Is it normal to feel your heart beating?

What Is Valvular Heart Disease?


Heart valve disease occurs when the heart valves do not work the way they should.
How Do Heart Valves Work?

Your heart valves lie at the exit of each of your four heart chambers and maintain one-way blood flow through your heart. The four heart valves make sure that blood always flows freely in a forward direction and that there is no backward leakage.

Blood flows from your right and left atria into your ventricles through the open mitral and tricuspid valves.

Heart Valves

When the ventricles are full, the mitral and tricuspid valves shut. This prevents blood from flowing backward into the atria while the ventricles contract (squeeze).

As the ventricles begin to contract, the pulmonic and aortic valves are forced open and blood is pumped out of the ventricles through the open valves into the pulmonary artery toward the lungs, the aorta, and the body.

When the ventricles finish contracting and begin to relax, the aortic and pulmonic valves snap shut. These valves prevent blood from flowing back into the ventricles.

This pattern is repeated over and over, causing blood to flow continuously to the heart, lungs and body.
What Are the Types of Valve Disease?

Valve Disease


There are several types of valve disease:

* Valvular stenosis. This occurs when a valve opening is smaller than normal due to stiff or fused leaflets. The narrowed opening may make the heart work very hard to pump blood through it. This can lead to heart failure and other symptoms (see below). All four valves can be stenotic (hardened, restricting blood flow); the conditions are called tricuspid stenosis, pulmonic stenosis, mitral stenosis or aortic stenosis.
* Valvular insufficiency. Also called regurgitation, incompetence or "leaky valve", this occurs when a valve does not close tightly. If the valves do not seal, some blood will leak backwards across the valve. As the leak worsens, the heart has to work harder to make up for the leaky valve, and less blood may flow to the rest of the body. Depending on which valve is affected, the conditioned is called tricuspid regurgitation, pulmonary regurgitation, mitral regurgitation or aortic regurgitation.

What Causes Valvular Heart Disease?

Valve disease can develop before birth (congenital) or can be acquired sometime during one's lifetime. Sometimes the cause of valve disease is unknown.

Congenital valve disease. Most often affects the aortic or pulmonic valve. Valves may be the wrong size, have malformed leaflets, or have leaflets that are not attached to the annulus correctly.

Bicuspid aortic valve disease is a congenital valve disease that affects the aortic valve. Instead of the normal three leaflets or cusps, the bicuspid aortic valve has only two. Without the third leaflet, the valve may be stiff (unable to open or close properly) or leaky (not able close tightly).

Acquired valve disease. This includes problems that develop with valves that were once normal. These may involve changes in the structure or your valve due to a variety of diseases or infections, including rheumatic fever or endocarditis.

* Rheumatic fever is caused by an untreated bacterial infection (usually strep. throat). Luckily, the introduction of antibiotics to treat this infection has dramatically reduced the numbers of this infection. The initial infection usually occurs in children, but the heart problems associated with the infection may not be seen until 20-40 years later. At that time, the heart valves become inflamed, the leaflets stick together and become scarred, rigid, thickened and shortened. This leads to mitral regurgitation.
* Endocarditis occurs when germs, especially bacteria, enter the bloodstream and attack the heart valves, causing growths and holes in the valves and scarring. This can lead to leaky valves. The germs that cause endocarditis enter the blood during dental procedures, surgery, IV drug use, or with severe infections. People with valve disease (except mitral valve prolapse without thickening or regurgitation/leaking) are at increased risk for developing this life-threatening infection.

There are many changes that can occur to the valves of the heart. The chordae tendinae or papillary muscles can stretch or tear; the annulus of the valve can dilate (become wide); or the valve leaflets can become fibrotic (stiff) and calcified.

Mitral valve prolapse (MVP) is a very common condition, affecting 1 to 2 percent of the population. MVP causes the leaflets of the mitral valve to flop back into the left atrium during the heart's contraction. MVP also causes the tissues of the valve to become abnormal and stretchy, causing the valve to leak. The condition rarely causes symptoms and usually doesn't require treatment.

