Conditions & Treatments


Preeclampsia

Preeclampsia is characterized as a sudden increase in blood pressure and protein in the urine after the 20th week of pregnancy. While the cause is unknown, possible causes include autoimmune disorders, blood vessel problems, your diet and genes. Other factors that can increase the risk of preeclampsia include obesity, a history of diabetes, age, multiple pregnancy (twins), and if it is a woman’s first pregnancy.

Symptoms

Often, women who have preeclampsia do not feel sick. Symptoms of preeclampsia can include:

  • Swelling of the hands and face or eyes (edema)
  • Sudden weight gain over 1 to 2 days or more than 2 pounds (0.9 kg) a week

Note: Some swelling of the feet and ankles is considered normal during pregnancy.

Symptoms of severe preeclampsia include:

  • Headache that does not go away
  • Trouble breathing
  • Belly pain on the right side, below the ribs. Pain may also be felt in the right shoulder, and can be confused with heartburn, gallbladder pain, a stomach virus, or kicking by the baby
  • Decreased urine output, not urinating very often
  • Nausea and vomiting (a worrisome sign)
  • Vision changes, including temporary blindness, seeing flashing lights or spots, sensitivity to light, and blurry vision
Treatment

The only way to cure preeclampsia is to deliver the baby.

Most often, at 37 weeks, your baby is developed enough to be healthy outside of the womb.

As a result, your provider may want your baby to be delivered so the preeclampsia does not get worse. You may get medicines to help trigger labor, or you may need a C-section.

If your baby is not fully developed and you have mild preeclampsia, the disease can often be managed at home until your baby has matured. The provider will recommend:

  • Bed rest, and lying on your left side most or all of the time
  • Drinking plenty of water
  • Eating less salt
  • Frequent doctor visits to make sure you and your baby are doing well
  • Medicines to lower your blood pressure (sometimes)

Sometimes, a pregnant woman with preeclampsia is admitted to the hospital. This allows the health care team to watch the baby and mother more closely.

Treatment in the hospital may include:

  • Close monitoring of the mother and baby
  • Medicines to control blood pressure and prevent seizures and other complications
  • Steroid injections for pregnancies under 34 weeks gestation to help speed up the development of the baby's lungs

You and your provider will continue to discuss the safest time to deliver your baby, considering how close you are to your due date, the severity of the preeclampsia and how well the baby is doing in the womb.



Aortic Valve Disease

Aortic insufficiency is a heart valve disease in which the aortic valve weakens or balloons, preventing the valve from closing tightly. This leads to the backward flow of blood from the aorta (the largest blood vessel) into the left ventricle (the left lower chamber of the heart).

Symptoms
  • Bounding pulse
  • Chest pain, angina type (rare)
    • Crushing, squeezing, pressure, tightness
    • Pain increases with exercise, and goes away with rest
    • Under the chest bone; pain may move to other areas of the body
  • Fainting
  • Fatigue, excessive tiredness
  • Irregular, rapid, racing, pounding, or fluttering pulse
  • Palpitations
  • Shortness of breath with activity or when lying down
  • Weakness, particularly with activity
Treatment

If there are no symptoms or if symptoms are mild, you may only need to get an echocardiogram from time to time and be monitored by a health care provider.

If the blood pressure is high, then treatment with certain blood pressure medications may help slow the worsening of aortic regurgitation.

ACE inhibitor drugs and diuretics (water pills) may be prescribed for more moderate or severe symptoms.

Moderate activity restriction may be recommended. People with severe symptoms should avoid strenuous activity.

Surgery to repair or replace the aortic valve corrects aortic insufficiency. The decision to have aortic valve replacement depends on your symptoms and the condition and function of the heart. Surgery to repair the aorta may be required if the condition is caused by disorders of the aorta.



Atrial fibrillation/flutter

Atrial fibrillation/flutter is a common type of abnormal heartbeat in which the heart rhythm is fast and irregular. You may not be aware that your heart is not beating in a normal pattern, especially if it has been happening for some time.

Symptoms
  • Pulse that feels rapid, racing, pounding, fluttering, irregular, or too slow
  • Shortness of breath
  • Confusion
  • Dizziness,light-headedness
  • Fainting
  • Fatigue
  • Loss of ability to exercise

Note: Symptoms may begin or stop suddenly. This is because atrial fibrillation may stop or start on its own.

Treatment

Sometimes, atrial fibrillation may need emergency treatment in the hospital to get the heart back into normal rhythm. This treatment may involve electrical shocks or special drugs.

Daily medicines taken by mouth are used in two different ways:

  • To slow the irregular heartbeat. These medications may include beta-blockers, calcium channel blockers, and digitalis.
  • To keep atrial fibrillation from coming back. These medications may work well in many people, but they can have serious side effects. Many patients go back to atrial fibrillation, even while taking these medications.

Blood thinners -- reduce the risk of a blood clot traveling in the body (such as a stroke). Because these drugs increase the chance of bleeding, not everyone can use them. Antiplatelet drugs such as aspirin or clopidogrel may also be prescribed. Your doctor will consider your age and other medical problems when deciding which drug is best.

