Brigham and Women's Cardiovascular Associates at Care New England

Diseases and Conditions

Brigham and Women’s Cardiovascular Associates at Care New England provides innovative, personalized, and compassionate care of the highest quality for the entire array of cardiovascular diseases and conditions.

From more common cardiovascular conditions, such as coronary artery disease, vascular disease, and heart rhythm disorders, to lesser-known diseases, we have the expertise and advanced technologies necessary to provide the best health care to patients.

Diseases and Conditions We Treat

Tests and Procedures

The staff at Brigham and Women’s Cardiovascular Associates at Care New England are among the most renowned. We offer highly integrated and comprehensive care with specialists in cardiovascular medicine, cardiac surgery, and vascular surgery working together to provide a collaborative and personal experience.

The specialized procedures consist of a variety of preventative, interventional, and non-invasive methods of care. These may require tests, clinical evaluation, advanced imaging, devices, or advanced cardiac care nursing support.

Tests

Some tests may include:

  • Electrical cardioversions
  • Exercise treadmill testing
  • Holter/event monitoring
  • Nuclear stress imaging
  • Stress echocardiography
  • Transthoracic and transesophageal echocardiography
  • Vascular imaging

Clinical Evaluation

We have consultative cardiology coverage 24 hours a day, seven days a week, 365 days a year. Our team of Care New England cardiologists also offers inpatient evaluations, outpatient evaluations at one of our convenient sites, preoperative assessment, diagnostic testing review, and second opinions for complex cases.

Advanced Imaging

We offer an array of advanced imaging modalities, including:

  • Advanced vascular ultrasound imaging
  • Cardiac CT technology to identify the coronary disease and coronary calcium build-up
  • Transesophageal echocardiography and vascular ultrasound imaging, to identify complex heart valve disease

Cardiac Arrhythmia

This service, led by Bruce Koplan, MD, provides a full range of consultative and procedural services focused on the heart's electrical system, including:

  • Ablations
  • Cardiac Catheterization 
  • Cardiac resynchronization therapy devices
  • Defibrillators
  • Electrophysiology studies
  • Pacemakers

Frequently Asked Questions
About Cardiac Diseases

Adult Congenital Heart Disease

From diagnosis and treatment to surgery and ongoing care, we offer comprehensive care for anyone with congenital heart disease.

If you are an adult with congenital heart disease, getting the proper care is vital to your well-being. You can receive a consultation, a meeting, or treatment with Brigham and Women’s Cardiovascular Associates at Care New England, no matter your condition, with the team led by Fred Wu, MD.

What is Adult Congenital Heart Disease?

Congenital heart defects occur during fetal development. For the heart to develop properly, a series of genetically and environmentally determined steps have to take place. If one of these steps doesn’t happen, a defect develops. The results can intensify over someone’s lifetime.

Congenital heart disease is the most common birth defect. According to the American Heart Association, about 1% of people born in the United States has a congenital heart defect.

Types of Congenital Heart Disease
  • Atrial septal defects
  • Coarctation of the aorta
  • Tetralogy of Fallot
  • Valve stenosis or regurgitation
  • Ventricular septal defects
Risk Factors

Someone should consider care for congenital heart disease if they:

  • Had heart surgery as a child
  • Have a cardiologist but are looking for more specialized care
  • Living with adult congenital heart disease and are having symptoms
Symptoms

There are many types of congenital heart disease, varying in severity and consequence. For many congenital heart defects, there are few or no symptoms. Severe defects, however, often cause symptoms at any age. These symptoms may include:

  • Abdominal swelling
  • Chest pain
  • Cough
  • Cyanosis (bluish skin, lips, and fingernails)
  • Fatigue
  • Fluid buildup in the lungs
  • Heart failure
  • Heart murmurs
  • Heart palpitations (rapid or skipped beats)
  • Lightheadedness
  • Poor circulation
  • Rapid breathing or shortness of breath
  • Swelling in the lower extremities or stomach or neck
Diagnosis

Severe defects may be diagnosed before or soon after birth, but some may not be diagnosed until much later in life or never detected.