Other causes of valve disease include: coronary artery disease, heart attack, cardiomyopathy (heart muscle disease), syphilis (a sexually transmitted disease), hypertension, aortic aneurysms, and connective tissue diseases. Less common causes of valve disease include tumors, some types of drugs and radiation.

What Are the Symptoms of Valve Disease?

* Shortness of breath and/or difficulty catching your breath. You may notice this most when you are active (doing your normal daily activities) or when you lie down flat in bed. You may need to sleep propped up on a few pillows to breathe easier.
* Weakness or dizziness. You may feel too weak to carry out your normal daily activities. Dizziness can also occur, and in some cases, passing out may be a symptom.
* Discomfort in your chest. You may feel a pressure or weight in your chest with activity or when going out in cold air.
* Palpitations. This may feel like a rapid heart rhythm, irregular heartbeat, skipped beats or a flip-flop feeling in your chest.
* Swelling of your ankles, feet or abdomen. This is called edema. Swelling may occur in your belly, which may cause you to feel bloated.
* Rapid weight gain. A weight gain of two or three pounds in one day is possible.

Symptoms do not always relate to the seriousness of your valve disease. You may have no symptoms at all and have severe valve disease, requiring prompt treatment. Or, as with mitral valve prolapse, you may have severe symptoms, yet tests may show your valve leak is not significant.
How Are Valve Diseases Diagnosed?

Your heart doctor can tell if you have valve disease by talking to you about your symptoms, performing a physical exam, and giving you other tests.

During a physical exam, your doctor will listen to your heart to hear the sounds the heart makes as the valves open and close. A murmur is a swishing sound made by blood flowing through a stenotic or leaky valve. Your doctor can also tell if your heart is enlarged or if your heart rhythm is irregular.

The doctor will listen to your lungs to hear if you are retaining fluid in your lungs, which shows your heart is not able to pump as well as it should.

By examining your body, the doctor can find clues about your circulation and the functioning of your other organs.

After the physical exam, the doctor may order diagnostic tests. These may include:

* Echocardiography
* Transesophageal echocardiography
* Cardiac catheterization (also called an angiogram)
* Radionuclide scans
* Magnetic resonance imaging (MRI)

By looking at the results, repeated over time, your doctor can also see the progress of your valve disease. This will help him or her make decisions about your treatment.

How Is Heart Valve Disease Treated?

Treatment for heart valve disease depends on the type and severity of valve disease. There are three goals of treatment for heart valve disease: protecting your valve from further damage; lessening symptoms; and repairing or replacing valves.

Protecting your valve from further damage. If you have valve disease, you are at risk for developing endocarditis, a serious condition. People who have mitral valve prolapse without thickening or regurgitation/leaking are not at risk of developing endocarditis.

You are still at risk for endocarditis, even if your valve is repaired or replaced through surgery. To protect yourself:

* Tell your doctors and dentist you have valve disease. You may want to carry an identification card with this information. The American Heart Association website (www.americanheart.org) has a bacterial endocarditis wallet card that you may download; or call your local American Heart Association office or the national office at 1-800-AHA-USA1.
* Call your doctor if you have symptoms of an infection (sore throat, general body aches, fever).
* Take good care of your teeth and gums to prevent infections. See your dentist for regular visits.
* Take antibiotics before you undergo any procedure that may cause bleeding, such as any dental work (even a basic teeth cleaning), invasive tests (any test that may involve blood or bleeding), and most major or minor surgery. Your doctor can provide you with a card that provides specific antibiotic guidelines.

Medications. You may be prescribed medications to treat your symptoms and to lessen the chance of further valve damage. Some medications may be stopped after you have had valve surgery to correct your problem. Other medications may need to be taken all your life. Medications may include:

Common types of medications What they do
Diuretics ("water pills") Remove extra fluid from the tissues and bloodstream; lessen the symptoms of heart failure
Antiarrhythmic medications Control the heart's rhythm
Vasodilators Lessen the heart's work. Also encourages blood to flow in a forward direction, rather than backwards through a leaky valve.
ACE inhibitors A type of vasodilator used to treat high blood pressure and heart failure.
Beta blockers Treat high blood pressure and lessen the heart's work by helping the heart beat slower and less forcefully. Used to decrease palpitations in some patients
Anticoagulants ("blood thinners") Prolong the clotting time of your blood, if you are at risk for developing blood clots on your heart valve.


