Cardiogenic shock

Definition

Cardiogenic shock is a condition in which your heart suddenly can't pump enough blood to meet your body's needs. Cardiogenic shock is most often caused by a severe heart attack.

Cardiogenic shock is rare, but it's often fatal if not treated immediately. If treated immediately, about half the people who develop cardiogenic shock survive.

Symptoms

Cardiogenic symptoms include:

• Rapid breathing
• Severe shortness of breath
• Sudden, rapid heartbeat (tachycardia)
• Confusion
• Loss of consciousness or fainting
• Weak pulse
• Sweating
• Pale skin
• Cold hands or feet
• Urinating less than normal or not at all

Symptoms of a heart attack
Because cardiogenic shock usually occurs in people who are having a severe heart attack, it's important to know the signs and symptoms of a heart attack. These include:

• Pressure, fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes
• Pain extending beyond your chest to your shoulder, arm, back, or even to your teeth and jaw
• Increasing episodes of chest pain
• Prolonged pain in the upper abdomen
• Shortness of breath
• Sweating
• Impending sense of doom
• Fainting
• Nausea and vomiting

If you seek medical attention quickly when having these signs or symptoms, you can decrease the chance that you'll develop cardiogenic shock.

When to see a doctor
Getting heart attack treatment quickly improves your chance of survival and minimizes damage to your heart. Don't "tough out" these symptoms for more than five minutes. Call 911 or other emergency medical services for help. If you don't have access to emergency medical services, have someone drive you to the nearest hospital.

Causes

Cardiogenic shock happens when your heart can't pump enough blood to the rest of your body. Most commonly, cardiogenic shock happens when your heart's main pumping chamber, the left ventricle, is damaged due to a lack of oxygen caused by a heart attack.

A heart attack occurs when one or more of the arteries supplying your heart with oxygen-rich blood (coronary arteries) become blocked. Over time, a coronary artery can become narrowed from the buildup of cholesterol. This buildup — collectively known as plaques — in arteries throughout the body is called atherosclerosis.

During a heart attack, one of these plaques can rupture and a blood clot forms on the site of the rupture and blocks the flow of blood through the artery. Without oxygen-rich blood circulating to that area of your heart, the heart muscle can weaken and progress into cardiogenic shock.

Rarely, cardiogenic shock happens when your heart's right ventricle is damaged. Your heart's right ventricle sends blood to your lungs to receive oxygen before being pumped to the rest of your body. Damage to the right ventricle makes it so your heart can't effectively pump blood to your lungs, so your body doesn't get sufficient oxygen.

Although heart attacks are the most common cause, cardiogenic shock can also occur due to other conditions, such as inflammation of the heart muscle (myocarditis) or infection of the heart valves (endocarditis). Other causes include drug overdoses or poisoning with substances that can affect your heart's pumping ability.

Risk factors

Some people who have a heart attack have a greater risk of developing cardiogenic shock than others have. Factors that increase your risk of cardiogenic shock include:

• Being age 65 or older
• Having a history of heart failure or previous heart attack
• Having blockages (coronary artery disease) in several of your heart's main arteries

Complications

If not treated immediately, cardiogenic shock can be fatal. Another serious complication of cardiogenic shock is organ damage.

If your heart can't pump enough oxygenated blood out to the rest of your body, your liver, kidneys or other organs could be damaged. The damage to your liver or kidneys can worsen cardiogenic shock, since the kidneys release chemicals that keep your muscles functioning and the liver releases proteins that help your blood to clot. Depending on how long you're in cardiogenic shock, the damage could be permanent.

Tests and diagnosis

Cardiogenic shock is usually diagnosed in an emergency setting. Doctors will check for signs and symptoms of shock, and will then perform additional tests to find out what's causing your condition.

Tests to diagnose cardiogenic shock include:

• Blood pressure measurement. People in shock often have very low blood pressure readings. If the person in shock is brought to the hospital by ambulance, blood pressure will be measured before he or she arrives at the hospital.
• Electrocardiogram (ECG). This is the first test done to diagnose a heart attack. It's often done while you're being asked questions about your symptoms. This test records the electrical activity of your heart via electrodes attached to your skin. Impulses are recorded as "waves" displayed on a monitor or printed on paper. Because injured heart muscle doesn't conduct electrical impulses normally, the ECG may show that a heart attack has occurred or is in progress.
• Chest X-ray. An X-ray image of your chest allows your doctor to check the size and shape of your heart and its blood vessels.
• Blood tests. Blood will be drawn to see if your kidneys or liver might be damaged, to look for signs of an infection in your heart, and to see if you've had a heart attack. Another type of blood test (arterial blood gas) may also be used to determine how much oxygen is present in the blood.
• Echocardiogram. This test uses sound waves to produce an image of your heart. During an echocardiogram, sound waves are directed at your heart from a wand-like device (transducer) held on your chest. The sound waves bounce off your heart and are reflected back through your chest wall and processed electronically to provide video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged by a heart attack and isn't pumping normally.
• Coronary catheterization (angiogram). This test can show if your coronary arteries are narrowed or blocked. A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's pushed through an artery, usually in your leg, to the arteries in your heart. As the dye fills your arteries, the arteries become visible on X-ray, revealing areas of blockage.
  
  Additionally, while the catheter is in position, your doctor may treat the blockage by performing an angioplasty. Angioplasty uses tiny balloons threaded through a blood vessel and into a coronary artery to widen the blocked area. In most cases, a mesh tube (stent) is also placed inside the artery to hold it open more widely and prevent re-narrowing in the future.
  

Treatments and drugs

Cardiogenic shock treatment focuses on repairing the damage to your heart muscle and other organs caused by lack of oxygen.

Emergency life support
Emergency life support is a necessary treatment for most people who have cardiogenic shock. During emergency life support, you're given extra oxygen to breathe to minimize damage to your muscles and organs. If necessary, you'll be connected to a breathing machine (ventilator). You'll receive medications and fluid through an intravenous (IV) line in your arm.

Medications
Medications to treat cardiogenic shock work to improve blood flow through your heart and increase your heart's pumping ability.

• Aspirin. You may be given aspirin by emergency medical personnel soon after they arrive on the scene or as soon as you get to the hospital. Aspirin reduces blood clotting and helps keep your blood flowing through a narrowed artery. Take an aspirin yourself while waiting for help to arrive only if your doctor has previously told you to do so if symptoms of a heart attack occur.
• Thrombolytics. These drugs, also called clot busters, help dissolve a blood clot that's blocking blood flow to your heart. The earlier you receive a thrombolytic drug after a heart attack, the greater the chance you'll survive and lessen the damage to your heart. You'll usually receive thrombolytics only if emergency cardiac catheterization isn't available.
• Superaspirins. Doctors in the emergency room may give you other drugs that are similar to aspirin to help prevent new clots from forming. These include medications, such as clopidogrel (Plavix) and others called platelet glycoprotein IIb/IIIa receptor blockers.
• Other blood-thinning medications. You'll likely be given other medications, such as heparin, to make your blood less likely to form more dangerous clots. Heparin is given intravenously or by an injection under your skin and is usually used during the first few days after a heart attack.
• Inotropic agents. You may be given medications, such as dopamine or epinephrine, to improve and support your heart function until other treatments start to work.

Medical procedures
Medical procedures to treat cardiogenic shock usually focus on restoring blood flow through your heart. They include:

• Angioplasty and stenting. Usually, once blood flow is restored through a blocked artery, the signs and symptoms of cardiogenic shock improve. Emergency angioplasty opens blocked coronary arteries, letting blood flow more freely to your heart. Doctors insert a long, thin tube (catheter) that's passed through an artery, usually in your leg, to a blocked artery in your heart. This catheter is equipped with a special balloon. Once in position, the balloon is briefly inflated to open up a blocked coronary artery. At the same time, a metal mesh stent may be inserted into the artery to keep it open long term, restoring blood flow to the heart. In most cases, you doctor will place a stent coated with a slow-releasing medication to help keep your artery open.
• Balloon pump. Depending on your condition, your doctors may choose to insert a balloon pump in the main artery of your heart (aorta). The balloon pump inflates and deflates to mimic the pumping action of your heart, helping blood flow through.

Surgery
If medications and medical procedures don't work to treat cardiogenic shock, your doctor may recommend surgery.

• Coronary artery bypass surgery. Bypass surgery involves sewing veins or arteries in place at a site beyond a blocked or narrowed coronary artery. This restores blood flow to the heart. Your doctor may suggest that you have this procedure after your heart has had time to recover from your heart attack.
• Surgery to repair an injury to your heart. Sometimes an injury in your heart, such as a tear in one of your heart's chambers or a damaged heart valve, can cause cardiogenic shock. If an injury causes your cardiogenic shock, your doctor may recommend surgery to correct the problem.
• Heart pumps. These mechanical devices, called ventricular assist devices (VADs), are implanted into the abdomen and attached to a weakened heart to help it pump. Implanted heart pumps can extend and improve the lives of some people with end-stage heart failure who aren't eligible for or able to undergo heart transplantation or are waiting for a new heart.
• Heart transplant. If your heart is so damaged that no other treatments work, a heart transplant may be a last resort for treating cardiogenic shock.

