What Is Cardiac MRI?
Magnetic resonance imaging (MRI) is a safe, noninvasive test that creates detailed images of your organs and tissues. “Noninvasive” means that no surgery is done and no instruments are inserted into your body.
MRI uses radio waves and magnets to create images of your organs and tissues. Unlike computed tomography (to-MOG-ra-fee) scans (also called CT scans) or conventional x rays, MRI imaging doesn’t use ionizing radiation or carry any risk of causing cancer.
Cardiac MRI uses a computer to create images of your heart as it’s beating, producing both still and moving pictures of your heart and major blood vessels. Doctors use cardiac MRI to get images of the beating heart and to look at the structure and function of the heart. These images can help them decide how best to treat patients with heart problems.
Cardiac MRI is a common test for diagnosing and evaluating a number of diseases and conditions, including:
Coronary artery disease
Damage caused by a heart attack
Heart failure
Heart valve problems
Congenital heart defects
Pericardial disease (a disease that affects the tissues around the heart)
Cardiac tumors
Cardiac MRI images can help explain results from other tests, such as x ray and CT scans. Cardiac MRI is sometimes used to avoid the need for other tests that use radiation (such as x rays), invasive procedures, and dyes containing iodine (these dyes may be harmful to people who have kidney problems).
Sometimes during cardiac MRI, a special dye is injected into a vein to help highlight the heart or blood vessels on the images. Unlike the case with x rays, the special dyes used for MRI don’t contain iodine, so they don’t present a risk to people who are allergic to iodine or have kidney problems.
Other Names for Cardiac MRI
Heart MRI
Cardiovascular MRI
Cardiac nuclear magnetic resonance (NMR)
What To Expect Before Cardiac MRI
You'll be asked to fill out a screening form before the test takes place. The form may ask whether you've had previous surgeries, whether you have any metal objects in your body, and whether you have any medical devices (like a cardiac pacemaker) surgically implanted in your body.
Most, but not all, implanted medical devices are allowed near the magnetic resonance imaging (MRI) machine. Ask your doctor or the technician operating the machine if you have concerns about any implanted devices or conditions that may interfere with the MRI.
MRI can interfere seriously with some types of implanted medical devices.
Implanted cardiac pacemakers and defibrillators can malfunction.
Cochlear (inner-ear) implants can be damaged. Cochlear implants are small electronic devices that are used to help people who are deaf or who can't hear well to get an idea of the sounds around them.
Brain aneurysm (AN-u-rism) clips can move due to MRI's strong magnetic field. This can cause severe injury.
Your doctor will let you know if you shouldn't have a cardiac MRI because of a medical device.
Your doctor or technician will tell you whether you need to change into a hospital gown for the test. Don't bring hearing aids, credit cards, jewelry and watches, eyeglasses, pens, removable dental work, and anything that's magnetic near the MRI machine.
Tell your doctor if you have a history of becoming anxious or fearful when in a fairly tight or confined space. This fear is called claustrophobia (klaw-stro-FO-be-a). In this case, your doctor might give you medicine to help you relax. Your doctor may ask you to stop eating 6 hours before you take this medicine on the day of the test.
Some of the newer cardiac MRI machines are open on all sides. Ask your doctor to help you find a facility that has an open MRI machine if you're fearful in tight or confined spaces.
Your doctor will let you know if you need to arrange for a ride home after the test
What To Expect During Cardiac MRI
Magnetic resonance imaging (MRI) machines are usually located at a hospital or at a special medical imaging facility. A radiologist (ra-de-OL-o-jist) or other physician with special training in medical imaging oversees MRI testing.
Cardiac MRI usually takes 45 to 90 minutes, depending on how many images are needed. The test may take less time with some newer MRI machines.
The MRI machine will be located in a specially constructed room. This will prevent radio waves from disrupting the machine and will prevent the strong magnetic fields generated by the MRI machine from interfering with other equipment.
Traditional MRI machines look like a long, narrow tunnel. Newer MRI machines called short-bore systems are shorter, wider, and don’t completely surround you. Some of the newer machines are open on all sides. Your doctor will help decide which machine type is best for you.
Cardiac MRI is painless and harmless. You will lie on your back on a sliding table that goes inside the tunnel-like machine. The technician will control the machine from the next room. He or she will be able to see you through a glass window and will be able to talk to you through an intercom system. Tell the technician if you have a hearing problem.
The MRI machine makes loud humming, tapping, and buzzing noises. Earplugs may help lessen the noises made by the MRI machine. Some facilities let you listen to music during the test.
Remaining very still during the test is important. Any movement may blur the images. If you’re unable to lie still, you may be given medicine to help you relax. You may be asked to hold your breath for 10 to 15 seconds at a time while the technician takes pictures of your heart. Researchers are studying ways that will allow someone having a cardiac MRI to breathe freely during the exam, while achieving the same image quality.
A contrast dye, such as gadolinium (gad-oh-LIN-ee-um), may be used to highlight your blood vessels or heart in the images. Contrast dye is usually injected into a vein in your arm with a needle. You may feel a cool sensation during the injection, and you may feel discomfort where the needle was inserted. Gadolinium doesn’t contain iodine so it won’t create problems for people who are allergic to iodine.
If your cardiac MRI includes a stress test to detect blockages in your coronary arteries, you will receive other medicines to increase the blood flow in your heart or to increase how fast your heart beats.
What To Expect After Cardiac MRI
Once the cardiac magnetic resonance imaging (MRI) is done, if you haven't received medicine to help you relax, you will be able to return to normal activities immediately.
If you did receive medicine to help you relax during the test, your doctor will tell you when you can return to normal activities. You will need someone to drive you home.
What Does Cardiac MRI Show?
The doctor supervising your scan will provide your doctor with the results of your cardiac MRI. Your doctor will discuss the findings with you.
Cardiac MRI can reveal various heart conditions and disorders, such as:
Coronary artery disease
Damage caused by a heart attack
Heart failure
Heart valve problems
Congenital heart defects
Pericardial disease (a disease that affects the tissues around the heart)
Cardiac tumors
Cardiac MRI is a fast, accurate tool that can help diagnose a heart attack by detecting areas of the heart that don’t move normally, have poor blood supply, or are scarred. Cardiac MRI can show whether any of the coronary arteries are blocked, causing reduced blood flow to your heart muscle.
Currently, coronary angiography is the procedure most commonly used to look at blockages in the coronary arteries. Coronary angiography is an invasive procedure that uses x rays and iodine-based contrast dye. Researchers have found that cardiac MRI can replace coronary angiography in some cases, avoiding the need to use x-ray radiation and iodine-based dyes.
Researchers are discovering new ways to use cardiac MRI. In the future, cardiac MRI may be able to replace x rays as the main way to guide invasive procedures such as cardiac catheterization (KATH-e-ter-i-ZA-shun). Also, improvements in cardiac MRI are likely to lead to better methods for detecting heart disease in the future.
Monday, February 25, 2008
Varicose Veins
What Causes Varicose Veins?
Veins, especially those in the legs, have to pump the blood “up hill” to the heart, against gravity. Inside the veins are one-way valves that help with pumping action and prevent blood from flowing backward. These valves allow blood to flow in only one direction, toward the heart. Varicose veins develop when the valves become weakened, damaged, or don’t work well.
Weakness in the valves may be due to weakness in the walls of the veins. This weakness tends to be associated with certain factors, including increasing age, a family history of varicose veins, or high pressure inside veins due to overweight or pregnancy.
When the walls of the veins are weak, they lose their normal elasticity, like an overstretched rubber band. This makes them longer and wider and causes the flaps of the valves to separate. Blood is then able to flow backward through the valves, filling the vein and stretching it even more. The vein becomes enlarged, swollen, and often twisted trying to squeeze into its normal space.
Who Is At Risk for Varicose Veins?
Populations Affected
About 25 million Americans are affected by varicose veins. They are most common in people aged 30 to 70.
Risk Factors
Risk factors for developing varicose veins include:
Genetics. Having a family member with varicose veins may increase the risk for developing them. Approximately half of the people who get varicose veins have a family history of them.
Age. The normal wear and tear of aging may cause valves to weaken and not work as well.
Gender. Women are two to three times more likely to develop varicose veins than men. Up to half of American women have varicose veins. Changes in hormones due to puberty, pregnancy, menopause, or taking birth control pills may increase a woman's risk of developing varicose veins.
Pregnancy. During pregnancy, the growth of the fetus increases the pressure on the veins in the legs. Varicose veins that occur during pregnancy usually improve within 3 to 12 months following delivery.
Overweight and obesity. Having extra weight on the body can put additional pressure on the veins.
Prolonged standing or sitting, particularly with legs bent or crossed. When standing or sitting with legs bent or crossed, the veins have to work harder to pump the blood up to the heart.
What Are the Signs and Symptoms of Varicose Veins?
Common signs and symptoms of varicose veins include:
Enlarged veins that are visible on your skin
Mild swelling of your ankles and feet
Painful, achy, or "heavy" legs
Throbbing or cramping in your legs
Itchy legs, especially in the lower leg and ankle (sometimes incorrectly diagnosed as dry skin)
Discoloration of your skin surrounding the varicose veins
Complications
Only a small percentage of people have complications from varicose veins. Complications may include dermatitis and thrombophlebitis.
Dermatitis
Dermatitis is an itchy rash that can occur on the lower leg or ankle of a person with varicose veins in the legs. It can sometimes cause bleeding or a skin ulcer to develop if scratched or irritated.
Thrombophlebitis
This is a blood clot (thrombus) that occurs in a vein. There are two types of thrombophlebitis:
Superficial thrombophlebitis is a blood clot that occurs in a superficial vein and usually causes only minor problems that are limited to the area of the affected vein. Clots in varicose veins are usually of this type. Infections, chemical irritation, or other conditions that cause irritation and inflammation of the veins also can lead to superficial thrombophlebitis.
Deep vein thrombosis is a blood clot that develops in veins deeper in the body. It can be life threatening if the clot breaks off and travels to the lungs, which is called pulmonary embolism. This type of thrombophlebitis does not occur in varicose veins.
How Are Varicose Veins Diagnosed?
Varicose veins are often diagnosed based simply on the appearance of the veins. For varicose veins in the legs, your doctor will examine your legs while you are standing or seated with your legs dangling. Your doctor may also ask you to describe pain or any other symptoms. Some diagnostic tests may be done to rule out other disorders or conditions.
Specialists Involved
The following specialists may be involved in your medical care if you have varicose veins:
A vascular medicine specialist or vascular surgeon (blood vessel system specialist)
A dermatologist (skin specialist)
Diagnostic Tests and Procedures
Your doctor may order a Doppler ultrasound to evaluate the flow of blood in your veins and to look for blood clots. During a Doppler ultrasound, a handheld device is placed on your body and passed back and forth over the affected area. A computer converts sound waves into a picture of the blood flow in the arteries and veins.
Rarely, your doctor may order an angiogram to look at blood flow through your blood vessels. The procedure involves injecting a dye into your veins that can be seen using x ray. An angiogram can help to rule out other diagnoses besides varicose veins.
How Are Varicose Veins Treated?
Goals of Treatment
The goals of treating varicose veins may include easing symptoms, avoiding complications, and improving cosmetic appearance. Although treatment can target existing varicose veins, it can't keep new varicose veins from forming.
Who Needs Treatment
Varicose veins that cause few signs and symptoms usually don’t need to be treated. Instead, your doctor may recommend simple self-care measures. Varicose veins causing more severe signs and symptoms may need medical or surgical treatment. Treatment may be recommended when the varicose veins are causing skin ulcers, serious skin conditions, blood clots, significant pain, or disruption of daily life activities. Some people with varicose veins may choose to have medical or surgical treatments to improve the cosmetic appearance of varicose veins.
Types of Treatment
Self-Care Measures
Self-care measures are a common option for treating varicose veins. If self-care measures are called for, your doctor may ask you to:
Avoid excess amounts of standing when possible. Take frequent breaks during prolonged periods of standing.
Elevate your legs when sitting, resting, or sleeping. Elevating your legs above the level of your heart is very important.
Wear compression stockings. These are typically worn all day long. Doctors may prescribe special-strength stockings or over-the-counter support stockings, which may be available at pharmacies and medical supply stores.
Exercise. Exercise gets the legs moving and improves muscle tone, which helps the circulation of blood through your veins.
Lose weight. Taking off extra pounds may help with blood circulation and pressure on your veins.
Avoid wearing tight clothes. Tight clothes, especially those that are tight around your waist, groin (upper thighs), and legs, can make varicose veins worse.
Medical and Surgical Treatments
Medical and surgical treatments are used to either remove varicose veins or close them. Removing or closing varicose veins usually doesn’t create circulation problems because the blood reroutes itself through other veins. These therapies range from approaches that don’t involve incisions or injections to those that are surgical procedures. It may be necessary to combine therapies, depending on your condition and lifestyle.
Sclerotherapy. This procedure uses a liquid chemical to close off the vein. The solution is injected into the vein to cause irritation and scarring inside the vein, which causes the vein to close off and fade away. It’s usually used to treat smaller varicose veins and spider veins. Sclerotherapy is usually done in the doctor’s office, while you stand. You may need several sclerotherapy treatments to close off a vein completely. In this case, treatments are typically given every 4 to 6 weeks. Following treatments, your legs are wrapped in elastic bandaging to help healing and decrease swelling.
Microsclerotherapy. This procedure is used to treat spider veins and other very small varicose veins. It involves injection of small amounts of a liquid chemical using a very fine needle. The chemical causes scarring in the inner lining of the veins, causing them to close off.
Laser surgery. This procedure uses no incisions or injections. Light energy from a laser is used to make the vein fade away. Laser surgery is typically used to treat smaller varicose veins. With new technology, lasers are more effective than they used to be.
Endovenous ablation therapy. This procedure uses an energy source (either laser or radiowave) to create heat to close off the vein. A tiny incision is made in the skin, and a small catheter (tube) is inserted into the vein. A device at the tip of the catheter heats up the inside of the vein, which causes it to close off. You’re awake during the procedure, but your doctor numbs the area of the vein. You can usually go home on the same day. You may experience less pain and recover more quickly with this procedure than with some of the others.
Endoscopic vein surgery. This procedure uses a tiny camera at the end of a thin tube to move through the varicose veins. A surgical instrument at the end of the camera is used to close the veins. Endoscopic vein surgery is currently only used in severe cases in which there are skin ulcers due to the varicose veins. Only small incisions are required for this procedure.
Ambulatory phlebectomy. In this procedure, small varicose veins are removed through small incisions in your skin. Ambulatory phlebectomy is typically used to treat varicose veins close to the surface of the skin. You’re awake during the procedure, but your doctor numbs the area of the vein. You can usually go home the same day.
Vein stripping and ligation. In this procedure, veins are tied shut (ligation) and removed (stripping) through small incisions. The procedure is typically used in severe cases, in which the varicose veins cause pain or skin ulcers. You’re given medicine to sleep so that you don’t feel any pain during the procedure.
What To Expect After Treatment
Recovery times vary based on the specific procedure that’s performed. Vein stripping and ligation requires more recovery than most other procedures. Activity is not significantly limited following most other procedures. In fact, walking is often recommended during recovery. Some treatments may require that you wear compression stockings or bandages for a period ranging from a couple days to a few weeks following the procedure.
Common side effects immediately following a procedure may include bruising, swelling, skin discoloration, cramping, and itching. Swelling and skin discoloration may last for several months. Less common side effects include blood clots or nerve damage. An uncommon side effect of sclerotherapy is liquid chemical leaking out of the vein, which could cause tissue damage or ulcers.
How Can Varicose Veins Be Prevented?
Varicose veins can't be prevented from forming, but there are ways to reduce the severity of existing varicose veins and the risk of getting new varicose veins. To decrease the risk for and severity of varicose veins, you can:
Exercise. Moving your legs by walking or other forms of exercise can help move blood through your body.
Control your weight. If you are overweight or obese, losing weight will reduce pressure on your veins.
Avoid high heels and tight clothes. Flat or low-heeled shoes give your calf muscles a better workout, which will help to improve muscle strength and blood circulation. Avoiding tight clothing will reduce unnecessary pressure on your veins.
Avoid excessive standing or sitting with your legs bent or crossed. This will help blood flow and avoid additional pressure on your veins. During long periods of standing, try to take sitting breaks often.
Elevate your legs. Elevating your legs when sitting, resting, or sleeping can help the flow of blood, especially if your legs are raised above the level of your heart.
Living With Varicose Veins
Varicose veins can typically be treated with self-care. If medical procedures are necessary, they are generally very effective, and treated veins eventually fade or disappear. But the treatments don't prevent new varicose veins or other vein problems. It's possible for the same varicose veins to reappear after treatment, but this is uncommon.
Ongoing Health Care Needs
Although it's not possible to completely prevent new varicose veins from forming, following the steps in the "How Can Varicose Veins Be Prevented?" section can help keep developing or worsening varicose veins under control. Watch for skin ulcers or other complications that may develop, and consult a doctor if this happens.
Key Points
Varicose veins are enlarged and twisted veins close to the surface of the skin. They usually don't cause medical problems, but occasionally require treatment for complications, including pain, skin ulcers, and blood clots.
Varicose veins are usually the result of damaged or improperly working valves in the veins, which cause blood to back up and make the vein swell.
Varicose veins can affect any vein, but are most common in the legs.
Varicose veins are more common in women than in men. Family history and increasing age also are risk factors for varicose veins.
Common signs and symptoms of varicose veins include enlarged veins visible on the skin, swelling, and sometimes pain or throbbing in the legs. More serious complications can occur, such as skin ulcers and blood clots, but these are usually the result of problems with deeper veins.
Varicose veins are usually diagnosed simply on the appearance of leg veins when you're standing or seated with your legs dangling. Medical tests are usually not needed for the diagnosis.
Most varicose veins don't require treatment. Doctors may recommend simple self-care measures, including exercise, weight loss (if you're overweight), and avoiding long periods of sitting or standing.
In cases where signs and symptoms are more severe or there are complications such as skin ulcers, medical treatment may be necessary. Treatments also are done for cosmetic reasons. Varicose vein treatments are typically very effective.
Goals of treatment include easing symptoms, avoiding complications, and improving cosmetic appearance.
Although there's no way to completely prevent new varicose veins from forming, existing varicose veins can be kept under control with simple self-care measures
Veins, especially those in the legs, have to pump the blood “up hill” to the heart, against gravity. Inside the veins are one-way valves that help with pumping action and prevent blood from flowing backward. These valves allow blood to flow in only one direction, toward the heart. Varicose veins develop when the valves become weakened, damaged, or don’t work well.
Weakness in the valves may be due to weakness in the walls of the veins. This weakness tends to be associated with certain factors, including increasing age, a family history of varicose veins, or high pressure inside veins due to overweight or pregnancy.
When the walls of the veins are weak, they lose their normal elasticity, like an overstretched rubber band. This makes them longer and wider and causes the flaps of the valves to separate. Blood is then able to flow backward through the valves, filling the vein and stretching it even more. The vein becomes enlarged, swollen, and often twisted trying to squeeze into its normal space.
Who Is At Risk for Varicose Veins?
Populations Affected
About 25 million Americans are affected by varicose veins. They are most common in people aged 30 to 70.
Risk Factors
Risk factors for developing varicose veins include:
Genetics. Having a family member with varicose veins may increase the risk for developing them. Approximately half of the people who get varicose veins have a family history of them.
Age. The normal wear and tear of aging may cause valves to weaken and not work as well.