Along with a careful physical examination and evaluation, a cardiologist may order one or more of the following tests or procedures:

  • Cardiac catheterization
  • Cardiac magnetic resonance imaging (MRI)
  • Cardiac ultrasound (Echocardiography)
  • Chest X-ray
  • Electrocardiogram
  • Exercise testing
  • Pulse oximetry
Treatment

Medications

  • Antiarrythmics
  • Beta Blockers
  • Digoxin
  • Diuretics
  • Vasodilators

Minimally Invasive Catheter Procedures

  • Atrial septal defect - A catheter with a small device attached at the end is placed inside the heart. When the defect begins to affect the heart, the device assists in causing natural tissue to grow in and around the device to improve heart function. 
  • Coarctation of the aorta - A catheter with a deflated balloon is placed inside the aorta. The balloon is inflated to stretch the aorta and to lessen a blockage. A stent (cylindrical metal tube) may be inserted to keep the area open. 

Surgery

Surgery may be recommended for the following reasons:

  • Expand arteries
  • Patch holes in the heart
  • Transplantation
  • Valve repair or replacement

Cardiac surgeons offer a variety of surgical techniques, which include:

  • Minimally invasive heart surgery
    • Mini sternotomy (through breastbone)
    • Mini thoracotomy (through ribs)
  • Open heart surgery
    • Sternotomy (large incision in chest)
    • Thoracotomy (incision in ribs in back)
Advanced Valvular Heart Disease

Brigham and Women’s Cardiovascular Associates at Care New England offers expert care for any condition affecting your heart’s valves or chambers. We use the latest treatments, including minimally invasive techniques and procedures.

The Care New England Advanced Valvular and Structural Heart Disease Clinic at Kent Hospital features a local heart care team lead by Cardiologist Alice Kim, MD, and Cardiothoracic Surgeon Tsuyoshi Kaneko, MD, who are both affiliated with Kent Hospital and Brigham and Women's Hospital.  Dr. Kim and Dr. Kaneko evaluate and manage patients who have advanced valvular disease and structural heart disease with the opportunity to have expert care for these complex conditions in a setting close to home.

Office visits, imaging studies, and diagnostic testing are performed locally in Rhode Island. Patients who require valve interventions such as transcatheter therapies or minimally invasive or traditional cardiac surgery at Brigham and Women’s Hospital will have the convenience of receiving pre and post-procedure care locally.

This unique link between the cardiologists at CareNew England and the team at the Heart and Vascular Center at Brigham and Women’s Hospital has widely advanced the options available for patients in Rhode Island who need cardiac care. 

We believe in the practice of patient-focused and evidence-based care delivered by a regional heart team of general cardiologists, cardiothoracic surgeons, interventional cardiologists, cardiac imaging specialists, and cardiac anesthesiologists.  We work together with the patient and their families in shared decision-making for optimal patient care, safety, and outcomes. 

Conditions Treated
  • Atrial septal defect
  • Mitral valve prolapse
  • Patent foramen ovale
  • Valve failure
    • Bioprosthetic aortic valve insufficiency
    • Bioprosthetic aortic valve stenosis
    • Prosthetic paravalvular leak
  • Valve regurgitation (leaky valves)
    • Aortic
    • Mitral
  • Valve stenosis (narrowed valves)
    • Aortic
    • Mitral

What is heart valve disease?

Heart valve disease involves two main types of conditions: regurgitation and stenosis.

  • Regurgitation – The valve does not completely close, causing the blood to flow backward. This forces the heart to pump more blood on the next beat, making it work harder.
  • Stenosis - The valve opening becomes narrowed, which limits the flow of blood. This causes the heart to pump blood with more force in order to move blood through the narrowed valve.

Heart valves can develop in both conditions at the same time. The consequences for the heart can be severe. Blood will not pump properly through the body.

Risk Factors
  • Aging
  • Congenital birth defect
  • Heart attack
  • History of rheumatic fever
  • Infection
  • Myxomatous degeneration
  • Syphilis
Symptoms
  • Abdominal pain
  • Chest pain
  • Dizziness
  • Fatigue
  • Low blood pressure
  • Palpitations
  • Shortness of breath
Diagnosis
  • Cardiac catheterization
  • Cardiac ultrasound (echocardiography)
  • Chest X-ray
  • Electrocardiogram
Procedures and Treatment
  • Balloon mitral valvuloplasty – Widen narrowed heart valves using a catheter.
  • Catheter-based repair of prosthetic paravalvular leaks using devices tailored to someone’s valve mechanics.
  • Closure of atrial septal defect (ASD) and patent foramen ovale (PFO).
  • Complex valve surgery to repair or replace the aortic, mitral, tricuspid, or pulmonary valve. We offer minimally invasive surgery, giving you a quicker recovery and a shorter hospital stay.
  • Left atrial appendage closure – Implanting a closure device, which can reduce the risk of stroke and other complications
  • Transcatheter mitral valve repair – Using a clip-like device to repair the mitral valve, ensuring blood continues to move through the heart.
  • Transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI - A minimally invasive technique to replace the aortic valve with new tissue or a biologic valve. It is performed using a catheter and small incisions.

