A Healthy Heart and How it Functions

The heart is a muscle and is also known as the body’s pumping system. A healthy heart is a strong, hardworking pump and is about the size of a fist. It is the center of the circulatory system and consists of a network of blood vessels that delivers blood to every part of the body. The blood carries oxygen and other important nutrients that all body organs need.

The heart is divided into two separate pumping systems: the right side and the left side. These sides contain the four chambers of the heart. The four chambers are: the right atrium, right ventricle, left atrium and left ventricle. The four chambers of the heart are made of a special muscle called myocardium, which does the main pumping work. Healthy heart blood flow patterns flow from body to heart to lungs to heart and back to body.

The four heart valves are:  The tricuspid valve (located between the right atrium and right ventricle), the pulmonary valve (located between the right ventricle and pulmonary artery) the mitral valve (between the left atrium and left ventricle) and the aortic valve (between the left ventricle and the aorta). All of the valves together control the flow of blood in and out of the chambers. The valves are designed to keep blood flowing forward only, which prevents backflow.

The right atrium receives oxygen poor blood from the body and pumps it to the right ventricle through the tricuspid valve. The right ventricle pumps the oxygen poor blood to the lungs through the pulmonary valve. The left atrium receives oxygen rich blood from the lungs and pumps it to the left ventricle through the mitral valve. The left ventricle pumps the oxygen rich blood through the aortic valve out to the rest of the body. When your heart functions properly all four chambers work together in a continuous and coordinated effort to keep oxygenated rich blood circulating throughout your body. 

Types of Heart Related Diseases

A large portion of heart related diseases are due to atherosclerosis. This is when arterial walls become thick and stiff due to fatty deposits called plaques. This then restricts blood flow. When blood flow is restricted, it can lead to heart diseases. There are many types of heart-related diseases. Here are some of the most common heart related diseases and how they present:

Ischemic heart disease is a broad name for heart conditions that include angina, coronary artery disease, coronary heart disease, heart attack and sudden death. Angina manifests as chest pain due to a narrowing or blockage of blood vessels that supply the heart. This may result in a heart attack if not immediately treated. Coronary artery disease is caused by narrowing of blood vessels that supply the heart with blood. The narrowing if severe enough may lead to angina and heart attacks. Coronary heart disease is the disease of the arteries of the heart. This disease may be caused by plaque build-up in the arteries causing reduction in oxygen rich blood supply to the heart muscle. Heart attack is the narrowing of the coronary arteries completely blocks the supply of blood to the heart. Sudden death is the abrupt loss of the heart’s ability to pump which is usually caused by an electrical malfunction in the heart’s pumping system.

Hypertensive heart diseases describe heart problems caused by high blood pressure and how it relates to the heart’s arteries and muscles. Prolonged high blood pressure creates stress on the blood vessels causing heart disease, strokes and renal disease. High blood pressure can also lead to an aneurysm which is a bulge or weakness in the wall of a blood vessel which can enlarge overtime and even rupture. Aneurysms can occur in arteries in any location of the body.

Rheumatic heart disease is a disease caused by one or more attacks of rheumatic fever which can damage the heart valves. This can then lead to valvular heart disease. There are three types of valvular heart disease which includes stenosis which is a narrowing of the heart valves, regurgitation which is when the valves leak or prolapsed in which the valves do not close properly. These conditions can all inhibit the heart from functioning properly.

Inflammatory heart disease includes pericarditis which is inflammation of the pericardium, the sac that encases the heart which is usually caused by a viral infection. Endocarditis which is inflammation of the heart’s inner lining which is usually caused by infection and most commonly affects the heart’s valves.

Congenital heart disease refers to a heart disease present at birth, such as holes in the heart, abnormal valves or heart chambers. Congenital heart disease may be caused by predisposed genetics or family history.

Cardiac arrhythmias refer to when the heart does not beat regularly due to a malfunction in the heart’s electrical system; whether too slow (bradycardia), too fast (tachycardia), or an irregular heartbeat.  Cardiac arrhythmias in severe cases can cause undue stress on the heart if not corrected.

Heart failure occurs when the heart becomes too damaged to properly function. It may not pump adequately, causing organs to not receive enough oxygen to function efficiently. 