Gender. Women are two to three times more likely to develop varicose veins than men. Up to half of American women have varicose veins. Changes in hormones due to puberty, pregnancy, menopause, or taking birth control pills may increase a woman's risk of developing varicose veins.
Pregnancy. During pregnancy, the growth of the fetus increases the pressure on the veins in the legs. Varicose veins that occur during pregnancy usually improve within 3 to 12 months following delivery.
Overweight and obesity. Having extra weight on the body can put additional pressure on the veins.
Prolonged standing or sitting, particularly with legs bent or crossed. When standing or sitting with legs bent or crossed, the veins have to work harder to pump the blood up to the heart.
What Are the Signs and Symptoms of Varicose Veins?
Common signs and symptoms of varicose veins include:
Enlarged veins that are visible on your skin
Mild swelling of your ankles and feet
Painful, achy, or "heavy" legs
Throbbing or cramping in your legs
Itchy legs, especially in the lower leg and ankle (sometimes incorrectly diagnosed as dry skin)
Discoloration of your skin surrounding the varicose veins
Complications
Only a small percentage of people have complications from varicose veins. Complications may include dermatitis and thrombophlebitis.
Dermatitis
Dermatitis is an itchy rash that can occur on the lower leg or ankle of a person with varicose veins in the legs. It can sometimes cause bleeding or a skin ulcer to develop if scratched or irritated.
Thrombophlebitis
This is a blood clot (thrombus) that occurs in a vein. There are two types of thrombophlebitis:
Superficial thrombophlebitis is a blood clot that occurs in a superficial vein and usually causes only minor problems that are limited to the area of the affected vein. Clots in varicose veins are usually of this type. Infections, chemical irritation, or other conditions that cause irritation and inflammation of the veins also can lead to superficial thrombophlebitis.
Deep vein thrombosis is a blood clot that develops in veins deeper in the body. It can be life threatening if the clot breaks off and travels to the lungs, which is called pulmonary embolism. This type of thrombophlebitis does not occur in varicose veins.
How Are Varicose Veins Diagnosed?
Varicose veins are often diagnosed based simply on the appearance of the veins. For varicose veins in the legs, your doctor will examine your legs while you are standing or seated with your legs dangling. Your doctor may also ask you to describe pain or any other symptoms. Some diagnostic tests may be done to rule out other disorders or conditions.
Specialists Involved
The following specialists may be involved in your medical care if you have varicose veins:
A vascular medicine specialist or vascular surgeon (blood vessel system specialist)
A dermatologist (skin specialist)
Diagnostic Tests and Procedures
Your doctor may order a Doppler ultrasound to evaluate the flow of blood in your veins and to look for blood clots. During a Doppler ultrasound, a handheld device is placed on your body and passed back and forth over the affected area. A computer converts sound waves into a picture of the blood flow in the arteries and veins.
Rarely, your doctor may order an angiogram to look at blood flow through your blood vessels. The procedure involves injecting a dye into your veins that can be seen using x ray. An angiogram can help to rule out other diagnoses besides varicose veins.
How Are Varicose Veins Treated?
Goals of Treatment
The goals of treating varicose veins may include easing symptoms, avoiding complications, and improving cosmetic appearance. Although treatment can target existing varicose veins, it can't keep new varicose veins from forming.
Who Needs Treatment
Varicose veins that cause few signs and symptoms usually don’t need to be treated. Instead, your doctor may recommend simple self-care measures. Varicose veins causing more severe signs and symptoms may need medical or surgical treatment. Treatment may be recommended when the varicose veins are causing skin ulcers, serious skin conditions, blood clots, significant pain, or disruption of daily life activities. Some people with varicose veins may choose to have medical or surgical treatments to improve the cosmetic appearance of varicose veins.
Types of Treatment
Self-Care Measures
Self-care measures are a common option for treating varicose veins. If self-care measures are called for, your doctor may ask you to:
Avoid excess amounts of standing when possible. Take frequent breaks during prolonged periods of standing.
Elevate your legs when sitting, resting, or sleeping. Elevating your legs above the level of your heart is very important.
Wear compression stockings. These are typically worn all day long. Doctors may prescribe special-strength stockings or over-the-counter support stockings, which may be available at pharmacies and medical supply stores.
Exercise. Exercise gets the legs moving and improves muscle tone, which helps the circulation of blood through your veins.
Lose weight. Taking off extra pounds may help with blood circulation and pressure on your veins.
Avoid wearing tight clothes. Tight clothes, especially those that are tight around your waist, groin (upper thighs), and legs, can make varicose veins worse.
Medical and Surgical Treatments
Medical and surgical treatments are used to either remove varicose veins or close them. Removing or closing varicose veins usually doesn’t create circulation problems because the blood reroutes itself through other veins. These therapies range from approaches that don’t involve incisions or injections to those that are surgical procedures. It may be necessary to combine therapies, depending on your condition and lifestyle.
Sclerotherapy. This procedure uses a liquid chemical to close off the vein. The solution is injected into the vein to cause irritation and scarring inside the vein, which causes the vein to close off and fade away. It’s usually used to treat smaller varicose veins and spider veins. Sclerotherapy is usually done in the doctor’s office, while you stand. You may need several sclerotherapy treatments to close off a vein completely. In this case, treatments are typically given every 4 to 6 weeks. Following treatments, your legs are wrapped in elastic bandaging to help healing and decrease swelling.
Microsclerotherapy. This procedure is used to treat spider veins and other very small varicose veins. It involves injection of small amounts of a liquid chemical using a very fine needle. The chemical causes scarring in the inner lining of the veins, causing them to close off.
Laser surgery. This procedure uses no incisions or injections. Light energy from a laser is used to make the vein fade away. Laser surgery is typically used to treat smaller varicose veins. With new technology, lasers are more effective than they used to be.
Endovenous ablation therapy. This procedure uses an energy source (either laser or radiowave) to create heat to close off the vein. A tiny incision is made in the skin, and a small catheter (tube) is inserted into the vein. A device at the tip of the catheter heats up the inside of the vein, which causes it to close off. You’re awake during the procedure, but your doctor numbs the area of the vein. You can usually go home on the same day. You may experience less pain and recover more quickly with this procedure than with some of the others.
Endoscopic vein surgery. This procedure uses a tiny camera at the end of a thin tube to move through the varicose veins. A surgical instrument at the end of the camera is used to close the veins. Endoscopic vein surgery is currently only used in severe cases in which there are skin ulcers due to the varicose veins. Only small incisions are required for this procedure.
Ambulatory phlebectomy. In this procedure, small varicose veins are removed through small incisions in your skin. Ambulatory phlebectomy is typically used to treat varicose veins close to the surface of the skin. You’re awake during the procedure, but your doctor numbs the area of the vein. You can usually go home the same day.
Vein stripping and ligation. In this procedure, veins are tied shut (ligation) and removed (stripping) through small incisions. The procedure is typically used in severe cases, in which the varicose veins cause pain or skin ulcers. You’re given medicine to sleep so that you don’t feel any pain during the procedure.
What To Expect After Treatment
Recovery times vary based on the specific procedure that’s performed. Vein stripping and ligation requires more recovery than most other procedures. Activity is not significantly limited following most other procedures. In fact, walking is often recommended during recovery. Some treatments may require that you wear compression stockings or bandages for a period ranging from a couple days to a few weeks following the procedure.
Common side effects immediately following a procedure may include bruising, swelling, skin discoloration, cramping, and itching. Swelling and skin discoloration may last for several months. Less common side effects include blood clots or nerve damage. An uncommon side effect of sclerotherapy is liquid chemical leaking out of the vein, which could cause tissue damage or ulcers.
How Can Varicose Veins Be Prevented?
Varicose veins can't be prevented from forming, but there are ways to reduce the severity of existing varicose veins and the risk of getting new varicose veins. To decrease the risk for and severity of varicose veins, you can:
Exercise. Moving your legs by walking or other forms of exercise can help move blood through your body.
Control your weight. If you are overweight or obese, losing weight will reduce pressure on your veins.
Avoid high heels and tight clothes. Flat or low-heeled shoes give your calf muscles a better workout, which will help to improve muscle strength and blood circulation. Avoiding tight clothing will reduce unnecessary pressure on your veins.
Avoid excessive standing or sitting with your legs bent or crossed. This will help blood flow and avoid additional pressure on your veins. During long periods of standing, try to take sitting breaks often.
Elevate your legs. Elevating your legs when sitting, resting, or sleeping can help the flow of blood, especially if your legs are raised above the level of your heart.
Living With Varicose Veins
Varicose veins can typically be treated with self-care. If medical procedures are necessary, they are generally very effective, and treated veins eventually fade or disappear. But the treatments don't prevent new varicose veins or other vein problems. It's possible for the same varicose veins to reappear after treatment, but this is uncommon.
Ongoing Health Care Needs
Although it's not possible to completely prevent new varicose veins from forming, following the steps in the "How Can Varicose Veins Be Prevented?" section can help keep developing or worsening varicose veins under control. Watch for skin ulcers or other complications that may develop, and consult a doctor if this happens.
Key Points
Varicose veins are enlarged and twisted veins close to the surface of the skin. They usually don't cause medical problems, but occasionally require treatment for complications, including pain, skin ulcers, and blood clots.
Varicose veins are usually the result of damaged or improperly working valves in the veins, which cause blood to back up and make the vein swell.
Varicose veins can affect any vein, but are most common in the legs.
Varicose veins are more common in women than in men. Family history and increasing age also are risk factors for varicose veins.
Common signs and symptoms of varicose veins include enlarged veins visible on the skin, swelling, and sometimes pain or throbbing in the legs. More serious complications can occur, such as skin ulcers and blood clots, but these are usually the result of problems with deeper veins.
Varicose veins are usually diagnosed simply on the appearance of leg veins when you're standing or seated with your legs dangling. Medical tests are usually not needed for the diagnosis.
Most varicose veins don't require treatment. Doctors may recommend simple self-care measures, including exercise, weight loss (if you're overweight), and avoiding long periods of sitting or standing.
In cases where signs and symptoms are more severe or there are complications such as skin ulcers, medical treatment may be necessary. Treatments also are done for cosmetic reasons. Varicose vein treatments are typically very effective.
Goals of treatment include easing symptoms, avoiding complications, and improving cosmetic appearance.
Although there's no way to completely prevent new varicose veins from forming, existing varicose veins can be kept under control with simple self-care measures
Holes in the Heart
What Are Holes in the Heart?
A hole in the heart (also called an atrial septal defect (ASD) or ventricular septal defect (VSD)) is a type of simple congenital (kon-JEN-i-tal) heart defect. This is a problem with the heart's structure that's present at birth. Congenital heart defects change the normal flow of blood through the heart.
Your heart has two sides, separated by an inner wall called the septum. With each heartbeat, the right side of the heart receives oxygen-poor blood from the body and pumps it to the lungs. The left side of the heart receives oxygen-rich blood from the lungs and pumps it to the body. The septum prevents mixing of blood between the two sides of the heart.
Some babies are born with a hole in the upper or lower septum. A hole in the septum between the heart's upper two chambers (the atria, pronounced AY-tree-uh) is an ASD. A hole in the septum between the heart's lower two chambers (the ventricles, pronounced VEN-trih-kuls) is a VSD.
A hole in the septum can allow blood to pass from the left side of the heart to the right side. This means that oxygen-rich blood can mix with oxygen-poor blood, causing the oxygen-rich blood to be pumped to the lungs a second time.
Over the past few decades, the diagnosis and treatment of ASDs and VSDs have greatly improved. As a result, a child with a simple heart defect can grow to adulthood and live a normal, active, and productive life because his or her heart defect closes on its own or has been repaired.
How the Heart Works
To understand holes in the heart, it's helpful to know how a healthy heart works.
Your child's heart is a muscle about the size of his or her fist. The heart works like a pump and beats 100,000 times a day.
The heart has two sides, separated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to pick up oxygen. Then, oxygen-rich blood returns from the lungs to the left side of the heart, and the left side pumps it to the body.
The heart has four chambers and four valves and is connected to various blood vessels. Veins are the blood vessels that carry blood from the body to the heart. Arteries are the blood vessels that carry blood away from the heart to the body.
Heart Chambers
The heart has four chambers or "rooms."
The atria are the two upper chambers that collect blood as it comes into the heart.
The ventricles are the two lower chambers that pump blood out of the heart to the lungs or other parts of the body.
Heart Valves
Four valves control the flow of blood from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart.
The tricuspid (tri-CUSS-pid) valve is in the right side of the heart, between the right atrium and the right ventricle.
The pulmonary (PULL-mun-ary) valve is in the right side of the heart, between the right ventricle and the entrance to the pulmonary artery, which carries blood to the lungs.
The mitral (MI-trul) valve is in the left side of the heart, between the left atrium and the left ventricle.
The aortic (ay-OR-tik) valve is in the left side of the heart, between the left ventricle and the entrance to the aorta, the artery that carries blood to the body.
Valves are like doors that open and close. They open to allow blood to flow through to the next chamber or to one of the arteries, and then they shut to keep blood from flowing backward.
When the heart's valves open and close, they make a "lub-DUB" sound that a doctor can hear using a stethoscope.
The first sound—the “lub”—is made by the mitral and tricuspid valves closing at the beginning of systole (SIS-toe-lee). Systole is when the ventricles contract, or squeeze, and pump blood out of the heart.
The second sound—the “DUB”—is made by the aortic and pulmonary valves closing at beginning of diastole (di-AS-toe-lee). Diastole is when the ventricles relax and fill with blood pumped into them by the atria.
Arteries
The arteries are major blood vessels connected to your heart.
The pulmonary artery carries blood pumped from the right side of the heart to the lungs to pick up a fresh supply of oxygen.
The aorta is the main artery that carries oxygen-rich blood pumped from the left side of the heart out to the body.
The coronary arteries are the other important arteries attached to the heart. They carry oxygen-rich blood from the aorta to the heart muscle, which must have its own blood supply to function.
Veins
The veins are also major blood vessels connected to your heart.
The pulmonary veins carry oxygen-rich blood from the lungs to the left side of the heart so it can be pumped out to the body.
The vena cava is a large vein that carries oxygen-poor blood from the body back to the heart.
For more information on how a healthy heart works, see the Diseases and Conditions Index article on How the Heart Works. This article contains animations that show how your heart pumps blood and how your heart’s electrical system works.
Types of Holes in the Heart
Atrial Septal Defect
An atrial septal defect (ASD) is a hole in the part of the septum that separates the atria (upper chambers of the heart). This heart defect allows oxygen-rich blood from the left atrium to flow across the atrial septum into the right atrium instead of flowing down to the left ventricle as it should. This is inefficient because oxygen-rich blood gets pumped back to the lungs, where it has just been, instead of going to the body.
An ASD can be small or large. Small ASDs allow only a little blood to flow from one atrium to the other. Small ASDs don't affect the way the heart works and therefore don't need any special treatment. Many small ASDs close on their own as the heart grows during childhood.
Medium to large ASDs allow more blood to leak from one atrium to the other, and they are less likely to close on their own. Most children with ASDs have no symptoms, even if they have large ASDs.
There are three major types of ASD:
Secundum. This defect is in the middle of the atrial septum. It’s the most common form of ASD. About 8 out of every 10 babies born with ASD have secundum defects. At least half of all secundum ASDs close on their own. This is less likely if the defect is large.
Primum. This defect is in the lower part of the atrial septum. It often occurs along with abnormalities in the heart valves that connect the upper and lower heart chambers. Primum defects aren’t very common. This type of defect doesn’t close on its own.
Sinus venosus. This defect is in the upper part of the atrial septum, near where a large vein (the superior vena cava) brings oxygen-poor blood from the upper body to the right atrium. Sinus venosus is a rare defect. Sinus venosus defects don’t close on their own.
Long-Term Effects of Atrial Septal Defects That Aren’t Repaired
Over time, the extra blood flow to the right side of the heart and the lungs may cause problems for a heart that has an ASD. Usually, most of these problems don’t show up until adulthood, often around age 30 or later. They are rare in infants and children. These possible problems include:
Right heart failure. The right side of the heart has to work harder to pump extra blood to the lungs. Over time, the heart may become tired from this extra work and not pump efficiently.
Arrhythmias (irregular heartbeats). Extra blood flowing into the right atrium through an ASD can cause the atrium to stretch and enlarge. Over time, this can lead to problems with the heart’s rhythm. When this occurs, an arrhythmia can develop, with signs or symptoms such as palpitations (a feeling that your heart has skipped a beat or is beating too hard) or a rapid heartbeat.
Stroke. Usually, the lungs filter out small clots that can form on the right side of the heart. Sometimes a blood clot formed on the right side of the heart can pass through an ASD to the left side and be pumped out to the body. A clot like this can travel to an artery in the brain, blocking blood flow through it and causing a stroke. This doesn’t occur in childhood.
Pulmonary arterial hypertension (PAH). PAH is high blood pressure in the arteries in the lungs. Over time, high blood pressure in the lungs can damage the arteries and the small blood vessels in the lungs. They thicken and become stiff, making it harder for blood to flow through them.
These problems develop over many years and don’t occur in children. They also are rare in adults because most ASDs either close on their own or are repaired in early childhood.
Ventricular Septal Defect
A ventricular septal defect (VSD) is a hole in the part of the septum that separates the ventricles, the lower chambers of the heart. The hole allows oxygen-rich blood to flow from the left ventricle across the heart into the right ventricle instead of flowing up into the aorta and out to the body as it should.
An infant born with a VSD may have a single hole or more than one hole in the wall that separates the two ventricles. The defect also may occur by itself or with other congenital heart defects.
Doctors classify VSDs based on the:
Size of the defect.
Location of the defect.
Number of defects.
Presence or absence of a ventricular septal aneurysm—a thin flap of tissue on the septum. This tissue is harmless and can help a VSD close on its own.
VSDs can be small or large. A small VSD doesn’t cause problems and may often close on its own. Because small VSDs allow only a small amount of blood to flow between the ventricles, they’re sometimes called restrictive VSDs. Small VSDs don’t cause any symptoms.
Medium VSDs are less likely than small defects to close on their own. They may require surgery to close and may cause symptoms during infancy and childhood.
Large VSDs allow a large amount of blood to flow from the left ventricle to the right ventricle and are sometimes called nonrestrictive VSDs. A large VSD is less likely to close completely on its own, but it may get smaller over time. Large VSDs often cause symptoms in infants and children, and surgery is usually needed to close them.
VSDs are found in different parts of the septum.
Membranous VSDs are located near the heart valves. They can close at any time.
Muscular VSDs are found in the lower part of the septum. They’re surrounded by muscle, and most close on their own during early childhood.
Inlet VSDs are located close to where blood enters the ventricles. They’re less common than membranous and muscular VSDs.
Outlet VSDs are found in the part of the ventricle where the blood leaves the heart. This is the rarest type of VSD.
Long-Term Effects of Large Ventricular Septal Defects That Aren’t Repaired
A moderate to large VSD can cause:
Heart failure. Infants with large VSDs may develop heart failure because the left side of the heart pumps blood into the right ventricle in addition to its normal work of pumping blood to the body. The increased workload on the heart also increases the heart rate and the body’s demand for energy.
Growth failure, especially in infancy. A baby may not be able to eat enough to keep up with his or her body’s increased energy demands. As a result, the baby may lose weight or fail to grow and develop normally.
Arrhythmias (irregular heartbeats). The extra blood flowing through the heart can cause areas of the heart to stretch and enlarge. This can disturb the normal electrical activity of the heart, leading to fast and irregular heart rhythms.