Prevention

The best way to prevent cardiogenic shock is to prevent a heart attack from happening. The same lifestyle changes you can use to treat heart disease can help prevent a heart attack. These lifestyle changes include:

• Control high blood pressure (hypertension). One of the most important things you can do to reduce your heart attack and cardiogenic shock risk is to keep your blood pressure under control. Exercising, managing stress, maintaining a healthy weight, and limiting sodium and alcohol intake are all ways to keep hypertension in check. In addition to recommendations for lifestyle changes, your doctor may prescribe medications to treat hypertension, such as diuretics, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers.
• Don't smoke. Quitting smoking reduces your risk of having a heart attack. Several years after quitting, a former smoker's risk of stroke is the same as that of a nonsmoker.
• Maintain a healthy weight. Being overweight contributes to other risk factors for heart attack and cardiogenic shock, such as high blood pressure, cardiovascular disease and diabetes. Weight loss of as little as 10 pounds (4.5 kilograms) may lower your blood pressure and improve your cholesterol levels.
• Lower the cholesterol and saturated fat in your diet. Eating less cholesterol and fat, especially saturated fat, may reduce your risk of developing heart disease. If you can't control your cholesterol through dietary changes alone, your doctor may prescribe a cholesterol-lowering medication.
• Exercise regularly. Exercise reduces your risk of having a heart attack in many ways. Exercise can lower your blood pressure, increase your level of high-density lipoprotein (HDL) cholesterol, and improve the overall health of your blood vessels and heart. It also helps you lose weight, control diabetes and reduce stress. Gradually work up to 30 minutes of activity — such as walking, jogging, swimming or bicycling — on most, if not all, days of the week.

If you have a heart attack, quick action can help prevent cardiogenic shock from occurring. Seek emergency medical help immediately if you think you're having a heart attack.

Sick sinus syndrome

Definition

Sick sinus syndrome is the name for a group of heart rhythm problems (arrhythmias) in which the sinus node — the heart's natural pacemaker — doesn't work properly.

The sinus node is an area of specialized cells in the upper right chamber of the heart that controls the rhythm of your heart. Normally, the sinus node produces a steady pace of regular electrical impulses.

In sick sinus syndrome, these signals are abnormally paced. A person with sick sinus syndrome may have heart rhythms that are too fast, too slow, punctuated by long pauses — or an alternating combination of all of these rhythm problems.

Sick sinus syndrome is relatively uncommon, but the risk of developing sick sinus syndrome increases with age. Many people with sick sinus syndrome eventually need a pacemaker to keep the heart in a regular rhythm.

Symptoms

Most people with sick sinus syndrome initially have few or no symptoms. In some cases, symptoms may come and go.

When they do occur, sick sinus syndrome symptoms may include:

• Slower than normal pulse (bradycardia)
• Fatigue
• Dizziness or lightheadedness
• Fainting or near fainting
• Shortness of breath
• Chest pains
• Interrupted sleeping
• Confusion or difficulty remembering things
• A sensation of rapid, fluttering heartbeats (palpitations)

Many of these signs and symptoms are caused by reduced blood flow to the brain when the heart beats too fast or too slowly.

When to see a doctor
If you have spells of lightheadedness, dizziness, fainting, fatigue, shortness of breath, or palpitations, talk to your doctor. Many medical conditions can cause these signs and symptoms — including sick sinus syndrome — and it's important to identify the problem.

Causes

Your heart is made up of four chambers — two upper chambers (atria) and two lower chambers (ventricles). The rhythm of your heart is normally controlled by the sinoatrial node (SA node) — or sinus node — an area of specialized cells located in the right atrium. This natural pacemaker produces the electrical impulses that trigger each heartbeat. From the sinus node, electrical impulses travel across the atria to the ventricles, causing them to contract and pump blood out to your lungs and body.

If you have sick sinus syndrome, your sinus node isn't functioning properly, so your heart rate may be too slow (bradycardia) or too fast (tachycardia) or irregular.

Types of sick sinus syndrome and their causes include:

• Sinoatrial block. Electrical signals move too slowly through the sinus node, causing an abnormally slow heart rate.
• Sinus arrest. The sinus node activity pauses.
• Bradycardia-tachycardia syndrome. The heart rate alternates between abnormally fast and slow rhythms, usually with a long pause (asystole) between heartbeats.

What makes the sinus node misfire?
Diseases and conditions that cause scarring or damage to your heart's electrical system can be the reason. Scar tissue from a previous heart surgery also may be the cause, particularly in children. Sick sinus syndrome may also be set off by medications, such as calcium channel blockers or beta blockers used to treat high blood pressure, heart disease or other conditions. However, in most cases, the sinus node doesn't work properly because of age-related wear and tear to the heart muscle.

Risk factors

Sick sinus syndrome can occur in people of all ages, even infants. Because it usually develops slowly, over many years, it's most common in people around age 70.

In rare cases, sick sinus syndrome may also be associated with certain conditions such as muscular dystrophy and other diseases that may affect the heart.

Complications

When your heart's natural pacemaker isn't working properly, your heart can't perform as efficiently as it should. This can lead to a very slow heart rate, which may cause fainting. In rare cases, long periods of slow heart rate or fast heart rate can keep your heart from pumping enough blood to meet your body's needs — a condition called heart failure.

If you have a type of sick sinus syndrome called bradycardia-tachycardia syndrome, you may also be at a higher risk of developing a blood clot in your heart that may lead to a stroke. That's because the fast heart rhythm that occurs in bradycardia-tachycardia syndrome is often atrial fibrillation. Atrial fibrillation is a chaotic rhythm of the upper chambers of the heart that can cause blood pooling in the heart. Blood clots are more likely to form when blood flow through the heart is altered in any way. A blood clot can break loose and travel to the brain, causing a stroke.

Preparing for your appointment

Symptoms of sick sinus syndrome, if present at all, may be so mild that you don't realize they're cause for concern. For this reason, sick sinus condition may not be diagnosed until it's in an advanced stage, when the risk of complications is greater. Call your family doctor or general practitioner if you have symptoms of sick sinus syndrome. In some cases when you call to set up an appointment, you may be referred to a doctor who specializes in the diagnosis and treatment of heart conditions (cardiologist).
Here's some information to help you prepare for your appointment.

What you can do

• Find out if you need to follow any pre-appointment restrictions, such as changing your activity level or your diet to prepare for diagnostic tests.
• Write down any symptoms you've been experiencing, and for how long.
• Write down key personal information, including any major stresses or recent changes in your life.
• Make a list of your key medical information, including other medical problems for which you've recently been treated and the names of any medications you're taking, including over-the-counter medications, vitamins and supplements.
• Find a family member or friend who can come with you to the appointment, if possible. Someone who accompanies you can help remember what the doctor says.
• Write down the questions you want to be sure to ask your doctor.

For sick sinus syndrome, some basic questions to ask your doctor include:

• What is likely causing my symptoms?
• Are there any other possible causes for these symptoms?
• What kinds of tests do I need?
• What treatment approach do you recommend?
• If you're recommending a pacemaker implantation, what's involved in the procedure?
• Will I need to stay in the hospital?
• What risks are associated with a pacemaker implantation?
• What will my recovery from surgery be like?
• Will I be able to resume normal activity? When?
• Do you expect a pacemaker will manage my symptoms permanently?
• Will I need additional surgery to maintain or, eventually, replace my pacemaker?
• Will I need any additional treatment for my condition?
• How will you monitor my health long term?
• I'm also being treated for another health problem. Will I need to change the treatments I'm using to manage that condition?
• Should my children or other close relatives be screened for heart problems?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:

• What are your symptoms?
• When did you first begin experiencing symptoms?
• Have your symptoms changed over time? If so, how?
• Do your symptoms include feeling lightheaded or dizzy?
• Have you ever fainted?
• Do you experience rapid, fluttering or pounding heartbeats (palpitations)?
• Do you experience squeezing, pressure, heaviness, tightness or pain in your chest (angina)?
• Does exercise or physical exertion make your symptoms worse?
• Are you aware of any history of heart problems in your family?
• Are you being treated for any other health conditions?

What you can do in the meantime
While you wait for your appointment, check with your family members to find out if any relatives have been diagnosed with heart problems. Although sick sinus syndrome is rare, the symptoms of this condition mimic those of many other cardiac illnesses. Knowing your family health history will help your doctor plan the right diagnostic tests and treatments based on your individual risks.
If exercise makes your symptoms worse, avoid exercise until you've been seen by your doctor.

Tests and diagnosis

Symptoms of sick sinus syndrome — such as dizziness, shortness of breath and fainting — are also symptoms of many other diseases and conditions. However, in sick sinus syndrome, these symptoms only occur when the heart is beating abnormally. In order to diagnose and treat sick sinus syndrome, your doctor will need to establish a connection between your symptoms and an abnormal heart rhythm.

Electrocardiogram
Testing for sick sinus syndrome usually starts with a standard electrocardiogram (ECG). However, if your abnormal heart rhythms tend to come and go, they may not be detected during the brief time a standard ECG is recording. You may need additional types of ECG:

• Standard ECG. During this test, sensors (electrodes) are attached to your chest and limbs to create a record of the electrical signals traveling through your heart. The test may show patterns that indicate sick sinus syndrome, including fast heart rate, slow heart rate or a long pause in the heartbeat (asystole) after a fast heart rate.
• Holter monitor ECG. This portable device is carried in your pocket or in a pouch on a belt or shoulder strap. It automatically records your heart's activity for an entire 24-hour period, which provides your doctor with an extended look at your heart rhythms. This type of monitoring can be very helpful for diagnosing sick sinus syndrome.
• Event recorder ECG. This portable electrocardiogram device can also be carried in your pocket or worn on a belt or shoulder strap for home monitoring of your heart's activity. You will often be given this device to use for a month. When you feel symptoms, you push a button, and a brief ECG recording is saved. This allows your doctor to see your heart rhythm at the time of your symptoms, which can help pinpoint sick sinus syndrome.

