Discover and reverse your artery disease before you have a heart attack or stroke, with the IMT test

At what age should you have your first IMT?

A higher lifetime tendency towards heart attack and stroke can often be measured on the IMT, in South Asians, by age 30, and in non-South Asians, by age 45, often much earlier.  At the latest, I recommend that South Asians have an IMT at 30 years old, and all others at 45. If you have an abnormal IMT, I recommend checking annually, to determine whether your disease is worsening, over time.

How does the IMT compare to the Cardiac Calcium Score (CAC)?

  • Only the IMT can see the thickened IMT layer, the earlier stage of disease that is most reversible.
  • Only the IMT can see the more dangerous soft plaque, which is the earlier, more reversible form of advanced disease.
  • Soft plaque is associated with 7 times more risk of a serious cardiac event than the later, irreversible, calcified plaque, which is all the CAC can see.
  • 47% of patients with a normal CAC score of zero, had soft plaque, or significant IMT thickening found by the IMT.

Only the IMT can see soft plaque, 7 times more dangerous than the calcified plaque that the CAC can see.

  • 34% of patients with a normal CAC score of zero, had soft plaque found by the IMT.
  • Only the IMT can show whether disease is improving or worsening over a 1 to 3 year period.
  • The cardiac calcium score requires 30 chest X-Rays worth of radiation. The IMT uses sound waves.

What is the carotid imt Ultrasound?

The carotid IMT is simply a 10-min ultrasound of the artery in the neck, that measures the thickness of cholesterol and inflammation in the wall of the artery, that correlates strongly with later heart attack or stroke. A continued thickening over time indicates a higher risk of heart attack and stroke.

What are some common uses of the
procedure?

CIMT is used to diagnose and determine the extent of plaque buildup in the walls of the vessels supplying oxygenated blood to the head. Increased thickness in the intimal and media is associated with an increasingly diseased artery. Because there is a link between intimal medial thickness and cardiovascular events, CIMT is an important test for detecting disease in its earliest stage, when interventions such as diet, lifestyle, and medications can have the greatest impact.

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Are you high-risk?

I recommend that South Asians have an IMT at 30 years old, and all others at 45. If you have an abnormal IMT, I recommend checking annually, to determine whether your disease is worsening, over time.

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I recognize that many physicians are smart but Dr. Sims has almost encyclopedic knowledge on a wide variety of topics. He's well-read on the latest academic research and has incorporated many modern techniques in his practice. Unlike other physicians, Dr. Sims isn't over-reliant on prescribing medicine. He considers diet, vitamins and even lifestyle.

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My quality of life has improved significantly since I became Dr. Sims' patient. He is the best primary care physician I have ever had.
For those of you concerned about Dr. Sims' prioritization of vitamin supplements as a key component to overall wellbeing, I encourage you to educate yourself with peer-reviewed studies on the matter. I would also like to add that being able to purchase supplements that I can trust are high quality and efficacious is a luxury, especially after the Dietary Supplement Health and Education Act of 1994.
I recommend Dr. Sims wholeheartedly.

Santa Clara, CA

Learn more

choose a topic below to learn more

Atherosclerosis (hardening of the arteries)

What is it?

Atherosclerosis is a disease in which plaque builds up inside your arteries. Arteries are blood vessels that carry oxygen-rich blood to your heart and other parts of your body.Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.Atherosclerosis can lead to serious problems, including heart attack, stroke, or even death.

Atherosclerosis-Related Diseases

Atherosclerosis can affect any artery in the body, including arteries in the heart, brain, arms, legs, pelvis, and kidneys. As a result, different diseases may develop based on which arteries are affected.

Ischemic Heart Disease

Ischemic heart disease happens when the arteries of the heart cannot deliver enough oxygen-rich blood to the tissues of the heart when it is needed during periods of stress or physical effort.Coronary heart disease, also called coronary artery disease, is a type of ischemic heart disease caused by the buildup of plaque in the coronary arteries that supply oxygen-rich blood to your heart.This buildup can partially or totally block blood flow in the large arteries of the heart. If blood flow to your heart muscle is reduced or blocked, you may have angina (chest pain or discomfort) or a heart attack.Coronary micro vascular disease is another type of ischemic heart disease. It occurs when the heart’s tiny arteries do not function normally.