Follow your doctor's orders when taking medications. Know the names of your medications, what they are for, and how often to take them.

Surgery and Other Procedures. The diagnostic tests your heart doctor orders help to identify the location, type, and extent of your valve disease. The results of these tests, the structure of your heart, your age, and your lifestyle will help your cardiologist (heart doctor), surgeon, and you decide what type of procedure will be best for you.

Surgical options include heart valve repair or replacement. Valves can be repaired or replaced with traditional heart valve surgery or a minimally invasive heart valve surgical procedure. Heart valves may also be repaired by other procedures such as percutaneous balloon valvotomy.

Living With Valve Disease

When you have valve disease, it is important to protect yourself from future heart problems, even if your valve has been repaired or replaced with surgery. Here are some tips to stay healthy:

* Know the type and extent of your valve disease.
* Tell all your doctors and dentist you have valve disease.
* Call your doctor if you have symptoms of an infection.
* Take good care of your teeth and gums.
* Take antibiotics before you undergo any procedure that may cause bleeding.
* Carry a wallet card that may be obtained from the American Heart Association with specific antibiotic guidelines.
* Take your medications. Your medications are used to control your symptoms and help your heart pump blood more efficiently. Follow your doctor's instructions when you take your medications.
* See your heart doctor for regular visits, even if you have no symptoms. Your appointments may be scheduled once a year or more often, if your doctor feels you need to be followed more closely.

April 30, 2008 -- New research shows that it may be possible to reprogram skin cells to act like embryonic stem cells, and then turn those stem cells into heart cells.

Scientists at the University of California at Los Angeles (UCLA) have done that with mouse cells.

"I'm hoping that these scientific findings are the first step towards one day developing new therapies that I can offer my patients," Robb MacLellan, MD, UCLA associate professor of cardiology and physiology, says in a news release.

First, MacLellan's team reprogrammed mouse skin cells to become induced pluripotent cells, or iPS cells, which act like embryonic stem cells.

Next, the researchers coaxed the iPS cells to become immature heart cells. And then they developed those immature heart cells into several types of heart and blood cells. Details of their work appear in the May 1 online edition of Stem Cells.

What about people? In 2007, scientists in the U.S. and Japan reported successfully reprogramming human skin cells to become iPS cells.

The next step is to see if human iPS cells can develop into immature heart cells, and then into cardiovascular and blood cells for use in patients. "I believe iPS cells address many of the shortcomings of human embryonic stem cells and are the future of regenerative medicine," says MacLellan.

What is atherosclerosis and how is it related to high blood pressure?

One of the most serious health problems related to untreated high blood pressure is atherosclerosis, which contributes to coronary artery disease.

People with high blood pressure are more likely to develop coronary artery disease because high blood pressure puts added force against the artery walls. Over time, this extra pressure can damage the arteries making them more vulnerable to the narrowing and plaque build up associated with atherosclerosis. The narrowed artery limits or blocks the flow of blood to the heart muscle depriving the heart of oxygen. The hardened surface of the artery can also encourage the formation of small blood clots.
What Are the Symptoms of Atherosclerosis?

Atherosclerosis usually has no symptoms until the narrowed coronary arteries severely restrict blood flow to the heart. At this point, you may feel chest pain because not enough blood is reaching the heart. These pains may come with exertion, or can occur when the person is at rest.
What Is a Heart Attack?

A heart attack is permanent damage to the heart muscle caused by loss of blood flow to the heart. A heart attack occurs when a clot or spasm blocks an already narrowed coronary artery. Left without oxygen, the portion of the heart muscle served by the blocked artery is injured.
How Is Atherosclerosis Diagnosed?

