome . [29]

causes

Heart attack rates are higher in association

with intense exertion, be it psychological

stress or physical exertion, especially if the

exertion is more intense than the individual

usually performs. [citation needed] The period

of intense exercise and subsequent recovery is

associated with about a 6-fold higher

myocardial infarction rate (compared with

other more relaxed time frames) for people

who are very physically fit. [citation needed]

For those in poor physical condition, the rate

differential is over 35-fold

higher. [citation needed] One observed

mechanism for this phenomenon is increased

pulse pressure , which increases stretching of

the arterial walls. [citation needed] This

stretching results in significant shear stress

on atheromas , which results in debris breaking

loose from these deposits. [citation needed]

This debris floats through the blood vessels,

eventually clogging the major coronary

arteries. [citation needed]

Acute severe infection, such as pneumonia ,

can trigger myocardial infarction. A more

controversial link is that between

Chlamydophila pneumoniae infection and

atherosclerosis . [30] While this intracellular

organism has been demonstrated in

atherosclerotic plaques, evidence is

inconclusive as to whether it can be considered

a causative factor. [30] Treatment with

antibiotics in patients with proven

atherosclerosis has not demonstrated a

decreased risk of heart attacks or other

coronary vascular diseases. [31]

There is an association of an increased

incidence of a heart attack in the morning

hours, more specifically around 9 a.m. [32][33]

[34] Some investigators have noticed that the

ability of platelets to aggregate varies

according to a circadian rhythm, although they

have not proven causation. [35]

Risk factors

Myocardial infarction results from

atherosclerosis . [10] Smoking appears to be the

cause of about 36% of coronary artery disease

and obesity 20%. [36] Lack of exercise has been

linked to 7-12% of cases. [36][37] Job stress

appear to play a minor role accounting for

about 3% of cases. [36]

Risk factors for myocardial infarction include:

Age [4]

Sex: At any given age men are more at risk

than women, particularly before menopause ,

[38] but because in general women live longer

than men ischemic heart disease causes

slightly more total deaths in women. [4]

Diabetes mellitus (type 1 or 2)[39]

High blood pressure [40]

Dyslipidemia / hypercholesterolemia (abnormal

levels of lipoproteins in the blood), particularly

high low-density lipoprotein, low high-density

lipoprotein and high triglycerides[40]

Tobacco smoking , including secondhand

smoke [40]

Short term exposure to air pollution

including: carbon monoxide , nitrogen dioxide ,

and sulfur dioxide but not the ozone . [41]

Family history of ischaemic heart disease or

myocardial infarction particularly if one has a

first-degree relative (father, brother,

mother, sister) who suffered a 'premature'

myocardial infarction (defined as occurring at

or younger than age 55 years (men) or 65

(women). [4]

Obesity [42] (defined by a body mass index of

more than 30 kg/m, or alternatively by waist

circumference or waist-hip ratio ).

Lack of physical activity. [4]

Psychosocial factors including, low socio-

economic status, social isolation, negative

emotions and stress increase the risk of

myocardial infarction and are associated with

worse outcomes after myocardial infarction.

Socioeconomic factors such as a shorter

education and lower income (particularly in

women), and unmarried cohabitation are also

correlated with a higher risk of MI. [43]

Alcohol Studies show that prolonged

exposure to high quantities of alcohol can

increase the risk of heart attack.

Oral contraceptive pill women who use

combined oral contraceptive pills have a

modestly increased risk of myocardial

infarction, especially in the presence of other

risk factors, such as smoking. [44]

Hyperhomocysteinemia (high homocysteine )

in homocysteinuria is associated with

premature atherosclerosis, [45] whether

elevated homocysteine in the normal range is

causal is contentious. [46]

Inflammation is known to be an important step

in the process of atherosclerotic plaque

formation. [47] C-reactive protein (CRP) is a

sensitive but non-specific marker for

inflammation . Elevated CRP blood levels,

especially measured with high-sensitivity

assays, can predict the risk of MI, as well as

stroke and development of diabetes. [47]

Moreover, some drugs for MI might also reduce

CRP levels. [47] The use of high-sensitivity

CRP assays as a means of screening the

general population is advised against, but it

may be used optionally at the physician's

discretion in patients who already present with

other risk factors or known coronary artery

disease. [48] Whether CRP plays a direct role in

atherosclerosis remains uncertain. [47]

Inflammation in periodontal disease may be

linked to coronary heart disease, and, since

periodontitis is very common, this could have

great consequences for public health . [49]

Serological studies measuring antibody levels

against typical periodontitis-causing bacteria

found that such antibodies were more present

in subjects with coronary heart disease. [50]

Periodontitis tends to increase blood levels of

CRP, fibrinogen and cytokines ; [51] thus,

periodontitis may mediate its effect on MI risk

via other risk factors. [52] Preclinical research

suggests that periodontal bacteria can promote

aggregation of platelets and promote the

formation of foam cells . [53][54] A role for

specific periodontal bacteria has been

suggested but remains to be established. [55]

There is some evidence that influenza may

trigger an acute myocardial infarction. [56]

Baldness , hair greying , a diagonal earlobe

crease (Frank's sign [57] ) and possibly other

skin features have been suggested as

independent risk factors for MI. [58] Their role

remains controversial; a common denominator

of these signs and the risk of MI is supposed,

possibly genetic. [59]

Calcium deposition is another part of

atherosclerotic plaque formation. Calcium

deposits in the coronary arteries can be

detected with CT scans. Several studies have

shown that coronary calcium can provide

predictive information beyond that of classical

risk factors. [60][61][62]

Many of these risk factors are modifiable, so

many heart attacks can be prevented by

maintaining a healthier lifestyle. Physical

activity, for example, is associated with a

lower risk profile. [63] Non-modifiable risk

factors include age, sex, and family history of

an early heart attack, which is thought of as

reflecting a genetic

predisposition . [citation needed] To understand

epidemiological study results, it is important to

note that many factors associated with MI

mediate their risk via other factors. For

example, the effect of education is partially

based on its effect on income and marital

status . [43]