A procedure called radiofrequency ablation can be used to destroy areas in your heart that may be causing your heart rhythm problems. Cardiac ablation procedures are done in a hospital laboratory by specially trained staff. Ablation may be done:

  • When medicines are not controlling the symptoms, or are causing side effects
  • When the condition will become dangerous if not treated
  • As a possible cure for some patients with atrial flutter


Coronary Heart Disease

Coronary heart disease is a narrowing of the small blood vessels that supply blood and oxygen to the heart. Coronary heart disease (CHD) is also called coronary artery disease.

CHD is caused by the buildup of plaque in the arteries to your heart, which may also be called hardening of the arteries. Fatty material and other substances form a plaque buildup on the walls of your coronary arteries, which are the arteries that bring blood and oxygen to your heart. This buildup causes the arteries to get narrow, causing blood flow to the heart to slow down or stop.

A risk factor for heart disease is something that increases your chance of getting it. You cannot change some risk factors for heart disease, but you can change others.

Symptoms

In some cases, symptoms may be very noticeable. But, you can have the disease and not have any symptoms. This is more often true in the early stages of heart disease.

Chest pain or discomfort (angina) is the most common symptom. You feel this pain when the heart is not getting enough blood or oxygen. The pain may feel different from person to person.

  • It may feel heavy or like someone is squeezing your heart. You may feel it under your breast bone (sternum). You may also feel it in your neck, arms, stomach, or upper back.
  • The pain most often occurs with activity or emotion. It goes away with rest or a medicine called nitroglycerin.
  • Other symptoms include shortness of breath and fatigue with activity (exertion).

Some people have symptoms other than chest pain, such as:

  • Fatigue
  • Shortness of breath
  • General weakness
Treatment

You may be asked to take one or more medicines to treat blood pressure, diabetes, or high cholesterol levels. Follow your provider's directions closely to help prevent coronary artery disease from getting worse.

Goals for treating these conditions in people who have coronary artery disease:

  • The most commonly used blood pressure target for people with heart disease is below 140/90 mm Hg, but sometimes less than 130/80. If you have diabetes, your HbA1c levels will be monitored and brought down to the level your provider recommends. Your LDL cholesterol level will be lowered with statin drugs.

Treatment depends on your symptoms and how severe the disease is. You should know about:

Never stop taking your medicines without first talking to your provider. Stopping heart medicines suddenly can make your angina worse or cause a heart attack.

You may be referred to a cardiac rehabilitation program to help improve your heart's fitness.

Procedures and surgeries used to treat CHD include:



Congestive Heart Failure

Heart failure is a condition in which the heart can no longer pump enough blood to the rest of the body.

Symptoms

Symptoms of heart failure often begin slowly. At first, they may only occur when you are very active. Over time, you may notice breathing problems and other symptoms even when you are resting. Heart failure symptoms may also begin suddenly; for example, after a heart attack or other heart problem.

  • Cough
  • Fatigue, weakness, faintness
  • Loss of appetite
  • Need to urinate at night
  • Pulse that feels fast or irregular, or a sensation of feeling the heart beat (palpitations)
  • Shortness of breath when you are active or after you lie down
  • Swollen (enlarged) liver or abdomen
  • Swollen feet and ankles
  • Waking up from sleep after a couple of hours due to shortness of breath
  • Weight gain
Treatment

If you have heart failure, your doctor will monitor you closely. You will have follow-up appointments at least every 3 to 6 months and tests to check your heart function.

Knowing your body and the symptoms that your heart failure is getting worse will help you stay healthier and out of the hospital. At home, watch for changes in your heart rate, pulse, blood pressure, and weight.

Weight gain, especially over a day or two, can be a sign that your body is holding onto extra fluid and your heart failure is getting worse. Talk to your doctor about what you should do if your weight goes up or if you develop more symptoms.

Limit how much salt you eat. Your doctor may also ask you to limit how much fluid you drink during the day.

Other important changes to make in your lifestyle:,/p>

  • Ask your doctor how much alcohol you may drink.
  • Do not smoke.
  • Stay active. Walk or ride a stationary bicycle. Your doctor can provide a safe and effective exercise plan for you. DO NOT exercise on days when your weight has gone up from fluid or you are not feeling well.
  • Lose weight if you are overweight.
  • Lower your cholesterol by changing your lifestyle.
  • Get enough rest, including after exercise, eating, or other activities. This allows your heart to rest too.



Heart Attack

A heart attack is a medical emergency. If you have symptoms of a heart attack, call 911 or your local emergency number right away.

  • DO NOT try to drive yourself to the hospital.
  • DO NOT WAIT. You are at greatest risk of sudden death in the early hours of a heart attack.

Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. The coronary arteries bring blood and oxygen to the heart, and if the blood flow is blocked, the heart is starved of oxygen and heart cells die. The medical term for this is myocardial infarction.