Electrophysiologic testing
This test isn't commonly used to screen for sick sinus syndrome. However, in some cases, electrophysiologic testing can help check the function of your sinus node, as well as other electrical properties of your heart. During this test, thin, flexible tubes (catheters) tipped with electrodes are threaded through your blood vessels to various spots along the electrical pathways in your heart. Once in place, the electrodes can precisely map the spread of electrical impulses during each beat and may identify the source of heart rhythm problems.

Treatments and drugs

Treatment for sick sinus syndrome focuses on eliminating or reducing unpleasant symptoms. If you aren't bothered by symptoms, you may only need regular checkups to monitor your condition. For people who are bothered by symptoms, the treatment of choice is usually an implanted electronic pacemaker.

Medication changes
Your doctor may start by looking at your current medications to see if any of them could be interfering with the function of your sinus node. Medications used to treat high blood pressure or heart disease — such as beta blockers or calcium channel blockers — can worsen abnormal heart rhythms. In some cases, adjusting these medications can relieve symptoms.

Pacing the heart
Most people with sick sinus syndrome eventually need a permanent artificial pacemaker to maintain a regular heartbeat. This small, battery-powered electronic device is implanted under the skin near your collarbone during a minor surgical procedure. The pacemaker is programmed to stimulate or "pace" your heart as needed to keep it beating normally.

The type of pacemaker you need depends on the type of irregular heart rhythm you're experiencing. Some rhythms can be treated with a single-chamber pacemaker, which uses only one wire (lead) to pace one chamber of the heart - in this case, the atrium. However, most people with sick sinus syndrome benefit from dual-chamber pacemakers, in which one lead paces the atrium and one lead paces the ventricle.

You'll be able to resume normal or near-normal activities after you recover from pacemaker implantation surgery. The risk of complications, such as swelling or infection in the area where the pacemaker was implanted, is small.

Additional treatments for fast heart rate
If you have rapid heart rate as part of your sick sinus syndrome, you may need additional treatments to control these rhythms:

• Medications. If you have a pacemaker and your heart rate is still too fast, your doctor may prescribe anti-arrhythmia medications to prevent fast rhythms. If you have atrial fibrillation or other abnormal heart rhythms that increase your risk of stroke, you may need a blood-thinning medicine, such as warfarin (Coumadin) or dabigatran (Pradaxa).
• AV node ablation. This procedure can also control fast heart rhythms in people with pacemakers. It involves applying radiofrequency energy through a long, thin tube (catheter) to destroy (ablate) the tissue around the atrioventricular (AV) node between the atria and the ventricles. This stops fast heart rates from reaching the ventricles and causing problems.
• Radiofrequency ablation of atrial fibrillation. This procedure is similar to AV node ablation. However, in this case, ablation targets the tissue that triggers atrial fibrillation. This actually eliminates atrial fibrillation itself, rather than just preventing it from reaching the ventricles.

Atrial septal defect (ASD)

Definition

An atrial septal defect (ASD) is a hole in the wall between the two upper chambers of your heart. The condition is present from birth (congenital). Smaller atrial septal defects may close on their own during infancy or early childhood.

Large and long-standing atrial septal defects can damage your heart and lungs. An adult who has had an undetected atrial septal defect for decades may have a shortened life span from heart failure or high blood pressure in the lungs. Surgery is often necessary to repair atrial septal defects to prevent complications.

Symptoms

Many babies born with atrial septal defects don't have associated signs or symptoms. In adults, signs or symptoms usually begin by age 30, but in some cases signs and symptoms may not occur until decades later.

Atrial septal defect symptoms may include:

• Heart murmur, a whooshing sound that can be heard through a stethoscope
• Shortness of breath, especially when exercising
• Fatigue
• Swelling of legs, feet or abdomen
• Heart palpitations or skipped beats
• Frequent lung infections
• Stroke
• Bluish skin color

When to see a doctor
Contact your doctor if you or your child has any of these signs or symptoms:

• Bluish discoloration of the skin
• Shortness of breath
• Tires easily, especially after activity
• Swelling of legs, feet or abdomen
• Heart palpitations or skipped beats

These could be symptoms of heart failure or another complication of congenital heart disease.

Causes

	Chambers and valves of the heart
	Atrial septal defect

Doctors know that heart defects present at birth (congenital) arise from errors early in the heart's development, but there's often no clear cause. Genetics and environmental factors may play a role.

An atrial septal defect allows freshly oxygenated blood to flow from the left upper chamber of the heart (left atrium) into the right upper chamber of the heart (right atrium). There, it mixes with deoxygenated blood and is pumped to the lungs, even though it's already refreshed with oxygen. If the atrial septal defect is large, this extra blood volume can overfill the lungs and overwork the heart. If not treated, the right side of the heart eventually enlarges and weakens. In some cases, the blood pressure in your lungs increases as well, leading to pulmonary hypertension.

Risk factors

It's not known why atrial septal defects occur, but congenital heart defects appear to run in families and sometimes occur with other genetic problems, such as Down syndrome. If you have a heart defect, or you have a child with a heart defect, a genetic counselor can estimate the odds that any future children will have one.

When the following conditions occur during pregnancy, they can increase your risk of having a baby with a heart defect:

• Rubella infection. Becoming infected with rubella (German measles) while pregnant can increase the risk of fetal heart defects.
• Drug or alcohol use or exposure to certain substances. Use of certain medications, alcohol or drugs, such as cocaine, during pregnancy can harm the developing fetus. 

Complications

A small atrial septal defect may never cause any problems. Small atrial septal defects often close during infancy.
Larger defects can cause mild to life-threatening problems, including:

• Right-sided heart failure
• Heart rhythm abnormalities
• Shortened life expectancy
• Increased risk of a stroke

Less common serious complications may include:

• Pulmonary hypertension. If a large atrial septal defect goes untreated, increased blood flow to your lungs increases the blood pressure in the lung arteries (pulmonary hypertension).
• Eisenmenger syndrome. In rare cases, pulmonary hypertension can cause permanent lung damage, and it becomes irreversible. This complication, called Eisenmenger syndrome, usually develops over many years and occurs only in a small percentage of people with large atrial septal defects.

Treatment can prevent or help manage many of these complications.

Atrial septal defect and pregnancy
Most women with an atrial septal defect can tolerate pregnancy without any problems. However, having a larger defect or having complications such as heart failure, arrhythmias or pulmonary hypertension can increase your risk of complications during pregnancy. Doctors strongly advise women with Eisenmenger syndrome not to become pregnant because it can endanger the woman's life.

The risk of congenital heart disease is higher for children of parents with congenital heart disease, whether in the father or the mother. Anyone with a congenital heart defect, repaired or not, who is considering starting a family should carefully discuss it beforehand with a doctor. Some medications may need to be stopped or adjusted before you become pregnant because they can cause serious problems for a developing fetus.

Preparing for your appointment

An atrial septal defect may first be detected when a suspicious heart murmur is heard during a routine examination. A heart murmur is an abnormal whooshing sound caused by turbulent blood flow. If your doctor suspects an atrial septal defect, you or your child will likely be referred to a doctor who specializes in disorders of the heart (cardiologist).

Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to arrive well prepared. Here's some information to help you get ready for your appointment, and know what to expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins or supplements that you're taking.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out.

For atrial septal defect, some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• Are there other possible causes for my symptoms?
• What kinds of tests do I need? Do these tests require any special preparation?
• Is this condition temporary or long lasting?
• What are my treatment options?
• What are the risks of cardiac catheterization or surgery?
• Are there any alternatives to the primary approach that you're suggesting?
• I have other health conditions. How can I best manage them together?
• Are there any activity restrictions that I need to follow?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you or your child first begin experiencing symptoms?
• Have the symptoms been continuous or occasional?
• Do your symptoms get worse when you exercise?
• Does anything else seem to make your symptoms worse?
• Is there anything that seems to improve the symptoms?
• Do you or does your child have any family history of heart problems?
• Do you or does your child have any family history of birth defects?

Tests and diagnosis

Your doctor may first suspect an atrial septal defect during a regular checkup if he or she hears a heart murmur while listening to your heart using a stethoscope. Or an atrial septal defect may be found when an ultrasound exam of the heart (echocardiogram) is done for another reason.