Symptoms of Various Heart Disease Conditions

Here are some of the symptoms for each heart related disease. If any of these symptoms come up, go see a doctor. These diseases are life threatening and should be taken seriously. If one has questions, got see a doctor as well. Being informed is the first way to prevent these types of diseases.

For Ischemic Heart Disease, there are a couple standout symptoms that should make a patient go see a doctor immediately. Those are fast heart rate, shortness of breath, and chest pain. These symptoms should not be ignored. Some other symptoms include sweating and nausea. For hypertensive heart disease, some symptoms too look out for are chest pain, pain in the neck, arms or shoulders, loss of appetite, and a persistent cough. These signs might come on gradually and when that happens it can be hard to notice them. Also tightness in the chest area, ankle or feet swelling, and heavy sweating can also be signs of this terrible disease.

Rheumatic heart disease has a signs and symptoms that very noticeable and those are a rash with pink rings or lines and multiple-joint inflammation. There is also the pain in the chest or joints, fatigue, fever, inability to exercise, and a fast heart rate. For Inflammatory heart disease symptoms there are only a few those were fever, shortness of breath, an achy feeling in the chest, a fever, and joint pain and swelling.

            Cardiac arrhythmias is also a serious heart disease and the symptoms include pain in the chest, dizziness, fainting, lightheadedness, shortness of breath, and palpitations of the heart. If one does not know what palpitations of the heart means, it is just when it feels like one’s heart is beating too fast or heard, or like it is skipping a beat. Congenital heart disease symptoms include a murmur or abnormal heart rhythm, shortness of breath, and swelling.

            The last heart disease talked about was heart failure. This is the type that everyone assumes with heart attacks. The symptoms include pain in the chest area, dry cough, dizziness, fatigue, water retention, bloating, and excess urination. Again if any of these symptoms occur or if one thinks they are occurring, don’t hesitate and go see the doctor. These symptoms might not sound serious but they certainly can become very serious. Below is a picture of a map of the United States and it shows that throughout the years, some states have been reducing heart diseases while others like the southern states have had an increase in the number of heart diseases. 

Risk Factors for Heart Related Disease

Several medical conditions can increase your risk for heart disease including high blood pressure which is a medical condition that occurs when the pressure of the blood in your arteries and other blood vessels is too high. The high pressure, if not controlled, can affect your heart and other major organs of your body, including your kidneys and brain. Another condition that can increase your risk of heart disease is high cholesterol. Cholesterol is a waxy, fat-like substance made by the liver or found in certain foods. If we take in more cholesterol than the body can use, the extra cholesterol can build up in the walls of the arteries, including those of the heart. This leads to narrowing of the arteries and can decrease the blood flow to the heart, brain, kidneys, and other parts of the body. Diabetes Mellitus is another medical condition that may increase your risk of developing a heart related disease. Your body needs glucose for energy. Insulin is a hormone made in the pancreas that helps move glucose from the food you eat to your body’s cells. If you have diabetes, your body does not make enough insulin, cannot use its own insulin as well as it should, or both. Diabetes causes sugars to build up in the blood. The risk of death from heart disease for adults with diabetes is two to four times higher than adults who do not have diabetes.

There are several lifestyle risk factors that can increase your risk of heart disease. These are risk factors that can be controlled with a healthy lifestyle. Eating an unhealthy diet is one example such as eating foods high in saturated fat, trans fats, sodium and cholesterol. Physical inactivity, such as not getting the recommended 30 minutes of exercise daily to reduce risk of heart disease. The previous two can lead to obesity which can then lead to high blood pressure, high cholesterol and diabetes mellitus which all increase risk of heart disease. Alcoholism as in consuming too much alcohol can lead to high blood pressure and high cholesterol, which can then increase risk of heart disease. Tobacco use is another risk factor that can be modified by leading a healthy lifestyle. Tobacco use can damage heart muscle and blood vessels leading to heart disease.

There are also risk factors for heart disease that cannot be controlled such as your age, sex, heredity and family history and race and ethnicity. Heart disease risk increases with age. Men and women alike have increased risk for heart disease but symptoms and severity of heart related conditions may present differently and at different ages. Family history of heart disease increases your risk of heart disease along with increasing factors such as high blood pressure and high cholesterol. Non-Hispanic blacks, Mexican Americans and American Indians have higher prevalence of risk factors such as diabetes and high blood pressure, which increases risk for heart disease.