What are the types of replacement valves?

  • Biologic valves are made from animal tissue, such as from a pig or cow, or a donated human heart. The animal tissue valves are sterilized and chemically treated for human use and then sewn onto a frame (stented) or left intact. A blood-thinning medication is not required but may be needed immediately after surgery.
  • Mechanical valves are made of graphite and pyrolytic carbon, or other synthetic materials. Mechanical valves may require blood-thinning medications to avoid blood clots forming on the valve.

What are the repair or replacement procedures?

  • Aortic root replacement
  • Aortic valve replacement 
  • Homograft mitral valve surgery
  • Leaflet repair
  • Ring annuloplasty
  • Root-enlarging procedure
  • Stented biological aortic valve replacement
  • Stentless biological aortic valve replacement
  • Valve-sparing root surgery
  • Tricuspid valve surgery

Minimally Invasive Surgery Procedures

  • Lower sternotomy
  • MitraClip
  • Percutaneous mitral valvuloplasty (widening of the valve)
  • Percutaneous aortic valvuloplasty
  • Transcatheter aortic valve replacement (TAVR)
  • Upper mini-sternotomy 
Aneurysm and Aortic Disease

If you or a loved one have an aortic aneurysm or another condition affecting your aorta, the boy’s largest blood vessel, it’s important to get timely treatment to prevent life-threatening complications.

Aortic Conditions We Treat
  • Aneurysms of the aorta, including abdominal and thoracic aortic aneurysms. A thoracic aortic aneurysm occurs in the chest, while an abdominal aortic aneurysm occurs in the abdomen. 
  • Genetic conditions that increase the risk for aortic disease, including bicuspid aortic valve disease, Marfan Syndrome, Loeys-Dietz Syndrome, Ehlers-Danlos Syndrome and Turner Syndrome.
  • Aortic dissection, a tear in the inner layer of your aorta. When blood gets behind the tear, it further separates the aorta’s inner and middle layers, increasing the chances of blocked blood flow, aortic rupture or other complications.
  • Aortic rupture, a breaking or bursting of the aorta that can cause extensive, life-threatening internal bleeding.
  • Aortic coarctation, a narrowing of the aorta that causes your heart to work harder to pump blood through the narrowed section. Aortic coarctation is usually something you’re born with, and it can range from mild (slightly narrow) to severe (very narrow).

What is an aneurysm?

  • An aneurysm is a bulging, weak area in the wall of a blood vessel. This weakened section is at risk of tearing (aortic dissection) or bursting (aortic rupture), which can lead to internal bleeding or other complications. Treating an aortic aneurysm early lowers the chance for a tear or rupture.

An aneurysm may be found in many areas of the body, such as: 

  • Aorta (aortic aneurysm)
  • Blood vessels in the legs (femoral, iliac, or popliteal aneurysm)
  • Brain (cerebral aneurysm)
  • Intestines
  • Kidney
  • Neck
  • Spleen

 The most common type of aneurysm is in the aorta. The aorta carries oxygenated blood from the heart to the rest the body.

What causes an aneurysm?

An aneurysm may be caused by factors that result in the breakdown of the artery wall. Atherosclerosis (hardening of the arteries) may be a cause.

Other causes of aneurysms are related to where they occur. Examples may include:

Risk Factors

  • Age
  • Atherosclerosis
  • Congenital heart disease
  • Diabetes
  • Family history
  • Gender
  • Genetic factors
  • Giant cell arteritis
  • Head injury
  • High cholesterol
  • High blood pressure
  • Infection
  • Injury
  • Obesity
  • Pregnancy
  • Smoking
Symptoms

Aneurysms may have no symptoms. If there are symptoms, they will depend on the location of the aneurysm in the body.