Atherosclerosis isn't usually diagnosed until a person complains of chest pain. At this point, the doctor may conduct tests to evaluate your risk for heart disease, including:

* Electrocardiogram (EKG or ECG): This test measures the electrical activity, rate, and rhythm of your heartbeat via electrodes attached to your arms, legs, and chest. This test may show if you've had a heart attack in the past or if you are currently having a heart attack, strain, or thickening of the heart muscle. It can also convey information about the size of your heart as well. It cannot predict your future risk.
* Exercise stress test: During this test you exercise on a stationary bicycle or treadmill to increase your heart rate while EKG readings are taken. This test is often performed with imaging of the heart, such as an echocardiogram or nuclear scans, to provide better detection of heart disease.
* Cardiac catheterization: During this procedure, a catheter -- a small flexible tube -- is inserted into an artery and guided to the coronary arteries, allowing the doctor an opportunity to locate any blockages in the coronary arteries and observe pressure and blood flow in the heart. During a cardiac catheterization, a cardiologist may be able to open up clogged arteries directly from the inside with a procedure called an angioplasty. This may also involve placing a small cylindrical support device in the vessel called a stent.
* Echocardiogram: This test sends ultrasound waves that provide pictures of the heart's valves and chambers, giving information about chamber size and wall thickness and how blood is flowing within the chambers.
* Computed tomography (CT) scan: An X-ray and a computer are used to construct a cross-sectional image of the heart.
* Magnetic resonance arteriography (MRA): This test provides images of blood vessels to show where they may be blocked

How Is Atherosclerosis Treated?

n general, atherosclerosis is treated by making changes to diet, increasing exercise, and often with medications to reduce the fats and cholesterol in the blood. Other treatments include angioplasty (a catheter with a balloon on the end is used to flatten plaque and open up the artery) and stenting (a small, metal mesh cylinder is placed inside the artery after angioplasty to keep the artery open). In some cases, open heart surgery is required.

Your doctor may prescribe medications to reduce hypertension and the risk of atherosclerosis. Hypertension medications include diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, or alpha blockers.

What is an aortic aneurysm?

An aortic aneurysm (say "a-OR-tik AN-yuh-rih-zum") is a bulge in a section of the aorta, the body’s main artery. The aorta carries oxygen-rich blood from the heart to the rest of the body. Because the section with the aneurysm is overstretched, it can burst. If the aorta bursts, it can cause serious bleeding that can quickly lead to death.

Aneurysms can form in any section of the aorta, but they are most common in the belly area (abdominal aortic aneurysm). They can also happen in the upper body (thoracic aortic aneurysm).
What causes an aortic aneurysm?

The wall of the aorta is normally very elastic. It can stretch and then shrink back as needed to adapt to blood flow. But some medical problems, such as high blood pressure and atherosclerosis (hardening of the arteries), weaken the artery walls. These problems, along with the wear and tear that naturally occurs with aging, can result in a weak aortic wall that bulges outward.
What are the symptoms?

Most aortic aneurysms don't cause symptoms. Sometimes a doctor finds them during exams or tests done for other reasons. People who do have symptoms complain of belly or chest pain and discomfort. The symptoms may come and go or stay constant.

In the worst case, an aneurysm can burst, or rupture. This causes severe pain and bleeding. It often leads to death within minutes.

An aortic aneurysm can also lead to other problems. Blood flow often slows in the bulging section of an aortic aneurysm, causing clots to form. If a blood clot breaks off from an aortic aneurysm in the chest area, it can travel to the brain and cause a stroke. Blood clots that break off from an aortic aneurysm in the belly area can block blood flow to the belly or legs.
How is an aortic aneurysm diagnosed?

Aneurysms are often diagnosed by chance during exams or tests done for other reasons. In some cases, they are found during a screening test for aneurysms. Screening tests help your doctor look for a certain disease or condition before any symptoms appear. Experts recommend screening tests for aneurysms for men between the ages of 65 and 75 who have ever smoked. These men are more likely to have an aneurysm than are women or nonsmoking men.

If your doctor thinks you have an aneurysm, you may have tests such as an ultrasound, a CT scan, or an MRI to find out where it is and how big it is.
How is it treated?