Genetic Predisposition

Cardiovascular disease, another name for heart disease, is one of the leading causes of mortality in nearly all countries of the world. Risks for developing this disease include gender, age, tobacco use, blood pressure, cholesterol levels, weight, and family history. There are many tests that physicians, and other health professionals alike, utilize to screen for certain genetic susceptibility. At this point in time, most of these tests are aimed at screening for single-gene disorders of the heart, with most aiming towards detection of familial hypercholesterolemia (L. Claassen et. al, 2012). It is known that individuals with a genetic predisposition, or familial history, have a higher risk of developing CVD and heart disease, a less healthy lifestyle, and believe that medications are more beneficial than modifying their lifestyle factors (L. Claassen et al, 2012). It is important to take this information into consideration when one has parents, grandparents, etc. with a history of heart disease.

A study done in Greece looked at the correlation between heart disease and a genetic risk score. The researchers looked at genotypes of 494 cases of CVD. Of those cases, the genetic risk score (GRS) was 1.74 times higher than those with no genetic risk factors for developing heart disease. This research is important to note before getting into details involved in the health history at the doctor’s office. To understand what one’s primary care doctor is saying regarding their risk of developing heart disease, he/she must first comprehend that if they have a familial history, they are automatically more at risk (at least 1.74 times higher) than those who do not have a family history of CVD (N. Yiannakouris et. al, 2012).

First, when having one-on-one visits with your health care provider, it is important to notify your primary care physician that you have a history of heart disease in your family. Questions such as, “Did your grandfather have a stroke?” or “Did your father have a heart attack?” may be brought up. Although these may seem odd, it is important that these questions be answered thoroughly and accurately, because questions like these are important in determining one’s risk for developing heart disease. Even if you do not know your grandfather or grandmother’s history, you can begin with your immediate family—father and mother, brothers and sisters. It is also helpful to know his/her ages if or when they developed this disease.

Next, patients are going to frequently ask, “What can I do about it if my family has a history of heart disease?” It is important to note that we, as humans, cannot change our genes. Patients with heart disease, or those who have a genetic history of heart disease,  just have to work around their genes and try to modify our risk factors as much as possible. Modifying one’s diet, exercising, and avoiding tobacco are all great ways to change one’s environment.

            Also, there are many other genetic factors involved with heart disease to be aware of. For example, if a patient is of African-American descent, he/she is automatically at a higher risk. There is genetic history for African-Americans to have higher blood pressure, a higher rate of diabetes, and higher risk for stroke. It is also shown that Hispanics have higher blood pressure and cholesterol levels. If patients are of this decent, it is imminent that modifiable risk factors (smoking, exercise, diet) are kept under control at an early age in order to decrease their chances of developing heart disease (“Family History and Heart Disease,” 2015).

            Conclusively, it was found that having a family history of CVD, or heart disease, is an important risk factor in developing heart disease. By modifying certain risk factors, such as not smoking, avoiding alcohol, exercising, and having a proper diet, patients can “work around” their genes to try to make their risk for developing the disease decrease.            

Here is a YouTube link that explains the genetic effect on heart disease and proves that, even when you have a genetic risk, there are still important modifiable risk factors that can decrease your risk of developing heart disease: 

Age Differences

As many of us know, the aging process can definitely take a toll on our body. Some of the age-related changes include: memory loss, weakened bones, arthritis, presbyopia (decreased sight) cataracts, glaucoma, other retinal disorders, presbycusis (hearing loss), slowing of the GI system, incontinent of urine, tooth decay, loss of skin elasticity, and an overall decrease in functional abilities. It is important to note that, as we age, our body’s organs become “played out” in a sense. This includes the heart, one of the most vital organs of the body.