Some include:

  • Pain in the abdomen, chest, groin, legs, or lower back
  • Headache
  • Nausea
  • Vomiting
  • Dizziness or loss of consciousness
  • Pulsing artery in the groin or in the back of the knee
  • Sores on lower extremities
Diagnosis
  • Arteriogram (angiogram) - X-ray image of the blood vessels used. Dye is injected through a thin tube placed in an artery. This dye will make the blood vessels visible on the X-ray.
  • CT scan - X-rays and computer technology to make images of the body that are more detailed than traditional X-rays.
  • Echocardiogram - Sound waves are recorded on an electronic sensor that creates a picture of the heart and heart valves and how they are functioning.
  • MRI - Magnets, radio waves, and a computer to make detailed images of organs and other parts inside the body.
  • Ultrasound - High-frequency sound waves and a computer are used to create images of blood vessels, tissues, and organs and how they interact.
Procedures and Tests
  • Emergency repair of aortic dissection or rupture.
  • Endovascular aortic repair – A catheter is used to place a stent (tube) within the abdominal section of the aorta and seal the aneurysm off from the inside.
  • Open-heart surgery to repair aneurysms when minimally invasive approaches aren’t an option.
  • Thoracic endovascular aortic repair – A catheter is used to place a stent (tube) within the thoracic (chest) section of the aorta and seal the aneurysm off from the inside.
  • Clinical trials to provide access to minimally invasive repair techniques that aren’t widely available elsewhere.

Other alternatives include:

  • Aortic root replacement - Removing the diseased portion of the aortic root and reconstructing it using a custom-designed synthetic tube.
  • Ascending aortic replacement – Removing the diseased section of the ascending aorta and reconstructing it with a custom-designed synthetic tube.
  • Aortic arch reconstruction or replacement – Removing the diseased section of the aortic arch and reconstructing it with a custom-designed synthetic tube.
  • Aortic coarctation repair- Removing the narrowed portion of the aorta and replacing it with an open synthetic tube.

 

Congestive Heart Failure/Cardiomyopathy

If you have advanced heart failure, you can manage it with world-class care from Brigham and Women’s Cardiovascular Associates at Care New England. From congestive heart failure to pulmonary hypertension, our comprehensive program treats every heart failure condition. Here’s what you can expect from our team, led by Garrick Stewart, MD:

Advanced Treatment Options

From medication and lifestyle management to surgery and heart transplant, Care New England offers every type of treatment you need to manage your heart failure. Our care offerings include:

  • Advanced heart transplant expertise and evaluations
  • Bypass surgery
  • Heart valve surgery
  • Implantable heart devices

What is congestive heart failure and cardiomyopathy?

Congestive heart failure is when the heart fails to sufficiently pump oxygenated blood. The heart continues to pump, but not as efficiently as a healthy heart.

Cardiomyopathy, which describes any disorder that affects the heart muscle, also can be a contributing cause of heart failure.

Three forms of cardiomyopathy are:

  • Dilated cardiomyopathy, the most common type of cardiomyopathy, refers to an enlarged heart with an impaired ability to function properly.
  • Hypertrophic cardiomyopathy is a rare condition that involves thickening of the left ventricle and stiffening of the heart, due to a genetic mutation in key proteins involved in heart muscle contraction.
  • Restrictive cardiomyopathy occurs when the heart muscle becomes stiff due to progressive fibrosis or accumulation of abnormal substances and is unable to properly fill with blood.
Risk Factors
  • Cancer therapy-associated heart failure
  • Congenital heart disease or defects
  • Coronary heart disease
  • Diabetes
  • Endocarditis
  • Genetic diseases
  • Heart rhythm disorders (cardiac arrhythmias)
  • Heart valve disease
  • High blood pressure
  • Pregnancy-associated heart failure and peripartum cardiomyopathy
  • Previous heart attacks
Symptoms
  • Abdominal Pain
  • Loss of appetite
  • Nausea, abdominal pain, and loss of appetite
  • Persistent cough
  • Shortness of breath
  • Weakness and fatigue
  • Weight gain or a gain of more than two pounds overnight or five pounds in a week
Diagnosis

After an evaluation from a physician, a cardiologist may order one of these tests or procedures:

  • Cardiac Biopsy
  • Cardiac catheterization
  • Cardiac CT
  • Cardiac MRI
  • Cardiac Ultrasound (Echocardiogram)
  • Chest X-ray
  • Electrocardiogram
  • Nuclear scan
  • Positron Emission Tomography
  • Standard Exercise Tolerance Test
Treatments and Tests

Lifestyle Changes

  • Alcohol elimination
  • Blood pressure control
  • Fat and salt intake reduction
  • Smoking cessation
  • Weight loss

Medication

  • Angiotensin converting enzyme inhibitors
  • Agiotensin II receptor blockers
  • Alpha blockers
  • Antiarrhythmics
  • Antibiotics
  • Antihyperlipidemics
  • Anti-inflammatory medications
  • Antiplatelet medications
  • Antiproliferative agents
  • Beta-blockers
  • Bile acid sequestrants
  • Calcium-channel blockers
  • Cilostazol
  • Digoxin
  • Diuretics
  • Endothelin receptor antagonists
  • Fibrates
  • Nicotinic acid
  • Non-steroidal anti-inflammatory drugs
  • Potassium-channel blockers
  • Prostacyclin analogues
  • Sodium-channel blockers
  • Statins
  • Thrombolysis
  • Vasodilators

Procedures

  • Cardiac ablation
  • Cardiac resynchronization therapy
  • Implantable cardioverter defibrillator
  • Percutaneous catheter-based interventions
  • Stents
  • Percutaneous transluminal coronary angioplasty (
  • Intra-aortic balloon pump
  • Intravenous Ultrasound
  • Oral and intravenous medications
  • Percutaneous ventricular assist device

Surgery

  • Aortic valve repair and replacement
  • Coronary artery bypass grafting
  • Ventricular assist device
  • Left ventricular assist device
  • Heart transplantation
Heart Rhythm Disorders

For personalized, comprehensive care of your irregular heartbeat (called an arrhythmia), the cardiac physicians of Brigham and Women’s Cardiovascular Associates at Care New England will develop a treatment plan that’s right for you.

From offering dedicated care for atrial fibrillation to the monitoring of your device, we combine deep clinical experience with expertise in the latest technologies.

Our experts are adept at providing exceptional care to patients with irregular heart rhythms, heart palpitations, and rapid heartbeats.

What is a heart rhythm disorder?

 Heart rhythm disorders (arrhythmias) are atypical heartbeats that cause the heart to beat too fast (tachycardia), too slow (bradycardia), or irregularly, which is caused by a problem with the heart’s electrical system.

Types of heart rhythm disorders
  • Atrial fibrillation - Very irregular and fast contraction of the atria.
  • Atrial flutter 
  • Paroxysmal supraventricular tachycardia - Fast heart rate that begins and ends suddenly
  • Premature beats - Fluttering in the chest.
  • Supraventricular arrhythmias - Tachycardias that start in the atria or atrioventricular node.
  • Ventricular arrhythmias - Begin in the ventricles, the heart's lower chambers.
  • Ventricular tachycardia – Fast beating of the ventricles
  • Ventricular fibrillation - Ventricles quiver.
  • Bradyarrhythmia - Heart rate is slow and decreases blood flow, which can cause fainting.
Risk Factors
  • Alcohol
  • Caffeine
  • Congenital heart disease
  • Coronary artery disease
  • Diabetes
  • Drugs and supplements
  • Genetics
  • Heart valve disorders
  • High blood pressure (hypertension)
  • Obesity
  • Sleep apnea
  • Smoking
  • Thyroid problems
Symptoms
  • Chest pain or tightness
  • Dizziness or lightheadedness
  • Fainting
  • Low blood pressure
  • Palpitations
  • Shortness of breath
  • Weakness or tiredness
Diagnosis

After an evaluation from a physician, a cardiologist may order one or some of the following tests or procedures:

  • Cardiac magnetic resonance imaging (MRI)
  • Cardiac ultrasound (Echocardiography)
  • Electrocardiogram
  • Electrophysiology studies
  • Event monitor
  • Exercise stress test
  • Holter ECG monitor
  • Implantable loop recorder
  • Transesophageal echocardiogram
Procedures and Treatment