PAH. The high pressure and high volume of extra blood pumped through a large VSD into the lungs can cause scarring of the delicate arteries in the lungs. Today, PAH rarely develops because most large VSDs are repaired in infancy.
What Causes Holes in the Heart?
Mothers of children born with an atrial septal defect (ASD), a ventricular septal defect (VSD), or another type of heart defect often think that they did something wrong during the pregnancy to cause the problem. However, most of the time, doctors don't know why these congenital heart defects develop.
Heredity may play a role in some heart defects. For example, a parent who has a congenital heart defect is slightly more likely than other people to have a child with the problem. In very rare cases, more than one child in a family is born with a heart defect. Children with genetic defects often have congenital heart defects. An example of this is Down syndrome—half of all babies with Down syndrome have congenital heart defects.
Scientists continue to search for the causes of congenital heart defects.
What Are the Signs and Symptoms of Holes in the Heart?
Atrial Septal Defect
A heart murmur (an extra flow sound associated with the heartbeat) is the most common sign of an atrial septal defect (ASD). Often, it’s the only sign. However, not all murmurs are a sign of a congenital heart defect. Many healthy children have heart murmurs, which are innocent, normal sounds of blood flow through the heart. A doctor can tell by listening whether a murmur is a normal flow sound or a sign of a heart problem. Many babies born with ASDs have no signs or symptoms.
If a large ASD isn’t repaired, the extra blood flow to the right side of the heart can eventually damage the heart and lungs, causing heart failure. This doesn’t occur until adulthood. Signs and symptoms of heart failure can include:
Fatigue or tiring easily during exercise or activity
Shortness of breath
A buildup of blood and fluid in the lungs
A buildup of fluid in the feet, ankles, and legs
Ventricular Septal Defect
A heart murmur is usually present in ventricular septal defect (VSD) and may be the first and only sign of this defect. The heart murmur is often present right after birth in many infants, but it may not be heard until the baby is 6 to 8 weeks old.
Most newborns who have VSDs don’t have heart-related symptoms. However, a baby with a medium or large VSD can develop heart failure. Signs and symptoms of heart failure usually appear during the baby’s first 2 months of life. The signs and symptoms of heart failure from VSD are similar to those listed above for ASD, but they occur in infancy.
The major sign of heart failure is difficulty feeding and poor growth. VSD symptoms are rare after infancy because the defect either decreases in size on its own or is repaired.
How Are Holes in the Heart Diagnosed?
Holes in the heart are usually diagnosed based on results from a physical exam and special tests. The exam findings for an atrial septal defect (ASD) often aren't obvious, so the diagnosis is sometimes not made until later childhood or even adulthood. A ventricular septal defect (VSD) has a very distinct heart murmur, so this diagnosis is usually made in infancy.
Specialists Involved
Doctors who specialize in heart problems are called cardiologists. Pediatric cardiologists take care of babies and children who have heart problems. Other specialists who treat heart defects include cardiac surgeons (doctors who repair heart defects using surgery).
Physical Exam
During a physical exam, the doctor:
Listens to your child's heart and lungs with a stethoscope
Looks for signs of a heart defect, such as a heart murmur or signs of heart failure
Diagnostic Tests and Procedures
The doctor will order several tests to diagnose an ASD or VSD. These tests also will help the doctor determine the location and size of the defect.
Echocardiography
This test, which is harmless and painless, uses sound waves to create a moving picture of the heart. During echocardiography, ultrasound waves bounce off the structures of the heart, and then a computer converts them into pictures on a video screen. The test allows the doctor to clearly see any problem with the way the heart is formed or the way it's working.
Echocardiography is an important test for diagnosing a hole in the heart and for following the problem over time. This test shows problems with the heart's structure and how the heart is reacting to these problems. Echocardiography helps the cardiologist decide whether and when treatment is needed.
EKG
An EKG (electrocardiogram) detects and records the electrical activity of the heart. This simple and painless test is used to assess the heart rhythm. An EKG shows how fast the heart is beating and whether the heart's rhythm is steady or irregular. It also can detect enlargement of one of the heart's chambers, which can help to diagnose a heart defect.
Chest X Ray
A chest x ray takes a picture of the heart and lungs. It can show whether the heart is enlarged or whether the lungs have extra blood flow or extra fluid, which can be a sign of heart failure.
Pulse Oximetry
Pulse oximetry shows how much oxygen is in the blood. A sensor is placed on the fingertip or toe (like an adhesive bandage). The sensor is attached to a small computer unit, which displays a number that indicates how much oxygen is in the blood.
Cardiac Catheterization
During cardiac catheterization (KATH-e-ter-i-ZA-shun), a thin, flexible tube called a catheter is put into a vein in the arm, groin (upper thigh), or neck and threaded to the heart. A dye that can be seen on an x ray is injected through the catheter into a blood vessel or a chamber of the heart. This allows the doctor to see the flow of blood through the heart and blood vessels on the x-ray image.
Cardiac catheterization also can be used to measure the pressure inside the heart chambers and blood vessels and can determine whether blood is mixing between the two sides of the heart. It's also used to repair some heart defects.
How Are Holes in the Heart Treated?
Although many holes in the heart don't need treatment, some do. These days, most holes in the heart that need treatment are repaired in infancy or early childhood. Sometimes, adults are treated for holes in the heart if problems develop.
The treatment your child receives depends on the type, location, and size of the hole. Other factors include your child's age, size, and general health.
Treating Atrial Septal Defect
Periodic checkups are done to see whether the defect closes on its own. About half of all ASDs close on their own over time, and about 20 percent close within the first year of life. Your child's doctor will recommend how often your child should be checked. For an ASD, frequent checkups aren't needed. When treatment of an ASD is required, it involves catheter or surgical procedures to close the hole.
Catheter or Surgical Procedures To Repair ASD
Doctors often decide to close an ASD in children who still have medium to large holes by the time they are 2 to 5 years old.
Catheter procedure. Until the early 1990s, surgery was the usual method for closing all ASDs. Now, thanks to medical advances, catheter procedures can be used to close secundum ASDs, which are the most common type of ASD. This procedure is done under general anesthesia, so the child sleeps throughout and doesn't feel any pain.
During the procedure, the doctor inserts a catheter (a thin, flexible tube) into a vein in the groin (upper thigh) and threads it to the heart's septum. The catheter has a tiny umbrella-like device folded up inside it. When the catheter reaches the septum, the device is pushed out of the catheter and positioned so that it plugs the hole between the atria. The device is secured in place and the catheter is withdrawn from the body. Within 6 months, normal tissue grows in and over the device. There is no need to replace the closure device as the child grows.
Doctors often use echocardiography or a transesophageal (trans-e-SOF-ah-ge-al) echocardiography (TEE) as well as angiography to guide them in threading the catheter to the heart and closing the defect. A TEE is a special type of echocardiography that takes pictures of the heart through the esophagus (the tube leading from the mouth to the stomach).
Catheter procedures are much easier than surgery on patients because they involve only a needle puncture in the skin where the catheter is inserted. This means that recovery is faster and easier. The outlook for children having this procedure is excellent. Closures are successful in more than 9 out of 10 patients, with no significant leakage. Rarely, a defect is too large for catheter closure, so surgery is needed.
Surgery. Open-heart surgery is generally done to repair primum or sinus venosus ASDs. General anesthesia is used so the child will sleep through the operation and not feel any pain.
During this procedure, the surgeon makes an incision in the chest to reach the ASD and repairs the defect with a special patch that covers the hole. The child is placed on a heart-lung bypass machine so that the heart can be opened to perform the operation.
The outlook for children after ASD surgery is excellent. On average, children spend 3 to 4 days in the hospital before going home. Complications, such as bleeding and infection, from ASD surgery are very rare. Some children may develop inflammation of the outer lining of the heart, causing fluid to collect around the heart in the weeks after surgery. This is a reaction to the heart operation and usually resolves with medicine.
While in the hospital, the child is given medicines as needed to reduce pain or anxiety. The doctors and nurses at the hospital teach parents how to care for the child at home. They will talk about preventing blows to the chest as the incision heals, limiting activity while the child recovers, bathing, scheduling followup appointments with the doctor, and determining when the child can resume regular activities.
Treating Ventricular Septal Defect
The doctor may choose to monitor and observe a child with VSD who doesn't have symptoms of heart failure. This means regular checkups and tests to see whether the defect closes on it own or gets smaller. More than half of VSDs eventually close, usually by the time a child is in preschool. Your child's doctor will recommend how often your child should be checked, ranging from monthly checkups to checkups every 1 or 2 years.
When treatment for VSD is required, options include extra nutrition and surgery to close the VSD.
Surgical treatment is needed if a child's VSD:
Is large
Is causing your child to have symptoms
Is medium-sized and is causing enlargement of the heart chambers
Affects the aortic valve
Extra Nutrition
Some infants with VSDs don't grow and develop or gain weight as they should. These infants usually:
Have large VSDs
Are born prematurely
Tire easily during feeding
Doctors usually recommend extra nutrition or special feedings for these infants. These feedings are high-calorie formulas or breast milk supplements that give the baby extra nourishment.
In some cases, tube feeding is needed. Food is given through a small tube that is placed through the nose into the stomach. Tube feeding can add to or take the place of bottle feeding. This treatment is usually temporary, because a VSD that causes symptoms will likely need surgery.
Surgery To Repair VSDs
Today, most doctors recommend surgery to close a large VSD that's causing symptoms or hasn't closed by 1 year of age. Surgery may be required earlier if:
The child fails to gain weight
Medicines are required to control the symptoms of heart failure
Rarely, a medium-sized VSD that's causing enlargement of the heart chambers is treated with surgery after infancy. However, most VSDs that need surgery are repaired in the first year of life.
Living With Holes in the Heart
The outlook for children with atrial septal defects (ASDs) and ventricular septal defects (VSDs) is excellent. Advances in treatment mean that most children with these heart defects have normal, active, and productive lives with no decrease in lifespan.
Many children with these defects need no special care or only occasional checkups with a cardiologist (a doctor who specializes in heart problems) as they go through childhood and adult life.
Living With an Atrial Septal Defect
Small ASDs often close on their own, and children with these heart defects don't have any problems or need treatment. Children and adults with small ASDs that don't close and don't cause symptoms are healthy and don't need treatment.
Many others with ASDs that don't close undergo procedures to close the hole and prevent possible long-term complications. Children recover well from these procedures and lead normal, healthy lives. Adults also do well after closure procedures.
Medical Needs
Arrhythmias. The risk of arrhythmias (irregular heartbeats) increases before and after surgery. Adults with ASDs who are older than 40 years are especially likely to have arrhythmias. People who had arrhythmias before surgery are more likely to have them after surgery.
Followup care. Regular followup care into adult life is advised for those who have had:
An ASD repaired as an adult
Arrhythmias before and after surgery
An ASD repaired with a catheter procedure
High blood pressure in the pulmonary artery at the time of surgery
Antibiotics. Some heart defects and their repairs can increase the risk of bacterial endocarditis, a serious infection of the heart valves or lining of the heart. You may need antibiotics before medical or dental procedures (such as surgery or dental cleanings) that could allow bacteria to enter your bloodstream. Talk to your doctor about whether you need to take antibiotics before such procedures. ASDs aren't associated with the risk of endocarditis, except in the 6 months after repair (for both catheter procedures and surgery).
Special Considerations for Children and Teens
Activity. Children with a repaired or closed ASD have no restrictions on their activity.
Growth and development. Children with ASDs don't have growth or development problems.
Regular health care. Your child should see his or her regular doctor for routine health care.
Additional surgery or procedures. When a child has an ASD, but no other heart defect, additional surgery isn't needed.
Special Considerations for Adults
Recovery from surgical repair of an ASD. When an ASD is repaired in adult life, the cardiologist or surgeon will explain what to expect during the recovery period and when to return to driving, working, exercising, and other activities.
Living With a Ventricular Septal Defect
Children with small VSDs have no symptoms and need only rare followup with a cardiologist. To protect these children from endocarditis, they may need antibiotics before medical or dental procedures (such as surgery or dental cleanings) that could allow bacteria to enter the bloodstream. Talk to your child's doctor about whether your child needs to take antibiotics before such procedures.
Children and adults who have had successful repair of a VSD and have no other congenital heart defects can expect to lead normal, healthy, and active lives.
Medical Needs
Sometimes problems and risks remain after surgical closure. They include:
Arrhythmias (irregular heartbeats). Serious and frequent arrhythmias require regular medical followup. The risk of arrhythmia is greater if surgery is done later in life.
Residual or remaining VSD. This is usually due to a leak at the edge of the patch used to close the hole. These VSDs tend to be very small and don't cause problems. They very rarely require another operation.
Antibiotics. People who have VSDs are at increased risk for bacterial endocarditis. Antibiotic treatment to prevent bacterial endocarditis may be recommended after VSD surgery. Residual VSDs or small VSDs that don't need surgery may require treatment with antibiotics before medical or dental procedures (such as surgery or dental cleanings) that could allow bacteria to enter the bloodstream. Talk to your doctor about whether you need to take antibiotics before such procedures.
Special Considerations for Children and Teens
Activity. There should be no activity restrictions on a child with a small VSD that doesn't need surgery, or after recovery from VSD repair. Be sure to check with your child's doctor about whether your child can take part in sports.
Growth and development. Your pediatrician or family doctor checks your child for growth and development at each routine checkup. Babies with large VSDs may not grow as quickly as other infants. These babies usually catch up after the VSD is closed.
Regular health care. Your child should see his or her regular doctor for routine health care.
Additional surgery or procedures. Teens and young adults rarely need additional surgery once a VSD closes or is repaired.
A hole in the heart (also called an atrial septal defect (ASD) or ventricular septal defect (VSD)) is a type of simple congenital (kon-JEN-i-tal) heart defect. This is a problem with the heart's structure that's present at birth. Congenital heart defects change the normal flow of blood through the heart.
Your heart has two sides, separated by an inner wall called the septum. With each heartbeat, the right side of the heart receives oxygen-poor blood from the body and pumps it to the lungs. The left side of the heart receives oxygen-rich blood from the lungs and pumps it to the body. The septum prevents mixing of blood between the two sides of the heart.
Some babies are born with a hole in the upper or lower septum. A hole in the septum between the heart's upper two chambers (the atria, pronounced AY-tree-uh) is an ASD. A hole in the septum between the heart's lower two chambers (the ventricles, pronounced VEN-trih-kuls) is a VSD.
A hole in the septum can allow blood to pass from the left side of the heart to the right side. This means that oxygen-rich blood can mix with oxygen-poor blood, causing the oxygen-rich blood to be pumped to the lungs a second time.
Over the past few decades, the diagnosis and treatment of ASDs and VSDs have greatly improved. As a result, a child with a simple heart defect can grow to adulthood and live a normal, active, and productive life because his or her heart defect closes on its own or has been repaired.
How the Heart Works
To understand holes in the heart, it's helpful to know how a healthy heart works.
Your child's heart is a muscle about the size of his or her fist. The heart works like a pump and beats 100,000 times a day.
The heart has two sides, separated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to pick up oxygen. Then, oxygen-rich blood returns from the lungs to the left side of the heart, and the left side pumps it to the body.
The heart has four chambers and four valves and is connected to various blood vessels. Veins are the blood vessels that carry blood from the body to the heart. Arteries are the blood vessels that carry blood away from the heart to the body.
Heart Chambers
The heart has four chambers or "rooms."
The atria are the two upper chambers that collect blood as it comes into the heart.
The ventricles are the two lower chambers that pump blood out of the heart to the lungs or other parts of the body.
Heart Valves
Four valves control the flow of blood from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart.
The tricuspid (tri-CUSS-pid) valve is in the right side of the heart, between the right atrium and the right ventricle.
The pulmonary (PULL-mun-ary) valve is in the right side of the heart, between the right ventricle and the entrance to the pulmonary artery, which carries blood to the lungs.
The mitral (MI-trul) valve is in the left side of the heart, between the left atrium and the left ventricle.
The aortic (ay-OR-tik) valve is in the left side of the heart, between the left ventricle and the entrance to the aorta, the artery that carries blood to the body.
Valves are like doors that open and close. They open to allow blood to flow through to the next chamber or to one of the arteries, and then they shut to keep blood from flowing backward.
When the heart's valves open and close, they make a "lub-DUB" sound that a doctor can hear using a stethoscope.
The first sound—the “lub”—is made by the mitral and tricuspid valves closing at the beginning of systole (SIS-toe-lee). Systole is when the ventricles contract, or squeeze, and pump blood out of the heart.
The second sound—the “DUB”—is made by the aortic and pulmonary valves closing at beginning of diastole (di-AS-toe-lee). Diastole is when the ventricles relax and fill with blood pumped into them by the atria.
Arteries
The arteries are major blood vessels connected to your heart.
The pulmonary artery carries blood pumped from the right side of the heart to the lungs to pick up a fresh supply of oxygen.
The aorta is the main artery that carries oxygen-rich blood pumped from the left side of the heart out to the body.
The coronary arteries are the other important arteries attached to the heart. They carry oxygen-rich blood from the aorta to the heart muscle, which must have its own blood supply to function.
Veins
The veins are also major blood vessels connected to your heart.
The pulmonary veins carry oxygen-rich blood from the lungs to the left side of the heart so it can be pumped out to the body.
The vena cava is a large vein that carries oxygen-poor blood from the body back to the heart.
For more information on how a healthy heart works, see the Diseases and Conditions Index article on How the Heart Works. This article contains animations that show how your heart pumps blood and how your heart’s electrical system works.
Types of Holes in the Heart
Atrial Septal Defect
An atrial septal defect (ASD) is a hole in the part of the septum that separates the atria (upper chambers of the heart). This heart defect allows oxygen-rich blood from the left atrium to flow across the atrial septum into the right atrium instead of flowing down to the left ventricle as it should. This is inefficient because oxygen-rich blood gets pumped back to the lungs, where it has just been, instead of going to the body.
An ASD can be small or large. Small ASDs allow only a little blood to flow from one atrium to the other. Small ASDs don't affect the way the heart works and therefore don't need any special treatment. Many small ASDs close on their own as the heart grows during childhood.
Medium to large ASDs allow more blood to leak from one atrium to the other, and they are less likely to close on their own. Most children with ASDs have no symptoms, even if they have large ASDs.
There are three major types of ASD:
Secundum. This defect is in the middle of the atrial septum. It’s the most common form of ASD. About 8 out of every 10 babies born with ASD have secundum defects. At least half of all secundum ASDs close on their own. This is less likely if the defect is large.
Primum. This defect is in the lower part of the atrial septum. It often occurs along with abnormalities in the heart valves that connect the upper and lower heart chambers. Primum defects aren’t very common. This type of defect doesn’t close on its own.
Sinus venosus. This defect is in the upper part of the atrial septum, near where a large vein (the superior vena cava) brings oxygen-poor blood from the upper body to the right atrium. Sinus venosus is a rare defect. Sinus venosus defects don’t close on their own.
Long-Term Effects of Atrial Septal Defects That Aren’t Repaired
Over time, the extra blood flow to the right side of the heart and the lungs may cause problems for a heart that has an ASD. Usually, most of these problems don’t show up until adulthood, often around age 30 or later. They are rare in infants and children. These possible problems include:
Right heart failure. The right side of the heart has to work harder to pump extra blood to the lungs. Over time, the heart may become tired from this extra work and not pump efficiently.