            As the heart begins to age, so do the vessels of the body. These vessels can become more rigid, making it harder for blood to flow through them. Through life processes, fatty deposits (plaque) also develop along the endothelium in the walls of the arteries, which also slows blood flow to and from the heart. Other heart related changes with age are as follows: The heart tends to get thicker, especially the left ventricle. Heart valves, the mitral and tricuspid, may become thickened, or even leaky. The heart rate also changes. Medications, anxiety, stress, lack of physical activity, illness, injury, and infection all affect the heart’s pumping ability throughout the aging process as well (“Age-related Heart Disease,” 2016). Having narrow vessels due to hardening and plaque formation, along with other risk factors (smoking, diabetes, hypertension), all add up to increase one’s risk for heart disease and put the individual at a greater risk of having a heart attack.

            Age is one of the number one risk factors for heart disease. The age differences related to the development of heart disease are also based on gender, which will be discussed in further detail in the next passage. For men, the development of heart disease occurs much earlier than it does in women. Once again, this will be discussed later as to why this occurs. For men, the typical ages seen in the development of heart disease range from 35-65. This large gap can be due to many factors, including environment (both work and home), stress, and certain genetic attributions. Women, on the other hand, tend to have heart attacks after menopause. These ages for females, depending on their postmenopausal state, are usually after 60.

            Problems associated with heart disease throughout the aging process include angina (chest pain), atherosclerosis, coronary artery disease, congestive heart failure, hypertension (high blood pressure), orthostatic hypotension, and atrial fibrillation (rapid, irregular heart beat) (“Age-related Heart Disease,” 2016).         

            However, despite any age, it is important to know that heart disease can develop at any point in time, especially if certain risk factors (genetic predisposition, smoking, diabetes, etc.) are present. Patients cannot expect to just have a development of heart disease between the ages of 35-70. Heart disease is a progressive condition that needs to be prophylactically treated early. Things that patients can do to assist in the age-related changes involved in heart disease include, but are not limited, to: exercising, smoking cessation, low-fat and low-sodium diet, yearly physical examinations including blood pressure and cholesterol checks, and taking medications, if prescribed, as ordered by the physician (“Age-related Heart Disease,” 2016).

Gender Differences

           Heart disease is one of the single most causes of death for both women and men in the United States. Women typically have a lower mortality rate than men when it comes to heart disease, so therefore heart disease has been considered a “male disease.” It is strange, however, that the reasons for the gender differences in heart disease are not quite known. Scientists, however, have hypothesized that there are differences in the physiology of the body between men and women. Also, it is noted that estrogen, which is higher in women, tends to have cardioprotective effects. When admitted to the hospital for a heart attack or chest pain, women, contrarily to men, undergo less types of heart surgeries. Tests for the diagnosis of heart disease are also performed less on women as well (Maserejian, N.  et. al, 2009).

           Heart disease tends to develop at least 10 years later in women than in men. However, even though it is seen later, heart disease is still one of the top causes of death in women. It is assumed, as stated above, that the exposure to estrogen during women’s fertile years delays the hardening of the blood vessels and other clinical manifestations. Nevertheless, signs and symptoms of atherosclerosis can still appear in women before they reach menopausal years. However, the plaques that cause atherosclerosis tend to become more “vulnerable” after the menopausal years. Other risk factors, such as gestational diabetes and hypertension during pregnancy, also increase a women’s chance of developing heart disease later in life (Maas & Appelman, 2010).

            When looking at the male perspective, heart disease is still a major killer—causing 1 in 4 deaths among men. It is important to remember that heart disease involves many other things besides just the narrowing of the arteries. It also includes heart attack, dysrhythmias, heart failure, valve disease, heart muscle disease, pericardial disease, aorta disease, and vascular disease. Men are two to three times more likely than women to have implanted defibrillators (pacemakers) to prevent a heart attack. It is important to note some of the pathophysiology at this point. The heart is divided between left and right sides, with ventricles and aortas. The right ventricle pumps blood to the lungs and brings back oxygen. It is noted that the right ventricle is larger in men than it is in women. Men differ from women in that their primary reason for having heart disease is having atherosclerosis, or a cholesterol-filled vessel. Women primarily develop small vessel occlusions rather than the large ones seen in males (Maas & Appelman, 2010).

             Conclusively, it is important to recognize the pathophysiology behind the gender differences associated with heart disease in males and females. By looking into this, health care providers can have a greater understanding of why the differences are occurring and what can be done to prevent them. Regardless of sex, it is important to know the risk factors for developing heart disease and to schedule regular health care checks in order to make sure that his/her’s modifiable risk factors are under control.