Lifestyle Modifications

  • No alcohol or caffeine
  • Reduce stress

Procedures

  • Antiarrhythmic medications
  • Cardiac resynchronization therapy
  • Cardioversion –Electrical current through the chest wall to the heart through special electrodes or paddles that are applied to the skin of the chest and back while the patient is under anesthesia. The purpose is to interrupt the abnormal electrical pulses in the heart and restore a normal heartbeat. This procedure does not damage or injure the heart.
  • Catheter ablation –Non-surgical procedure using heating or cooling ablation where a wire or tube is inserted through a vein in the leg and into the heart.
  • Implantation of cardiac pacing devices – Pacemakers and implantable cardioverter-defibrillators.
  • Laser and mechanical lead and device extraction – Removal of a damaged device or its wires when they are causing scarring or infection
  • Surgical and minimally invasive surgical ablation – Creating minor lines or grooves on the heart that redirect irregular electrical movement.
  • Left atrial appendage closure 
  • antiarrhythmic medications
  • Transvenous lead extraction
Pulmonary Hypertension

This service, led by Fred Wu, MD, provides consultation for patients with pulmonary hypertension and symptoms that might require advanced medical or interventional management. This clinic also serves adult patients with a history of congenital heart disease requiring local follow-up.

Brigham and Women’s Cardiovascular Associates at Care New England brings together pulmonary and critical care medicine physicians, cardiothoracic surgeons, interventional cardiologists, and cardiovascular medicine clinicians who have extensive experience in the diagnosis of implementation of treatment for all forms of pulmonary vascular disease and hypertension.

What is pulmonary hypertension?

Pulmonary hypertension is high blood pressure in the blood vessels of the lungs. It occurs when the blood vessels that go through the lungs become thicker, constrictor becomes blocked. This leads to increased pressure in those vessels, which causes the heart to work harder to pump blood through the lungs. This weakens and enlarges the heart and its proper functions.

Risk Factors

 While the exact cause of pulmonary hypertension is unknown, there are a number of factors that may contribute, including:

  • Connective tissue disease
  • Family history
  • HIV
  • Liver disease
  • Lung disease
  • Valvular or hypertensive heart disease
Symptoms
  • Fatigue or tiredness
  • Shortness of breath, or dyspnea

Other common symptoms include:

  • Ankle or leg swelling, which is commonly called edema
  • Chest pain or pressure during activity commonly called angina
  • Cough
  • Dizziness
  • Fainting
  • Fast heart rate, or tachycardia
  • Heart palpitations
Diagnosis

Pulmonary hypertension is rarely discovered during a routine medical examination, and it can be confused with other conditions that affect the heart and lungs.

Diagnosis typically is a process of exclusion. Diagnostic procedures may include:

  • Cardiac catheterization
  • Cardiac ultrasound (Echocardiography)
  • Electrocardiogram
  • Ventilation/Perfusion lung scan to detect a blood clot
  • Pulmonary function tests 
    • Diffusion capacity
    • Lung volume
    • Spirometry
Treatment and Procedures:

Medication

  • Calcium-channel blockers
  • Digoxin
  • Diuretics
  • Endothelin Receptor Antagonists
  • Intravenous treatment
  • Oxygen therapy
  • Phosphodiesterase Inhibitors
  • Prostacylin Analogues
  • Selective IP Receptor Agonists
  • Soluable Guanylate Cyclase Stimulators
  • Subcutaneous treatment
  • Warfarin to prevent clotting
Heart Attack (Myocardial Infarction)

When a heart attack assaults the body, every second counts. Care New England is a regional leader in cardiac care and can provide the rapid and advanced response needed to provide life-saving care to those suffering from a heart attack.

If you or a loved one is experiencing symptoms of a heart attack, call 911 immediately.

What Causes a Heart Attack?

A heart attack occurs when the flow of blood to a portion of the heart is blocked suddenly. With coronary artery disease, a buildup of a fatty substance, which is called plaque, within artery walls leads to the development of atherosclerosis, or the stiffening and narrowing of the arteries. When a piece of plaque breaks or splits off, a blood clot forms inside the artery. That stops blood flow to that portion of the heart.

Risk Factors
  • Diabetes
  • Family history
  • High blood pressure (hypertension)
  • High LDL cholesterol
  • Inactive lifestyle or lack of exercise
  • Obesity
  • Smoking

A heart attack can occur at any age but the risk increases over time.