Arrhythmias (irregular heartbeats). Extra blood flowing into the right atrium through an ASD can cause the atrium to stretch and enlarge. Over time, this can lead to problems with the heart’s rhythm. When this occurs, an arrhythmia can develop, with signs or symptoms such as palpitations (a feeling that your heart has skipped a beat or is beating too hard) or a rapid heartbeat.
Stroke. Usually, the lungs filter out small clots that can form on the right side of the heart. Sometimes a blood clot formed on the right side of the heart can pass through an ASD to the left side and be pumped out to the body. A clot like this can travel to an artery in the brain, blocking blood flow through it and causing a stroke. This doesn’t occur in childhood.
Pulmonary arterial hypertension (PAH). PAH is high blood pressure in the arteries in the lungs. Over time, high blood pressure in the lungs can damage the arteries and the small blood vessels in the lungs. They thicken and become stiff, making it harder for blood to flow through them.
These problems develop over many years and don’t occur in children. They also are rare in adults because most ASDs either close on their own or are repaired in early childhood.
Ventricular Septal Defect
A ventricular septal defect (VSD) is a hole in the part of the septum that separates the ventricles, the lower chambers of the heart. The hole allows oxygen-rich blood to flow from the left ventricle across the heart into the right ventricle instead of flowing up into the aorta and out to the body as it should.
An infant born with a VSD may have a single hole or more than one hole in the wall that separates the two ventricles. The defect also may occur by itself or with other congenital heart defects.
Doctors classify VSDs based on the:
Size of the defect.
Location of the defect.
Number of defects.
Presence or absence of a ventricular septal aneurysm—a thin flap of tissue on the septum. This tissue is harmless and can help a VSD close on its own.
VSDs can be small or large. A small VSD doesn’t cause problems and may often close on its own. Because small VSDs allow only a small amount of blood to flow between the ventricles, they’re sometimes called restrictive VSDs. Small VSDs don’t cause any symptoms.
Medium VSDs are less likely than small defects to close on their own. They may require surgery to close and may cause symptoms during infancy and childhood.
Large VSDs allow a large amount of blood to flow from the left ventricle to the right ventricle and are sometimes called nonrestrictive VSDs. A large VSD is less likely to close completely on its own, but it may get smaller over time. Large VSDs often cause symptoms in infants and children, and surgery is usually needed to close them.
VSDs are found in different parts of the septum.
Membranous VSDs are located near the heart valves. They can close at any time.
Muscular VSDs are found in the lower part of the septum. They’re surrounded by muscle, and most close on their own during early childhood.
Inlet VSDs are located close to where blood enters the ventricles. They’re less common than membranous and muscular VSDs.
Outlet VSDs are found in the part of the ventricle where the blood leaves the heart. This is the rarest type of VSD.
Long-Term Effects of Large Ventricular Septal Defects That Aren’t Repaired
A moderate to large VSD can cause:
Heart failure. Infants with large VSDs may develop heart failure because the left side of the heart pumps blood into the right ventricle in addition to its normal work of pumping blood to the body. The increased workload on the heart also increases the heart rate and the body’s demand for energy.
Growth failure, especially in infancy. A baby may not be able to eat enough to keep up with his or her body’s increased energy demands. As a result, the baby may lose weight or fail to grow and develop normally.
Arrhythmias (irregular heartbeats). The extra blood flowing through the heart can cause areas of the heart to stretch and enlarge. This can disturb the normal electrical activity of the heart, leading to fast and irregular heart rhythms.
PAH. The high pressure and high volume of extra blood pumped through a large VSD into the lungs can cause scarring of the delicate arteries in the lungs. Today, PAH rarely develops because most large VSDs are repaired in infancy.
What Causes Holes in the Heart?
Mothers of children born with an atrial septal defect (ASD), a ventricular septal defect (VSD), or another type of heart defect often think that they did something wrong during the pregnancy to cause the problem. However, most of the time, doctors don't know why these congenital heart defects develop.
Heredity may play a role in some heart defects. For example, a parent who has a congenital heart defect is slightly more likely than other people to have a child with the problem. In very rare cases, more than one child in a family is born with a heart defect. Children with genetic defects often have congenital heart defects. An example of this is Down syndrome—half of all babies with Down syndrome have congenital heart defects.
Scientists continue to search for the causes of congenital heart defects.
What Are the Signs and Symptoms of Holes in the Heart?
Atrial Septal Defect
A heart murmur (an extra flow sound associated with the heartbeat) is the most common sign of an atrial septal defect (ASD). Often, it’s the only sign. However, not all murmurs are a sign of a congenital heart defect. Many healthy children have heart murmurs, which are innocent, normal sounds of blood flow through the heart. A doctor can tell by listening whether a murmur is a normal flow sound or a sign of a heart problem. Many babies born with ASDs have no signs or symptoms.
If a large ASD isn’t repaired, the extra blood flow to the right side of the heart can eventually damage the heart and lungs, causing heart failure. This doesn’t occur until adulthood. Signs and symptoms of heart failure can include:
Fatigue or tiring easily during exercise or activity
Shortness of breath
A buildup of blood and fluid in the lungs
A buildup of fluid in the feet, ankles, and legs
Ventricular Septal Defect
A heart murmur is usually present in ventricular septal defect (VSD) and may be the first and only sign of this defect. The heart murmur is often present right after birth in many infants, but it may not be heard until the baby is 6 to 8 weeks old.
Most newborns who have VSDs don’t have heart-related symptoms. However, a baby with a medium or large VSD can develop heart failure. Signs and symptoms of heart failure usually appear during the baby’s first 2 months of life. The signs and symptoms of heart failure from VSD are similar to those listed above for ASD, but they occur in infancy.
The major sign of heart failure is difficulty feeding and poor growth. VSD symptoms are rare after infancy because the defect either decreases in size on its own or is repaired.
How Are Holes in the Heart Diagnosed?
Holes in the heart are usually diagnosed based on results from a physical exam and special tests. The exam findings for an atrial septal defect (ASD) often aren't obvious, so the diagnosis is sometimes not made until later childhood or even adulthood. A ventricular septal defect (VSD) has a very distinct heart murmur, so this diagnosis is usually made in infancy.
Specialists Involved
Doctors who specialize in heart problems are called cardiologists. Pediatric cardiologists take care of babies and children who have heart problems. Other specialists who treat heart defects include cardiac surgeons (doctors who repair heart defects using surgery).
Physical Exam
During a physical exam, the doctor:
Listens to your child's heart and lungs with a stethoscope
Looks for signs of a heart defect, such as a heart murmur or signs of heart failure
Diagnostic Tests and Procedures
The doctor will order several tests to diagnose an ASD or VSD. These tests also will help the doctor determine the location and size of the defect.
Echocardiography
This test, which is harmless and painless, uses sound waves to create a moving picture of the heart. During echocardiography, ultrasound waves bounce off the structures of the heart, and then a computer converts them into pictures on a video screen. The test allows the doctor to clearly see any problem with the way the heart is formed or the way it's working.
Echocardiography is an important test for diagnosing a hole in the heart and for following the problem over time. This test shows problems with the heart's structure and how the heart is reacting to these problems. Echocardiography helps the cardiologist decide whether and when treatment is needed.
EKG
An EKG (electrocardiogram) detects and records the electrical activity of the heart. This simple and painless test is used to assess the heart rhythm. An EKG shows how fast the heart is beating and whether the heart's rhythm is steady or irregular. It also can detect enlargement of one of the heart's chambers, which can help to diagnose a heart defect.
Chest X Ray
A chest x ray takes a picture of the heart and lungs. It can show whether the heart is enlarged or whether the lungs have extra blood flow or extra fluid, which can be a sign of heart failure.
Pulse Oximetry
Pulse oximetry shows how much oxygen is in the blood. A sensor is placed on the fingertip or toe (like an adhesive bandage). The sensor is attached to a small computer unit, which displays a number that indicates how much oxygen is in the blood.
Cardiac Catheterization
During cardiac catheterization (KATH-e-ter-i-ZA-shun), a thin, flexible tube called a catheter is put into a vein in the arm, groin (upper thigh), or neck and threaded to the heart. A dye that can be seen on an x ray is injected through the catheter into a blood vessel or a chamber of the heart. This allows the doctor to see the flow of blood through the heart and blood vessels on the x-ray image.
Cardiac catheterization also can be used to measure the pressure inside the heart chambers and blood vessels and can determine whether blood is mixing between the two sides of the heart. It's also used to repair some heart defects.
How Are Holes in the Heart Treated?
Although many holes in the heart don't need treatment, some do. These days, most holes in the heart that need treatment are repaired in infancy or early childhood. Sometimes, adults are treated for holes in the heart if problems develop.
The treatment your child receives depends on the type, location, and size of the hole. Other factors include your child's age, size, and general health.
Treating Atrial Septal Defect
Periodic checkups are done to see whether the defect closes on its own. About half of all ASDs close on their own over time, and about 20 percent close within the first year of life. Your child's doctor will recommend how often your child should be checked. For an ASD, frequent checkups aren't needed. When treatment of an ASD is required, it involves catheter or surgical procedures to close the hole.
Catheter or Surgical Procedures To Repair ASD
Doctors often decide to close an ASD in children who still have medium to large holes by the time they are 2 to 5 years old.
Catheter procedure. Until the early 1990s, surgery was the usual method for closing all ASDs. Now, thanks to medical advances, catheter procedures can be used to close secundum ASDs, which are the most common type of ASD. This procedure is done under general anesthesia, so the child sleeps throughout and doesn't feel any pain.
During the procedure, the doctor inserts a catheter (a thin, flexible tube) into a vein in the groin (upper thigh) and threads it to the heart's septum. The catheter has a tiny umbrella-like device folded up inside it. When the catheter reaches the septum, the device is pushed out of the catheter and positioned so that it plugs the hole between the atria. The device is secured in place and the catheter is withdrawn from the body. Within 6 months, normal tissue grows in and over the device. There is no need to replace the closure device as the child grows.
Doctors often use echocardiography or a transesophageal (trans-e-SOF-ah-ge-al) echocardiography (TEE) as well as angiography to guide them in threading the catheter to the heart and closing the defect. A TEE is a special type of echocardiography that takes pictures of the heart through the esophagus (the tube leading from the mouth to the stomach).
Catheter procedures are much easier than surgery on patients because they involve only a needle puncture in the skin where the catheter is inserted. This means that recovery is faster and easier. The outlook for children having this procedure is excellent. Closures are successful in more than 9 out of 10 patients, with no significant leakage. Rarely, a defect is too large for catheter closure, so surgery is needed.
Surgery. Open-heart surgery is generally done to repair primum or sinus venosus ASDs. General anesthesia is used so the child will sleep through the operation and not feel any pain.
During this procedure, the surgeon makes an incision in the chest to reach the ASD and repairs the defect with a special patch that covers the hole. The child is placed on a heart-lung bypass machine so that the heart can be opened to perform the operation.
The outlook for children after ASD surgery is excellent. On average, children spend 3 to 4 days in the hospital before going home. Complications, such as bleeding and infection, from ASD surgery are very rare. Some children may develop inflammation of the outer lining of the heart, causing fluid to collect around the heart in the weeks after surgery. This is a reaction to the heart operation and usually resolves with medicine.
While in the hospital, the child is given medicines as needed to reduce pain or anxiety. The doctors and nurses at the hospital teach parents how to care for the child at home. They will talk about preventing blows to the chest as the incision heals, limiting activity while the child recovers, bathing, scheduling followup appointments with the doctor, and determining when the child can resume regular activities.
Treating Ventricular Septal Defect
The doctor may choose to monitor and observe a child with VSD who doesn't have symptoms of heart failure. This means regular checkups and tests to see whether the defect closes on it own or gets smaller. More than half of VSDs eventually close, usually by the time a child is in preschool. Your child's doctor will recommend how often your child should be checked, ranging from monthly checkups to checkups every 1 or 2 years.
When treatment for VSD is required, options include extra nutrition and surgery to close the VSD.
Surgical treatment is needed if a child's VSD:
Is large
Is causing your child to have symptoms
Is medium-sized and is causing enlargement of the heart chambers
Affects the aortic valve
Extra Nutrition
Some infants with VSDs don't grow and develop or gain weight as they should. These infants usually:
Have large VSDs
Are born prematurely
Tire easily during feeding
Doctors usually recommend extra nutrition or special feedings for these infants. These feedings are high-calorie formulas or breast milk supplements that give the baby extra nourishment.
In some cases, tube feeding is needed. Food is given through a small tube that is placed through the nose into the stomach. Tube feeding can add to or take the place of bottle feeding. This treatment is usually temporary, because a VSD that causes symptoms will likely need surgery.
Surgery To Repair VSDs
Today, most doctors recommend surgery to close a large VSD that's causing symptoms or hasn't closed by 1 year of age. Surgery may be required earlier if:
The child fails to gain weight
Medicines are required to control the symptoms of heart failure
Rarely, a medium-sized VSD that's causing enlargement of the heart chambers is treated with surgery after infancy. However, most VSDs that need surgery are repaired in the first year of life.
Living With Holes in the Heart
The outlook for children with atrial septal defects (ASDs) and ventricular septal defects (VSDs) is excellent. Advances in treatment mean that most children with these heart defects have normal, active, and productive lives with no decrease in lifespan.
Many children with these defects need no special care or only occasional checkups with a cardiologist (a doctor who specializes in heart problems) as they go through childhood and adult life.
Living With an Atrial Septal Defect
Small ASDs often close on their own, and children with these heart defects don't have any problems or need treatment. Children and adults with small ASDs that don't close and don't cause symptoms are healthy and don't need treatment.
Many others with ASDs that don't close undergo procedures to close the hole and prevent possible long-term complications. Children recover well from these procedures and lead normal, healthy lives. Adults also do well after closure procedures.
Medical Needs
Arrhythmias. The risk of arrhythmias (irregular heartbeats) increases before and after surgery. Adults with ASDs who are older than 40 years are especially likely to have arrhythmias. People who had arrhythmias before surgery are more likely to have them after surgery.
Followup care. Regular followup care into adult life is advised for those who have had:
An ASD repaired as an adult
Arrhythmias before and after surgery
An ASD repaired with a catheter procedure
High blood pressure in the pulmonary artery at the time of surgery
Antibiotics. Some heart defects and their repairs can increase the risk of bacterial endocarditis, a serious infection of the heart valves or lining of the heart. You may need antibiotics before medical or dental procedures (such as surgery or dental cleanings) that could allow bacteria to enter your bloodstream. Talk to your doctor about whether you need to take antibiotics before such procedures. ASDs aren't associated with the risk of endocarditis, except in the 6 months after repair (for both catheter procedures and surgery).
Special Considerations for Children and Teens
Activity. Children with a repaired or closed ASD have no restrictions on their activity.
Growth and development. Children with ASDs don't have growth or development problems.
Regular health care. Your child should see his or her regular doctor for routine health care.
Additional surgery or procedures. When a child has an ASD, but no other heart defect, additional surgery isn't needed.
Special Considerations for Adults
Recovery from surgical repair of an ASD. When an ASD is repaired in adult life, the cardiologist or surgeon will explain what to expect during the recovery period and when to return to driving, working, exercising, and other activities.
Living With a Ventricular Septal Defect
Children with small VSDs have no symptoms and need only rare followup with a cardiologist. To protect these children from endocarditis, they may need antibiotics before medical or dental procedures (such as surgery or dental cleanings) that could allow bacteria to enter the bloodstream. Talk to your child's doctor about whether your child needs to take antibiotics before such procedures.
Children and adults who have had successful repair of a VSD and have no other congenital heart defects can expect to lead normal, healthy, and active lives.
Medical Needs
Sometimes problems and risks remain after surgical closure. They include:
Arrhythmias (irregular heartbeats). Serious and frequent arrhythmias require regular medical followup. The risk of arrhythmia is greater if surgery is done later in life.
Residual or remaining VSD. This is usually due to a leak at the edge of the patch used to close the hole. These VSDs tend to be very small and don't cause problems. They very rarely require another operation.
Antibiotics. People who have VSDs are at increased risk for bacterial endocarditis. Antibiotic treatment to prevent bacterial endocarditis may be recommended after VSD surgery. Residual VSDs or small VSDs that don't need surgery may require treatment with antibiotics before medical or dental procedures (such as surgery or dental cleanings) that could allow bacteria to enter the bloodstream. Talk to your doctor about whether you need to take antibiotics before such procedures.
Special Considerations for Children and Teens
Activity. There should be no activity restrictions on a child with a small VSD that doesn't need surgery, or after recovery from VSD repair. Be sure to check with your child's doctor about whether your child can take part in sports.
Growth and development. Your pediatrician or family doctor checks your child for growth and development at each routine checkup. Babies with large VSDs may not grow as quickly as other infants. These babies usually catch up after the VSD is closed.
Regular health care. Your child should see his or her regular doctor for routine health care.
Additional surgery or procedures. Teens and young adults rarely need additional surgery once a VSD closes or is repaired.
Angina
What Is Angina?
Angina (an-JI-nuh or AN-juh-nuh) is chest pain or discomfort that occurs when an area of your heart muscle doesn't get enough oxygen-rich blood. Angina may feel like pressure or squeezing in your chest. The pain also may occur in your shoulders, arms, neck, jaw, or back. It can feel like indigestion.
Angina itself isn't a disease. Rather, it's a symptom of an underlying heart problem. Angina is usually a symptom of coronary artery disease (CAD), the most common type of heart disease.
CAD occurs when a fatty material called plaque (plak) builds up on the inner walls of the coronary arteries. These arteries carry oxygen-rich blood to your heart. When plaque builds up in the arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis).
Plaque causes the coronary arteries to become narrow and stiff. The flow of oxygen-rich blood to the heart muscle is reduced. This causes pain and can lead to a heart attack.
Types of Angina
The three types of angina are stable, unstable, and variant (Prinzmetal's). Knowing how the types are different is important. This is because they have different symptoms and require different treatment.
Stable Angina
Stable angina is the most common type. It occurs when the heart is working harder than usual. Stable angina has a regular pattern. If you know you have stable angina, you can learn to recognize the pattern and predict when the pain will occur.
The pain usually goes away in a few minutes after you rest or take your angina medicine.
Stable angina isn't a heart attack, but it makes a heart attack more likely in the future.
Unstable Angina
Unstable angina doesn't follow a pattern. It can occur with or without physical exertion and isn't relieved by rest or medicine.
Unstable angina is very dangerous and needs emergency treatment. It's a sign that a heart attack may happen soon.
Variant (Prinzmetal's) Angina
Variant angina is rare. It usually occurs while you're at rest. The pain can be severe. It usually happens between midnight and early morning. This type of angina is relieved by medicine.
Overview
It's thought that nearly 7 million people in the United States suffer from angina. About 400,000 patients go to their doctors with new cases of angina every year.
Angina occurs equally in men and women. It can be a sign of heart disease, even when initial tests don't show evidence of CAD.
Not all chest pain or discomfort is angina. A heart attack, lung problems (such as an infection or a blood clot), heartburn, or a panic attack also can cause chest pain or discomfort. All chest pain should be checked by a doctor.
Other Names for Angina
Angina pectoris
Acute coronary syndrome
Chest pain
Coronary artery spasms
Prinzmetal's angina
Stable or common angina
Unstable angina
Variant angina
What Causes Angina?
Underlying Causes
Angina is a symptom of an underlying heart condition. Angina pain is the result of reduced blood flow to an area of heart muscle. Coronary artery disease (CAD) usually causes the reduced blood flow.