Treatment of an aortic aneurysm is based upon how big it is and how fast it is growing. If you have a large or fast-growing aneurysm, you need surgery to fix it. In most cases, a doctor will replace the damaged part of the blood vessel with a man-made graft.

Small aneurysms rarely rupture and are usually treated with high blood pressure medicine, such as beta-blockers. This medicine helps to lower blood pressure and stress on the aortic wall. If you don't have surgery, you will have routine ultrasound tests to make sure that the aneurysm is not getting bigger.

Even if your aneurysm does not grow or rupture, you may be at risk for heart problems. Your doctor may suggest that you exercise more, eat a heart-healthy diet, and stop smoking. He or she may also prescribe medicines to help lower high cholesterol.

The most common symptom of coronary artery disease is angina or "angina pectoris," also known as chest pain. Angina can be described as a discomfort, heaviness, pressure, aching, burning, fullness, squeezing or painful feeling. Often, it can be mistaken for indigestion.

Angina is usually felt in the chest, but may also be felt in the shoulders, arms, neck, throat, jaw or back.

If you have this symptom, take notice. If you've never been diagnosed with heart disease, you should seek treatment immediately. If you've had angina before, use your angina medications as directed by your doctor and try to determine if this is your regular pattern of angina or if the symptoms are worse. (This is called unstable angina, see below.)
What Causes Angina?

When blood flow to an area of the heart is decreased, it impairs the delivery of oxygen and vital nutrients to the heart muscle cells. When this happens, the heart muscle must use alternative, less efficient forms of fuel so that it can perform its function of pumping blood to the body. The byproduct of using this less efficient fuel is a compound called lactic acid that builds up in the muscle and causes pain.
What Are the Types of Angina?

The types of angina are:

* Stable angina. The pain is predictable and present only during exertion or extreme emotional distress, disappearing with rest.
* Unstable angina. This may signal an impending heart attack. Unstable angina is angina pain that is different from your regular angina pain or pain that occurs while at rest. The angina may occur more frequently, more easily at rest, feel more severe, last longer, or come on with minimal activity. Although this type of angina can often be relieved with oral medications (medicine taken by mouth), it is unstable and may progress to a heart attack. Usually more intense medical treatment or a procedure is required.
* Prinzmetal's angina. This is when angina occurs at rest, when sleeping, or when exposed to cold temperatures. In these cases, the symptoms are caused by decreased blood flow to the heart's muscle or from spasm of the coronary artery. The majority of people with this type of angina also have coronary artery disease. These spasms occur close to the blockage.

Can Angina Occur In the Absence of Coronary Disease?

Rarely, angina can occur in the absence of any coronary disease. People with a heart valve problem called aortic stenosis have decreased blood flow to the coronary arteries from the heart. People with severe anemia may have angina because their blood doesn't carry enough oxygen. People with thickened heart muscles need more oxygen and can have angina when they don't get enough oxygen.
How Is Angina Evaluated?

First, your doctor will ask you a series of questions to determine what your symptoms are and what brings them on. After examining you, your doctor will order one or more of a series of tests to determine the underlying cause of the angina and the extent of coronary artery disease, if present. These tests include:

* Exercise stress test
* Electrocardiogram (ECG or EKG)
* Nuclear imaging tests. These are specialized imaging tests that can accurately localize the part of the heart that has decreased blood flow. They are often performed in association with a stress test or echocardiography.
* Echocardiogram
* Cardiac catheterization

How Is Angina Treated?

The treatment you receive depends on the severity of the underlying problem, namely the amount of damage to the heart. For most people with mild angina, a combination of medications and lifestyle changes can control the symptoms. Lifestyle changes include: eating a heart-healthy diet, lowering cholesterol, getting regular exercise, quitting smoking and controlling diabetes and high blood pressure.

