Heart Disease

Heart disease is a type of cardiovascular disease that affects the heart’s structure and function. Several different heart conditions fall under the umbrella term for heart disease. The most common type is coronary artery disease, in which plaque builds up in the arteries and blocks blood flow to the heart, potentially leading to heart attacks or heart failure.

According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death in the United States in men and women. Nearly 650,000 Americans die from heart disease annually. Young adults make up a growing percentage of cardiovascular disease events, with heart attack rates increasing by two percent every year in people under age forty.

Types of Heart Disease

There are several different types of heart disease and symptoms corresponding to each type.

They include:

• Coronary artery disease

• Heart arrhythmias

• Cardiomyopathy

• Heart valve disease

• Heart failure

• Pericarditis

• Endocarditis

• Congenital heart disease

Coronary Artery Disease

Coronary artery disease, or coronary heart disease, is the most common type of heart disease. It occurs when fatty deposits called plaques build up in your arteries, making them thicker-walled, harder, and narrower — a disease process known as atherosclerosis. These fatty deposits contain cholesterol, waste products, calcium, and proteins like fibrin.

These plaques can suddenly and unpredictably rupture, leading to sudden and severe blood flow blockages that can prevent the heart muscle from receiving enough oxygen and nutrients due to limited blood supply. When this happens, part of the heart muscle can stop functioning or even die.  This event is called a myocardial infarction or heart attack, and can lead to permanent heart damage or be fatal.  According to the American Heart Association, men tend to develop coronary artery disease at a younger age than women.

Heart Arrhythmias

Heart arrhythmias refer to problems involving the heart rate or heart rhythm that result from abnormal electrical activity in the heart. Arrhythmias can cause your heart to beat too rapidly (tachycardia), too slowly (bradycardia), or irregularly. 

Arrhythmias can sometimes cause relatively mild symptoms like palpitations, irregular heartbeats, or lightheadedness. 

Unfortunately, more severe arrhythmias can result in complete failure of the heart to pump blood and sudden cardiac death if the normal electrical activity of the heart cannot be quickly restored by medication, CPR, or immediate defibrillation (administering electrical shocks to reset the heart’s electrical circuit). These types of severe arrhythmias are often the cause of death when someone has a fatal heart attack.     

Cardiomyopathy

Cardiomyopathy refers to a diseased heart muscle. The disease makes it difficult for the heart to pump blood throughout the body. Over time, cardiomyopathy causes the heart muscle to become rigid, enlarged, or weak.

There are several distinct types of cardiomyopathy:

• Dilated cardiomyopathy. This common type causes the heart chambers to dilate.

• Hypertrophic cardiomyopathy. Certain genes or other causes result in thickening of the heart chamber walls.

• Restrictive cardiomyopathy. This rare type causes scar tissue to replace normal heart muscle.

• Stress-induced cardiomyopathy. Also known as “broken heart syndrome,” this type of cardiomyopathy is induced by emotional stress.

Heart Valve Disease

Heart valves open and close to allow blood to flow through the heart. When these valves become damaged, your heart has to work harder and may not work as well. There are a few different ways your heart valves can malfunction, leading to poor circulation and extra stress on the heart that can ultimately lead to heart failure.

Heart valve diseases include:

• Stenosis. Stenosis causes your heart valves to narrow or harden, limiting blood flow and putting extra stress on the heart muscle because it needs to squeeze harder to move blood forward

• Regurgitation or leaky valve. Regurgitation occurs when a valve doesn’t close properly, leading blood to flow backward or leak into the heart chamber in between heart contractions.

• Atresia. Artesia is a condition in which a heart valve doesn’t fully open. This is usually considered a congenital heart disease, which means it’s present from birth.

• Rheumatic heart disease. Rheumatic heart disease occurs when the heart valves have been damaged by rheumatic fever. It typically arises from inadequately treated strep throat and is the most common acquired heart disease in people under 25.