This means that the underlying causes of angina are generally the same as the underlying causes of CAD.
Research suggests that damage to the inner layers of the coronary arteries causes CAD. Smoking, high levels of fat and cholesterol in the blood, high blood pressure, and a high level of sugar in the blood (due to insulin resistance or diabetes) can damage the coronary arteries.
When damage occurs, your body starts a healing process. Excess fatty tissues release compounds that promote this process. This healing causes plaque to build up where the arteries are damaged. Plaque narrows or blocks the arteries, reducing blood flow to the heart muscle.
Some plaque is hard and stable and leads to narrowed and hardened arteries. Other plaque is soft and is more likely to break open and cause blood clots.
The buildup of plaque on the arteries' inner walls can cause angina in two ways. It can:
Narrow the arteries and greatly reduce blood flow to the heart
Form blood clots that partially or totally block the arteries
Immediate Causes
There are different triggers for angina pain, depending on the type of angina you have.
Stable Angina
Physical exertion is the most common trigger of stable angina. Severely narrowed arteries may allow enough blood to reach the heart when the demand for oxygen is low (such as when you're sitting). But with exertion, like walking up a hill or climbing stairs, the heart works harder and needs more oxygen.
Other triggers of stable angina include:
Emotional stress
Exposure to very hot or cold temperatures
Heavy meals
Smoking
Unstable Angina
Blood clots that partially or totally block an artery cause unstable angina. If plaque in an artery ruptures or breaks open, blood clots may form. This creates a larger blockage. A clot may grow large enough to completely block the artery and cause a heart attack. For more information, see the animation in "What Causes a Heart Attack?"
Blood clots may form, partly dissolve, and later form again. Angina can occur each time a clot blocks an artery.
Variant Angina
A spasm in a coronary artery causes variant angina. The spasm causes the walls of the artery to tighten and narrow. Blood flow to the heart slows or stops. Variant angina may occur in people with or without CAD.
Other causes of spasms in the coronary arteries are:
Exposure to cold
Emotional stress
Medicines that tighten or narrow blood vessels
Smoking
Cocaine use
Who Is At Risk for Angina?
Angina is a symptom of an underlying heart condition, usually coronary artery disease (CAD). So if you're at risk for CAD, you're also at risk for angina.
Risk factors for CAD include:
Unhealthy cholesterol levels.
High blood pressure.
Cigarette smoking.
Insulin resistance or diabetes.
Overweight or obesity.
Metabolic syndrome.
Lack of physical activity.
Age. (The risk increases for men after 45 years of age and for women after 55 years of age.)
Family history of early heart disease.
You can read more about CAD risk factors in "Who Is At Risk for Coronary Artery Disease?"
Populations Affected
People sometimes think that because men have more heart attacks than women, men also suffer from angina more often. In fact, angina occurs equally among women and men. It can be a sign of heart disease, even when initial tests don't show evidence of CAD.
Unstable angina occurs more often in older adults.
Variant angina is rare. It accounts for only about 2 out of 100 cases of angina. People who have variant angina are often younger than those who have other forms of angina.
What Are the Signs and Symptoms of Angina?
Pain and discomfort are the main symptoms of angina. Angina is often described as pressure, squeezing, burning, or tightness in the chest. It usually starts in the chest behind the breastbone.
Pain from angina also can occur in the arms, shoulders, neck, jaw, throat, or back. It may feel like indigestion.
Some people say that angina discomfort is hard to describe or that they can't tell exactly where the pain is coming from.
Symptoms such as nausea (feeling sick to your stomach), fatigue (tiredness), shortness of breath, sweating, light-headedness, or weakness also may occur. Women are more likely to feel discomfort in their back, shoulders, and abdomen.
Symptoms vary based on the type of angina.
Stable Angina
The pain or discomfort:
Occurs when the heart must work harder, usually during physical exertion
Doesn't come as a surprise, and episodes of pain tend to be alike
Usually lasts a short time (5 minutes or less)
Is relieved by rest or medicine
May feel like gas or indigestion
May feel like chest pain that spreads to the arms, back, or other areas
Unstable Angina
The pain or discomfort:
Often occurs at rest, while sleeping at night, or with little physical exertion
Comes as a surprise
Is more severe and lasts longer (as long as 30 minutes) than episodes of stable angina
Is usually not relieved with rest or medicine
May get continually worse
May mean that a heart attack will happen soon
Variant Angina
The pain or discomfort:
Usually occurs at rest and during the night or early morning hours
Tends to be severe
Is relieved by medicine
Lasting Chest Pain
Chest pain that lasts longer than a few minutes and isn't relieved by rest or angina medicine may mean you're having (or are about to have) a heart attack
How Is Angina Diagnosed?
The most important issues to address when you go to the doctor with chest pain are:
What's causing the chest pain
Whether you're having or are about to have a heart attack
Angina is a symptom of an underlying heart problem, usually coronary artery disease (CAD). The type of angina pain you have can be a sign of how severe the CAD is and whether it's likely to cause a heart attack.
If you have chest pain, your doctor will want to find out whether it's angina. He or she also will want to know whether the angina is stable or unstable. If it's unstable, you may need emergency medical attention to try to prevent a heart attack.
To diagnose chest pain as stable or unstable angina, your doctor will do a physical exam, ask about your symptoms, and ask about your risk factors and your family history of CAD or other heart disease.
He or she may also ask questions about your symptoms, such as:
What brings on the pain or discomfort and what relieves it?
What does the pain or discomfort feel like (for example, heaviness or tightness)?
How often does the pain occur?
Where do you feel the pain or discomfort?
How severe is the pain or discomfort?
How long does the pain or discomfort last?
Diagnostic Tests and Procedures
If your doctor suspects that you have unstable angina or that your angina is related to a serious heart condition, he or she may order one or more tests.
EKG (Electrocardiogram)
An EKG is a simple test that detects and records the electrical activity of your heart. An EKG shows how fast your heart is beating and whether it has a regular rhythm. It also shows the strength and timing of electrical signals as they pass through each part of your heart.
Certain electrical patterns that the EKG detects can suggest whether CAD is likely. An EKG also can show signs of a previous or current heart attack.
However, some people with angina have a normal EKG.
Stress Testing
During stress testing, you exercise to make your heart work hard and beat fast while heart tests are performed. If you can't exercise, you're given medicine to speed up your heart rate.
During exercise stress testing, your blood pressure and EKG readings are checked while you walk or run on a treadmill or pedal a bicycle. Other heart tests, such as nuclear heart scanning or echocardiography, also can be done at the same time.
If you're unable to exercise, a medicine can be injected into your bloodstream to make your heart work hard and beat fast. Nuclear heart scanning or echocardiography is then usually done.
When your heart is beating fast and working hard, it needs more blood and oxygen. Arteries narrowed by plaque can't supply enough oxygen-rich blood to meet your heart's needs.
A stress test can show possible signs of CAD, such as:
Abnormal changes in your heart rate or blood pressure
Symptoms such as shortness of breath or chest pain
Abnormal changes in your heart rhythm or your heart's electrical activity
Chest X Ray
A chest x ray takes a picture of the organs and structures inside the chest, including your heart, lungs, and blood vessels. A chest x ray can reveal signs of heart failure, as well as lung disorders and other causes of symptoms that aren't due to CAD.
Coronary Angiography and Cardiac Catheterization
Your doctor may ask you to have coronary angiography (an-jee-OG-ra-fee) if other tests or factors show that you're likely to have CAD. This test uses dye and special x rays to show the insides of your coronary arteries.
To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization (KATH-e-ter-i-ZA-shun). A long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is then threaded into your coronary arteries, and the dye is released into your bloodstream. Special x rays are taken while the dye is flowing through the coronary arteries.
Cardiac catheterization is usually done in a hospital. You're awake during the procedure. It usually causes little to no pain, although you may feel some soreness in the blood vessel where your doctor put the catheter.
Blood Tests
Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels may show that you have risk factors for CAD.
Your doctor may order a blood test to check the level of C-reactive protein (CRP) in your blood. Some studies suggest that high levels of CRP in the blood may increase the risk for CAD and heart attack.
Your doctor also may order a blood test to check for low hemoglobin (HEE-muh-glow-bin) in your blood. Hemoglobin is an iron-rich protein in the red blood cells that carries oxygen from the lungs to all parts of your body. If you have low hemoglobin, you may have a condition called anemia (uh-NEE-me-eh).
How Is Angina Treated?
Treatments for angina include lifestyle changes, medicines, medical procedures, and cardiac rehabilitation (rehab). The main goals of treatment are to:
Reduce pain and discomfort and how often it occurs
Prevent or lower the risk of heart attack and death by treating the underlying heart condition
Lifestyle changes and medicines may be the only treatments needed if your symptoms are mild and aren't getting worse. When lifestyle changes and medicines don't control angina, you may need medical procedures or cardiac rehab.
Unstable angina is an emergency condition that requires treatment in the hospital.
Lifestyle Changes
Making lifestyle changes can help prevent episodes of angina. You can:
Slow down or take rest breaks if angina comes on with exertion.
Avoid large meals and rich foods that leave you feeling stuffed if angina comes on after a heavy meal.
Try to avoid situations that make you upset or stressed if angina comes on with stress. Learn ways to handle stress that can't be avoided.
You also can make lifestyle changes that help lower your risk of heart disease. An important lifestyle change is adopting a healthy diet. This will help prevent or reduce high blood pressure, high blood cholesterol, and obesity.
Follow a heart healthy eating plan that focuses on fruits, vegetables, whole grains, low-fat or no-fat diary products, and lean meat and fish. The plan also should be low in salt, fat, saturated fat, trans fat, and cholesterol.
Examples of healthy eating plans are the National Heart, Lung, and Blood Institute's Therapeutic Lifestyle Changes (TLC) diet and the Dietary Approaches to Stop Hypertension (DASH) eating plan.
Your doctor may recommend TLC if you have high cholesterol or the DASH eating plan if you have high blood pressure. Even if you don't have these conditions, you can still benefit from these heart healthy plans.
Other important lifestyle changes include:
Quitting smoking, if you smoke. Avoid secondhand smoke.
Being physically active. Check with your doctor to find out how much and what kinds of activity are safe for you.
Losing weight, if you're overweight or obese.
Taking all medicines as your doctor prescribes, especially if you have diabetes.
Medicines
Nitrates are the most commonly used medicines to treat angina. They relax and widen blood vessels. This allows more blood to flow to the heart while reducing its workload.
Nitroglycerin is the most commonly used nitrate for angina. Nitroglycerin that dissolves under your tongue or between your cheeks and gum is used to relieve an angina episode. Nitroglycerin in the form of pills and skin patches is used to prevent attacks of angina. These forms of nitroglycerin act too slowly to relieve pain during an angina attack.
You also may need other medicines to treat angina. These medicines may include beta blockers, calcium channel blockers, ACE inhibitors, oral antiplatelet (an-ty-PLAYT-lit) medicines, and anticoagulants (AN-te-ko-AG-u-lants). These medicines can help:
Lower blood pressure and cholesterol levels
Slow the heart rate
Relax blood vessels
Reduce strain on the heart
Prevent blood clots from forming
Medical Procedures
When medicines and other treatments don't control angina, you may need a medical procedure to treat the underlying heart disease. Angioplasty (AN-jee-oh-plas-tee) and coronary artery bypass grafting (CABG) are both commonly used to treat angina.
Angioplasty opens blocked or narrowed coronary arteries. During angioplasty, a thin tube with a balloon or other device on the end is threaded through a blood vessel to the narrowed or blocked coronary artery. Once in place, the balloon is inflated to push the plaque outward against the wall of the artery. This widens the artery and restores blood flow.
Angioplasty can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. Sometimes a small mesh tube called a stent is placed in the artery to keep it open after the procedure.
During CABG, healthy arteries or veins taken from other areas in your body are used to bypass (that is, go around) your narrowed coronary arteries. Bypass surgery can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack.
Your doctor will help decide which treatment is right for you.
Cardiac Rehabilitation
Your doctor may prescribe cardiac rehab for angina or after angioplasty, CABG, or a heart attack.
The cardiac rehab team may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians, and psychologists or other behavioral therapists.
Rehab has two parts:
Exercise training. This part helps you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your individual abilities, needs, and interests.
Education, counseling, and training. This part of rehab helps you understand your heart condition and find ways to reduce your risk of future heart problems. The cardiac rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and to deal with your fears about the future.
Angina (an-JI-nuh or AN-juh-nuh) is chest pain or discomfort that occurs when an area of your heart muscle doesn't get enough oxygen-rich blood. Angina may feel like pressure or squeezing in your chest. The pain also may occur in your shoulders, arms, neck, jaw, or back. It can feel like indigestion.
Angina itself isn't a disease. Rather, it's a symptom of an underlying heart problem. Angina is usually a symptom of coronary artery disease (CAD), the most common type of heart disease.
CAD occurs when a fatty material called plaque (plak) builds up on the inner walls of the coronary arteries. These arteries carry oxygen-rich blood to your heart. When plaque builds up in the arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis).
Plaque causes the coronary arteries to become narrow and stiff. The flow of oxygen-rich blood to the heart muscle is reduced. This causes pain and can lead to a heart attack.
Types of Angina
The three types of angina are stable, unstable, and variant (Prinzmetal's). Knowing how the types are different is important. This is because they have different symptoms and require different treatment.
Stable Angina
Stable angina is the most common type. It occurs when the heart is working harder than usual. Stable angina has a regular pattern. If you know you have stable angina, you can learn to recognize the pattern and predict when the pain will occur.
The pain usually goes away in a few minutes after you rest or take your angina medicine.
Stable angina isn't a heart attack, but it makes a heart attack more likely in the future.
Unstable Angina
Unstable angina doesn't follow a pattern. It can occur with or without physical exertion and isn't relieved by rest or medicine.
Unstable angina is very dangerous and needs emergency treatment. It's a sign that a heart attack may happen soon.
Variant (Prinzmetal's) Angina
Variant angina is rare. It usually occurs while you're at rest. The pain can be severe. It usually happens between midnight and early morning. This type of angina is relieved by medicine.
Overview
It's thought that nearly 7 million people in the United States suffer from angina. About 400,000 patients go to their doctors with new cases of angina every year.
Angina occurs equally in men and women. It can be a sign of heart disease, even when initial tests don't show evidence of CAD.
Not all chest pain or discomfort is angina. A heart attack, lung problems (such as an infection or a blood clot), heartburn, or a panic attack also can cause chest pain or discomfort. All chest pain should be checked by a doctor.
Other Names for Angina
Angina pectoris
Acute coronary syndrome
Chest pain
Coronary artery spasms
Prinzmetal's angina
Stable or common angina
Unstable angina
Variant angina
What Causes Angina?
Underlying Causes
Angina is a symptom of an underlying heart condition. Angina pain is the result of reduced blood flow to an area of heart muscle. Coronary artery disease (CAD) usually causes the reduced blood flow.
This means that the underlying causes of angina are generally the same as the underlying causes of CAD.
Research suggests that damage to the inner layers of the coronary arteries causes CAD. Smoking, high levels of fat and cholesterol in the blood, high blood pressure, and a high level of sugar in the blood (due to insulin resistance or diabetes) can damage the coronary arteries.
When damage occurs, your body starts a healing process. Excess fatty tissues release compounds that promote this process. This healing causes plaque to build up where the arteries are damaged. Plaque narrows or blocks the arteries, reducing blood flow to the heart muscle.
Some plaque is hard and stable and leads to narrowed and hardened arteries. Other plaque is soft and is more likely to break open and cause blood clots.
The buildup of plaque on the arteries' inner walls can cause angina in two ways. It can:
Narrow the arteries and greatly reduce blood flow to the heart
Form blood clots that partially or totally block the arteries
Immediate Causes
There are different triggers for angina pain, depending on the type of angina you have.
Stable Angina
Physical exertion is the most common trigger of stable angina. Severely narrowed arteries may allow enough blood to reach the heart when the demand for oxygen is low (such as when you're sitting). But with exertion, like walking up a hill or climbing stairs, the heart works harder and needs more oxygen.
Other triggers of stable angina include:
Emotional stress
Exposure to very hot or cold temperatures
Heavy meals
Smoking
Unstable Angina
Blood clots that partially or totally block an artery cause unstable angina. If plaque in an artery ruptures or breaks open, blood clots may form. This creates a larger blockage. A clot may grow large enough to completely block the artery and cause a heart attack. For more information, see the animation in "What Causes a Heart Attack?"
Blood clots may form, partly dissolve, and later form again. Angina can occur each time a clot blocks an artery.
Variant Angina
A spasm in a coronary artery causes variant angina. The spasm causes the walls of the artery to tighten and narrow. Blood flow to the heart slows or stops. Variant angina may occur in people with or without CAD.
Other causes of spasms in the coronary arteries are:
Exposure to cold
Emotional stress
Medicines that tighten or narrow blood vessels
Smoking
Cocaine use
Who Is At Risk for Angina?
Angina is a symptom of an underlying heart condition, usually coronary artery disease (CAD). So if you're at risk for CAD, you're also at risk for angina.
Risk factors for CAD include:
Unhealthy cholesterol levels.
High blood pressure.
Cigarette smoking.
Insulin resistance or diabetes.
Overweight or obesity.
Metabolic syndrome.
Lack of physical activity.
Age. (The risk increases for men after 45 years of age and for women after 55 years of age.)
Family history of early heart disease.
You can read more about CAD risk factors in "Who Is At Risk for Coronary Artery Disease?"
Populations Affected
People sometimes think that because men have more heart attacks than women, men also suffer from angina more often. In fact, angina occurs equally among women and men. It can be a sign of heart disease, even when initial tests don't show evidence of CAD.
Unstable angina occurs more often in older adults.
Variant angina is rare. It accounts for only about 2 out of 100 cases of angina. People who have variant angina are often younger than those who have other forms of angina.
What Are the Signs and Symptoms of Angina?
Pain and discomfort are the main symptoms of angina. Angina is often described as pressure, squeezing, burning, or tightness in the chest. It usually starts in the chest behind the breastbone.
Pain from angina also can occur in the arms, shoulders, neck, jaw, throat, or back. It may feel like indigestion.
Some people say that angina discomfort is hard to describe or that they can't tell exactly where the pain is coming from.
Symptoms such as nausea (feeling sick to your stomach), fatigue (tiredness), shortness of breath, sweating, light-headedness, or weakness also may occur. Women are more likely to feel discomfort in their back, shoulders, and abdomen.
Symptoms vary based on the type of angina.
Stable Angina
The pain or discomfort:
Occurs when the heart must work harder, usually during physical exertion
Doesn't come as a surprise, and episodes of pain tend to be alike
Usually lasts a short time (5 minutes or less)
Is relieved by rest or medicine
May feel like gas or indigestion
May feel like chest pain that spreads to the arms, back, or other areas
Unstable Angina
The pain or discomfort:
Often occurs at rest, while sleeping at night, or with little physical exertion
Comes as a surprise
Is more severe and lasts longer (as long as 30 minutes) than episodes of stable angina
Is usually not relieved with rest or medicine
May get continually worse
May mean that a heart attack will happen soon
Variant Angina
The pain or discomfort:
Usually occurs at rest and during the night or early morning hours
Tends to be severe
Is relieved by medicine
Lasting Chest Pain
Chest pain that lasts longer than a few minutes and isn't relieved by rest or angina medicine may mean you're having (or are about to have) a heart attack
How Is Angina Diagnosed?