If your doctor hears a heart murmur or finds other signs or symptoms of a heart defect, he or she may request one or more of the following tests:

• Echocardiogram. This is a commonly used test to diagnose an atrial septal defect. And some atrial septal defects are found during an echocardiogram done for another reason. In echocardiography, sound waves produce a video image of the heart. It allows your doctor to see your heart's chambers and measure their pumping strength. This test also checks heart valves and looks for any signs of heart defects.
• Chest X-ray. An X-ray image helps your doctor see the condition of your heart and lungs. An X-ray may identify conditions other than a heart defect that may explain your signs or symptoms.
• Electrocardiogram (ECG). This test records the electrical activity of your heart and helps identify heart rhythm problems.
• Cardiac catheterization. In this test, a thin, flexible tube (catheter) is inserted into a blood vessel at the groin or arm and guided to your heart. Through catheterization, doctors can diagnose congenital heart defects, test how well your heart is pumping and check the function of your heart valves. Using catheterization, the blood pressure in your lungs also can be measured. Doctors are investigating catheterization techniques to repair heart defects as well.
• Magnetic resonance imaging (MRI). MRI is a technique that uses a magnetic field and radio waves to create 3-D images of your heart and other organs and tissues within your body. Your doctor may request an MRI if echocardiography can't definitively diagnose an atrial septal defect.
• Pulse oximetry. This painless test measures how well oxygen is reaching your tissues. It helps detect whether oxygenated blood is mixing with deoxygenated blood, which can help diagnose the type of heart defect present. A small clip on your fingertip measures the amount of oxygen in your blood.

Treatments and drugs

If your child has an atrial septal defect, your doctor may recommend monitoring it for a period of time to see if it closes on its own, while treating any symptoms with medications. Many atrial septal defects close on their own during childhood. For those that don't close, some small atrial septal defects don't cause any problems and may not require any treatment. But many persistent atrial septal defects eventually require surgery to be corrected.

If your child needs treatment, the timing of it depends on your child's condition and whether your child has any other congenital heart defects.

Medications
Medications won't repair the hole, but they may be used to reduce some of the signs and symptoms that can accompany an atrial septal defect. Drugs may also be used to reduce the risk of complications after surgery. Medications may include those to:

• Keep the heartbeat regular. Examples include beta blockers (Lopressor, Inderal) and digoxin (Lanoxin).
• Reduce the risk of blood clots. Anticoagulants, often called blood thinners, can help reduce the chances of developing a blood clot and having a stroke. Anticoagulants include warfarin (Coumadin) and anti-platelet agents, such as aspirin.

Surgery
Many doctors recommend repairing an atrial septal defect diagnosed during childhood to prevent complications as an adult. For adults and children, surgery involves plugging or patching the abnormal opening between the atria. Doctors can do this through two methods:

• Cardiac catheterization. A thin tube (catheter) is inserted into a blood vessel in the groin and guided to the heart. Through the catheter, a mesh patch or plug is put into place to close the hole. The heart tissue grows around the mesh, permanently sealing the hole.
• Open-heart surgery. This type of surgery is done under general anesthesia and requires the use of a heart-lung machine. Through an incision in the chest, surgeons use patches or stitches to close the hole.

Medical monitoring
Follow-up care depends on the type of defect and whether other defects are present. For simple atrial septal defects closed during childhood, only occasional follow-up care is needed. For adults, follow-up care may depend on any resulting complications.

Lifestyle and home remedies

If you find out you have a congenital heart defect, or you've had surgery to correct one, you may wonder about limitations on activities and other issues.

• Exercise. Having an atrial septal defect usually doesn't restrict you from activities or exercise. If you have complications, such as heart failure or pulmonary hypertension, you may not be able to do some activities or exercises. Your cardiologist can help you learn what is safe.
• Diet. A heart-healthy diet based on fruits, vegetables and whole grains — and low in saturated fat, cholesterol and sodium — can help you keep your heart healthy. Eating one or two servings of fish a week also is beneficial.
• Preventing infection. Some heart defects, and the repair of defects, create changes to the surface of the heart in which bacteria can become stuck and grow into an infection (infective endocarditis). Atrial septal defects generally aren't associated with infective endocarditis. But if you have other heart defects in addition to an atrial septal defect, or if you've recently had atrial septal defect repair, you may need to take antibiotics before certain dental or surgical procedures.

Prevention

In most cases, atrial septal defects can't be prevented. If you're planning to become pregnant, schedule a preconception visit with your health care provider. This visit should include:

• Getting tested for immunity to rubella. If you're not immune, you should be vaccinated.
• Going over your current health conditions and medications. You'll need to carefully monitor certain health problems during pregnancy. Your doctor also may recommend adjusting or stopping certain medications before you become pregnant.
• Reviewing your family medical history. If you have a family history of heart defects or other genetic disorders, consider talking with a genetic counselor to determine what the risk might be before getting pregnant.

Angina

Definition

Angina is a type of chest pain caused by reduced blood flow to the heart muscle. Angina is a symptom of coronary artery disease. Angina is typically described as squeezing, pressure, heaviness, tightness or pain in your chest. Many people with angina say it feels like someone is standing on their chest.

Angina, also called angina pectoris, can be a recurring problem or a sudden, acute health concern.

Angina is relatively common, but can be hard to distinguish from other types of chest pain, such as the pain or discomfort of indigestion. If you have unexplained chest pain, seek medical attention right away.

Symptoms

Angina symptoms include:

• Chest pain or discomfort
• Pain in your arms, neck, jaw, shoulder or back accompanying chest pain
• Nausea
• Fatigue
• Shortness of breath
• Anxiety
• Sweating
• Dizziness

The chest pain and discomfort common with angina may be described as pressure, squeezing, fullness or pain in the center of your chest. Some people with angina symptoms describe angina as feeling like a vise is squeezing their chest, or feeling like a heavy weight has been placed on their chest.

The severity, duration and type of angina can vary. It's important to recognize if you have new or changing chest pain. New or different symptoms may signal a more dangerous form of angina (unstable angina) or a heart attack.

Stable angina is the most common form of angina and typically occurs with exertion and goes away with rest. If chest pain is a new symptom for you, it's important to see your doctor to find out what's causing your chest pain and to get proper treatment. If your stable angina gets worse or changes, seek medical attention immediately.

Characteristics of stable angina

• Develops when your heart works harder, such as when you exercise or climb stairs
• Can usually be predicted and the pain is usually similar to previous types of chest pain you've had
• Lasts a short time, perhaps five minutes or less
• Disappears sooner if you rest or use your angina medication
• Could feel like indigestion
• Might spread to your arms, back or other areas
• Can be triggered by mental or emotional stress

Characteristics of unstable angina (a medical emergency)

• Occurs even at rest
• Is a change in your usual pattern of angina
• Is unexpected
• Is usually more severe and lasts longer than stable angina, maybe as long as 30 minutes
• May not disappear with rest or use of angina medication
• Might signal a heart attack

Characteristics of variant angina (Prinzmetal's angina)

• Usually happens when you're resting
• Is often severe
• May be relieved by angina medication

Prinzmetal's angina is rare — only about 2 percent of angina cases are Prinzmetal's angina. This type of angina is caused by a spasm in your heart's arteries that temporarily reduces blood flow.

Angina in women
A woman's angina symptoms can be different from the classic angina symptoms. For example, a woman may have chest pain that feels like a stabbing, pulsating or sharp form of chest pain rather than the more typical vise-like pressure. Women are also more likely to experience symptoms, such as nausea, shortness of breath or abdominal pain. These differences may lead to delays in seeking treatment.

When to see a doctor
If your chest pain lasts longer than a few minutes and doesn't go away when you rest or take your angina medications, it may be a sign you're having a heart attack. Call 911 or emergency medical help. Arrange for transportation. Only drive yourself to the hospital as a last resort.

Causes

Angina is caused by reduced blood flow to your heart muscle. Your blood carries oxygen, which your heart muscle needs to survive. When your heart muscle isn't getting enough oxygen, it causes a condition called ischemia.

The most common cause of reduced blood flow to your heart muscle is coronary artery disease (CAD). Your heart (coronary) arteries can become narrowed by fatty deposits called plaques. This is called atherosclerosis.

This reduced blood flow is a supply problem — your heart is not getting enough oxygen-rich blood. You may wonder why you don't always have angina if your heart arteries are narrowed due to fatty buildup. This is because during times of low oxygen demand — when you're resting, for example — your heart muscle may be able to get by on the reduced amount of blood flow ithout triggering angina symptoms. But when you increase the demand for oxygen, such as when you exercise, this can cause angina.

• Stable angina. Stable angina is usually triggered by physical exertion. When you climb stairs, exercise or walk, your heart demands more blood, but it's harder for the muscle to get enough blood when your arteries are narrowed. Besides physical activity, factors such as emotional stress, cold temperatures, heavy meals and smoking also can narrow arteries and trigger angina.
• Unstable angina. If fatty deposits (plaques) in a blood vessel rupture or a blood clot forms, it can quickly block or reduce flow through a narrowed artery, suddenly and severely decreasing blood flow to your heart muscle. Unstable angina can also be caused by conditions such as severe anemia, especially if you already have narrowed coronary arteries.
  Unstable angina worsens and is not relieved by rest or your usual medications. If the blood flow doesn't improve, heart muscle deprived of oxygen dies — a heart attack. Unstable angina is dangerous and requires emergency treatment.
  
• Variant angina. Variant angina, also called Prinzmetal's angina, is caused by a spasm in a coronary artery in which the artery temporarily  narrows. This narrowing reduces blood flow to your heart, causing chest pain. Variant angina accounts for about 2 percent of angina cases.