Symptoms
  • Sudden pain or discomfort in the chest
  • Pain in the arms, jaw, neck, shoulders, or upper abdomen
  • Shortness of breath

Not all heart attacks come on abruptly. Symptoms may be different for some individuals, including involving indigestion.

Learn more about how to detect a heart attack >>

How is a heart attack treated?

  • Asprin or clopidogrelMedication to prevent more blood clotting.
  • Beta-blockersMedication to help the heart muscle rest, decrease blood pressure, and prevent an irregular heartbeat.
  • Fibrinolytic therapy – Intravenous medication to dissolve the blood clot
  • Intravenous therapy -Medicines such as nitroglycerin and morphine are given through a tube into a vein.
  • Oxygen therapy
  • Pain medication
  • Statins – Lower cholesterol

You may also need other procedures to restore blood flow to the heart. These may include: 

Percutaneous coronary intervention or coronary angioplasty

This procedure opens up a blocked or narrowed coronary artery by using a small balloon inserted with a catheter and then inflated inside the blocked artery, which helps open the blocked area. The blockage can also be cut out or destroyed using other methods. A special tube called a stent may also be placed inside the artery to help it open.

Coronary artery bypass graft

This surgery is also called bypass surgery. It is often done in people who have chest pain (angina) and severe coronary artery disease that can't be treated with percutaneous coronary intervention.

During the surgery, the surgeon makes a bypass to let blood flow around the blockage. This is done by grafting a piece of a vein from the aorta to the coronary artery beyond the blocked part of the artery. A healthy blood vessel is used for the graft and usually is taken from:

  • Internal thoracic artery in the chest
  • Radial artery in the wrist
  • Saphenous vein in the leg
Coronary Artery Disease

What is coronary artery disease?

The heart is a muscle that needs oxygen in order to function and pump blood, and it receives the oxygen it needs from coronary arteries. Blood flows easily through the artery when it is healthy, but blockages inside the arteries can cause damage. These blockages include plaque, which can be caused by issues like cholesterol buildup, high blood pressure, and high blood sugar.

The arteries are narrowed, which, when the body is under stress, such as when exercising, can cause pressure, tightness, pain in the chest or in other parts of the body.

A blocked artery occurs when plaque breaks off inside the artery, or a blood clot forms, and blocks the passageway, which causes the blood flow to stop. This is the reason why a heart attack occurs.

Coronary artery disease, or coronary heart disease, is the most common type of heart disease.

Risk Factors
  • Age
  • Diabetes
  • Excessive alcohol consumption
  • Gender
  • Family history
  • High blood pressure
  • High cholesterol
  • Smoking
Symptoms
  • Dizziness or cold sweats
  • Fatigue
  • Heart palpitations
  • Indigestion or heartburn
  • Nausea
  • Shortness of breath
  • Weight gain
Diagnosis
  • Cardiac catheterization (link to P1)
  • Cardiac ultrasound (echocardiogram)
  • Chest X-ray
  • Coronary angiogram
  • Electrocardiogram
  • Exercise Stress test
  • Nuclear Scan
Treatments and Procedures

Medications

  • Angiotensin converting enzyme inhibitors
  • Antiplatelet medications
  • Beta-blockers
  • Statins
  • Vasodilators

Procedures

  • Angioplasty
  • Artery Bypass Grafting
  • Endarterectomy
Atrial Fibrillation

What is atrial fibrillation?

Atrial fibrillation, or AFib, is the most common type of abnormal heart rhythm, or arrhythmia. A group of cells signals the heart to begin a heartbeat. This signal originates in the right atrium, which is the upper right chamber of the heart. It travels through the heart to the upper-left chamber or the left atrium and then to the pumping chambers. The heart contracts and blood is moved.

During atrial fibrillation, the signals are not regular and not organized. The blood is not being provided to the body, and blood can also pool and cause clots to form. These clots are usually found in the left atrium because of an area in the chamber where several lobes are located. These clots can be pumped to the brain and cause a stroke.