The most important issues to address when you go to the doctor with chest pain are:
What's causing the chest pain
Whether you're having or are about to have a heart attack
Angina is a symptom of an underlying heart problem, usually coronary artery disease (CAD). The type of angina pain you have can be a sign of how severe the CAD is and whether it's likely to cause a heart attack.
If you have chest pain, your doctor will want to find out whether it's angina. He or she also will want to know whether the angina is stable or unstable. If it's unstable, you may need emergency medical attention to try to prevent a heart attack.
To diagnose chest pain as stable or unstable angina, your doctor will do a physical exam, ask about your symptoms, and ask about your risk factors and your family history of CAD or other heart disease.
He or she may also ask questions about your symptoms, such as:
What brings on the pain or discomfort and what relieves it?
What does the pain or discomfort feel like (for example, heaviness or tightness)?
How often does the pain occur?
Where do you feel the pain or discomfort?
How severe is the pain or discomfort?
How long does the pain or discomfort last?
Diagnostic Tests and Procedures
If your doctor suspects that you have unstable angina or that your angina is related to a serious heart condition, he or she may order one or more tests.
EKG (Electrocardiogram)
An EKG is a simple test that detects and records the electrical activity of your heart. An EKG shows how fast your heart is beating and whether it has a regular rhythm. It also shows the strength and timing of electrical signals as they pass through each part of your heart.
Certain electrical patterns that the EKG detects can suggest whether CAD is likely. An EKG also can show signs of a previous or current heart attack.
However, some people with angina have a normal EKG.
Stress Testing
During stress testing, you exercise to make your heart work hard and beat fast while heart tests are performed. If you can't exercise, you're given medicine to speed up your heart rate.
During exercise stress testing, your blood pressure and EKG readings are checked while you walk or run on a treadmill or pedal a bicycle. Other heart tests, such as nuclear heart scanning or echocardiography, also can be done at the same time.
If you're unable to exercise, a medicine can be injected into your bloodstream to make your heart work hard and beat fast. Nuclear heart scanning or echocardiography is then usually done.
When your heart is beating fast and working hard, it needs more blood and oxygen. Arteries narrowed by plaque can't supply enough oxygen-rich blood to meet your heart's needs.
A stress test can show possible signs of CAD, such as:
Abnormal changes in your heart rate or blood pressure
Symptoms such as shortness of breath or chest pain
Abnormal changes in your heart rhythm or your heart's electrical activity
Chest X Ray
A chest x ray takes a picture of the organs and structures inside the chest, including your heart, lungs, and blood vessels. A chest x ray can reveal signs of heart failure, as well as lung disorders and other causes of symptoms that aren't due to CAD.
Coronary Angiography and Cardiac Catheterization
Your doctor may ask you to have coronary angiography (an-jee-OG-ra-fee) if other tests or factors show that you're likely to have CAD. This test uses dye and special x rays to show the insides of your coronary arteries.
To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization (KATH-e-ter-i-ZA-shun). A long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is then threaded into your coronary arteries, and the dye is released into your bloodstream. Special x rays are taken while the dye is flowing through the coronary arteries.
Cardiac catheterization is usually done in a hospital. You're awake during the procedure. It usually causes little to no pain, although you may feel some soreness in the blood vessel where your doctor put the catheter.
Blood Tests
Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels may show that you have risk factors for CAD.
Your doctor may order a blood test to check the level of C-reactive protein (CRP) in your blood. Some studies suggest that high levels of CRP in the blood may increase the risk for CAD and heart attack.
Your doctor also may order a blood test to check for low hemoglobin (HEE-muh-glow-bin) in your blood. Hemoglobin is an iron-rich protein in the red blood cells that carries oxygen from the lungs to all parts of your body. If you have low hemoglobin, you may have a condition called anemia (uh-NEE-me-eh).
How Is Angina Treated?
Treatments for angina include lifestyle changes, medicines, medical procedures, and cardiac rehabilitation (rehab). The main goals of treatment are to:
Reduce pain and discomfort and how often it occurs
Prevent or lower the risk of heart attack and death by treating the underlying heart condition
Lifestyle changes and medicines may be the only treatments needed if your symptoms are mild and aren't getting worse. When lifestyle changes and medicines don't control angina, you may need medical procedures or cardiac rehab.
Unstable angina is an emergency condition that requires treatment in the hospital.
Lifestyle Changes
Making lifestyle changes can help prevent episodes of angina. You can:
Slow down or take rest breaks if angina comes on with exertion.
Avoid large meals and rich foods that leave you feeling stuffed if angina comes on after a heavy meal.
Try to avoid situations that make you upset or stressed if angina comes on with stress. Learn ways to handle stress that can't be avoided.
You also can make lifestyle changes that help lower your risk of heart disease. An important lifestyle change is adopting a healthy diet. This will help prevent or reduce high blood pressure, high blood cholesterol, and obesity.
Follow a heart healthy eating plan that focuses on fruits, vegetables, whole grains, low-fat or no-fat diary products, and lean meat and fish. The plan also should be low in salt, fat, saturated fat, trans fat, and cholesterol.
Examples of healthy eating plans are the National Heart, Lung, and Blood Institute's Therapeutic Lifestyle Changes (TLC) diet and the Dietary Approaches to Stop Hypertension (DASH) eating plan.
Your doctor may recommend TLC if you have high cholesterol or the DASH eating plan if you have high blood pressure. Even if you don't have these conditions, you can still benefit from these heart healthy plans.
Other important lifestyle changes include:
Quitting smoking, if you smoke. Avoid secondhand smoke.
Being physically active. Check with your doctor to find out how much and what kinds of activity are safe for you.
Losing weight, if you're overweight or obese.
Taking all medicines as your doctor prescribes, especially if you have diabetes.
Medicines
Nitrates are the most commonly used medicines to treat angina. They relax and widen blood vessels. This allows more blood to flow to the heart while reducing its workload.
Nitroglycerin is the most commonly used nitrate for angina. Nitroglycerin that dissolves under your tongue or between your cheeks and gum is used to relieve an angina episode. Nitroglycerin in the form of pills and skin patches is used to prevent attacks of angina. These forms of nitroglycerin act too slowly to relieve pain during an angina attack.
You also may need other medicines to treat angina. These medicines may include beta blockers, calcium channel blockers, ACE inhibitors, oral antiplatelet (an-ty-PLAYT-lit) medicines, and anticoagulants (AN-te-ko-AG-u-lants). These medicines can help:
Lower blood pressure and cholesterol levels
Slow the heart rate
Relax blood vessels
Reduce strain on the heart
Prevent blood clots from forming
Medical Procedures
When medicines and other treatments don't control angina, you may need a medical procedure to treat the underlying heart disease. Angioplasty (AN-jee-oh-plas-tee) and coronary artery bypass grafting (CABG) are both commonly used to treat angina.
Angioplasty opens blocked or narrowed coronary arteries. During angioplasty, a thin tube with a balloon or other device on the end is threaded through a blood vessel to the narrowed or blocked coronary artery. Once in place, the balloon is inflated to push the plaque outward against the wall of the artery. This widens the artery and restores blood flow.
Angioplasty can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. Sometimes a small mesh tube called a stent is placed in the artery to keep it open after the procedure.
During CABG, healthy arteries or veins taken from other areas in your body are used to bypass (that is, go around) your narrowed coronary arteries. Bypass surgery can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack.
Your doctor will help decide which treatment is right for you.
Cardiac Rehabilitation
Your doctor may prescribe cardiac rehab for angina or after angioplasty, CABG, or a heart attack.
The cardiac rehab team may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians, and psychologists or other behavioral therapists.
Rehab has two parts:
Exercise training. This part helps you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your individual abilities, needs, and interests.
Education, counseling, and training. This part of rehab helps you understand your heart condition and find ways to reduce your risk of future heart problems. The cardiac rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and to deal with your fears about the future.
Aneurysm
What Is an Aneurysm?
An aneurysm (AN-u-rism) is an abnormal bulge or “ballooning” in the wall of an artery. Arteries are blood vessels that carry oxygen-rich blood from the heart to other parts of the body. An aneurysm that grows and becomes large enough can burst, causing dangerous, often fatal, bleeding inside the body.
Most aneurysms occur in the aorta. The aorta is the main artery that carries blood from the heart to the rest of the body. The aorta comes out from the left ventricle (VEN-trih-kul) of the heart and travels through the chest and abdomen. An aneurysm that occurs in the aorta in the chest is called a thoracic (tho-RAS-ik) aortic aneurysm. An aneurysm that occurs in the aorta in the abdomen is called an abdominal aortic aneurysm.
Aneurysms also can occur in arteries in the brain, heart, intestine, neck, spleen, back of the knees and thighs, and in other parts of the body. If an aneurysm in the brain bursts, it causes a stroke.
About 15,000 Americans die each year from ruptured aortic aneurysms. Ruptured aortic aneurysm is the 10th leading cause of death in men over age 50 in the United States.
Many cases of ruptured aneurysm can be prevented with early diagnosis and medical treatment. Because aneurysms can develop and become large before causing any symptoms, it is important to look for them in people who are at the highest risk. Experts recommend that men who are 65 to 75 years old and have ever smoked (at least 100 cigarettes in their lifetime) should be checked for abdominal aortic aneurysms.
When found in time, aneurysms can usually be treated successfully with medicines or surgery. If an aortic aneurysm is found, the doctor may prescribe medicine to reduce the heart rate and blood pressure. This can reduce the risk of rupture.
Large aortic aneurysms, if found in time, can often be repaired with surgery to replace the diseased portion of the aorta. The outlook is usually excellent.
Types of Aneurysm
Types of aneurysm include aortic aneurysms, cerebral aneurysms, and peripheral aneurysms.
Aortic Aneurysm
Most aneurysms occur in the aorta. The aorta is the main artery that carries blood from the heart to the rest of the body. The aorta comes out from the left ventricle of the heart and travels through the chest and abdomen. The two types of aortic aneurysm are thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA).
Thoracic Aortic Aneurysm
An aortic aneurysm that occurs in the part of the aorta running through the thorax (chest) is a thoracic aortic aneurysm. One in four aortic aneurysms is a TAA.
Most TAAs do not produce symptoms, even when they are large. Only half of all people with TAAs notice any symptoms. TAAs are identified more often now than in the past because of chest computed tomography (CT) scans performed for other medical problems.
In a common type of TAA, the walls of the aorta become weak and a section nearest to the heart enlarges. Then the valve between the heart and the aorta cannot close properly and blood leaks backward into the heart. Less commonly, a TAA can develop in the upper back away from the heart. A TAA in this location can result from and injury to the chest such as from an auto crash.
Abdominal Aortic Aneurysm
An aortic aneurysm that occurs in the part of the aorta running through the abdomen is an abdominal aortic aneurysm. Three in four aortic aneurysms are AAAs.
An AAA can grow very large without producing symptoms. About 1 in 5 AAAs rupture.
Cerebral Aneurysm
Aneurysms that occur in an artery in the brain are called cerebral aneurysms. They are sometimes called berry aneurysms because they are often the size of a small berry. Most cerebral aneurysms produce no symptoms until they become large, begin to leak blood, or rupture.
ruptured cerebral aneurysm causes a stroke. Signs and symptoms can include a sudden, extremely severe headache, nausea, vomiting, stiff neck, sudden weakness in an area of the body, sudden difficulty speaking, and even loss of consciousness, coma, or death. The danger of a cerebral aneurysm depends on its size and location in the brain, whether it leaks or ruptures, and the person’s age and overall health.
Peripheral Aneurysm
Aneurysms that occur in arteries other than the aorta (and not in the brain) are called peripheral aneurysms. Common locations for peripheral aneurysms include the artery that runs down the back of the thigh behind the knee (popliteal artery), the main artery in the groin (femoral artery), and the main artery in the neck (carotid artery).
Peripheral aneurysms are not as likely to rupture as aortic aneurysms, but blood clots can form in peripheral aneurysms. If a blood clot breaks away from the aneurysm, it can block blood flow through the artery. If a peripheral aneurysm is large, it can press on a nearby nerve or vein and cause pain, numbness, or swelling
Other Names for Aneurysm
Aortic aneurysm
Abdominal aortic aneurysm, or AAA
Thoracic aortic aneurysm, or TAA
Cerebral aneurysm
Peripheral aneurysm
What Causes an Aneurysm?
An aneurysm can result from atherosclerosis (hardening and narrowing of the inside of arteries). As atherosclerosis develops, the artery walls become thick and damaged and lose their normal inner lining. This damaged area of artery can stretch or "balloon" from the pressure of blood flow inside the artery, resulting in an aneurysm.
An aneurysm also can develop from constant high blood pressure inside an artery.
A thoracic aortic aneurysm can result from an injury to the chest (for example, an injury that occurs from an auto crash). Certain medical conditions, such as Marfan syndrome, that weaken the body's connective tissues, also can cause aneurysms.
In rare cases, infections such as untreated syphilis (a sexually transmitted infection) can cause aortic aneurysms. Aortic aneurysms also can occur as a result of diseases that cause inflammation of blood vessels, such as vasculitis.
Who Is At Risk for an Aneurysm?
Populations Affected
Men are 5 to 10 times more likely than women to have an abdominal aortic aneurysm (AAA)-the most common type of aneurysm.
The risk of AAA increases as you get older, and it is more likely to occur in people between the ages of 60 to 80. A peripheral aneurysm also is more likely to affect people ages 60 to 80. Cerebral (brain) aneurysms, though rare, are more likely to occur in people ages 35 to 60.
Risk Factors
Factors that increase your risk for aneurysm include:
Atherosclerosis, a buildup of fatty deposits in the arteries.
Smoking. You are eight times more likely to develop an aneurysm if you smoke.
Overweight or obesity.
A family history of aortic aneurysm, heart disease, or other diseases of the arteries.
Certain diseases that can weaken the wall of the aorta, such as:
Marfan syndrome (an inherited disease in which tissues don't develop normally)
Untreated syphilis (a very rare cause today)
Tuberculosis (also a very rare cause today)
Trauma such as a blow to the chest in a car accident.
Severe and persistent high blood pressure between the ages of 35 and 60. This increases the risk for a cerebral aneurysm.
Use of stimulant drugs such as cocaine.
What Are the Signs and Symptoms of an Aneurysm?
The signs and symptoms of an aneurysm depend on its type, location, and whether it has ruptured or is interfering with other structures in the body. Aneurysms can develop and grow for years without causing any signs or symptoms. It is often not until an aneurysm ruptures or grows large enough to press on nearby parts of the body or block blood flow that it produces any signs or symptoms.
Abdominal Aortic Aneurysm
Most abdominal aortic aneurysms (AAAs) develop slowly over years and have no signs or symptoms until (or if) they rupture. Sometimes, a doctor can feel a pulsating mass while examining a patient's abdomen. When symptoms are present, they can include:
Deep penetrating pain in your back or the side of your abdomen
Steady gnawing pain in your abdomen that lasts for hours or days at a time
Coldness, numbness, or tingling in your feet due to blocked blood flow in your legs
If an AAA ruptures, symptoms can include sudden, severe pain in your lower abdomen and back; nausea and vomiting; clammy, sweaty skin; lightheadedness; and a rapid heart rate when standing up. Internal bleeding from a ruptured AAA can send you into shock. Shock is a life-threatening condition in which the organs of the body do not get enough blood flow.
Thoracic Aortic Aneurysm
A thoracic (chest) aortic aneurysm may have no symptoms until the aneurysm begins to leak or grow. Signs or symptoms may include:
Pain in your jaw, neck, upper back (or other part of your back), or chest
Coughing, hoarseness, or trouble breathing
Cerebral Aneurysm
If a cerebral (brain) aneurysm presses on nerves in your brain, it can cause signs and symptoms. These can include:
A droopy eyelid
Double vision or other changes in vision
Pain above or behind the eye
A dilated pupil
Numbness or weakness on one side of the face or body
If a cerebral aneurysm ruptures, symptoms can include a sudden, severe headache, nausea and vomiting, stiff neck, loss of consciousness, and signs of a stroke. Signs of a stroke are similar to those listed above for cerebral aneurysm, but they usually come on suddenly and are more severe. Any of these symptoms require immediate medical attention.
Peripheral Aneurysm
Signs and symptoms of peripheral aneurysm may include:
A pulsating lump that can be felt in your neck, arm, or leg
Leg or arm pain, or cramping with exercise
Painful sores on toes or fingers
Gangrene (tissue death) from severely blocked blood flow in your limbs
An aneurysm in the popliteal artery (behind the knee) can compress nerves and cause pain, weakness, and numbness in your knee and leg.
Blood clots can form in peripheral aneurysms. If a clot breaks loose and travels through the bloodstream, it can lodge in your arm, leg, or brain and block the artery. An aneurysm in your neck can block the artery to the brain and cause a stroke.
How Is an Aneurysm Diagnosed?
An aneurysm may be found by chance during a routine physical exam. More often, an aneurysm is found by chance during an x ray, ultrasound, or computed tomography (CT) scan performed for another reason, such as chest or abdominal pain.
If you have an abdominal aortic aneurysm (AAA), the doctor may feel a pulsating mass in your abdomen. A rapidly growing aneurysm about to rupture can be tender and very painful when pressed. If you are overweight or obese, it may be difficult for your doctor to feel even a large abdominal aneurysm.
If you have an AAA, your doctor may hear rushing blood flow instead of the normal whooshing sound when listening to your abdomen with a stethoscope.
Specialists Involved
You may be referred to a cardiothoracic surgeon, vascular surgeon, or neurosurgeon for diagnosis and treatment of an aneurysm. A cardiothoracic surgeon performs surgery on the heart, lungs, and other organs and structures in the chest, including the aorta. A vascular surgeon performs surgery on the abdominal aorta and on the peripheral arteries. A neurosurgeon performs surgery on the brain, including the arteries in the head, and on the spine and nerves.
Diagnostic Tests and Procedures
To diagnose and evaluate an aneurysm, one or more of the following tests or procedures may be performed:
Chest x ray. A chest x ray provides a picture of the organs and structures inside the chest, including the heart, lungs, and blood vessels.
Ultrasound. This simple and painless test uses sound waves to create a picture of the inside of the body. It shows the size of an aneurysm, if one is detected. The ultrasound scan may be repeated every few months to see how quickly an aneurysm is growing.
CT scan. A CT scan provides computer-generated, x-ray images of the internal organs. A CT scan may be performed if the doctor suspects a TAA or AAA. A liquid dye that can be seen on an x ray is injected into an arm vein to outline the aorta or artery on the CT scan. The CT scan images can be used to determine the size and shape of an abdominal aneurysm more accurately than an ultrasound.
MRI. MRI uses magnets and radio waves to create images of the inside of the body. It is very accurate in detecting aneurysms and determining their size and exact location.
Angiography. Angiography also uses a special dye injected into the blood stream to make the insides of arteries show up on x-ray pictures. An angiogram shows the amount of damage and blockage in blood vessels.
Aortogram. An aortogram is an angiogram of the aorta. It may show the location and size of an aortic aneurysm, and the arteries of the aorta that are involved.
How Is an Aneurysm Treated?
Goals of Treatment
Some aneurysms, mainly small ones that are not causing pain, can be treated with "watchful waiting." Others need to be treated to prevent growth and complications. The goals of treatment are to prevent the aneurysm from growing, prevent or reverse damage to other body structures, prevent or treat a rupture, and to allow you to continue to participate in normal daily activities.
