What Is Heart Disease?

"Heart disease," or cardiovascular disease (CVD), is an umbrella term for conditions affecting the heart and blood vessels. Sometimes people are born with heart disease (known as congenital heart disease), while in others, it develops over time, as in coronary artery disease (CAD).

CVD is a leading cause of death in the United States, and coronary artery disease is estimated to affect 18.2 million American adults. In 2020, CVD accounted for 697,000—or 1 in 5–deaths.

It is important to know the early signs and symptoms of heart disease and how it can be prevented and treated. This article will explain the types of heart disease, signs and symptoms, treatment options, and best practices for preventing heart disease.

Types of Heart Disease

Heart disease refers to several distinct heart and blood (cardiovascular) conditions. Types of CVD include the following:

• Congenital heart disease occurs when people are born with defects in their heart structure.
• Coronary heart disease (coronary artery disease) is the most common type of heart disease; it's characterized by a buildup of plaque and hardening of artery walls (atherosclerosis), which disrupts blood flow.
• Heart attack (myocardial infarction) is often caused by CAD and occurs when blood flow is blocked, causing heart muscles to die.  
• Heart failure is a form of heart disease characterized by the heart not pumping enough blood; the heart is still working but not well enough.
• Arrhythmia is an irregular heartbeat, which can impact your heart’s ability to pump enough blood; your heart may beat too fast (tachycardia), too slowly (bradycardia), or inconsistently.
• Valvular stenosis occurs when one or more of the four valves of the heart do not open all the way; this can cause regurgitation, when blood leaks backward because the valve is closed.

Heart Disease Symptoms: How Do You Know You Have It?

Heart disease represents a wide range of conditions, and its symptoms can vary; different types come with different signs. CVD can be asymptomatic, meaning many people live for months or years without symptoms. Often, the underlying issue is not identified until it starts causing complications.  

The symptoms of heart attack, arrhythmia, and heart failure often include the following:

• Chest pain and discomfort (angina)
• Pain in the upper back or neck
• Indigestion and heartburn
• Nausea, vomiting
• Dizziness
• Fatigue
• Shortness of breath
• Fluttering the chest (palpitations)
• Swelling in the feet, ankles, legs, abdomen (belly and chest), or neck veins
• Syncope (passing out)

CVD presents differently based on sex. Researchers found if you're assigned female at birth and younger than 65, you're less likely to report chest pain.

Early Signs of Heart Disease

Since many people with CVD have the condition without knowing it, it can be crucial to identify the early warning signs. People may experience these warning signs for months before serious complications, such as heart attack, occur. Warning signs include:

• Tightness, squeezing, pressure, or pain in the chest
• Discomfort or tightness in the body, including one or both arms, back, neck, jaw
• Difficulty breathing and shortness of breath
• Cold sweats
• Nausea or vomiting
• Light-headedness

For heart failure, troubling signs include:

• Difficulty breathing
• Persistent cough, wheezing
• Swollen ankles, feet, or other body parts
• Fatigue, lack of energy
• Nausea and loss of appetite
• Impaired thinking, confusion, and difficulty remembering
• Increased heart rate, heart palpitations

What Causes Heart Disease?

Heart disease is caused by various factors depending on the type of heart disease.

Some people are born with structural problems with their heart and associated arteries, affecting the heart's ability to pump blood effectively.

The most common cause of heart disease is atherosclerosis, which causes plaque buildup and hardened arterial walls. It develops gradually over time and eventually restricts blood flow due to narrowing arteries.

In some cases, people experience blood vessel problems. For instance, they may not respond to signals that the body needs more oxygen (such as during physical activity) and dilate as they should. Arteries of the heart can cause them to tighten or close up, a condition called vasospasm.

Heart Disease Risk Factors

Various factors can increase your risk of developing heart disease. Certain populations and people with specific underlying diseases are at higher risk of developing heart disease.

Non-Modifiable

Non-modifiable risk factors include:

• Age
• Family history of early heart disease
• Genetics
  

Modifiable

Modifiable risk factors include:

• Smoking or consistent exposure to secondhand smoke
• Physical inactivity, lack of exercise
• Insufficient or irregular sleep, insomnia, or other sleep disorders
• Stress
• Unhealthy diet, especially one high in saturated fats and refined carbohydrates
• Environment (e.g., pollution, work conditions, etc.)

Underlying Conditions

Heart disease risk is also raised if you have any of the following diseases or conditions:

• High blood pressure (hypertension)
• High levels of low-density lipoprotein (LDL) cholesterol (considered "bad" cholesterol)
• High levels of blood triglycerides
• Atherosclerosis
• Autoimmune inflammatory conditions, including Crohn’s disease, psoriasis, ulcerative colitis, and others
• Diabetes mellitus 
• Chronic kidney disease
• Being overweight or having obesity
• Human immunodeficiency virus (HIV)
• Depression, anxiety, or other mental health conditions
• Metabolic syndrome (a group of symptoms that when occurring together contribute to heart disease, stroke, or type 2 diabetes)

How to Prevent Heart Disease

You can take steps to reduce your risk and prevent heart disease. Most involve modifying lifestyle factors, such as in the following ways, to improve your overall health:

• Eat a heart-healthy diet: Eat various fruits and vegetables, limit food high in saturated and trans fats and added sugar and salt, and minimize alcohol consumption.
• Exercise regularly: Aim for 150 minutes of light to moderate activity, such as cycling, walking, running, or swimming, each week.
• Quit smoking: Tobacco use increases your risk of heart disease. If you use tobacco, talk to a healthcare provider about options for quitting.
• Manage your weight: Excess weight can stress your heart and blood vessels.
• Get good sleep: Aim for seven to eight hours each night. Following a sleep schedule can help you improve your sleep quality.
• Monitor risk factors: Manage any underlying conditions that put you at more risk by taking prescribed medications or making lifestyle changes to manage diabetes, high blood pressure, and other risk factors.