Risk factors

The following risk factors increase your risk of coronary artery disease and angina:

• Tobacco use. Chewing tobacco, smoking and long-term exposure to secondhand smoke damage the interior walls of arteries — including arteries to your heart — allowing deposits of cholesterol to collect and block blood flow.
• Diabetes. Diabetes is the inability of your body to produce or respond to insulin properly. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, which is a form of sugar from foods. Diabetes greatly increases the risk of coronary artery disease, which leads to angina and heart attacks by speeding up atherosclerosis and increasing your cholesterol levels
• High blood pressure. Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. Over time, high blood pressure damages arteries by accelerating atherosclerosis. High blood pressure can be an inherited problem. The risk of high blood pressure increases as you age, but the main causes are eating a diet too high in salt, stress, inadequate exercise and being overweight.
• High blood cholesterol or triglyceride levels. Cholesterol is a major part of the deposits that can narrow arteries throughout your body, including those that supply your heart. A high level of the wrong kind of cholesterol in your blood increases your risk of angina and heart attacks. Low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol) is most likely to narrow arteries. A high LDL level is undesirable and is often a byproduct of a diet high in saturated fats and cholesterol. A high level of triglycerides, a type of blood fat related to your diet, also is undesirable.
• Personal or family history of heart disease. If you have coronary artery disease or if you've had a heart attack, you're at a greater risk of developing angina.
• Older age. Men older than 45 and women older than 55 have a greater risk than younger adults.
• Lack of exercise. An inactive lifestyle contributes to high blood cholesterol levels and obesity. Exercise is beneficial in lowering high blood pressure. However, it is important to consult with your doctor before starting an exercise program.
• Obesity. Obesity raises the risk of angina and heart disease because it's associated with high blood cholesterol levels, high blood pressure and diabetes. Also, your heart has to work harder to supply blood to the excess tissue.
• Stress. You may respond to stress in ways that can increase your risk of angina and heart attacks. If you're under stress, you may overeat or smoke from nervous tension. Too much stress, as well as anger, can also raise your blood pressure. Surges of hormones produced during stress can narrow your arteries and worsen angina.

Complications

The chest pain that can occur with angina can make doing some normal activities, such as walking, uncomfortable. However, the most dangerous complication to be concerned about with angina is a heart attack.
Common symptoms of a heart attack include:

• Pressure, fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes
• Pain extending beyond your chest to your shoulder, arm, back, or even to your teeth and jaw
• Increasing episodes of chest pain
• Prolonged pain in the upper abdomen
• Shortness of breath
• Sweating
• Impending sense of doom
• Fainting
• Nausea and vomiting

If you have any of these symptoms, seek emergency medical attention immediately.

Preparing for your appointment

If you think you may have recurring angina or are worried about your angina risk because of a strong family history, make an appointment with your family doctor. If angina is found early, your treatment may be easier and more effective. If you're having sudden chest pain (unstable angina), seek emergency medical attention immediately.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet. For a blood test to check your cholesterol or other indicators of heart disease, for example, you may need to fast for a period of time beforehand.
• Write down any symptoms you're experiencing, including any that may seem unrelated to angina.
• Write down key personal information, including any family history of angina, chest pain, heart disease, stroke, high blood pressure or diabetes, and any major stresses or recent life changes.
• Make a list of all medications, vitamins or supplements you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Be prepared to discuss your diet and exercise habits. If you don't already follow a diet or exercise routine, be ready to talk to your doctor about any challenges you might face in getting started.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For angina, some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• What are other possible causes for my symptoms or condition?
• What kinds of tests will I need?
• What's the best treatment?
• What foods should I eat or avoid?
• What's an appropriate level of physical activity?
• What are the alternatives to the primary approach that you're suggesting?
• I have other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me?
• What websites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

The doctor will also ask you to describe your discomfort or pain:

• Is it pain? Discomfort? Tightness? Pressure? Sharp? Stabbing?
• Where is the pain located? Is it in a specific area or more generalized?
• Does the pain spread to your neck and arms? How and when did the pain start? Did something specific seem to trigger the pain? Does it start gradually and build up? Or start suddenly?
• How long does it last?
• What makes it worse? Activity? Breathing? Body movement?
• What makes it feel better? Rest? Deep breath? Sitting up?
• Do you have other symptoms with the pain, such as nausea or dizziness?
• Do you have trouble swallowing?
• Do you often have heartburn? (Heartburn can mimic the feeling of angina.)

What you can do in the meantime
It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and becoming more physically active. These are primary lines of defense against angina and its complications, including heart attack and stroke.

Tests and diagnosis

To diagnose angina, your doctor will start by doing a physical exam and asking about your symptoms. You'll also be asked about any risk factors, including whether you have a family history of heart disease.

There are several tests your doctor may order to help confirm whether you have angina:

• Electrocardiogram (ECG). Each beat of your heart is triggered by an electrical impulse generated from special cells in your heart. An electrocardiogram — also called an ECG or EKG — records these electrical signals as they travel through your heart. Your doctor can look for patterns among these heartbeats to see if the blood flow through your heart has been slowed or interrupted or if you are having a heart attack.
• Stress test. Sometimes angina is easier to diagnose when your heart is working harder. During a stress test, you exercise by walking on a treadmill or pedaling a stationary bicycle. While exercising, your blood pressure is monitored and your ECG readings are watched. Other tests also may be conducted while you're undergoing stress testing. If you're unable to exercise, you may be given drugs that cause your heart to work harder to simulate exercising.
• Chest X-ray. This test takes images of your heart and lungs. This is to look for other conditions that might explain your symptoms and to see if you have an enlarged heart.
• Echocardiogram. An echocardiogram uses sound waves to produce images of the heart. Your doctor can use these images to identify angina-related problems, including whether there are areas of your heart not getting enough blood or heart muscle that's been damaged by poor blood flow. An echocardiogram is sometimes given during a stress test.
• Nuclear stress test. A nuclear stress test helps measure blood flow to your heart muscle at rest and during stress. It is similar to a routine stress test, but during a nuclear stress test, a radioactive substance is injected into your bloodstream. This substance mixes with your blood and travels to your heart. A special scanner — which detects the radioactive material in your heart — creates images of your heart muscle. Inadequate blood flow to any part of your heart will show up as a light spot on the images — because not as much of the radioactive substance is getting there.
• Coronary angiography. Coronary angiography uses X-ray imaging to examine the inside of your heart's blood vessels. It's part of a general group of procedures known as cardiac catheterization. During coronary angiography, a type of dye that's visible by X-ray machine is injected into the blood vessels of your heart. The X-ray machine rapidly takes a series of images (angiograms), offering a detailed look at the inside of your blood vessels.
• Blood tests. Certain heart enzymes slowly leak out into your blood if your heart has been damaged by a heart attack. Samples of your blood can be tested for the presence of these enzymes.
• Cardiac computerized tomography (CT) scan. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest, which can show if any of your heart's arteries are narrowed or if your heart is enlarged.

Treatments and drugs

There are many options for angina treatment, including lifestyle changes, medications, angioplasty and stenting, or coronary bypass surgery. The goals of treatment are to reduce the frequency and severity of your symptoms and to lower your risk of heart attack and death.
However, if you have unstable angina or angina pain that's different from what you usually have, such as occurring when you're at rest, you need immediate treatment in a hospital.

Lifestyle changes
If your angina is mild, lifestyle changes may be all you need to do. Even if your angina is severe, making lifestyle changes can still help. Changes include:

• If you smoke, stop smoking. Avoid exposure to secondhand smoke.
• If you're overweight, talk to your doctor about weight-loss options.
• If you have diabetes make sure that it is well controlled and that you are following an optimal diet and exercise plan.
• Because angina is often brought on by exertion, it's helpful to pace yourself and take rest breaks.
• Avoid large meals.
• Avoiding stress is easier said than done, but try to find ways to relax. Talk with your doctor about stress-reduction techniques.
• Eat a healthy diet with limited amounts of saturated fat, lots of whole grains, and many fruits and vegetables.
• Talk to your doctor about starting a safe exercise plan.

Medications
If lifestyle changes alone don't help your angina, you may need to take medications. These may include:

• Aspirin. Aspirin reduces the ability of your blood to clot, making it easier for blood to flow through narrowed heart arteries. Preventing blood clots can also reduce your risk of a heart attack. But don't start taking a daily aspirin without talking to your doctor first.
• Nitrates. Nitrates are often used to treat angina. Nitrates relax and widen your blood vessels, which allows more blood to flow to your heart muscle. You might take a nitrate when you have angina-related chest discomfort, before doing something that normally triggers angina (such as physical exertion), or on a long-term preventive basis. The most common form of nitrate used to treat angina is with nitroglycerin tablets put under your tongue.
• Beta blockers. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. As a result, the heart beats more slowly and with less force, thereby reducing blood pressure. Beta blockers also help blood vessels relax and open up to improve blood flow, thus reducing or preventing angina.
• Statins. Statins are drugs used to lower blood cholesterol. They work by blocking a substance your body needs to make cholesterol. They may also help your body reabsorb cholesterol that has accumulated in plaques in your artery walls, helping prevent further blockage in your blood vessels. Statins also have many other beneficial effects on your heart arteries.
• Calcium channel blockers. Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels by affecting the muscle cells in the arterial walls. This increases blood flow in your heart, reducing or preventing angina.
• Angiotensin-converting enzyme (ACE) inhibitors. These drugs help relax blood vessels. ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance in your body that affects your cardiovascular system in numerous ways, including narrowing your blood vessels. This narrowing can cause high blood pressure and force your heart to work harder.
• Ranolazine (Ranexa). Ranexa can be used alone or with other angina medications, such as calcium channel blockers, beta blockers or nitroglycerin. Unlike some other angina medications, Ranexa can be used if you're taking oral erectile dysfunction medications.