A substance called plaque can build up in the walls of your coronary arteries, which is made up of cholesterol and other cells.

A heart attack may occur when:

  • A tear in the plaque occurs. This triggers blood platelets and other substances to form a blood clot at the site that blocks most or all of the oxygen-carrying blood from flowing to a part of the heart muscle. This is the most common cause of heart attack.
  • A slow buildup of plaque may narrow one of the coronary arteries so that it is almost blocked.

In either case, there is not enough blood flow to the heart muscle and heart muscle dies.

The cause of heart attack is not always known.

Heart attack may occur:

  • When you are resting or asleep, after a sudden increase in physical activity, when you are active outside in cold weather or after sudden, severe emotional or physical stress, including an illness
  • Chest pain is the most common symptom of a heart attack.
  • You may feel the pain in only one part of your body OR
  • Pain may move from your chest to your arms, shoulder, neck, teeth, jaw, belly area, or back

The pain can be severe or mild. It can feel like:

  • A tight band around the chest
  • Bad indigestion
  • Something heavy sitting on your chest
  • Squeezing or heavy pressure

The pain most often lasts longer than 20 minutes. Rest and a medicine to relax the blood vessels (called nitroglycerin) may not completely relieve the pain of a heart attack. Symptoms may also go away and come back.

Other symptoms of a heart attack can include:

Some people (the older adults, people with diabetes, and women) may have little or no chest pain. Or, they may have unusual symptoms such as shortness of breath, fatigue, and weakness. A "silent heart attack" is a heart attack with no symptoms.




Heart Palpitations

Palpitations are feelings or sensations that your heart is pounding or racing. They can be felt in your chest, throat, or neck. You may have an unpleasant awareness of your own heartbeat or feel like your heart skipped or stopped beats. The heart's rhythm may be normal or abnormal when you have palpitations.

Heart palpitations can be due to:

  • Anxiety, stress, panic attack, or fear
  • Caffeine intake
  • Nicotine intake
  • Cocaine or other illegal drugs
  • Diet pills
  • Exercise
  • Fever

However, some palpitations are due to an abnormal heart rhythm, which may be caused by:

  • Heart disease
  • Abnormal heart valve, such as mitral valve prolapse
  • Abnormal blood level of potassium
  • Certain medicines, including those used to treat asthma, high blood pressure, or heart problems
  • Overactive thyroid
  • Low level of oxygen in your blood
  • If you have never had heart palpitations before, see your health care provider.

    Call 911 or your local emergency number if you have:

    • Loss of alertness (consciousness)
    • Chest pain
    • Shortness of breath
    • Unusual sweating
    • Dizziness or lightheadedness

    Call your doctor right away if:

    • You often feel extra heartbeats (more than 6 per minute or coming in groups of 3 or more).
    • You have risk factors for heart disease, such as high cholesterol, diabetes, or high blood pressure.
    • You have new or different heart palpitations.
    • Your pulse is more than 100 beats per minute (without exercise, anxiety, or fever).



    Mitral Valve Prolapse

    Mitral valve prolapse is a heart problem involving the mitral valve, which separates the upper and lower chambers of the left side of the heart. In this condition, the valve does not close normally.

    Causes

    The mitral valve helps blood on the left side of the heart flow in one direction. It closes to keep blood from moving backwards when the heart beats (contracts).

    Mitral valve prolapse is the term used when the valve does not close properly. It can be caused by many different things.

    In most cases, it is harmless. The problem generally does not affect health and most people with the condition are not aware of it. In a small number of cases, the prolapse can cause blood to leak backwards. This is called mitral regurgitation.

    Mitral valve prolapse often affects thin women who may have minor chest wall deformities, scoliosis, or other disorders. Some forms of mitral valve prolapse seem to be passed down through families (inherited).

    Mitral valve prolapse is also seen with some connective tissue disorders such as Marfan syndrome and other rare genetic disorders.

    Symptoms

    Many people with mitral valve prolapse DO NOT have symptoms. The group of symptoms found in people with mitral valve prolapse is called "mitral valve prolapse syndrome," and includes:

    • Chest pain (not caused by coronary artery disease or a heart attack)
    • Dizziness
    • Fatigue
    • Panic attacks
    • Sensation of feeling the heart beat (palpitations)
    • Shortness of breath with activity or when lying flat (orthopnea)

    When mitral regurgitation occurs, symptoms may be related to this leaking.

    Treatment

    Most of the time, there are few or no symptoms and treatment is not needed.

    In the past, most people with heart valve problems were given antibiotics before dental work or procedures such as colonoscopy to prevent an infection in the heart. However, antibiotics are now used much less often. Check with your health care provider to see if you need antibiotics.

    There are many heart medicines that may be used to control this condition. You may need surgery to repair or replace your mitral valve if it becomes very leaky (regurgitation), and if the leakiness also causes symptoms. However, this may not occur.

    You may need mitral valve repair or replacement if:

  • Your symptoms get worse.
  • The left ventricle of your heart is enlarged.
  • Your heart function gets worse.