Some medications used to treat angina work by either increasing the amount of oxygen delivered to the heart muscle or reducing the heart's need for oxygen. These medicines include:

* Beta-blockers
* Nitrates
* Calcium channel blockers
* Angiotensin-converting enzyme inhibitors (ACE inhibitors)

Others work to prevent the formation of blood clots, which can further block blood flow to the heart muscle. These medicines include:

* Antiplatelet medications
* Blood thinners
* Anticoagulants

For people with more serious or worsening angina, your doctor may recommend treatment to open blocked arteries. These include:

* Angioplasty
* Stenting
* Coronary artery bypass grafting (CABG) surgery
* Transmyocardial revascularization (TMR)
* External counterpulsation (EECP)

What Should I Do if I Have Angina?

With any type of angina, stop what you are doing and rest.

If you have been prescribed a medication called nitroglycerin to treat your angina, take one tablet and let it dissolve under your tongue. If using the spray form, spray it under your tongue. Wait five minutes.

If you still have angina after five minutes, take another dose of nitroglycerin. Wait another five minutes and if angina is still present, take a third dose.

If you still have angina after resting and taking two doses of nitroglycerin or 15 minutes, call for emergency help (dial 911 in most areas) or have someone take you to the local emergency room.

If you think you are having a heart attack, do not delay. Call for emergency help right away. Do not drive yourself to the hospital. Consider taking an aspirin. Quick treatment of a heart attack is very important to lessen the amount of damage to your heart.
Why Shouldn't I Drive Myself or Have Someone Drive Me to the Hospital?

When the ambulance arrives, the emergency personnel can begin to give you heart-saving care right away. They can start an IV to give you important drugs and give you oxygen to help improve the flow of oxygen-rich blood to your heart. Should problems occur, they are there to provide life-saving help as well.
Something to Remember

Carry nitroglycerin with you at all times; you never know when you will need it. Nitroglycerin must be kept in a dark container. Keep it away from heat or moisture. Check the expiration date on the container. Once the container of nitroglycerin tablets is opened, it must be replaced every six months. The spray form has a longer shelf life and should be replaced every 2 years.

An irregular heartbeat is an arrhythmia (also called dysrhythmia). Heart rates can also be irregular. A normal heart rate is 50 to 100 beats per minute. Arrhythmias and abnormal heart rates don't necessarily occur together. Arrhythmias can occur with a normal heart rate, or with heart rates that are slow (called bradyarrhythmias -- less than 60 beats per minute). arrhythmias can also occur with rapid heart rates (called tachyarrhythmias -- faster than 100 beats per minute). In the United States more than 850,000 people are hospitalized for an arrhythmia each year.
What Causes an Arrhythmia?

Arrhythmias may be caused by many different factors, including:

* Coronary artery disease.
* Electrolyte imbalances in your blood (such as sodium or potassium).
* Changes in your heart muscle.
* Injury from a heart attack.
* Healing process after heart surgery.

Irregular heart rhythms can also occur in "normal, healthy" hearts.

What Are the Types of Arrhythmias?

The types of arrhythmias include:

* Premature atrial contractions. These are early extra beats that originate in the atria (upper chambers of the heart). They are harmless and do not require treatment.
* Premature ventricular contractions (PVCs). These are among the most common arrhythmias and occur in people with and without heart disease. This is the skipped heartbeat we all occasionally experience. In some people, it can be related to stress, too much caffeine or nicotine, or too much exercise. But sometimes, PVCs can be caused by heart disease or electrolyte imbalance. People who have a lot of PVCs, and/or symptoms associated with them, should be evaluated by a heart doctor. However, in most people, PVCs are usually harmless and rarely need treatment.
* Atrial fibrillation. AF is a very common irregular heart rhythm that causes the atria, the upper chambers of the heart to contract abnormally.
* Atrial flutter. This is an arrhythmia caused by one or more rapid circuits in the atrium. Atrial flutter is usually more organized and regular than atrial fibrillation. This arrhythmia occurs most often in people with heart disease, and in the first week after heart surgery. It often converts to atrial fibrillation.
* Paroxysmal supraventricular tachycardia (PSVT). A rapid heart rate, usually with a regular rhythm, originating from above the ventricles. PSVT begins and ends suddenly. There are two main types: accessory path tachycardias and AV nodal reentrant tachycardias (see below).
* Accessory pathway tachycardias. A rapid heart rate due to an extra abnormal pathway or connection between the atria and the ventricles. The impulses travel through the extra pathways as well as through the usual route. This allows the impulses to travel around the heart very quickly, causing the heart to beat unusually fast.
* AV nodal reentrant tachycardia. A rapid heart rate due to more than one pathway through the AV node. It can cause heart palpitations, fainting or heart failure. In many cases, it can be terminated using a simple maneuver performed by a trained medical professional, medications or a pacemaker.
* Ventricular tachycardia (V-tach). A rapid heart rhythm originating from the lower chambers (or ventricles) of the heart. The rapid rate prevents the heart from filling adequately with blood; therefore, less blood is able to pump through the body. This can be a serious arrhythmia, especially in people with heart disease, and may be associated with more symptoms. A heart doctor should evaluate this arrhythmia.
* Ventricular fibrillation. An erratic, disorganized firing of impulses from the ventricles. The ventricles quiver and are unable to contract or pump blood to the body. This is a medical emergency that must be treated with cardiopulmonary resuscitation (CPR) and defibrillation as soon as possible.
* Long QT syndrome. The QT interval is the area on the electrocardiogram (ECG) that represents the time it takes for the heart muscle to contract and then recover, or for the electrical impulse to fire impulses and then recharge. When the QT interval is longer than normal, it increases the risk for "torsade de pointes," a life-threatening form of ventricular tachycardia. Long QT syndrome is an inherited condition that can cause sudden death in young people. It can be treated with antiarrhythmic drugs, pacemaker, electrical cardioversion, defibrillation, implanted cardioverter/defibrillator or ablation therapy.
* Bradyarrhythmias. These are slow heart rhythms, which may arise from disease in the heart's electrical conduction system. Examples include sinus node dysfunction and heart block.
* Sinus node dysfunction. A slow heart rhythm due to an abnormal SA (sinus) node. Sinus node dysfunction is treated with a pacemaker.
* Heart block. A delay or complete block of the electrical impulse as it travels from the sinus node to the ventricles. The level of the block or delay may occur in the AV node or HIS-Purkinje system. The heart may beat irregularly and, often, more slowly. If serious, heart block is treated with a pacemaker.

What Are the Symptoms of Arrhythmias?

An arrhythmia can be silent and not cause any symptoms. A doctor can detect an irregular heartbeat during a physical exam by taking your pulse or through an electrocardiogram (ECG).

When symptoms occur, they may include:

* Palpitations (a feeling of skipped heart beats, fluttering or "flip-flops," or feeling that your heart is "running away").
* Pounding in your chest.
* Dizziness or feeling light-headed.
* Fainting.
* Shortness of breath.
* Chest discomfort.
* Weakness or fatigue (feeling very tired).

How Are Arrhythmias Diagnosed?

Tests used to diagnose an arrhythmia or determine its cause include:

* Electrocardiogram
* Holter monitor
* Event monitor
* Stress test
* Echocardiogram
* Cardiac catheterization
* Electrophysiology study (EPS)
* Head-up tilt table test

How Are Arrhythmias Treated?

Treatment depends on the type and seriousness of your arrhythmia. Some people with arrhythmias require no treatment. For others, treatments can include medication, making lifestyle changes and undergoing surgical procedures.
What Medications Are Used to Treat Arrhythmias?

A variety of drugs are available to treat arrhythmias. These include:

* Antiarrhythmic drugs. These drugs control heart-rate, and include beta-blockers.
* Anticoagulant or antiplatelet therapy. These drugs reduce the risk of blood clots and stroke. These include warfarin (a "blood thinner") or aspirin.

Because everyone is different, it may take trials of several medications and doses to find the one that works best for you.
What Lifestyle Changes Should Be Made?

* If you notice that your irregular heart rhythm occurs more often with certain activities, you should avoid them.
* If you smoke, stop.
* Limit your intake of alcohol.
* Limit or stop using caffeine. Some people are sensitive to caffeine and may notice more symptoms when using caffeine products (such as tea, coffee, colas and some over-the-counter medications).
* Stay away from stimulants used in cough and cold medications. Some such medications contain ingredients that promote irregular heart rhythms. Read the label and ask your doctor or pharmacist what medication would be best for you.