Atrial fibrillation is normally classified into three types:

  • Parosyxmal – Brief quivering or fibrillation and then stops and goes away. It may then return to normal rhythm.
  • Peristent – Treatment is used to return the heart to a regular rhythm.
  • Permanent – Even through treatment, the rhythm cannot be restored to normal.
Risk Factors

There are many causes, but some include:

  • Age
  • Congenital heart defects
  • Coronary artery disease
  • Diabetes
  • Heart failure
  • High blood pressure
  • Hyperthyroidism
  • Obesity
  • Obstructive sleep apnea
  • Pericarditis
  • Rheumatic heart disease from a Streptococcus infection
Symptoms
  • Chest pain
  • Confusion
  • Dizziness
  • Fatigue
  • Heart skipping a beat
  • Shortness of breath
  • Swelling of lower extremities
Diagnosis
  • Blood tests
  • Echocardiogram
  • Sleep study (for sleep apnea)
  • Stress testing
Treatment and procedures

Medication

  • Angiotensin converting enzyme inhibitors
  • Antiarrhythmics
  • Anticoagulant medication
  • Beta-blockers
  • Calcium-channel blockers
  • Digoxin

Procedures

  • Cardioversion
  • Catheter ablation
  • Surgery
High Blood Pressure (Hypertension)

Blood pressure is the force of blood traveling through an artery. With each heartbeat, blood is pumped from the heart and into the blood vessels. Every time the heart beats, pressure is created inside arteries as the heart contracts and relaxes.

High blood pressure occurs when the force inside the arteries is too high during the contraction or relaxation.

Complications of high blood pressure include:

  • Death
  • Heart attack
  • Heart failure
  • Kidney failure
  • Loss of eyesight
  • Stroke
Risk Factors
  • Diabetes
  • Excessive alcohol consumption
  • Family history
  • High sodium
  • Kidney disease
  • Lack of physical activity
  • Sleep
  • Smoking
  • Stimulant drugs
  • Stress
  • Weight
Symptoms

Very high blood pressure may exhibit:

  • Changes in vision
  • Chest pain
  • Headache
Diagnosis
  • Check blood pressure

    • Systolic pressure – top number is the pressure inside the artery when the heart contracts

    • Diastolic pressure- the bottom number is the pressure inside the artery when the heart is at rest

There are four ratings of blood pressure:

  • Normal – 120/80 or less

  • Elevated – Systolic 120-129 and diastolic less than 80

  • Stage 1 high blood pressure – Systolic is 130-139 or diastolic is 80-89

  • Stage 2 high blood pressure – Systolic is 140 or higher or diastolic is 90 or higher

Treatment

Lifestyle changes 

  • Exercise

  • High fiber foods

  • Limit calories and fat in food

  • Limit salt (sodium) in food

  • Limit serving sizes in food

  • Quit smoking

  • Reduce alcohol consumption

  • Reduce stress

  • Sleep

  • Weight

Medicine

  • Alpha blockers

  • Angiotensin-converting enzyme inhibitors

  • Angiotensin II receptor blockers

  • Beta blockers

  • Calcium channel blockers

  • Diuretics

Ventricular Tachycardia

What is ventricular tachycardia?

Ventricular tachycardia is a fast, abnormal heart rate. It starts in your heart’s lower chambers, called the ventricles. It is defined as a heartbeat that is three or more heartbeats in a row, at a rate of more than 120 beats per minute.

It can become life-threatening if it is sustained for more than 30 seconds. The rapid heartbeat doesn't give the heart enough time to fill with blood before it contracts again. This can affect blood flow to the rest of the body.  

Ventricular tachycardia is caused in two ways:

  • An abnormal heart circuit in the muscle is triggered
  • The muscle becomes self-activated

At Brigham and Women’s Cardiovascular Associates at Care New England, treatment is provided by some of the world's most experienced physicians in cardiac electrophysiology (the study of heart’s electrical system).

Risk Factors
  • Cardiomyopathy
  • Coronary artery disease
  • Heart valve disease
  • Sarcoidosis
Symptoms
  • Cardiac arrest
  • Chest pain
  • Dizziness
  • Fainting
  • Heart palpitations
  • Neck tightness
  • Shortness of breath
Diagnosis

To diagnose ventricular tachycardia, the heart rhythm has to be recorded. That requires an electrocardiogram, or heart activity can be monitored using a Holter monitor or diagnosed from a stress test.

Treatment and Procedures

Medicine 

  • Antiarrhythmics
  • Beta-blocker

Procedures

  • Cardiac ablation
  • Cardiac defibrillator
  • Cardiac resynchronization
  • Cardioversion
  • Transvenous lead extraction