Medical procedures and surgery
Lifestyle changes and medications are frequently used to treat stable angina. But medical procedures such as angioplasty, stenting and coronary artery bypass surgery are also used to treat angina.

• Angioplasty and stenting. During an angioplasty — also called a percutaneous coronary intervention (PCI) — a tiny balloon is inserted into your narrowed artery. The balloon is inflated to widen the artery, and then a small wire mesh coil (stent) is usually inserted to keep the artery open. This procedure improves blood flow in your heart, reducing or eliminating angina. Angioplasty and stenting is a good treatment option if you have unstable angina or if lifestyle changes and medications don't effectively treat your chronic, stable angina.
• Coronary artery bypass surgery. During coronary artery bypass surgery, a vein or artery from somewhere else in your body is used to bypass a blocked or narrowed heart artery. Bypass surgery increases blood flow to your heart and reduces or eliminates angina. It's a treatment option for both unstable angina as well as stable angina that has not responded to other treatments.

Lifestyle and home remedies

Because heart disease is often the cause of most forms of angina, you can reduce or prevent angina by working on reducing your heart disease risk factors. Making lifestyle changes is the most important step you can take.

• If you smoke, stop smoking.
• Eat a healthy diet with limited amounts of saturated fat, lots of whole grains, and many fruits and vegetables.
• Talk to your doctor about starting a safe exercise plan.
• If you're overweight, talk to your doctor about weight-loss options.
• Take anti-angina medications as prescribed and follow your doctor's directions.
• Treat diseases or conditions that can increase your risk of angina, such as diabetes, high blood pressure and high blood cholesterol.
• Because angina is often brought on by exertion, pace yourself and take rest breaks.
• Avoid large meals that make you feel overly full.
• Try to find ways to relax. Talk with your doctor about stress-reduction techniques.

Alternative medicine

Supplements that may help improve your angina treatment include:

• L-arginine
• L-carnitine

Both of these supplements may help reduce the swelling in your arteries that causes them to narrow, which contributes to high blood pressure and chest pain. Before adding either of these supplements to your treatment, talk to your doctor. Supplements can interact with other medications, causing dangerous side effects.

Prevention

You can help prevent angina by making the same lifestyle changes that might improve your symptoms if you already have angina. These include:

• Quit smoking.
• Monitor and control other health conditions, such as high blood pressure, high cholesterol and diabetes.
• Eat a healthy diet.
• Increase your physical activity, with your doctor's OK.
• Maintain a healthy weight.
• Reduce your stress level.

Acute coronary syndrome

Definition

Acute coronary syndrome is a term used for any condition brought on by sudden, reduced blood flow to the heart. Acute coronary syndrome symptoms may include the type of chest pressure that you feel during a heart attack, or pressure in your chest while you're at rest or doing light physical activity (unstable angina). The first sign of acute coronary syndrome can be sudden stopping of your heart (cardiac arrest). Acute coronary syndrome is often diagnosed in an emergency room or hospital.
Acute coronary syndrome is treatable if diagnosed quickly. Acute coronary syndrome treatments vary, depending on your signs, symptoms and overall health condition.

Symptoms

Acute coronary syndrome symptoms are the same as those of a heart attack. And if acute coronary syndrome isn't treated quickly, a heart attack will occur. It's important to take acute coronary syndrome symptoms very seriously as this is a life-threatening condition. Call 911 or your local emergency number right away if you have these signs and symptoms and think you're having a heart attack:

• Chest pain (angina) that feels like burning, pressure or tightness
• Pain elsewhere in the body, such as the left upper arm or jaw (referred pain)
• Nausea
• Vomiting
• Shortness of breath (dyspnea)
• Sudden, heavy sweating (diaphoresis)

If you're having a heart attack, the signs and symptoms may vary depending on your sex, age and whether you have an underlying medical condition, such as diabetes.
Some additional heart attack symptoms include:

• Abdominal pain
• Pain similar to heartburn
• Clammy skin
• Lightheadedness, dizziness or fainting
• Unusual or unexplained fatigue
• Feeling restless or apprehensive

When to see a doctor
If you're having chest pain and you believe it's an emergency situation, call 911 or your local emergency number immediately. Whenever possible, get emergency medical assistance rather than driving yourself to the hospital. You could be having a heart attack.
If you have recurring chest pain, talk to your doctor. It could be a form of angina, and your doctor can help you choose the best treatment. Stable angina occurs predictably. For example, if you jog, you may experience chest pain that goes away when you rest. In unstable angina, chest pain isn't predictable and often occurs at rest. It may also be more intense pain than stable angina.

Causes

Acute coronary syndrome is most often a complication of plaque buildup in the arteries in your heart (coronary atherosclerosis) These plaques, made up of fatty deposits, cause the arteries to narrow and make it more difficult for blood to flow through them.

Eventually, this buildup means that your heart can't pump enough oxygen-rich blood to the rest of your body, causing chest pain (angina) or a heart attack. Most cases of acute coronary syndrome occur when the surface of the plaque buildup in your heart arteries ruptures and causes a blood clot to form. The combination of the plaque buildup and the blood clot dramatically limits the amount of blood flowing to your heart muscle. If the blood flow is severely limited, a heart attack will occur.

Risk factor

The risk factors for acute coronary syndrome are similar to those for other types of heart disease. Acute coronary syndrome risk factors include:

• Older age (older than 45 for men and older than 55 for women)
• High blood pressure
• High blood cholesterol
• Cigarette smoking
• Lack of physical activity
• Type 2 diabetes
• Family history of chest pain, heart disease or stroke. For women, a history of high blood pressure, preeclampsia or diabetes during pregnancy
  

  Preparing for your appointment

  Acute coronary syndrome is often diagnosed in emergency situations, and your doctor will perform a number of tests to figure out the cause of your symptoms.
  
  If you're having chest pain or pressure regularly, tell your doctor about it. Your doctor will probably order several tests to figure out the cause of your chest pain. These tests may include a blood draw to check your cholesterol and blood sugar levels. If you need these tests, you'll need to fast to get the most accurate results. Your doctor will tell you if you need to fast before having these tests, and for how long.
  
  Your doctor may also want to perform imaging tests to check for blockages in your heart and the blood vessels leading to it.
  
  
  

  Tests and diagnosis

  If you have signs and symptoms of acute coronary syndrome, your doctor may run several tests to see if your symptoms are caused by a heart attack or another form of chest discomfort. If your doctor thinks you're having a heart attack, the first two tests you have are:
  
• Electrocardiogram (ECG). This is the first test done to diagnose a heart attack. It's often done while you're being asked questions about your symptoms. This test records the electrical activity of your heart via electrodes attached to your skin. Impulses are recorded as "waves" displayed on a monitor or printed on paper. Because injured heart muscle doesn't conduct electrical impulses normally, the ECG may show that a heart attack has occurred or is in progress.
• Blood tests. Certain heart enzymes slowly leak into your blood if your heart has been damaged by a heart attack. Emergency room staff will take samples of your blood to test for the presence of these enzymes.

Your doctor will look at these test results and determine the seriousness of your condition. If your blood tests show no markers of a heart attack and your chest pain has gone away, you'll likely be given tests to check the blood flow through your heart. If your test results reveal that you've had a heart attack or that you may be at high risk to have a heart attack, you'll likely be admitted to the hospital. You may then have more-invasive tests, such as a coronary angiogram.

Your doctor may also order additional tests, either to figure out if your heart's been damaged by a heart attack, or if your symptoms have been brought on by another cause:

• Echocardiogram. If your doctor decides you haven't had a heart attack and your risk of having a heart attack is low, you'll likely have an echocardiogram before you leave the hospital. This test uses sound waves to produce an image of your heart. During an echocardiogram, sound waves are directed at your heart from a transducer, a wand-like device, held on your chest. The sound waves bounce off your heart and are reflected back through your chest wall and processed electronically to provide video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged by a heart attack and isn't pumping normally.
• Chest X-ray. An X-ray image of your chest allows your doctor to check the size and shape of your heart and its blood vessels.
• Nuclear scan. This test helps identify blood flow problems to your heart. Small amounts of radioactive material are injected into your bloodstream. Special cameras can detect the radioactive material as it is taken up by your heart muscle. Areas of reduced blood flow to the heart muscle — through which less of the radioactive material flows — appear as dark spots on the scan. Nuclear scans are occasionally done while you're having chest pain to check the blood flow to your heart muscle, but more often, are done as part of a stress test.
• Computerized tomography (CT) angiogram. A CT angiogram allows your doctor to check your arteries to see if they're narrowed or blocked. In this minimally invasive test, you'll change into a hospital gown and lie on a table that's part of the CT scanning machine. You'll receive an injection of a radioactive dye, and the doughnut-shaped CT scanner will be moved to take images of the arteries in your heart. The images are then sent to a computer screen for your doctor to view. This test is usually only done if your blood tests and electrocardiogram don't reveal the cause of your symptoms.
• Coronary angiogram (cardiac catheterization). This test can show if your coronary arteries are narrowed or blocked. A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's fed through an artery, usually in your leg, to the arteries in your heart. As the dye fills your arteries, the arteries become visible on X-ray, revealing areas of blockage. Additionally, while the catheter is in position, your doctor may treat the blockage by performing an angioplasty. Angioplasty uses tiny balloons threaded through a blood vessel and into a coronary artery to widen the blocked area. Often, a mesh tube (stent) also is placed inside the artery to hold it open more widely and prevent re-narrowing in the future.
• Exercise stress test. In the days or weeks following your heart symptoms, you may also undergo a stress test. Stress tests measure how your heart and blood vessels respond to exertion. You may walk on a treadmill or pedal a stationary bike while attached to an ECG machine. Or you may receive a drug intravenously that stimulates your heart in a manner that's similar to the way you heart would be stimulated during exercise. Stress tests help doctors decide the best long-term treatment for you. Your doctor also may order a nuclear stress test, which is similar to an exercise stress test, but uses an injected dye and special imaging techniques to produce detailed images of your heart while you're exercising.