What Is Electrical Cardioversion?

If drugs are not able to control a persistent irregular heart rhythm (such as atrial fibrillation), cardioversion may be required. After administration of a short-acting anesthesia, an electrical shock is delivered to your chest wall that synchronizes the heart and allows the normal rhythm to restart.
What Is a Pacemaker?

A pacemaker is a device that sends small electrical impulses to the heart muscle to maintain a suitable heart rate. Pacemakers primarily prevent the heart from beating too slowly. The pacemaker has a pulse generator (which houses the battery and a tiny computer) and leads (wires) that send impulses from the pulse generator to the heart muscle. Newer pacemakers have many sophisticated features that are designed to help manage arrhythmias and optimize heart-rate-related function as much as possible.
What Is an Implantable Cardioverter-Defibrillator (ICD)?

An ICD is a sophisticated device used primarily to treat ventricular tachycardia and ventricular fibrillation, two life-threatening heart rhythms. The ICD constantly monitors the heart rhythm. When it detects a very fast, abnormal heart rhythm, it delivers energy to the heart muscle to cause the heart to beat in a normal rhythm again. There are several ways the ICD can be used to restore normal heart rhythm. They include:

* Anti-tachycardia pacing (ATP). When the heart beats too fast, a series of small electrical impulses may be delivered to the heart muscle to restore a normal heart rate and rhythm.
* Cardioversion. A low energy shock may be delivered at the same time as the heart beats to restore normal heart rhythm.
* Defibrillation. When the heart is beating dangerously fast or irregularly, a higher energy shock may be delivered to the heart muscle to restore a normal rhythm.
* Anti-bradycardia pacing. Many ICDs provide back-up pacing to prevent too slow of a heart rhythm.

What Is Catheter Ablation?

During an ablation, high-frequency electrical energy is delivered through a catheter to a small area of tissue inside the heart that causes the abnormal heart rhythm. This energy "disconnects" the pathway of the abnormal rhythm. Ablation is used to treat most PSVTs, atrial flutter, atrial fibrillation, and some atrial and ventricular tachycardias. Ablation may be combined with other procedures to achieve optimal treatment.
What Is Heart Surgery?

Heart surgery may be needed to correct heart disease that may be causing the arrhythmia. The Maze procedure is a type of surgery used to correct atrial fibrillation. During this procedure, a series (or "maze")of incisions are made in the right and left atria to confine the electrical impulses to defined pathways. Some people may require a pacemaker after this procedure.

May 2, 2008 -- A pill containing aged garlic extract, vitamins, and other nutrients may slow the progression of atherosclerosis, a preliminary study shows.

The study included 65 people (average age: 60) who were at intermediate risk for heart disease. They took a placebo pill or a pill containing aged garlic extract, vitamin B-12, folic acid, vitamin B-6, and L-arginine for one year; 58 patients completed the study.

The patients got cholesterol tests and other blood tests every three months. They also got heart scans at the study's start and end.

Atherosclerosis worsened to a lesser extent in patients taking the garlic-and-vitamins pill compared to those taking the placebo.

The patients' age, gender, degree of atherosclerosis at the study's start, high blood pressure, high cholesterol levels, and diabetes medications didn't affect the results, note the researchers, who included Matthew Budoff, MD, associate professor of medicine, and Naser Ahmadi, MD, of the Los Angeles Biomedical Research Institute at the Harbor-UCLA Medical Center.

It's not clear which ingredient in the pill mattered most, but Budoff tells WebMD via email that the aged garlic extract delivered the "primary benefit," though other ingredients may have lowered the patients' blood levels of homocysteine, an amino acid associated with higher risk of heart disease.

The researchers call for larger studies of the potential ability of garlic plus vitamins to slow coronary artery calcification. Ahmadi presented the findings in May 1 in Baltimore at the American Heart Association's 2008 Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke Conference.

The study was funded by Wakunaga of America, which makes the garlic pill used in the study. Budoff had full control over the study.