Treatment Options
Medicine and surgery are the two types of treatment for an aneurysm. Medicines may be prescribed before surgery or instead of surgery. Medicines are used to reduce pressure, relax blood vessels, and reduce the risk of rupture. Beta blockers and calcium channel blockers are the medicines most commonly used.
Surgery may be recommended if an aneurysm is large and likely to rupture.
Treatment by Type of Aneurysm
Aortic Aneurysm
Experts recommend that men who have ever smoked (at least 100 cigarettes in their lifetime) and are between the ages of 65 and 75 should have an ultrasound screening to check for abdominal aortic aneurysms.
Treatment recommendations for aortic aneurysms are based on the size of the aneurysm. Small aneurysms found early can be treated with "watchful waiting."
If the diameter of the aorta is small-less than 3 centimeters (cm)-and there are no symptoms, "watchful waiting" and a followup screening in 5 to 10 years may be all that is needed, as determined by the doctor.
If the aorta is between 3 and 4 cm in diameter, the patient should return to the doctor every year for an ultrasound to see if the aneurysm has grown.
If the aorta is between 4 and 4.5 cm, testing should be repeated every 6 months.
If the aorta is larger than 5 cm (2 inches around or about the size of a lemon) or growing more than 1 cm per year, surgery should be considered as soon as possible.
Two main types of surgery to repair aortic aneurysms are open abdominal or open chest repair and endovascular repair.
The traditional and most common type of surgery for aortic aneurysms is open abdominal or open chest repair. It involves a major incision in the abdomen or chest. General anesthesia is needed with this procedure.
The aneurysm is removed and the section of aorta is replaced with an artificial graft made of material such as Dacron® or Teflon®. The surgery takes 3 to 6 hours, and the patient remains in the hospital for 5 to 8 days. It often takes a month to recover from open abdominal or open chest surgery and return to full activity. Open abdominal and chest surgeries have been performed for 50 years. More than 90 percent of patients make a full recovery.
In endovascular repair, the aneurysm is not removed, but a graft is inserted into the aorta to strengthen it. This type of surgery is performed through catheters (tubes) inserted into the arteries; it does not require surgically opening the chest or abdomen.
To perform endovascular repair, the doctor first inserts a catheter into an artery in the groin (upper thigh) and threads it up to the area of the aneurysm. Then, watching on x ray, the surgeon threads the graft (also called a stent graft) into the aorta to the aneurysm. The graft is then expanded inside the aorta and fastened in place to form a stable channel for blood flow. The graft reinforces the weakened section of the aorta to prevent the aneurysm from rupturing
Endovascular repair surgery reduces recovery time to a few days and greatly reduces time in the hospital. The procedure has been used since 1999. Not all aortic aneurysms can be repaired with this procedure. The exact location or size of the aneurysm may prevent the stent graft from being safely or reliably positioned inside the aneurysm.
Cerebral Aneurysm
Treatment for cerebral (brain) aneurysms depends on the size and location of the aneurysm, whether it is infected, and whether it has ruptured. A small cerebral aneurysm that hasn't burst may not need treatment. A large cerebral aneurysm may press against brain tissue, causing a severe headache or impaired vision, and is likely to burst. If the aneurysm ruptures, there will be bleeding into the brain which will cause a stroke. If a cerebral aneurysm becomes infected, it requires immediate medical treatment. Treatment of many cerebral aneurysms, especially large or growing ones, involves surgery, which can be risky depending on the location of the aneurysm.
Peripheral Aneurysm
Most peripheral aneurysms have no symptoms, especially if they are small. They seldom rupture.
Treatment of peripheral aneurysms depends on the presence of symptoms, the location of the aneurysm, and whether the blood flow through the artery is blocked. Blood clots can form in a peripheral aneurysm, break loose, and block the artery.
An aneurysm in the back of the knee that is larger than 1 inch in diameter usually requires surgery. An aneurysm in the thigh also is usually repaired with surgery.
How Can an Aneurysm Be Prevented?
The best way to prevent an aneurysm is to avoid the risk factors that increase the changes of developing one. To do this, you can:
Quit smoking.
Eat a low-fat, low-cholesterol diet to reduce the buildup of plaque in the arteries. Plaque is a fatty buildup that narrows the arteries.
Control high blood pressure (eating a low-salt diet helps).
Control high cholesterol.
Get regular physical activity.
An aneurysm (AN-u-rism) is an abnormal bulge or “ballooning” in the wall of an artery. Arteries are blood vessels that carry oxygen-rich blood from the heart to other parts of the body. An aneurysm that grows and becomes large enough can burst, causing dangerous, often fatal, bleeding inside the body.
Most aneurysms occur in the aorta. The aorta is the main artery that carries blood from the heart to the rest of the body. The aorta comes out from the left ventricle (VEN-trih-kul) of the heart and travels through the chest and abdomen. An aneurysm that occurs in the aorta in the chest is called a thoracic (tho-RAS-ik) aortic aneurysm. An aneurysm that occurs in the aorta in the abdomen is called an abdominal aortic aneurysm.
Aneurysms also can occur in arteries in the brain, heart, intestine, neck, spleen, back of the knees and thighs, and in other parts of the body. If an aneurysm in the brain bursts, it causes a stroke.
About 15,000 Americans die each year from ruptured aortic aneurysms. Ruptured aortic aneurysm is the 10th leading cause of death in men over age 50 in the United States.
Many cases of ruptured aneurysm can be prevented with early diagnosis and medical treatment. Because aneurysms can develop and become large before causing any symptoms, it is important to look for them in people who are at the highest risk. Experts recommend that men who are 65 to 75 years old and have ever smoked (at least 100 cigarettes in their lifetime) should be checked for abdominal aortic aneurysms.
When found in time, aneurysms can usually be treated successfully with medicines or surgery. If an aortic aneurysm is found, the doctor may prescribe medicine to reduce the heart rate and blood pressure. This can reduce the risk of rupture.
Large aortic aneurysms, if found in time, can often be repaired with surgery to replace the diseased portion of the aorta. The outlook is usually excellent.
Types of Aneurysm
Types of aneurysm include aortic aneurysms, cerebral aneurysms, and peripheral aneurysms.
Aortic Aneurysm
Most aneurysms occur in the aorta. The aorta is the main artery that carries blood from the heart to the rest of the body. The aorta comes out from the left ventricle of the heart and travels through the chest and abdomen. The two types of aortic aneurysm are thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA).
Thoracic Aortic Aneurysm
An aortic aneurysm that occurs in the part of the aorta running through the thorax (chest) is a thoracic aortic aneurysm. One in four aortic aneurysms is a TAA.
Most TAAs do not produce symptoms, even when they are large. Only half of all people with TAAs notice any symptoms. TAAs are identified more often now than in the past because of chest computed tomography (CT) scans performed for other medical problems.
In a common type of TAA, the walls of the aorta become weak and a section nearest to the heart enlarges. Then the valve between the heart and the aorta cannot close properly and blood leaks backward into the heart. Less commonly, a TAA can develop in the upper back away from the heart. A TAA in this location can result from and injury to the chest such as from an auto crash.
Abdominal Aortic Aneurysm
An aortic aneurysm that occurs in the part of the aorta running through the abdomen is an abdominal aortic aneurysm. Three in four aortic aneurysms are AAAs.
An AAA can grow very large without producing symptoms. About 1 in 5 AAAs rupture.
Cerebral Aneurysm
Aneurysms that occur in an artery in the brain are called cerebral aneurysms. They are sometimes called berry aneurysms because they are often the size of a small berry. Most cerebral aneurysms produce no symptoms until they become large, begin to leak blood, or rupture.
ruptured cerebral aneurysm causes a stroke. Signs and symptoms can include a sudden, extremely severe headache, nausea, vomiting, stiff neck, sudden weakness in an area of the body, sudden difficulty speaking, and even loss of consciousness, coma, or death. The danger of a cerebral aneurysm depends on its size and location in the brain, whether it leaks or ruptures, and the person’s age and overall health.
Peripheral Aneurysm
Aneurysms that occur in arteries other than the aorta (and not in the brain) are called peripheral aneurysms. Common locations for peripheral aneurysms include the artery that runs down the back of the thigh behind the knee (popliteal artery), the main artery in the groin (femoral artery), and the main artery in the neck (carotid artery).
Peripheral aneurysms are not as likely to rupture as aortic aneurysms, but blood clots can form in peripheral aneurysms. If a blood clot breaks away from the aneurysm, it can block blood flow through the artery. If a peripheral aneurysm is large, it can press on a nearby nerve or vein and cause pain, numbness, or swelling
Other Names for Aneurysm
Aortic aneurysm
Abdominal aortic aneurysm, or AAA
Thoracic aortic aneurysm, or TAA
Cerebral aneurysm
Peripheral aneurysm
What Causes an Aneurysm?
An aneurysm can result from atherosclerosis (hardening and narrowing of the inside of arteries). As atherosclerosis develops, the artery walls become thick and damaged and lose their normal inner lining. This damaged area of artery can stretch or "balloon" from the pressure of blood flow inside the artery, resulting in an aneurysm.
An aneurysm also can develop from constant high blood pressure inside an artery.
A thoracic aortic aneurysm can result from an injury to the chest (for example, an injury that occurs from an auto crash). Certain medical conditions, such as Marfan syndrome, that weaken the body's connective tissues, also can cause aneurysms.
In rare cases, infections such as untreated syphilis (a sexually transmitted infection) can cause aortic aneurysms. Aortic aneurysms also can occur as a result of diseases that cause inflammation of blood vessels, such as vasculitis.
Who Is At Risk for an Aneurysm?
Populations Affected
Men are 5 to 10 times more likely than women to have an abdominal aortic aneurysm (AAA)-the most common type of aneurysm.
The risk of AAA increases as you get older, and it is more likely to occur in people between the ages of 60 to 80. A peripheral aneurysm also is more likely to affect people ages 60 to 80. Cerebral (brain) aneurysms, though rare, are more likely to occur in people ages 35 to 60.
Risk Factors
Factors that increase your risk for aneurysm include:
Atherosclerosis, a buildup of fatty deposits in the arteries.
Smoking. You are eight times more likely to develop an aneurysm if you smoke.
Overweight or obesity.
A family history of aortic aneurysm, heart disease, or other diseases of the arteries.
Certain diseases that can weaken the wall of the aorta, such as:
Marfan syndrome (an inherited disease in which tissues don't develop normally)
Untreated syphilis (a very rare cause today)
Tuberculosis (also a very rare cause today)
Trauma such as a blow to the chest in a car accident.
Severe and persistent high blood pressure between the ages of 35 and 60. This increases the risk for a cerebral aneurysm.
Use of stimulant drugs such as cocaine.
What Are the Signs and Symptoms of an Aneurysm?
The signs and symptoms of an aneurysm depend on its type, location, and whether it has ruptured or is interfering with other structures in the body. Aneurysms can develop and grow for years without causing any signs or symptoms. It is often not until an aneurysm ruptures or grows large enough to press on nearby parts of the body or block blood flow that it produces any signs or symptoms.
Abdominal Aortic Aneurysm
Most abdominal aortic aneurysms (AAAs) develop slowly over years and have no signs or symptoms until (or if) they rupture. Sometimes, a doctor can feel a pulsating mass while examining a patient's abdomen. When symptoms are present, they can include:
Deep penetrating pain in your back or the side of your abdomen
Steady gnawing pain in your abdomen that lasts for hours or days at a time
Coldness, numbness, or tingling in your feet due to blocked blood flow in your legs
If an AAA ruptures, symptoms can include sudden, severe pain in your lower abdomen and back; nausea and vomiting; clammy, sweaty skin; lightheadedness; and a rapid heart rate when standing up. Internal bleeding from a ruptured AAA can send you into shock. Shock is a life-threatening condition in which the organs of the body do not get enough blood flow.
Thoracic Aortic Aneurysm
A thoracic (chest) aortic aneurysm may have no symptoms until the aneurysm begins to leak or grow. Signs or symptoms may include:
Pain in your jaw, neck, upper back (or other part of your back), or chest
Coughing, hoarseness, or trouble breathing
Cerebral Aneurysm
If a cerebral (brain) aneurysm presses on nerves in your brain, it can cause signs and symptoms. These can include:
A droopy eyelid
Double vision or other changes in vision
Pain above or behind the eye
A dilated pupil
Numbness or weakness on one side of the face or body
If a cerebral aneurysm ruptures, symptoms can include a sudden, severe headache, nausea and vomiting, stiff neck, loss of consciousness, and signs of a stroke. Signs of a stroke are similar to those listed above for cerebral aneurysm, but they usually come on suddenly and are more severe. Any of these symptoms require immediate medical attention.
Peripheral Aneurysm
Signs and symptoms of peripheral aneurysm may include:
A pulsating lump that can be felt in your neck, arm, or leg
Leg or arm pain, or cramping with exercise
Painful sores on toes or fingers
Gangrene (tissue death) from severely blocked blood flow in your limbs
An aneurysm in the popliteal artery (behind the knee) can compress nerves and cause pain, weakness, and numbness in your knee and leg.
Blood clots can form in peripheral aneurysms. If a clot breaks loose and travels through the bloodstream, it can lodge in your arm, leg, or brain and block the artery. An aneurysm in your neck can block the artery to the brain and cause a stroke.
How Is an Aneurysm Diagnosed?
An aneurysm may be found by chance during a routine physical exam. More often, an aneurysm is found by chance during an x ray, ultrasound, or computed tomography (CT) scan performed for another reason, such as chest or abdominal pain.
If you have an abdominal aortic aneurysm (AAA), the doctor may feel a pulsating mass in your abdomen. A rapidly growing aneurysm about to rupture can be tender and very painful when pressed. If you are overweight or obese, it may be difficult for your doctor to feel even a large abdominal aneurysm.
If you have an AAA, your doctor may hear rushing blood flow instead of the normal whooshing sound when listening to your abdomen with a stethoscope.
Specialists Involved
You may be referred to a cardiothoracic surgeon, vascular surgeon, or neurosurgeon for diagnosis and treatment of an aneurysm. A cardiothoracic surgeon performs surgery on the heart, lungs, and other organs and structures in the chest, including the aorta. A vascular surgeon performs surgery on the abdominal aorta and on the peripheral arteries. A neurosurgeon performs surgery on the brain, including the arteries in the head, and on the spine and nerves.
Diagnostic Tests and Procedures
To diagnose and evaluate an aneurysm, one or more of the following tests or procedures may be performed:
Chest x ray. A chest x ray provides a picture of the organs and structures inside the chest, including the heart, lungs, and blood vessels.
Ultrasound. This simple and painless test uses sound waves to create a picture of the inside of the body. It shows the size of an aneurysm, if one is detected. The ultrasound scan may be repeated every few months to see how quickly an aneurysm is growing.
CT scan. A CT scan provides computer-generated, x-ray images of the internal organs. A CT scan may be performed if the doctor suspects a TAA or AAA. A liquid dye that can be seen on an x ray is injected into an arm vein to outline the aorta or artery on the CT scan. The CT scan images can be used to determine the size and shape of an abdominal aneurysm more accurately than an ultrasound.
MRI. MRI uses magnets and radio waves to create images of the inside of the body. It is very accurate in detecting aneurysms and determining their size and exact location.
Angiography. Angiography also uses a special dye injected into the blood stream to make the insides of arteries show up on x-ray pictures. An angiogram shows the amount of damage and blockage in blood vessels.
Aortogram. An aortogram is an angiogram of the aorta. It may show the location and size of an aortic aneurysm, and the arteries of the aorta that are involved.
How Is an Aneurysm Treated?
Goals of Treatment
Some aneurysms, mainly small ones that are not causing pain, can be treated with "watchful waiting." Others need to be treated to prevent growth and complications. The goals of treatment are to prevent the aneurysm from growing, prevent or reverse damage to other body structures, prevent or treat a rupture, and to allow you to continue to participate in normal daily activities.
Treatment Options
Medicine and surgery are the two types of treatment for an aneurysm. Medicines may be prescribed before surgery or instead of surgery. Medicines are used to reduce pressure, relax blood vessels, and reduce the risk of rupture. Beta blockers and calcium channel blockers are the medicines most commonly used.
Surgery may be recommended if an aneurysm is large and likely to rupture.
Treatment by Type of Aneurysm
Aortic Aneurysm
Experts recommend that men who have ever smoked (at least 100 cigarettes in their lifetime) and are between the ages of 65 and 75 should have an ultrasound screening to check for abdominal aortic aneurysms.
Treatment recommendations for aortic aneurysms are based on the size of the aneurysm. Small aneurysms found early can be treated with "watchful waiting."
If the diameter of the aorta is small-less than 3 centimeters (cm)-and there are no symptoms, "watchful waiting" and a followup screening in 5 to 10 years may be all that is needed, as determined by the doctor.
If the aorta is between 3 and 4 cm in diameter, the patient should return to the doctor every year for an ultrasound to see if the aneurysm has grown.
If the aorta is between 4 and 4.5 cm, testing should be repeated every 6 months.
If the aorta is larger than 5 cm (2 inches around or about the size of a lemon) or growing more than 1 cm per year, surgery should be considered as soon as possible.
Two main types of surgery to repair aortic aneurysms are open abdominal or open chest repair and endovascular repair.
The traditional and most common type of surgery for aortic aneurysms is open abdominal or open chest repair. It involves a major incision in the abdomen or chest. General anesthesia is needed with this procedure.
The aneurysm is removed and the section of aorta is replaced with an artificial graft made of material such as Dacron® or Teflon®. The surgery takes 3 to 6 hours, and the patient remains in the hospital for 5 to 8 days. It often takes a month to recover from open abdominal or open chest surgery and return to full activity. Open abdominal and chest surgeries have been performed for 50 years. More than 90 percent of patients make a full recovery.
In endovascular repair, the aneurysm is not removed, but a graft is inserted into the aorta to strengthen it. This type of surgery is performed through catheters (tubes) inserted into the arteries; it does not require surgically opening the chest or abdomen.
To perform endovascular repair, the doctor first inserts a catheter into an artery in the groin (upper thigh) and threads it up to the area of the aneurysm. Then, watching on x ray, the surgeon threads the graft (also called a stent graft) into the aorta to the aneurysm. The graft is then expanded inside the aorta and fastened in place to form a stable channel for blood flow. The graft reinforces the weakened section of the aorta to prevent the aneurysm from rupturing
Endovascular repair surgery reduces recovery time to a few days and greatly reduces time in the hospital. The procedure has been used since 1999. Not all aortic aneurysms can be repaired with this procedure. The exact location or size of the aneurysm may prevent the stent graft from being safely or reliably positioned inside the aneurysm.
Cerebral Aneurysm
Treatment for cerebral (brain) aneurysms depends on the size and location of the aneurysm, whether it is infected, and whether it has ruptured. A small cerebral aneurysm that hasn't burst may not need treatment. A large cerebral aneurysm may press against brain tissue, causing a severe headache or impaired vision, and is likely to burst. If the aneurysm ruptures, there will be bleeding into the brain which will cause a stroke. If a cerebral aneurysm becomes infected, it requires immediate medical treatment. Treatment of many cerebral aneurysms, especially large or growing ones, involves surgery, which can be risky depending on the location of the aneurysm.
Peripheral Aneurysm
Most peripheral aneurysms have no symptoms, especially if they are small. They seldom rupture.
Treatment of peripheral aneurysms depends on the presence of symptoms, the location of the aneurysm, and whether the blood flow through the artery is blocked. Blood clots can form in a peripheral aneurysm, break loose, and block the artery.