Carotid Artery Disease

Carotid (ka-ROT-id) artery disease occurs if plaque builds up in the arteries on each side of your neck (the carotid arteries). These arteries supply oxygen-rich blood to your brain. If blood flow to your brain is reduced or blocked, you may have a stroke.

Peripheral Artery Disease

Peripheral artery disease (P.A.D.) occurs if plaque builds up in the major arteries that supply oxygen-rich blood to your legs, arms, and pelvis.If blood flow to these parts of your body is reduced or blocked, you may have numbness, pain, and, sometimes, dangerous infections.

Chronic Kidney Disease

Chronic kidney disease can occur if plaque builds up in the renal arteries. These arteries supply oxygen-rich blood to your kidneys.Over time, chronic kidney disease causes a slow loss of kidney function. The main function of the kidneys is to remove waste and extra water from the body.

Outlook

Improved treatments have reduced the number of deaths from atherosclerosis-related diseases. These treatments also have improved the quality of life for people who have these diseases. However, atherosclerosis remains a common health problem.You may be able to prevent or delay atherosclerosis and the diseases it can cause. Making lifestyle changes and getting ongoing care can help you avoid the problems of atherosclerosis and live a long, healthy life.

Information Resource: National Heart, Lung, and Blood Institute

Peripheral Artery Disease (PAD)

PAD is similar to coronary artery disease (CAD)

Peripheral artery disease is a narrowing of the peripheral arteries serving the legs, stomach, arms and head. (“Peripheral” in this case means away from the heart, in the outer regions of the body.) PAD most commonly affects arteries in the legs.

Both PAD and coronary artery disease (CAD) are caused by atherosclerosis. Atherosclerosis narrows and blocks arteries in critical regions of the body.

Quick facts about PAD

The most common symptoms of PAD involving the lower extremities are cramping, pain or tiredness in the leg or hip muscles while walking or climbing stairs. Typically, this pain goes away with rest and returns when you walk again.

Be aware that:

  • Many people mistake the symptoms of PAD for something else.
  • PAD often goes undiagnosed by healthcare professionals.
  • People with peripheral arterial disease have a higher risk of coronary artery disease, heart attack or stroke.
  • Left untreated, PAD can lead to gangrene and amputation.

Added risks for PAD

Other factors can increase your chances for peripheral artery disease, including:

The good news

If you’re at risk for peripheral artery disease or have been diagnosed with PAD, it’s worth knowing that:

Atherosclerosis and PAD

If you have atherosclerosis, that means that plaque has built up inside your artery walls. Plaque is made up of deposits of fats, cholesterol and other substances. Atherosclerosis in the peripheral arteries is the most common cause of PAD.

To see how plaque limits blood flow, view our interactive PAD library.

What happens is this: First, plaque builds up enough to narrow an artery, which chokes off blood flow. Next, if that plaque becomes brittle or inflamed, it may rupture, triggering a blood clot to form. A clot can further narrow the artery, or completely block it.

If that blockage remains in the peripheral arteries of the legs, it can cause pain, changes in skin color, difficulty walking and sores or ulcers. Total loss of circulation to the legs and feet can cause gangrene and the loss of a limb.

If the blockage occurs in a carotid artery, it can cause a stroke.

It’s important to learn the facts about PAD. As with any disease, the more you understand, the more you’ll be able to help your doctor make an early diagnosis. PAD has common symptoms, but many people with PAD never have any symptoms at all.

Learn the facts, talk to your doctor and take control of your cardiovascular health.

Information Resource: Heart.org

Artery Plaque

What is Arterial Plaque?

You have probably heard of plaque on your teeth, but your body also has another type of plaque. This is plaque that builds up in arteries - the blood vessels that carry oxygen and nutrient-rich blood from your heart to your body’s tissues.