Heart Failure

Heart failure is a scary term, but it doesn’t indicate a non-beating heart. It means the heart muscle isn’t pumping blood efficiently enough to meet the demands of the body.

Heart failure causes the heart to overcompensate — it grows larger, develops more muscle, and may pump faster to supply blood to the body adequately. These measures may help temporarily, but over time, the heart grows weaker, causing symptoms like fatigue, breathing issues, and mental fog. Most people who develop heart failure have another heart condition, such as coronary artery disease, heart valve disease, or cardiomyopathy.

Pericarditis

Pericarditis refers to inflammation of the thin sac surrounding the heart. The most common symptom is sharp chest pain, which is felt in the middle or left side of the chest or sometimes in the shoulders. 

Numerous types of infections, including bacterial, fungal, or viral, can cause pericarditis. The condition can also develop after a heart attack, heart surgery, or radiation treatments. Some autoimmune disorders, such as scleroderma, lupus, and rheumatoid arthritis, may also contribute to pericarditis.

Endocarditis

When a person has endocarditis, it means the thin inner lining of their heart and heart valves is inflamed. It’s usually caused by bacteria in the bloodstream and can lead to symptoms like fever, fatigue, rapid heartbeat, and body aches.

Endocarditis is usually treated with antibiotics. The condition can be life-threatening if left untreated. 

Congenital Heart Disease

Congenital heart disease refers to heart problems that you’re born with, like holes in the heart, malformed valves, and others. 

Some examples of congenital heart disease include:

• Pulmonary stenosis. This is a type of heart valve disease in which the pulmonary artery, the vessel connecting the heart to the lungs, is too narrow or thick.

• Atrial septal defect. An atrial septal defect is a hole between the two upper chambers of the heart.

• Ventricular septal defect. A ventricular septal defect is a hole between the two lower chambers of the heart

• Tricuspid atresia. The tricuspid valve is located between the right atrium and the right ventricle. If you have tricuspid atresia, the valve doesn’t have an opening, which blocks blood flow between the atrium and the ventricle.

However, this list is not exhaustive. There are many other types of congenital heart disease. Sometimes, these issues resolve on their own without treatment, and other times they are life-threatening and require surgery.

Some people don’t experience heart disease symptoms. They only find out they have a heart condition after experiencing a heart attack or heart failure, or when heart disease is diagnosed on a test like an echocardiogram or cardiac stress test.

Heart disease symptoms depend on the type and severity of the heart disease but generally may include:

• Chest pain (angina)

• Shortness of breath

• Lightheadedness

• Heartburn

• Heart palpitations (fluttering feelings in the chest)

• Extreme fatigue

• Fainting

• Nausea

• Swelling of legs, feet, ankles, abdomen, or neck veins

Early Warning Signs of Heart Disease

Some warning signs of heart disease may include:

• Chest pain or shortness of breath during activity or while at rest

• Chronic coughing or wheezing

• Sudden weight gain

• Erectile dysfunction (we’ll talk more about this later)

• Tiredness that interferes with daily activities

• Weakness in legs

• Poor appetite

• Nausea

• Brain fog or memory loss

• Fainting

• Rapid or irregular heart rate

Symptoms of a Heart Attack

A heart attack, or myocardial infarction, occurs when blood flow to the heart is suddenly blocked. This medical emergency is often the result of coronary artery disease.

Often, heart attack symptoms are immediate and intense, and other times they develop gradually. The longer you wait to get treatment for a heart attack, the greater the damage to your heart muscle.

Signs you are having a heart attack include:

• Chest pain, pressure, or discomfort in the center or left side of the chest that lasts for more than a few minutes

• Weakness

• Lightheadedness

• Shortness of breath

• Cold sweat

• Discomfort in the back, neck, or jaw

• Pain in one or both arms

The causes of heart disease depend on the type you have. For instance, unhealthy lifestyle habits can contribute to the plaque buildup that leads to coronary artery disease. But congenital heart disease is determined by your genes or how you developed in the womb.