Treatments and drugs

Treatment for acute coronary syndrome varies, depending on your symptoms and how blocked your arteries are.

Medications
It's likely that your doctor will recommend medications that can relieve chest pain and improve flow through the heart. These could include:

• Aspirin. Aspirin decreases blood clotting, helping to keep blood flowing through narrowed heart arteries. Aspirin is one of the first things you may be given in the emergency room for suspected acute coronary syndrome. You may be asked to chew the aspirin so that it's absorbed into your bloodstream more quickly. If your doctor diagnoses your symptoms as acute coronary syndrome, he or she may recommend taking an 81-milligram dose of aspirin daily.
• Thrombolytics. These drugs, also called clotbusters, help dissolve a blood clot that's blocking blood flow to your heart. If you're having a heart attack, the earlier you receive a thrombolytic drug after a heart attack, the greater the chance you will survive and lessen the damage to your heart. However, if you are close to a hospital with a cardiac catheterization laboratory, you'll usually be treated with emergency angioplasty and stenting instead of thrombolytics. Clotbuster medications are generally used when it will take too long to get to a cardiac catheterization laboratory, such as in rural communities.
• Nitroglycerin. This medication for treating chest pain and angina temporarily widens narrowed blood vessels, improving blood flow to and from your heart.
• Beta blockers. These drugs help relax your heart muscle, slow your heart rate and decrease your blood pressure, which decreases the demand on your heart. These medications can increase blood flow through your heart, decreasing chest pain and the potential for damage to your heart during a heart attack.
• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). These drugs allow blood to flow from your heart more easily. Your doctor may prescribe ACE inhibitors or ARBs if you've had a moderate to severe heart attack that has reduced your heart's pumping capacity. These drugs also lower blood pressure and may prevent a second heart attack.
• Calcium channel blockers. These medications relax the heart and allow more blood to flow to and from the heart. Calcium channel blockers are generally given if symptoms persist after you've taken nitroglycerin and beta blockers.
• Cholesterol-lowering drugs. Commonly used drugs known as statins can lower your cholesterol levels, making plaque deposits less likely, and they can stabilize plaque, making it less likely to rupture.
• Clot-preventing drugs. Medications such as clopidogrel (Plavix) and prasugrel (Effient) can help prevent blood clots from forming by making your blood platelets less likely to stick together. However, clopidogrel increases your risk of bleeding, so be sure to let everyone on your health care team know that you're taking it, particularly if you need any type of surgery.

Surgery and other procedures
If medications aren't enough to restore blood flow through your heart, your doctor may recommend one of these procedures:

• Angioplasty and stenting. In this procedure, your doctor inserts a long, thin tube (catheter) into the blocked or narrowed part of your artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls. A mesh tube (stent) is usually left in the artery to help keep the artery open.
• Coronary bypass surgery. This procedure creates an alternative route for blood to go around a blocked coronary artery.

Lifestyle and home remedies

You can take steps to prevent acute coronary syndrome or improve your symptoms.

• Don't smoke. If you smoke, stop to improve your heart's health. Talk to your doctor if you're having trouble with quitting. It's also important to stay away from secondhand smoke.
• Eat a heart-healthy diet. Too much saturated fat and cholesterol in your diet can narrow arteries to your heart. Follow the advice of your doctor and dietitian on eating a heart-healthy diet that includes plenty of whole grains, lean meat, low-fat dairy, and fruits and vegetables. Also, limit saturated and trans fats, as well as the salt in your diet.
• Be active. Physical activity and regular exercise helps reduce your risk of acute coronary syndrome by helping you to achieve and maintain a healthy weight, and control diabetes, elevated cholesterol and high blood pressure. Exercise doesn't have to be vigorous. For example, walking 30 minutes a day five days a week can improve your health. The 30 minutes can even be broken down into three 10-minute periods of activity. Physical activity doesn't necessarily mean working out on a treadmill or in a gym. Activities such as gardening, dancing and household chores can all help reduce your risk of heart disease. Slow down or rest if activity triggers chest pain, and let your doctor know if this is new pain.
• Check your cholesterol. Have your blood cholesterol levels checked regularly, through a blood test at your doctor's office. If your cholesterol levels are undesirably high, your doctor can prescribe changes to your diet and medications to help lower the numbers and protect your cardiovascular health. It's recommended that overall cholesterol levels be below 200 milligrams per deciliter (mg/dL), and that high-density lipoprotein (HDL, or "good") cholesterol levels be above 40 mg/dL for men and above 50 mg/dL for women. Recommended low-density lipoprotein (LDL, or "bad") cholesterol levels depend on your heart disease risk. For those with a low risk of heart disease, LDL cholesterol should be below 130 mg/dL. In people with a moderate risk of heart disease, a level of less than 100 mg/dL is recommended. For those with a high risk of heart disease, including people who've already had a heart attack, it's recommended that LDL levels be below 70 mg/dL.
• Control your blood pressure. Have your blood pressure checked at least every two years. Your doctor may recommend more frequent checks if you have high blood pressure or a history of heart disease. Normal blood pressure is less than 120/80 millimeters of mercury.
• Maintain a healthy weight. Excess weight strains your heart and can contribute to high cholesterol, high blood pressure and diabetes. Losing weight can lower your risk of acute coronary syndrome.
• Manage stress. To reduce your risk of a heart attack, reduce stress in your day-to-day activities. Rethink workaholic habits and find healthy ways to minimize or deal with stressful events in your life. Emotional stress can increase inflammation in your heart and make plaque rupture more likely.
• Drink alcohol in moderation. Drinking more than one to two alcoholic drinks a day raises blood pressure, so cut back on your drinking if necessary. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger. One drink is equivalent to 12 ounces (360 milliliters, or mL) of beer, 4 ounces (120 mL) of wine or 1.5 ounces (45 mL) of an 80-proof liquor.

Prevention

The same lifestyle changes that help reduce the symptoms of acute coronary syndrome also can help prevent it from happening in the first place. Eat a healthy diet, exercise most days of the week for at least 30 minutes each day, see your doctor regularly for checks of your blood pressure and cholesterol levels, and don't smoke.

Abdominal aortic aneurysm

Definition

Abdominal aortic aneurysm

      An abdominal aortic aneurysm is an enlarged area in the lower part of the aorta, the major blood vessel that supplies blood to the body. The aorta, about the thickness of a garden hose, runs from your heart through the center of your chest and abdomen. Because the aorta is the body's main supplier of blood, a ruptured abdominal aortic aneurysm can cause life-threatening bleeding.
      Depending on the size and rate at which your abdominal aortic aneurysm is growing, treatment may vary from watchful waiting to emergency surgery. Once an abdominal aortic aneurysm is found, doctors will closely monitor it so that surgery can be planned if it's necessary. Emergency surgery for a ruptured abdominal aortic aneurysm can be risky.

Symptoms

      Abdominal aortic aneurysms often grow slowly and usually without symptoms, making them difficult to detect. Some aneurysms will never rupture. Many start small and stay small, although many expand over time. Others expand quickly. Predicting how fast an abdominal aortic aneurysm may enlarge is difficult.
As an abdominal aortic aneurysm enlarges, some people may notice:

• A pulsating feeling near the navel
• Deep, constant pain in your abdomen or on the side of your abdomen
• Back pain

When to see a doctor
You should see your doctor if you have any of the symptoms listed above.
      Anyone age 60 and older who has risk factors for developing an abdominal aortic aneurysm, such as smoking or a family history of abdominal aortic aneurysm, should consider regular screening for the condition. Because being male and smoking significantly increase the risk of abdominal aortic aneurysm, men ages 65 to 75 who have ever smoked cigarettes should have a one-time screening for abdominal aortic aneurysm using abdominal ultrasound.
      If you have a family history of abdominal aortic aneurysm, your doctor may recommend an ultrasound exam to screen for the condition.
There are no specific screening recommendations for women. Ask your doctor if you need to have an ultrasound screening based on your risk factors.

Causes

Most aortic aneurysms occur in the part of your aorta that's in your abdomen. Although the exact cause of abdominal aortic aneurysms is unknown, a number of factors may play a role, including:

• Tobacco use. Cigarette smoking and other forms of tobacco use appear to increase your risk of aortic aneurysms. In addition to the damaging effects that smoking causes directly to the arteries, smoking contributes to the buildup of fatty plaques in your arteries (atherosclerosis) and high blood pressure. Smoking can also cause your aneurysm to grow faster by further damaging your aorta.
• Hardening of the arteries (atherosclerosis). Atherosclerosis occurs when fat and other substances build up on the lining of a blood vessel, increasing your risk of an aneurysm.
• Infection in the aorta (vasculitis). In rare cases, abdominal aortic aneurysm may be caused by an infection or inflammation that weakens a section of the aortic wall.