Plaque in the arteries is a fatty, waxy substance that forms deposits in the artery wall. These deposits can narrow the artery and reduce blood flow. This is called atherosclerosis or “hardening of the arteries.” Plaques can also rupture and create a blood clot at the rupture site, as your body’s natural processes try to repair the “injury.” The blood clot can cut off blood flow through the artery and starve your body’s tissues of oxygen and nutrients. Therefore, a ruptured plaque can be serious: It is the most common cause of a heart attack or stroke.

What Is Plaque Made Of?

Arterial plaque is made up of materials that enter the artery wall from the bloodstream. These include fat, cholesterol, calcium, waste products from cells and a clotting agent called fibrin. This is why your physician tests your cholesterol levels. High levels of “bad cholesterol” (low-density lipoprotein, or LDL cholesterol) can indicate a higher risk of plaque build-up.

What Causes Plaque in Arteries?

Plaque build-up in arteries is, unfortunately, a natural part of living. Even children and adolescents have early evidence of the process.

However, diet and other lifestyle factors play an important role. High blood pressure, high LDL cholesterol and smoking can all worsen atherosclerosis. High blood pressure and the toxins in tobacco products damage the smooth inner lining of the artery, called the endothelium. These and other causes of inflammation of the artery lining contribute to cholesterol and other materials embedding in the artery wall to form plaques.

Additionally, some people are predisposed to having atherosclerosis. A genetic condition called familial hypercholesterolemia causes some people to have abnormally very high LDL cholesterol levels in the bloodstream.

Is All Plaque Dangerous?

Plaque builds up in arteries throughout the body, but not all plaques are equally dangerous. You might hear the term vulnerable plaque. This refers to a soft plaque that has a thin, fibrous cap. This plaque is more likely to rupture, causing a blood clot to form at the rupture site, cutting off or restricting blood flow, and potentially causing a heart attack or stroke

Can Plaque Build-Up in the Arteries Be Stopped?

Plaque formation in arteries can be slowed. It may also be possible to reverse some of the damage, but mostly, it’s a process of controlling further damage. Unlike going to the dentist and having plaque removed from your teeth, this is not so easily done in the blood vessels. But improvements can be made. Work with your physician to identify if you are at risk of, or already have, heart disease from atherosclerosis. This may require a physical exam with personal and family medical histories, lab tests and other diagnostic tests. You may be recommended to take medications to control high blood pressure and to lower cholesterol levels. Eating a heart-healthy diet, quitting smoking and getting regular exercise will also help your arteries be their healthiest.

Information Resource: secondscount.org

Stroke

Is the no. 5 cause of death and leading cause of disability in the United States

What is it?

Stroke is a disease that affects the arteries leading to and within the brain. It is the No. 5 cause of death and a leading cause of disability in the United States.

A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures). When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it and brain cells die.

What are the types of stroke?

Stroke can be caused either by a clot obstructing the flow of blood to the brain (called an ischemic stroke) or by a blood vessel rupturing and preventing blood flow to the brain (called a hemorrhagic stroke). A TIA (transient ischemic attack), or "mini stroke", is caused by a temporary clot.

Types of Stroke:

Ischemic Stroke (Clots)

Occurs when a blood vessel supplying blood to the brain is obstructed. It accounts for 87 percent of all strokes.

Hemorrhagic Stroke (Bleeds)

Occurs when a weakened blood vessel ruptures. The two types of weakened blood vessels that usually cause hemorrhagic stroke are aneurysms and arteriovenous malformations (AVMs). The most common cause of hemorrhagic stroke is uncontrolled high blood pressure.

TIA (Transient Ischemic Attack)

Called a “mini stroke,” it’s caused by a serious temporary clot. This is a warning stroke and should be taken seriously.

Cryptogenic Stroke

In most cases, a stroke is caused by a blood clot that blocks the flow of blood to the brain. In some instances, despite testing, the cause of a stroke cannot be determined. A stroke of unknown cause is called a “cryptogenic stroke.”