Lifestyle habits like poor nutrition and smoking, genetics, other diseases, and aging can all play a role in the development of heart disease.

Lifestyle Habits

There is extensive evidence showing that lifestyle habits can contribute to heart disease. The primary lifestyle habits associated with heart disease include:

• Poor diet. A diet high in refined grains, added sugars, salt, and saturated fats can raise cholesterol, increase inflammation, and contribute to plaque buildup in the vessels. A poor diet also raises your risk of obesity, making the heart work harder to pump blood throughout the body.

• Lack of exercise. Physical inactivity is the fourth leading risk factor of death worldwide. It plays a role in heart disease by contributing to weight gain and obesity, promotes inflammation, and increases the risk of blood clots.

• Smoking. The chemicals in cigarette smoke harm the entire body, including the heart and blood vessels. This damage makes you more prone to plaque buildup in the arteries. A 2021 study by Northwestern researchers found that smokers were more likely to die from cardiovascular diseases like heart attacks, strokes, and heart failure, than lung cancer.

• Excessive alcohol use. Binge drinking is associated with a higher risk of heart disease. Studies show that alcohol weakens the heart’s ability to contract and pump blood. Binge drinking has been shown to cause arrhythmias, such as atrial fibrillation. Long-term heavy drinking can also cause alcohol cardiomyopathy, which involves damage to the heart’s structure, cells, and tissues.

• Stress. Temporary stress might help you meet a deadline or avoid danger, but chronic stress can hurt your heart. Studies reveal stress induces inflammation within the arteries and disrupts endothelial function (your blood vessels’ ability to regulate blood flow) by increasing heart rate and blood pressure. These changes can lead to atherosclerosis, blood flow blockages, and cardiovascular events.

• Sleep. Research shows that sleep disorders and sleep deprivation are linked to increased inflammation throughout the body, which can raise your risk of heart disease. Lack of sleep can also contribute to unhealthy lifestyle choices like poor nutrition and stress, which can contribute to obesity, high blood pressure, and other cardiovascular risk factors. 

• Dental health. Keeping your teeth clean isn’t just a good way to banish bad breath and stay on your dentist’s good side – it can also protect your heart. Studies show there’s a link between heart disease and periodontal disease, a condition characterized by gum inflammation and tooth damage. 

Genetics

In addition to congenital heart defects, heart disease can develop over time if it runs in your family. According to a 2020 study, cardiac disorders like arrhythmias, cardiomyopathy, and high cholesterol that can cause coronary artery disease can be caused by genetic variations or mutations that are sometimes passed down from your parents.

But the risk of developing heart disease isn’t just based on your genetic code. The study also pointed out that families share lifestyle and environmental factors that can contribute to the development of heart disease. 

While genetics can double or even triple your heart disease risk, poor dietary habits, smoking, having excess weight, and other diseases like diabetes can also play significant roles.

Diseases

Some diseases that seem unrelated to your heart at first glance can actually contribute to the development of heart disease. This can happen because many chronic diseases cause systemic inflammation or other metabolic processes that can result in structural or functional damage to blood vessels or the heart itself.  

They include:

• Hypertension (high blood pressure)

• High cholesterol

• Chronic kidney disease

• Autoimmune and inflammatory diseases

• HIV/AIDS

• Diabetes

• Metabolic syndrome

In some cases, medications used to treat other medical conditions have been shown to cause heart disease and cardiovascular events like heart failure. These drugs include anthracyclines (a drug used in cancer treatment) and nonsteroidal anti-inflammatory drugs (NSAIDs), although these events are rare.

Aging

Research from the National Institute on Aging suggests that aging can alter the heart and blood vessels. Arteries may become thick and stiff, contributing to limited blood flow and high blood pressure. The heart’s electrical system can change, leading to irregular heartbeats. And heart chambers can become enlarged, causing the heart to fill too slowly.

Based on what we know about the causes of heart disease, there are numerous risk factors. The good news is that many of them are modifiable or even avoidable.