Aneurysms can develop anywhere along the aorta, but when they occur in the upper part of the aorta, they are called thoracic aortic aneurysms. More commonly, aneurysms form in the lower part of your aorta and are called abdominal aortic aneurysms. These aneurysms may also be referred to as AAA or triple A.

Risk factors

Abdominal aortic aneurysm risk factors include:

• Age. Abdominal aortic aneurysms occur most often in people age 65 and older.
• Tobacco use. Tobacco use is a strong risk factor for the development of an abdominal aortic aneurysm. The longer you've smoked or chewed tobacco, the greater your risk.
• Atherosclerosis. Atherosclerosis, the buildup of fat and other substances that can damage the lining of a blood vessel, increases your risk of an aneurysm.
• Being male. Men develop abdominal aortic aneurysms much more often than women do.
• Family history. People who have a family history of abdominal aortic aneurysm are at increased risk of having the condition. People who have a family history of aneurysms tend to develop aneurysms at a younger age and are at higher risk of rupture.

Complications

Dissecting aneurysm

      Tears in the wall of the aorta (dissection) are the main complications of abdominal aortic aneurysm. A ruptured aortic aneurysm can lead to life-threatening internal bleeding. In general, the larger the aneurysm, the greater the risk of rupture.
Signs and symptoms that your aortic aneurysm has burst include:

• Sudden, intense and persistent abdominal or back pain
• Pain that radiates to your back or legs
• Sweatiness
• Clamminess
• Dizziness
• Nausea
• Vomiting
• Low blood pressure
• Fast pulse
• Loss of consciousness
• Shortness of breath

      Another complication of aortic aneurysms is the risk of blood clots. Small blood clots can develop in the area of the aortic aneurysm. If a blood clot breaks loose from the inside wall of an aneurysm and blocks a blood vessel elsewhere in your body, it can cause pain or block the blood flow to the legs, toes, kidneys or abdominal organs.

Preparing for your appointment

      If you think you may have an abdominal aortic aneurysm, or are worried about your aneurysm risk because of a strong family history, make an appointment with your family doctor. If an aneurysm is found early, your treatment may be easier and more effective.
Since many abdominal aortic aneurysms are found during a routine physical exam, or while your doctor is looking for another condition, there are no special preparations necessary. If you're being screened for an aortic aneurysm, your doctor will likely ask if anyone in your family has ever had an aortic aneurysm, so have that information ready.
      Because appointments can be brief and there's often a lot of ground to cover, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet. For an ultrasound or echocardiogram, for example, you may need to fast for a period of time beforehand.
• Write down any symptoms you're experiencing, including any that may seem unrelated to an abdominal aortic aneurysm.
• Write down key personal information, including a family history of heart disease or aneurysms.
• Make a list of all medications, vitamins or supplements that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Be prepared to discuss your diet, exercise habits and tobacco use. If you don't already follow a healthy diet or exercise routine, talk to your doctor about any challenges you might face in getting started. Be sure to tell your doctor if you're a current or former smoker.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For an abdominal aortic aneurysm, some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• What kinds of tests will I need?
• What treatments are available, and which do you think would be the best treatment for me?
• What's an appropriate level of physical activity?
• How often do I need to be screened for this aneurysm?
• Should I tell other family members to be screened for an aneurysm?
• I have other health conditions. How can I best manage these conditions together?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me?
• What websites do you recommend visiting for more information?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first notice your symptoms?
• Do your symptoms come and go, or do you always feel them?
• How severe are your symptoms?
• Do you have a family history of aneurysms?
• Have you ever smoked?
• Does anything seem to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

What you can do in the meantime
It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and becoming more physically active. These are primary lines of defense to keep your blood vessels healthy and prevent an abdominal aortic aneurysm from developing or worsening.
If you're diagnosed with an abdominal aortic aneurysm, you should ask about the size of your aneurysm, whether your doctor has noticed any changes, and how frequently you should visit your doctor for follow-up appointments.

Tests and diagnosis

      Abdominal aortic aneurysms are often found during an examination for another reason. For example, during a routine exam, your doctor may feel a pulsating bulge in your abdomen, though it's unlikely your doctor will be able to hear signs of an aneurysm through a stethoscope. Aortic aneurysms are often found during routine medical tests, such as a chest X-ray or ultrasound of the heart or abdomen, sometimes ordered for a different reason.
If your doctor suspects that you have an aortic aneurysm, specialized tests can confirm it. These tests might include:

• Abdominal ultrasound. This exam can help diagnose an abdominal aortic aneurysm. During this painless exam, you lie on your back on an examination table and a small amount of warm gel is applied to your abdomen. The gel helps eliminate the formation of air pockets between your body and the instrument the technician uses to see your aorta, called a transducer. The technician presses the transducer against your skin over your abdomen, moving from one area to another. The transducer sends images to a computer screen that the technician monitors to check for a potential aneurysm.
• Computerized tomography (CT) scan. This painless test can provide your doctor with clear images of your aorta. During a CT scan, you lie on a table inside a doughnut-shaped machine called a gantry. Detectors inside the gantry measure the radiation that has passed through your body and converts it into electrical signals. A computer gathers these signals and assigns them a color ranging from black to white, depending on signal intensity. The computer then assembles the images and displays them on a computer monitor.
• Magnetic resonance imaging (MRI). MRI is another painless imaging test. Most MRI machines contain a large magnet shaped like a doughnut or tunnel. You lie on a movable table that slides into the tunnel. The magnetic field aligns atomic particles in some of your cells. When radio waves are broadcast toward these aligned particles, they produce signals that vary according to the type of tissue they are. Your doctor can use the images produced by the signals to see if you have an aneurysm.

Regular screening for people at risk of abdominal aortic aneurysms
The U.S. Preventive Services Task Force recommends that men ages 65 to 75 who have ever smoked should have a one-time screening for abdominal aortic aneurysm using abdominal ultrasound. People older than age 60 with a family history of abdominal aortic aneurysm or other risk factors should talk with their doctors about whether to have a screening ultrasound.

Treatments and drugs

Here are the general guidelines for treating abdominal aortic aneurysms.

Small aneurysm
If you have a small abdominal aortic aneurysm — about 1.6 inches, or 4 centimeters (cm), in diameter or smaller — and you have no symptoms, your doctor may suggest a watch-and-wait (observation) approach, rather than surgery. In general, surgery isn't needed for small aneurysms because the risk of surgery likely outweighs the risk of rupture.
If you choose this approach, your doctor will monitor your aneurysm with periodic ultrasounds, usually every six to 12 months and encourage you to report immediately if you start having abdominal tenderness or back pain — potential signs of a dissection.
Medium aneurysm
A medium aneurysm measures between 1.6 and 2.1 inches (4 and 5.3 cm). It's less clear how the risks of surgery versus waiting stack up in the case of a medium-size abdominal aortic aneurysm. You'll need to discuss the benefits and risks of waiting versus surgery and make a decision with your doctor. If you choose watchful waiting, you'll need to have an ultrasound every six to 12 months to monitor your aneurysm.
Large, fast-growing or leaking aneurysm. If you have an aneurysm that is large (larger than 2.2 inches, or 5.6 cm) or growing rapidly (grows more than 0.5 cm in six months), you'll probably need surgery. In addition, a leaking, tender or painful aneurysm requires treatment. There are two types of surgery for abdominal aortic aneurysms.

• Open-abdominal surgery to repair an abdominal aortic aneurysm involves removing the damaged section of the aorta and replacing it with a synthetic tube (graft), which is sewn into place, through an open-abdominal approach. With this type of surgery, it will likely take you a month or more to fully recover.
• Endovascular surgery is a less invasive procedure sometimes used to repair an aneurysm. Doctors attach a synthetic graft to the end of a thin tube (catheter) that's inserted through an artery in your leg and threaded up into your aorta. The graft — a woven tube covered by a metal mesh support — is placed at the site of the aneurysm and fastened in place with small hooks or pins. The graft reinforces the weakened section of the aorta to prevent rupture of the aneurysm.
  
Recovery time for people who have endovascular surgery is shorter than for people who have open-abdominal surgery. However, follow-up appointments are more frequent because endovascular grafts can leak. Follow-up ultrasounds are generally done every six months for the first year, and then once a year after that. Long-term survival rates are similar for both endovascular surgery and open surgery.

The options for treatment of your aneurysm will depend on a variety of factors, including location of the aneurysm, your age, kidney function and other conditions that may increase your risk of surgery or endovascular repair.

Lifestyle and home remedies

The best approach to prevent an aortic aneurysm is to keep your blood vessels as healthy as possible. That means taking these steps:

• Quit smoking or chewing tobacco.
• Keep your blood pressure under control.
• Get regular exercise.
• Reduce cholesterol and fat in your diet.

If you have some risk factors for aortic aneurysm, talk to your doctor. If you are at risk, your doctor may recommend additional measures, including medications to lower your blood pressure and relieve stress on weakened arteries.