An aneurysm in the back of the knee that is larger than 1 inch in diameter usually requires surgery. An aneurysm in the thigh also is usually repaired with surgery.
How Can an Aneurysm Be Prevented?
The best way to prevent an aneurysm is to avoid the risk factors that increase the changes of developing one. To do this, you can:
Quit smoking.
Eat a low-fat, low-cholesterol diet to reduce the buildup of plaque in the arteries. Plaque is a fatty buildup that narrows the arteries.
Control high blood pressure (eating a low-salt diet helps).
Control high cholesterol.
Get regular physical activity.
Cardiac CT
What Is Cardiac CT?
Cardiac computed tomography (to-MOG-rah-fee),
or cardiac CT, is a painless test that uses an x-ray machine to take clear, detailed pictures of your heart. It's a common test for showing problems of the heart. During a cardiac CT scan, the x-ray machine will move around your body in a circle and take a picture of each part of your heart.
Because an x-ray machine is used, cardiac CT scans involve radiation. However, the amount of radiation used is small. This test gives out a radiation dose similar to the amount of radiation you’re naturally exposed to over 3 years. There is a very small chance that cardiac CT will cause cancer.
Each picture that the machine takes shows a small slice of the heart. A computer will put the pictures together to make a large picture of the whole heart. Sometimes an iodine-based dye is injected into one of your veins during the scan to help highlight blood vessels and arteries on the x-ray images.
Overview
Cardiac CT is a common test for finding and evaluating:
Problems in the heart. Iodine-based dye used with a cardiac CT scan can show pictures of the coronary arteries. The coronary arteries are blood vessels on the surface of the heart. If these blood vessels are narrowed or blocked, you may have chest pain or a heart attack. The CT scan also can find problems with heart function and heart valves.
Problems with the aorta. The aorta is the main artery that carries oxygen-rich blood from the heart to the body. Cardiac CT can detect two serious problems in the aorta:
Aneurysms, which are diseased areas of a weak blood vessel wall that bulge out. Aneurysms can be life threatening because they can burst.
Dissections, which can occur when the layers of the aortic artery wall peel away from each other. This condition can cause pain and also may be life threatening.
Blood clots in the lungs. A cardiac CT scan also may be used to find a pulmonary embolism, a serious but treatable condition. A pulmonary embolism is a sudden blockage in a lung artery, usually due to a blood clot that traveled to the lung from the leg.
Pericardial disease. This is a disease that occurs in the pericardium, a sac around your heart.
Because the heart is in motion, a fast type of CT scanner, called multidetector computed tomography (MDCT), is used to show high-quality pictures of the heart.
Another type of CT scanner, called electron-beam computed tomography (EBCT), is used to detect calcium in the coronary arteries. Calcium in the coronary arteries may be an early sign of coronary artery disease (CAD).
CAD occurs when the coronary arteries (the arteries that supply blood and oxygen to the heart muscle) harden and narrow due to the buildup of a material called plaque (plak) on their inner walls. CAD is the leading cause of death for both men and women in the United States.
Researchers also are studying new ways to use cardiac CT
Other Names for Cardiac CT
CAT scan
Coronary CT angiography (an-je-OG-ra-fee)
Coronary artery scan
CT angiography (CTA)
What To Expect Before Cardiac CT
Your doctor will give you instructions before the cardiac computed tomography (CT) scan. Usually he or she will ask you to avoid drinks that contain caffeine before the test. Normally you’ll be able to drink water, but you won’t be able to eat for 4 hours before the scan.
If you take medicines for diabetes, ask your doctor whether you will need to change how you take them on the day of your cardiac CT scan.
Tell your doctor if you:
Are pregnant or may be pregnant. Even though cardiac CT uses a low radiation dose, you shouldn’t have the scan if you’re pregnant. The x-rays may harm the developing fetus.
Have asthma or kidney problems or are allergic to any medicines, iodine, and/or shellfish. These may increase your chance of having an allergic reaction to the contrast dye.
A technician will ask you to remove your clothes above the waist and wear a hospital gown. You also will be asked to remove any jewelry from around your neck or chest.
Taking pictures of the heart can be difficult because the heart is always beating (in motion). A slower heart rate will help produce better quality pictures. If you don’t have asthma or heart failure, your doctor may give you a medicine called a beta blocker to help slow your heart rate. The medicine will be given by mouth or injected into a vein.
What To Expect During Cardiac CT
The cardiac computed tomography (CT) scan will take place in a hospital or outpatient office.
Because an x-ray machine is used, cardiac CT scans involve radiation. However, the amount of radiation used is small. This test gives out a radiation dose similar to the amount of radiation you’re naturally exposed to over 3 years. There’s a very small chance that cardiac CT will cause cancer. A doctor who has experience with CT scanning will supervise the test.
If your doctor wants to use contrast dye during the cardiac CT scan, a small needle connected to an intravenous (IV) line will be put in a vein in your hand or arm.
The contrast dye will be injected through the IV during the scan. You may have a warm feeling during the injection. The dye will highlight your blood vessels on thex-ray pictures from the cardiac CT scan.
The technician who operates the cardiac CT scanner will clean areas of your chest and place small sticky patches on those areas. The patches are attached to an ECG (electrocardiogram) machine to record the electrical activity of your heart during the exam.
The CT scanner is a large, square machine that has a hollow, circular tube in the middle. You will lie on your back on a sliding table that can move up and down and goes inside the tunnel-like machine.
Inside the scanner, an x-ray tube moves around your body to take pictures of different parts of your heart. These pictures can be shown on a computer as one large, three-dimensional picture. The technician controls the machine from the next room. The technician can see you through a glass window and talk to you through an intercom system.
Moving your body can cause the pictures to blur. You will be asked to lie still and hold your breath for short periods, while each picture is taken.
A cardiac CT scan usually takes about 15 minutes to complete. However, it can take over an hour to get ready for the test and for the medicine to slow your heart rate enough.
What To Expect After Cardiac CT
Once the cardiac computed tomography (CT) scan is done, you’re able to return to your normal activities.
A doctor who has experience with CT will provide your doctor with the results of your test. Your doctor will discuss the findings with you.
What Does Cardiac CT Show?
Many x rays are taken while you’re in the computed tomography (CT) scanner. Each picture that the machine takes shows a small slice of the heart. A computer can put the pictures together to make a large picture of the whole heart. This picture shows the inside of the heart and the structures that surround the heart.
Cardiac CT is a common test for finding and evaluating:
Problems in the heart. Iodine-based dye used with a cardiac CT scan can show pictures of the coronary arteries. The coronary arteries are blood vessels on the surface of the heart. If these blood vessels are narrowed or blocked, you may have chest pain or a heart attack. The CT scan also can find problems with heart function and heart valves.
Problems with the aorta. The aorta is the main artery that carries oxygen-rich blood from the heart to the body. Cardiac CT can detect two serious problems in the aorta:
Aneurysms, which are diseased areas of a weak blood vessel wall that bulge out. Aneurysms can be life threatening because they can burst.
Dissections, which can occur when the layers of the aortic artery wall peel away from each other. This condition can cause pain and also may be life threatening.
Blood clots in the lungs. A cardiac CT scan also may be used to find a pulmonary embolism, a serious but treatable condition. A pulmonary embolism is a sudden blockage in a lung artery, usually due to a blood clot that traveled to the lung from the leg.
Pericardial disease. This is a disease that occurs in the pericardium, a sac around your heart.
Because the heart is in motion, a fast type of CT scanner, called multidetector computed tomography (MDCT), is used to take high-quality pictures of the heart.
Another type of CT scanner, called electron-beam computed tomography (EBCT), is used to detect calcium in the coronary arteries. Calcium in the coronary arteries may be an early sign of coronary artery disease (CAD).
What Are the Risks of Cardiac CT?
Cardiac computed tomography (CT) scans are safe, painless tests. Although cardiac CT uses radiation, the amount is small. This test gives out a radiation dose similar to the amount of radiation you’re naturally exposed to over 3 years. There is a very small chance that cardiac CT will cause cancer.
Some people feel side effects from the contrast dye that’s used during the cardiac CT scan, including the following:
An itchy feeling or a rash may appear after the injection of the contrast dye. Neither one normally lasts for a long time, so medicine often isn’t needed. If you do want medicine to relieve these symptoms, you can ask your doctor to prescribe you a medicine called an antihistamine, which is used to help stop allergic reactions.
Although rare, it’s possible to have a serious allergic reaction that may lead to breathing difficulties. Medicines are used to treat serious reactions.
People who have asthma or emphysema may have breathing problems during cardiac CT if they’re given beta blockers to slow down their heart rates.
Key Points
Cardiac computed tomography (CT) is a painless test that uses an x-ray machine to take clear, detailed pictures of your heart.
Each picture that the machine takes shows a small slice of the heart. A computer can put the pictures together to make a large picture of the whole heart.
Because an x-ray machine is used, cardiac CT scans involve radiation. However, the amount of radiation used is small.
Cardiac CT is a common test for finding and evaluating heart problems, such as aortic aneurysm, aortic dissection, and pericardial disease. Cardiac CT also may be used to find pulmonary embolisms.
Sometimes cardiac CT scans show early signs of coronary artery disease (CAD), before a person shows any symptoms.
Your doctor will give you instructions before the cardiac CT. Usually he or she will ask you to avoid drinks with caffeine before the test. You also may be asked not to eat for 4 hours before the test.
Cardiac CT will take place in a hospital or outpatient office.
The CT scanner is a large, square machine that has a hollow, circular tube in the middle. You lie on your back on a sliding table that can move up and down and goes inside the scanner.
Many x rays are taken while you’re in the CT scanner. A computer can put the pictures together to make a large picture of the whole heart. This picture shows the inside of the heart and the structures that surround the heart.
A cardiac CT scan usually takes about 15 minutes to complete, but getting ready before the scan can take more time.
Once the cardiac CT scan is done, you’re able to return to your normal activities.
A doctor who has experience with CT will provide your doctor with the results of your scan. Your doctor will discuss the findings with you.
Cardiac CT scans are painless. Some people feel side effects from the contrast dye that’s used during the scan. Serious complications are rare.
Researchers are studying new ways to use cardiac CT.
Cardiac computed tomography (to-MOG-rah-fee),
or cardiac CT, is a painless test that uses an x-ray machine to take clear, detailed pictures of your heart. It's a common test for showing problems of the heart. During a cardiac CT scan, the x-ray machine will move around your body in a circle and take a picture of each part of your heart.
Because an x-ray machine is used, cardiac CT scans involve radiation. However, the amount of radiation used is small. This test gives out a radiation dose similar to the amount of radiation you’re naturally exposed to over 3 years. There is a very small chance that cardiac CT will cause cancer.
Each picture that the machine takes shows a small slice of the heart. A computer will put the pictures together to make a large picture of the whole heart. Sometimes an iodine-based dye is injected into one of your veins during the scan to help highlight blood vessels and arteries on the x-ray images.
Overview
Cardiac CT is a common test for finding and evaluating:
Problems in the heart. Iodine-based dye used with a cardiac CT scan can show pictures of the coronary arteries. The coronary arteries are blood vessels on the surface of the heart. If these blood vessels are narrowed or blocked, you may have chest pain or a heart attack. The CT scan also can find problems with heart function and heart valves.
Problems with the aorta. The aorta is the main artery that carries oxygen-rich blood from the heart to the body. Cardiac CT can detect two serious problems in the aorta:
Aneurysms, which are diseased areas of a weak blood vessel wall that bulge out. Aneurysms can be life threatening because they can burst.
Dissections, which can occur when the layers of the aortic artery wall peel away from each other. This condition can cause pain and also may be life threatening.
Blood clots in the lungs. A cardiac CT scan also may be used to find a pulmonary embolism, a serious but treatable condition. A pulmonary embolism is a sudden blockage in a lung artery, usually due to a blood clot that traveled to the lung from the leg.
Pericardial disease. This is a disease that occurs in the pericardium, a sac around your heart.
Because the heart is in motion, a fast type of CT scanner, called multidetector computed tomography (MDCT), is used to show high-quality pictures of the heart.
Another type of CT scanner, called electron-beam computed tomography (EBCT), is used to detect calcium in the coronary arteries. Calcium in the coronary arteries may be an early sign of coronary artery disease (CAD).
CAD occurs when the coronary arteries (the arteries that supply blood and oxygen to the heart muscle) harden and narrow due to the buildup of a material called plaque (plak) on their inner walls. CAD is the leading cause of death for both men and women in the United States.
Researchers also are studying new ways to use cardiac CT
Other Names for Cardiac CT
CAT scan
Coronary CT angiography (an-je-OG-ra-fee)
Coronary artery scan
CT angiography (CTA)
What To Expect Before Cardiac CT
Your doctor will give you instructions before the cardiac computed tomography (CT) scan. Usually he or she will ask you to avoid drinks that contain caffeine before the test. Normally you’ll be able to drink water, but you won’t be able to eat for 4 hours before the scan.
If you take medicines for diabetes, ask your doctor whether you will need to change how you take them on the day of your cardiac CT scan.
Tell your doctor if you:
Are pregnant or may be pregnant. Even though cardiac CT uses a low radiation dose, you shouldn’t have the scan if you’re pregnant. The x-rays may harm the developing fetus.
Have asthma or kidney problems or are allergic to any medicines, iodine, and/or shellfish. These may increase your chance of having an allergic reaction to the contrast dye.
A technician will ask you to remove your clothes above the waist and wear a hospital gown. You also will be asked to remove any jewelry from around your neck or chest.
Taking pictures of the heart can be difficult because the heart is always beating (in motion). A slower heart rate will help produce better quality pictures. If you don’t have asthma or heart failure, your doctor may give you a medicine called a beta blocker to help slow your heart rate. The medicine will be given by mouth or injected into a vein.
What To Expect During Cardiac CT
The cardiac computed tomography (CT) scan will take place in a hospital or outpatient office.
Because an x-ray machine is used, cardiac CT scans involve radiation. However, the amount of radiation used is small. This test gives out a radiation dose similar to the amount of radiation you’re naturally exposed to over 3 years. There’s a very small chance that cardiac CT will cause cancer. A doctor who has experience with CT scanning will supervise the test.
If your doctor wants to use contrast dye during the cardiac CT scan, a small needle connected to an intravenous (IV) line will be put in a vein in your hand or arm.
The contrast dye will be injected through the IV during the scan. You may have a warm feeling during the injection. The dye will highlight your blood vessels on thex-ray pictures from the cardiac CT scan.
The technician who operates the cardiac CT scanner will clean areas of your chest and place small sticky patches on those areas. The patches are attached to an ECG (electrocardiogram) machine to record the electrical activity of your heart during the exam.
The CT scanner is a large, square machine that has a hollow, circular tube in the middle. You will lie on your back on a sliding table that can move up and down and goes inside the tunnel-like machine.
Inside the scanner, an x-ray tube moves around your body to take pictures of different parts of your heart. These pictures can be shown on a computer as one large, three-dimensional picture. The technician controls the machine from the next room. The technician can see you through a glass window and talk to you through an intercom system.
Moving your body can cause the pictures to blur. You will be asked to lie still and hold your breath for short periods, while each picture is taken.
A cardiac CT scan usually takes about 15 minutes to complete. However, it can take over an hour to get ready for the test and for the medicine to slow your heart rate enough.
What To Expect After Cardiac CT
Once the cardiac computed tomography (CT) scan is done, you’re able to return to your normal activities.
A doctor who has experience with CT will provide your doctor with the results of your test. Your doctor will discuss the findings with you.
What Does Cardiac CT Show?
Many x rays are taken while you’re in the computed tomography (CT) scanner. Each picture that the machine takes shows a small slice of the heart. A computer can put the pictures together to make a large picture of the whole heart. This picture shows the inside of the heart and the structures that surround the heart.
Cardiac CT is a common test for finding and evaluating:
Problems in the heart. Iodine-based dye used with a cardiac CT scan can show pictures of the coronary arteries. The coronary arteries are blood vessels on the surface of the heart. If these blood vessels are narrowed or blocked, you may have chest pain or a heart attack. The CT scan also can find problems with heart function and heart valves.
Problems with the aorta. The aorta is the main artery that carries oxygen-rich blood from the heart to the body. Cardiac CT can detect two serious problems in the aorta:
Aneurysms, which are diseased areas of a weak blood vessel wall that bulge out. Aneurysms can be life threatening because they can burst.
Dissections, which can occur when the layers of the aortic artery wall peel away from each other. This condition can cause pain and also may be life threatening.
Blood clots in the lungs. A cardiac CT scan also may be used to find a pulmonary embolism, a serious but treatable condition. A pulmonary embolism is a sudden blockage in a lung artery, usually due to a blood clot that traveled to the lung from the leg.
Pericardial disease. This is a disease that occurs in the pericardium, a sac around your heart.
Because the heart is in motion, a fast type of CT scanner, called multidetector computed tomography (MDCT), is used to take high-quality pictures of the heart.
Another type of CT scanner, called electron-beam computed tomography (EBCT), is used to detect calcium in the coronary arteries. Calcium in the coronary arteries may be an early sign of coronary artery disease (CAD).
What Are the Risks of Cardiac CT?
Cardiac computed tomography (CT) scans are safe, painless tests. Although cardiac CT uses radiation, the amount is small. This test gives out a radiation dose similar to the amount of radiation you’re naturally exposed to over 3 years. There is a very small chance that cardiac CT will cause cancer.
Some people feel side effects from the contrast dye that’s used during the cardiac CT scan, including the following:
An itchy feeling or a rash may appear after the injection of the contrast dye. Neither one normally lasts for a long time, so medicine often isn’t needed. If you do want medicine to relieve these symptoms, you can ask your doctor to prescribe you a medicine called an antihistamine, which is used to help stop allergic reactions.
Although rare, it’s possible to have a serious allergic reaction that may lead to breathing difficulties. Medicines are used to treat serious reactions.
People who have asthma or emphysema may have breathing problems during cardiac CT if they’re given beta blockers to slow down their heart rates.
Key Points
Cardiac computed tomography (CT) is a painless test that uses an x-ray machine to take clear, detailed pictures of your heart.
Each picture that the machine takes shows a small slice of the heart. A computer can put the pictures together to make a large picture of the whole heart.
Because an x-ray machine is used, cardiac CT scans involve radiation. However, the amount of radiation used is small.
Cardiac CT is a common test for finding and evaluating heart problems, such as aortic aneurysm, aortic dissection, and pericardial disease. Cardiac CT also may be used to find pulmonary embolisms.
Sometimes cardiac CT scans show early signs of coronary artery disease (CAD), before a person shows any symptoms.
Your doctor will give you instructions before the cardiac CT. Usually he or she will ask you to avoid drinks with caffeine before the test. You also may be asked not to eat for 4 hours before the test.
Cardiac CT will take place in a hospital or outpatient office.
The CT scanner is a large, square machine that has a hollow, circular tube in the middle. You lie on your back on a sliding table that can move up and down and goes inside the scanner.
Many x rays are taken while you’re in the CT scanner. A computer can put the pictures together to make a large picture of the whole heart. This picture shows the inside of the heart and the structures that surround the heart.
A cardiac CT scan usually takes about 15 minutes to complete, but getting ready before the scan can take more time.
Once the cardiac CT scan is done, you’re able to return to your normal activities.
A doctor who has experience with CT will provide your doctor with the results of your scan. Your doctor will discuss the findings with you.
Cardiac CT scans are painless. Some people feel side effects from the contrast dye that’s used during the scan. Serious complications are rare.
Researchers are studying new ways to use cardiac CT.
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