Risk factors include:

• High blood pressure (hypertension)

• High cholesterol levels

• Diabetes

• Family history of heart disease

• Having overweight or obesity

• Smoking

• Binge drinking

• High stress levels

• Being male and over age 45

• Poor dietary choices

• Sedentary lifestyle

• Sleep apnea

Complications of Heart Disease

If left untreated, heart disease can lead to various complications, including:

• Heart attack

• Cardiac arrest

• Chronic fatigue

• Weakness

• Stroke

Heart Attack

When your heart muscle is suddenly deprived of oxygen because a plaque on one of the blood vessels to your heart ruptures, you may experience a heart attack. This event, characterized by symptoms like chest pain, weakness, and shortness of breath, can damage the heart muscle permanently and may be fatal.  

According to the American Heart Association, someone in the U.S. has a heart attack every 40 seconds.

Cardiac Arrest

When the heart suddenly stops pumping, it’s known as cardiac arrest. This medical emergency deprives the brain and other vital organs of blood and oxygen and can cause death within minutes without immediate attention. Nine out of 10 people who have a cardiac arrest outside of a hospital do not survive.

People experiencing cardiac arrest lose consciousness, stop breathing, become unresponsive, and have no pulse.

Arrhythmias are the main cause of cardiac arrest but can be triggered by other cardiac events such as heart attacks. Other risk factors include coronary heart disease, heart valve disease, and congenital heart defects.

Stroke

A stroke occurs when blood flow to the brain becomes blocked or if there is sudden bleeding in the brain. This medical emergency can result in brain damage, disability, or even death.

Symptoms of a stroke can include weakness, numbness, or paralysis on one side of the face or body, sudden and severe headaches, vision problems, and trouble speaking.

Certain heart diseases, such as atrial fibrillation or congenital heart defects, can predispose to strokes if they are not treated appropriately. Other strokes are not directly caused by heart disease but are related to blood vessel disease (e.g., carotid artery stenosis).  

Conditions Related to Heart Disease

If you have heart disease, your risk of developing other health conditions may also be increased. These include:

• Aneurysm

• Peripheral artery disease

• Erectile dysfunction

Aneurysms

Aneurysms are balloon-like bulges that form within arteries damaged by atherosclerosis, the same process that causes coronary artery disease. Aneurysms can predispose to strokes or other types of embolisms. They can also sometimes rupture, especially when they become large, causing rapid and often catastrophic internal bleeding.  

Aortic aneurysms are a serious type of aneurysm because they form in the aorta, the main artery of the body. They can happen within the chest or just below it in the abdomen, and when they become large, they cause symptoms like chest pain, back pain, and shortness of breath.

Your chance of having an aneurysm is higher if you have hardened arteries, high blood pressure, or high cholesterol.

Peripheral Artery Disease

Similar to coronary artery disease, peripheral artery disease (PAD) involves the narrowing and hardening of blood vessels due to plaque buildup. Since PAD is also a result of atherosclerosis, it often occurs in patients who also have coronary artery disease. 

Hardening and narrowing of the affected blood vessels that carry blood from the heart to other body parts can affect the legs, feet, arms, and hands.

The most common signs of PAD include cramping, fatigue, and pain in the leg or buttock muscles. This pain may go away when you’re resting.

Erectile Dysfunction

Erectile dysfunction (ED) occurs when you have trouble getting or keeping an erection long enough to have satisfying sex. 

Studies show ED is often the first indicator of cardiovascular disease in men. The arteries that bring blood to the penis can be damaged by atherosclerosis, just like the coronary arteries that bring blood to the heart.  Since the arteries to the penis are smaller than the arteries to the heart, symptoms of atherosclerosis tend to show up earlier in the penis than the heart.  The clogged arteries make it difficult for blood to rapidly fill the penis during sexual arousal, limiting the ability of the penis to get and stay hard. Men experience that as ED.

In one study of 2,000 men without known heart disease that examined ED as a possible predictor of cardiovascular risk, subjects with ED experienced more than twice the number of cardiovascular events than men without ED. 