Brain Stem Stroke

When stroke occurs in the brain stem, it can affect both sides of the body and may leave someone in a ‘locked-in’ state. When a locked-in state occurs, the patient is generally unable to speak or move below the neck.

80 percent of strokes are preventable.
Information Resource: stroke.org

Heart Attack

Overview

A heart attack occurs when the flow of blood to the heart is blocked. The blockage is most often a buildup of fat, cholesterol and other substances, which form a plaque in the arteries that feed the heart (coronary arteries).

The plaque eventually breaks away and forms a clot. The interrupted blood flow can damage or destroy part of the heart muscle.

A heart attack, also called a myocardial infarction, can be fatal, but treatment has improved dramatically over the years. It's crucial to call 911 or emergency medical help if you think you might be having a heart attack.

Symptoms

Common heart attack signs and symptoms include:

  • Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back
  • Nausea, indigestion, heartburn or abdominal pain
  • Shortness of breath
  • Cold sweat
  • Fatigue
  • Lightheadedness or sudden dizziness

Heart attack symptoms vary

Not all people who have heart attacks have the same symptoms or have the same severity of symptoms. Some people have mild pain; others have more severe pain. Some people have no symptoms; for others, the first sign may be sudden cardiac arrest. However, the more signs and symptoms you have, the greater the likelihood you're having a heart attack.

Some heart attacks strike suddenly, but many people have warning signs and symptoms hours, days or weeks in advance. The earliest warning might be recurrent chest pain or pressure (angina) that's triggered by exertion and relieved by rest. Angina is caused by a temporary decrease in blood flow to the heart.

When to see a doctor

Act immediately. Some people wait too long because they don't recognize the important signs and symptoms. Take these steps:

  • Call for emergency medical help. If you suspect you're having a heart attack, don't hesitate. Immediately call 911 or your local emergency number. If you don't have access to emergency medical services, have someone drive you to the nearest hospital.
  • Drive yourself only if there are no other options. Because your condition can worsen, driving yourself puts you and others at risk.
  • Take nitroglycerin, if prescribed to you by a doctor. Take it as instructed while awaiting emergency help.
  • Take aspirin, if recommended. Taking aspirin during a heart attack could reduce heart damage by helping to keep your blood from clotting.
  • Aspirin can interact with other medications, however, so don't take an aspirin unless your doctor or emergency medical personnel recommend it. Don't delay calling 911 to take an aspirin. Call for emergency help first.

What to do if you see someone who might be having a heart attack

If you see someone who's unconscious and you believe is having a heart attack, first call for emergency medical help. Then check if the person is breathing and has a pulse. If the person isn't breathing or you don't find a pulse, only then should you begin CPR to keep blood flowing.

Push hard and fast on the person's chest in a fairly rapid rhythm — about 100 to 120 compressions a minute.

If you haven't been trained in CPR, doctors recommend performing only chest compressions. If you have been trained in CPR, you can go on to opening the airway and rescue breathing.

Causes

A heart attack occurs when one or more of your coronary arteries become blocked. Over time, a coronary artery can narrow from the buildup of various substances, including cholesterol (atherosclerosis). This condition, known as coronary artery disease, causes most heart attacks.

During a heart attack, one of these plaques can rupture and spill cholesterol and other substances into the bloodstream. A blood clot forms at the site of the rupture. If large enough, the clot can block the flow of blood through the coronary artery, starving the heart muscle of oxygen and nutrients (ischemia).

You might have a complete blockage or partial. A complete blockage means you've had an ST elevation myocardial infarction (STEMI). A partial blockage means you've had a non-ST elevation myocardial infarction (NSTEMI). Diagnostic steps and treatment might be different depending on which you've had.

Another cause of a heart attack is a spasm of a coronary artery that shuts down blood flow to part of the heart muscle. Using tobacco and illicit drugs, such as cocaine, can cause a life-threatening spasm.

Risk factors

Certain factors contribute to the unwanted buildup of fatty deposits (atherosclerosis) that narrows arteries throughout your body. You can improve or eliminate many of these risk factors to reduce your chances of having a first or another heart attack.