How Is Heart Disease Diagnosed?

A healthcare provider will assess your symptoms, take a medical history, and determine your risk factors of heart disease. A CVD diagnosis also based on the results of tests and imaging techniques.

Depending on your symptoms, a healthcare provider may use one or more of the following methods to diagnose and evaluate heart disease:

• Blood tests: A provider may order a blood test to examine your cholesterol levels, triglycerides, blood glucose (sugar), and lipoproteins (a sign of inflammation), which are markers of heart disease.
• Imaging: Healthcare providers may use various imaging techniques, including electrocardiogram (ECG/EKG), cardiac magnetic resonance imaging (MRI), Cardiac positron-emission tomography (PET), cardiac computed tomography (CT), coronary calcium scan, or coronary angiography to diagnose heart disease.
• Stress testing: During a stress test, a healthcare provider will perform a single photon emission computed tomography (SPECT) scan while you run on a treadmill or pedal on an exercise bike to see how well your heart works under stress.
• Stress echo: This test assesses your heart using an echocardiogram while you exercise.

Heart Disease Treatment

Treatment approaches to heart disease can involve lifestyle changes, medications, or surgery, depending on the type of heart disease you have.

Lifestyle Changes

Preventive measures for CVD are a significant component of standard treatment and may include:

• Changing your diet
• Boosting physical activity or incorporating exercise
• Quitting smoking
• Ensuring you are getting good sleep
• Stress management techniques, such as mindfulness, yoga, and others

Medications

Prescribed medications for heart disease focus on treating risk factors to prevent complications or reduce symptoms. Several classes are considered for CVD:

• Angiotensin-converting enzyme (ACE) inhibitors are drugs used to treat high blood pressure and heart failure. Examples include Lotensin (benazepril) and Capoten (captopril).
• Beta-blockers like Lopressor (metoprolol) and Tenormin (atenolol) treat heart arrhythmia, prevent a second heart attack, and lower blood pressure.
• Antidiabetics are drugs used to reduce sugar levels in people with diabetes and include Jardiance (empagliflozin), Invokana (canagliflozin), and Victoza (liraglutide). They also reduce the risk of complications if you have diabetes and heart disease.
• Nitrates, such as Nitrostat (nitroglycerin), dilate blood vessels to restore blood flow and treat CVD.
• Statins, such as Mevacor (lovastatin) and Livalo (pitavastatin) reduce the risk of heart disease and lower cholesterol. A provider may recommend a statin if you’re at higher risk or have diabetes.
• Non-statins like Zetia (ezetimibe) or Repatha (alirocumab), among others, manage cholesterol, while Lopid (gemfibrozil) or Lipofen (fenofibrate) treat high triglycerides.

Complementary and Alternative Medicine

Some people with heart disease use various complementary and alternative medicine (CAM) approaches alongside standard therapies. These include:

• Certain supplements
• Yoga
• Tai chi
• Meditation

Talk to a healthcare provider before implementing these approaches.

Percutaneous Coronary Intervention

Percutaneous coronary intervention (PCI), or angioplasty with stent placement, is a way for healthcare providers to treat CVD by way of the arteries and involves using a minimally invasive technique to access blockages or obstructions and open them up. After the procedure, a stent—a mesh support tube—is implanted to prevent the artery from closing.

Coronary Artery Bypass Graft

During coronary artery bypass graft (CABG), or bypass surgery, a surgeon uses healthy vessels from the chest wall to reroute blood flow in the heart. The newly attached vessels bypass the blockage. This therapy is typically reserved for more severe or extensive cases.

Myocardial Revascularization

When other surgeries for CVD are unsuccessful or not recommended, healthcare providers use myocardial revascularization to treat blood clots and blockages in the heart. Using lasers, these procedures create holes in the heart's walls to allow blood to move more easily from the left ventricle to the middle of the heart.

Living With Heart Disease

Managing heart disease can be challenging since it requires lifestyle changes and keeping up with medications and appointments. It’s important to know where to find support and what you can do to help manage your condition. Here are some tips:

• Talk to your provider: If you need help to improve your diet, incorporate exercise, or need additional support, seek your provider’s insight. They may be able to point you to helpful professionals, programs, and resources.
• Seek support from family and friends: Talk to your family and friends to help them understand what you are going through; don’t be afraid to enlist their help.
• Consider therapy: Working with a mental health professional in individual or group sessions may help you cope with your condition and teach you strategies to manage stress.
• Log your health: Keep track of your medications and any unusual symptoms; this information can be helpful for appointments.
• Find support online: There also are support groups for those living with heart disease. Social media pages and message boards can be vital sources of information and community.
• Advocacy organizations: Advocacy agencies, such as the American Heart Association, promote heart research.

 Outlook for Heart Disease

Complications like heart attacks are much more dangerous the second or third time they occur, so it's crucial to be proactive about managing heart disease. One wide-ranging review found that nearly 50% of people readmitted to the hospital with a second heart attack within 90 days of a first died within five years.

However, managing risk factors, implementing healthy lifestyle habits, and taking your medication as prescribed can help you reduce your risk of future cardiac events or complications.