Though none of the 2,000 men had a history of heart disease or stroke at the beginning of the study, 115 men with ED had or died from cardiac arrest, heart attack, or stroke after nearly four years.

Whether you have a family history of heart disease, you’ve been noticing symptoms like chest pain or shortness of breath, or you’ve developed related symptoms such as ED, it’s always a good idea to make sure your heart is healthy or strong.

Your healthcare provider can run several tests to diagnose heart disease, as well as gather information on your family history, lifestyle, blood pressure and other factors that will help them estimate your risk of heart disease.

These tests include:

• An electrocardiogram (ECG or EKG). This test evaluates and records your heart’s electrical signals to check if your heart rhythm is irregular (too fast, too slow, or uneven). If the ECG doesn’t provide enough data, you may be asked to wear a Holter monitor, a device that records your heart’s rhythm over a few days.

• Echocardiogram. This noninvasive imaging test uses sound waves to collect pictures of the heart. It allows your healthcare provider to check how your blood flows through your heart’s valves and chambers.

• Coronary calcium scoring/CT. This scanning procedure measures how much calcium is in your arteries to see how much plaque buildup you have.

• Stress test. Your healthcare provider may test how well your heart works during exercise or in response to medication with an ECG or other imaging test. During a stress test, you might be asked to walk or run on a treadmill or take medication that increases your heart rate.

• Cardiac catheterization. This more invasive procedure involves placing a thin tube into a blood vessel to evaluate your heart valves. Your healthcare provider may also use dye to check if your arteries are narrowed or blocked.

Treatments for heart disease vary depending on the specific type and severity of the disease. They may involve various combinations of medication, surgery or other procedures, and lifestyle changes to improve heart function and prevent disease progression.

Medication

Medications for heart disease include:

• ACE inhibitors. Angiotensin-converting enzyme (ACE) inhibitors relax muscles in blood vessels to lower blood pressure. They’re typically prescribed for heart failure, high blood pressure, and heart attacks.

• Antiplatelet agents and dual antiplatelet therapy. These drugs, which include aspirin, prevent blood clotting in patients with various types of heart disease.

• ARBs and ARNIs. Angiotensin 2 receptor blockers (ARBs) and angiotensin receptor-neprilysin inhibitors (ARNIs) reduce blood pressure by keeping your blood vessels from constricting. They’re usually prescribed for heart failure and high blood pressure. ARNIs can also reduce sodium retention.

• Beta-blockers. Beta-blockers slow the heart rate, lowering blood pressure and making the heart beat less forcefully. They’re prescribed to treat and prevent heart attacks, high blood pressure, and chest pain.

• Blood thinners. Anticoagulants, sometimes called blood thinners, prevent blood clots and are typically prescribed after heart attacks or strokes.

• Calcium channel blockers. These drugs relax blood vessels by impeding the movement of calcium into the heart’s cells.

• Cholesterol medications. Since high cholesterol is a major risk factor for heart disease, cholesterol-lowering medications like statins are among the most important treatments for heart diseases that involve atherosclerosis, like coronary artery disease. Statins lower bad cholesterol and thereby decrease the number of fatty deposits in your arteries to prevent plaque buildup that leads to blockages and heart attacks.

• Antiarrhythmic medications. Prescribed for heart failure and arrhythmia, these drugs work on the heart’s electrical system to improve heart function and decrease the risk of arrhythmia.  

• Diuretics. These drugs prevent the heart from working too hard by ridding the body of excess fluid and sodium.

• Vasodilators. These drugs, such as nitrates, are strong relaxing agents for the muscle in blood vessel walls.  They are used to increase blood flow to the heart.  

Surgery

Heart surgery may be performed during a heart attack or if other treatment methods don’t work. Some surgeries, like coronary artery bypass grafting, which reroutes blood flow, are major and involve longer recovery time. Others, like percutaneous coronary intervention, are less invasive.