Heart attack risk factors include:

  • Age. Men age 45 or older and women age 55 or older are more likely to have a heart attack than are younger men and women.
  • Tobacco. This includes smoking and long-term exposure to secondhand smoke.
  • High blood pressure. Over time, high blood pressure can damage arteries that feed your heart. High blood pressure that occurs with other conditions, such as obesity, high cholesterol or diabetes, increases your risk even more.
  • High blood cholesterol or triglyceride levels. A high level of low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol) is most likely to narrow arteries. A high level of triglycerides, a type of blood fat related to your diet, also ups your risk of heart attack. However, a high level of high-density lipoprotein (HDL) cholesterol (the "good" cholesterol) lowers your risk of heart attack.
  • Obesity. Obesity is associated with high blood cholesterol levels, high triglyceride levels, high blood pressure and diabetes. Losing just 10 percent of your body weight can lower this risk, however.
  • Diabetes. Not producing enough of a hormone secreted by your pancreas (insulin) or not responding to insulin properly causes your body's blood sugar levels to rise, increasing your risk of heart attack.
  • Metabolic syndrome. This occurs when you have obesity, high blood pressure and high blood sugar. Having metabolic syndrome makes you twice as likely to develop heart disease than if you don't have it.
  • Family history of heart attack. If your siblings, parents or grandparents have had early heart attacks (by age 55 for male relatives and by age 65 for female relatives), you might be at increased risk.
  • Lack of physical activity. Being inactive contributes to high blood cholesterol levels and obesity. People who exercise regularly have better cardiovascular fitness, including lower high blood pressure.
  • Stress. You might respond to stress in ways that can increase your risk of a heart attack.
  • Illicit drug use. Using stimulant drugs, such as cocaine or amphetamines, can trigger a spasm of your coronary arteries that can cause a heart attack.
  • A history of preeclampsia. This condition causes high blood pressure during pregnancy and increases the lifetime risk of heart disease.
  • An autoimmune condition. Having a condition such as rheumatoid arthritis or lupus can increase your risk of heart attack.

Complications

Complications are often related to the damage done to your heart during an attack, which can lead to:

  • Abnormal heart rhythms (arrhythmias). Electrical "short circuits" can develop, resulting in abnormal heart rhythms, some of which can be serious, even fatal.
  • Heart failure. An attack might damage so much heart tissue that the remaining heart muscle can't pump enough blood out of your heart. Heart failure can be temporary, or it can be a chronic condition resulting from extensive and permanent damage to your heart.
  • Sudden cardiac arrest. Without warning, your heart stops due to an electrical disturbance that causes an arrhythmia. Heart attacks increase the risk of sudden cardiac arrest, which can be fatal without immediate treatment.

Prevention

It's never too late to take steps to prevent a heart attack — even if you've already had one. Here are ways to prevent a heart attack.

  • Medications. Taking medications can reduce your risk of a subsequent heart attack and help your damaged heart function better. Continue to take what your doctor prescribes, and ask your doctor how often you need to be monitored.
  • Lifestyle factors. You know the drill: Maintain a healthy weight with a heart-healthy diet, don't smoke, exercise regularly, manage stress and control conditions that can lead to heart attack, such as high blood pressure, high cholesterol and diabetes.

Information Resource: mayoclinic.org

Congestive Heart Failure

Overview

Heart failure, sometimes known as congestive heart failure, occurs when your heart muscle doesn't pump blood as well as it should. Certain conditions, such as narrowed arteries in your heart (coronary artery disease) or high blood pressure, gradually leave your heart too weak or stiff to fill and pump efficiently.

Not all conditions that lead to heart failure can be reversed, but treatments can improve the signs and symptoms of heart failure and help you live longer. Lifestyle changes — such as exercising, reducing sodium in your diet, managing stress and losing weight — can improve your quality of life.

One way to prevent heart failure is to prevent and control conditions that cause heart failure, such as coronary artery disease, high blood pressure, diabetes or obesity.

Symptoms

Heart failure can be ongoing (chronic), or your condition may start suddenly (acute).