During heart surgery, your healthcare provider might repair or replace heart valves or other structures, implant medical devices that support your heart’s function, or even replace a severely damaged heart with a healthy heart from a donor.

Heart surgery types include: 

• Coronary artery bypass grafting (CABG). Also known as heart bypass surgery, CABG is a type of open heart surgery that improves blood flow to the heart. During the procedure, a surgeon connects healthy blood vessels from one part of the body to blood vessels above and below the blocked artery.

• Percutaneous coronary intervention (PCI). This minimally invasive surgery for coronary artery disease involves your surgeon placing a stent inside a blocked artery to restore blood flow.

• Heart valve procedures. During a heart valve procedure, your surgeon will either repair or replace a faulty valve to improve blood flow. Replacement valves may come from a donated human heart or animal or be a manufactured mechanical valve.

• Surgery for congenital heart defects. Surgery for congenital heart defects depends on the type you have. A surgery can help repair holes in the heart, replace a valve, widen blood vessels, or in severe cases, replace the heart entirely through heart transplant surgery.

Prevention of cardiovascular disease is one of the most important things you can do to prolong your life. Prevention efforts generally involve lifestyle modifications, understanding your own cardiovascular risk, and sometimes taking preventative medications like statins if you are at high risk.   

Here are some lifestyle tips to improve your heart health:

• Follow a healthy diet. Eat plenty of vegetables, fruits, and whole grains, and limit your intake of salt, added sugars, and saturated fats.

• Exercise. Get at least 150 minutes per week of moderate-intensity physical activity.

• Maintain a healthy weight. A higher BMI is associated with an increased risk of heart disease. In addition to a healthy diet and regular physical activity, your healthcare provider may suggest other methods of losing weight to protect your heart, such as weight loss medication.

• Stop smoking. If you smoke and already have heart disease, quitting reduces your risk of cardiac death, heart attacks, and death from other chronic diseases. If you don’t smoke, don’t start.

• Manage your stress levels. Practicing mindfulness, talking to a therapist, and maintaining a healthy work-life balance are just a few ways to control your stress before it wreaks havoc on your heart.

• Limit how much alcohol you drink. You don’t have to stop drinking if you enjoy it. Just don’t overdo it. Moderate alcohol use can actually be cardioprotective by improving HDL (good cholesterol). Try to limit your alcohol intake to two drinks or less per day. 

Understanding Your Risk

Another way to prevent heart disease is to assess your current risk. Fortunately, there are tools that make this a lot easier, such as the ASCVD Risk Estimator Plus from the American College of Cardiology.   

The tool evaluates your estimated 10-year and lifetime risk of developing heart disease based on factors like age, sex, race, cholesterol levels, blood pressure, hypertension treatment status, diabetes status, and whether or not you’re a smoker.

The risk estimator also offers customized recommendations to help you create a plan to lower your risk of heart disease based on the data you provided.

Medications That Support Your Heart

Patients at high risk for cardiovascular disease-related medical events should strongly consider taking a statin to reduce their bad cholesterol and lower their future risk of a heart attack or stroke. There is also emerging evidence that men who take phosphodiesterase-5 inhibitors for ED, like tadalafil (the active ingredient in Cialis®), appear to be at lower risk for heart attacks, strokes, and death than men with similar health who do not take ED medications.   

Duel-action medication containing both a statin and phosphodiesterase-5 inhibitor, like Hims Sex Rx + Heart Support, can be especially useful in men with ED who want to proactively lower their future cardiovascular risk and treat their ED at the same time.   

The medication includes the active ingredients in Lipitor® (atorvastatin) and Cialis (tadalafil), which help lower cholesterol and improve blood flow, respectively. However, this drug is not suitable for everyone, including those taking nitrates for heart disease. Find out if you’re a good candidate.

Though it can feel like a daunting subject, you’re not powerless against heart disease. You can do so much right now to improve your heart health, starting with something simple like what you eat for lunch. Remember, taking early action is critical. If you're noticing unusual symptoms you think are related to heart disease, call your healthcare provider today.