Heart failure signs and symptoms may include:

  • Shortness of breath (dyspnea) when you exert yourself or when you lie down
  • Fatigue and weakness
  • Swelling (edema) in your legs, ankles and feet
  • Rapid or irregular heartbeat
  • Reduced ability to exercise
  • Persistent cough or wheezing with white or pink blood-tinged phlegm
  • Increased need to urinate at night
  • Swelling of your abdomen (ascites)
  • Very rapid weight gain from fluid retention
  • Lack of appetite and nausea
  • Difficulty concentrating or decreased alertness
  • Sudden, severe shortness of breath and coughing up pink, foamy mucus
  • Chest pain if your heart failure is caused by a heart attack

When to see a doctor

See your doctor if you think you might be experiencing signs or symptoms of heart failure. Seek emergency treatment if you experience any of the following:

  • Chest pain
  • Fainting or severe weakness
  • Rapid or irregular heartbeat associated with shortness of breath, chest pain or fainting
  • Sudden, severe shortness of breath and coughing up pink, foamy mucus

Although these signs and symptoms may be due to heart failure, there are many other possible causes, including other life-threatening heart and lung conditions. Don't try to diagnose yourself. Call 911 or your local emergency number for immediate help. Emergency room doctors will try to stabilize your condition and determine if your symptoms are due to heart failure or something else.

If you have a diagnosis of heart failure and if any of the symptoms suddenly become worse or you develop a new sign or symptom, it may mean that existing heart failure is getting worse or not responding to treatment. This may be also the case if you gain 5 pounds (2.3 kg) or more within a few days. Contact your doctor promptly.

Causes

Heart failure often develops after other conditions have damaged or weakened your heart. However, the heart doesn't need to be weakened to cause heart failure. It can also occur if the heart becomes too stiff.

In heart failure, the main pumping chambers of your heart (the ventricles) may become stiff and not fill properly between beats. In some cases of heart failure, your heart muscle may become damaged and weakened, and the ventricles stretch (dilate) to the point that the heart can't pump blood efficiently throughout your body.

Over time, the heart can no longer keep up with the normal demands placed on it to pump blood to the rest of your body.

An ejection fraction is an important measurement of how well your heart is pumping and is used to help classify heart failure and guide treatment. In a healthy heart, the ejection fraction is 50 percent or higher — meaning that more than half of the blood that fills the ventricle is pumped out with each beat.

But heart failure can occur even with a normal ejection fraction. This happens if the heart muscle becomes stiff from conditions such as high blood pressure.

Heart failure can involve the left side (left ventricle), right side (right ventricle) or both sides of your heart. Generally, heart failure begins with the left side, specifically the left ventricle — your heart's main pumping chamber.

Type of heart failure

Lef-sided heart failure

Right-sided heart failure

Systolic heart failure

Diastolic heart failure (also called heart failure with preserved ejection fraction)

Description
Fluid may back up in your lungs, causing shortness of breath.
Fluid may back up into your abdomen, legs and feet, causing swelling.
The left ventricle can't contract vigorously, indicating a pumping problem.
The left ventricle can't relax or fill fully, indicating a filling problem.

Risk factors

A single risk factor may be enough to cause heart failure, but a combination of factors also increases your risk.

Risk factors include:

  • High blood pressure. Your heart works harder than it has to if your blood pressure is high.
  • Coronary artery disease. Narrowed arteries may limit your heart's supply of oxygen-rich blood, resulting in weakened heart muscle.
  • Heart attack. A heart attack is a form of coronary disease that occurs suddenly. Damage to your heart muscle from a heart attack may mean your heart can no longer pump as well as it should.
  • Diabetes. Having diabetes increases your risk of high blood pressure and coronary artery disease.
  • Some diabetes medications. The diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) have been found to increase the risk of heart failure in some people. Don't stop taking these medications on your own, though. If you're taking them, discuss with your doctor whether you need to make any changes.
  • Certain medications. Some medications may lead to heart failure or heart problems. Medications that may increase the risk of heart problems include nonsteroidal anti-inflammatory drugs (NSAIDs); certain anesthesia medications; some anti-arrhythmic medications; certain medications used to treat high blood pressure, cancer, blood conditions, neurological conditions, psychiatric conditions, lung conditions, urological conditions, inflammatory conditions and infections; and other prescription and over-the-counter medications.
  • Don't stop taking any medications on your own. If you have questions about medications you're taking, discuss with your doctor whether he or she recommends any changes.
  • Sleep apnea. The inability to breathe properly while you sleep at night results in low blood oxygen levels and increased risk of abnormal heart rhythms. Both of these problems can weaken the heart.
  • Congenital heart defects. Some people who develop heart failure were born with structural heart defects.
  • Valvular heart disease. People with valvular heart disease have a higher risk of heart failure.
  • Viruses. A viral infection may have damaged your heart muscle.
  • Alcohol use. Drinking too much alcohol can weaken heart muscle and lead to heart failure.
  • Tobacco use. Using tobacco can increase your risk of heart failure.
  • Obesity. People who are obese have a higher risk of developing heart failure.
  • Irregular heartbeats. These abnormal rhythms, especially if they are very frequent and fast, can weaken the heart muscle and cause heart failure.

Complications

If you have heart failure, your outlook depends on the cause and the severity, your overall health, and other factors such as your age. Complications can include:

  • Kidney damage or failure. Heart failure can reduce the blood flow to your kidneys, which can eventually cause kidney failure if left untreated. Kidney damage from heart failure can require dialysis for treatment.
  • Heart valve problems. The valves of your heart, which keep blood flowing in the proper direction through your heart, may not function properly if your heart is enlarged or if the pressure in your heart is very high due to heart failure.
  • Heart rhythm problems. Heart rhythm problems (arrhythmias) can be a potential complication of heart failure.
  • Liver damage. Heart failure can lead to a buildup of fluid that puts too much pressure on the liver. This fluid backup can lead to scarring, which makes it more difficult for your liver to function properly.

Some people's symptoms and heart function will improve with proper treatment. However, heart failure can be life-threatening. People with heart failure may have severe symptoms, and some may require heart transplantation or support with a ventricular assist device.

Any of the following conditions can damage or weaken your heart and can cause heart failure. Some of these can be present without your knowing it:

  • Coronary artery disease and heart attack. Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. The disease results from the buildup of fatty deposits (plaque) in your arteries, which reduce blood flow and can lead to heart attack.
  • High blood pressure (hypertension). If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body. Over time, this extra exertion can make your heart muscle too stiff or too weak to effectively pump blood.
  • Faulty heart valves. The valves of your heart keep blood flowing in the proper direction through the heart. A damaged valve — due to a heart defect, coronary artery disease or heart infection — forces your heart to work harder, which can weaken it over time.
  • Damage to the heart muscle (cardiomyopathy). Heart muscle damage (cardiomyopathy) can have many causes, including several diseases, infections, alcohol abuse and the toxic effect of drugs, such as cocaine or some drugs used for chemotherapy. Genetic factors also can play a role.
  • Myocarditis. Myocarditis is an inflammation of the heart muscle. It's most commonly caused by a virus and can lead to left-sided heart failure.
  • Heart defects you're born with (congenital heart defects). If your heart and its chambers or valves haven't formed correctly, the healthy parts of your heart have to work harder to pump blood through your heart, which, in turn, may lead to heart failure.
  • Abnormal heart rhythms (heart arrhythmias). Abnormal heart rhythms may cause your heart to beat too fast, creating extra work for your heart. A slow heartbeat also may lead to heart failure.
  • Other diseases. Chronic diseases — such as diabetes, HIV, hyperthyroidism, hypothyroidism, or a buildup of iron (hemochromatosis) or protein (amyloidosis) — also may contribute to heart failure.
  • Causes of acute heart failure include viruses that attack the heart muscle, severe infections, allergic reactions, blood clots in the lungs, the use of certain medications or any illness that affects the whole body.

Prevention

The key to preventing heart failure is to reduce your risk factors. You can control or eliminate many of the risk factors for heart disease — high blood pressure and coronary artery disease, for example — by making lifestyle changes along with the help of any needed medications.

Lifestyle changes you can make to help prevent heart failure include:

  • Not smoking
  • Controlling certain conditions, such as high blood pressure and diabetes
  • Staying physically active
  • Eating healthy foods
  • Maintaining a healthy weight
  • Reducing and managing stress
Information Resource: mayoclinic.org

LDL: The "Bad" Cholesterol

Also called: Low-density lipoprotein

What is cholesterol?

Cholesterol is a waxy, fat-like substance that's found in all the cells in your body. Your liver makes cholesterol, and it is also in some foods, such as meat and dairy products. Your body needs some cholesterol to work properly. But having too much cholesterol in your blood raises your risk of coronary artery disease.

What are LDL and HDL?

LDL and HDL are two types of lipoproteins. They are a combination of fat (lipid) and protein. The lipids need to be attached to the proteins so they can move through the blood. LDL and HDL have different purposes:

  • LDL stands for low-density lipoproteins. It is sometimes called the "bad" cholesterol because a high LDL level leads to a buildup of cholesterol in your arteries.
  • HDL stands for high-density lipoproteins. It is sometimes called the "good" cholesterol because it carries cholesterol from other parts of your body back to your liver. Your liver then removes the cholesterol from your body.

How can a high LDL level raise my risk of coronary artery disease and other diseases?

If you have a high LDL level, this means that you have too much LDL cholesterol in your blood. This extra LDL, along with other substances, forms plaque. The plaque builds up in your arteries; this is a condition called atherosclerosis.

Coronary artery disease happens when the plaque buildup is in the arteries of your heart. It causes the arteries to become hardened and narrowed, which slows down or blocks the blood flow to your heart. Since your blood carries oxygen to your heart, this means that your heart may not be able to get enough oxygen. This can cause angina (chest pain), or if the blood flow is completely blocked, a heart attack.

How do I know what my LDL level is?

A blood test can measure your cholesterol levels, including LDL. When and how often you should get this test depends on your age, risk factors, and family history. The general recommendations are:

For people who are age 19 or younger:

  • The first test should be between ages 9 to 11
  • Children should have the test again every 5 years
  • Some children may have this test starting at age 2 if there is a family history of high blood cholesterol, heart attack, or stroke

For people who are age 20 or older:

  • Younger adults should have the test every 5 years
  • Men ages 45 to 65 and women ages 55 to 65 should have it every 1 to 2 years

What can affect my LDL level?

Things that can affect your LDL level include

  • Diet. Saturated fat and cholesterol in the food you eat make your blood cholesterol level rise
  • Weight. Being overweight tends to raise your LDL level, lower your HDL level, and increase your total cholesterol level
  • Physical Activity. A lack of physical activity can lead to weight gain, which can raise your LDL level
  • Smoking. Cigarette smoking lowers your HDL cholesterol. Since HDL helps to remove LDL from your arteries, if you have less HDL, that can contribute to you having a higher LDL level.
  • Age and Gender. As women and men get older, their cholesterol levels rise. Before the age of menopause, women have lower total cholesterol levels than men of the same age. After the age of menopause, women's LDL levels tend to rise.
  • Genetics. Your genes partly determine how much cholesterol your body makes. High cholesterol can run in families. For example, familial hypercholesterolemia (FH) is an inherited form of high blood cholesterol.
  • Medicines. Certain medicines, including steroids, some blood pressure medicines, and HIV/AIDS medicines, can raise your LDL level.
  • Other medical conditions. Diseases such as chronic kidney disease, diabetes, and HIV/AIDS can cause a higher LDL level.
  • Race. Certain races may have an increased risk of high blood cholesterol. For example, African Americans typically have higher HDL and LDL cholesterol levels than whites.
Information resource: medlineplus.gov

Copyright © 2019 Dr. Stephen Sims for Cogent Family Healthcare, A Division of BASS Medical Group.