For most of us, the beating of our hearts signifies life itself, so any health problem connected to this powerful organ cuts to the very core of our fears about our own mortality. Fear alone will hardly keep this killer at bay. A better approach lies in the number of steps you can take to protect yourself. Some, like eating more fruits and vegetables, are fairly simple. Others, like maintaining a regular workout routine or managing stress, take a little more time and effort. But one of the easiest things you can do is get informed. Read through the following sections so you understand the symptoms of some of the most common heart problems, and contact your doctor if you think something is wrong. Get to know the lifestyle changes that can make a difference. Most of them will not only keep you healthier in the long term. they'll make you feel better right now.

Coronary artery disease is the most common health problem in both American men and women. It can lead to actual heart attacks, which is the number one killer for both sexes, causing about a quarter million deaths in American men alone every year.
Researchers have identified many risk factors that contribute to this process (such as smoking, elevated blood fats, and high blood pressure) and are beginning to better understand what happens at the cellular level to initiate the clogging of our coronary arteries. Atherosclerosis, the major cause of coronary artery disease, usually begins with damage to the innermost lining of the arteries, the endothehum. When this lining is damaged, various substances like fat and sometimes calcium start to collect and form plaques. These plaques can break apart (rupture), leading to the sudden formation of blood clots which can block the flow of blood to heart muscle. In order to understand what happens when plaques form and sometimes rupture, it is helpful to understand some of the terms that we doctors toss around. Specifically, I want to take the time to discuss the process that can lead to an actual heart attack so that you can better understand the discussions about screening, diagnosis, and treatment.

First I should explain that heart muscle cells must get their oxygen and nutrients from blood brought to them by the coronary arteries. They cannot get these essentials by simply extracting them from the blood flowing through the chambers of the heart. The coronary arteries that supply blood to heart muscle cells arise from the aorta, the major artery emerging from the heart's main pumping chamber (the left ventricle). Every time the heart beats, it pushes blood out through the aorta to all parts of the body. And just above the heart there are two coronary arteries that branch off the aorta, carrying blood directly back to the heart muscle cells through a branching system of arteries that run over the surface of the heart. Blockages to the flow of blood to heart muscle can occur anywhere in this system of coronary arteries; obviously, the larger the blocks and/or the larger the artery blocked, the more likely it is to be dangerous since it will affect a larger area of heart muscle.

Heart failure is now the leading cause of hospitalization in people over age 65. It kills about 4O,OOO people a year and afflicts about 5 million Americans. One recent estimate suggests the direct and indirect costs of heart failure in this country are about $21 billion a year.
Heart failure is not a specific disease but rather usually a chronic condition that can be caused by many underlying diseases. Whatever the specific causes, the result is a heart so damaged that it cannot pump vigorously enough to meet the body's needs. Therefore, blood coming into the heart tends to "back up" in the lungs, producing congestion in the lungs. (That's why the condition is often known as "congestive heart failure", or CHF for short.) The typical symptom of GHE is shortness of breath, even with mild exertion or in worst cases even at rest. Symptoms elsewhere in the body depend on which organs or tissues are most affected, but swelling in the legs is very characteristic of heart failure.

Since heart failure is really a condition resulting from specific diseases, the prevention of heart failure usually means the prevention of the diseases most likely to lead to heart failure, including:

When blockages in the coronary arteries are big enough to cause actual heart attacks, heart muscle is permanently damaged and replaced by scar tissue that cannot contract and contribute to the heart's pumping ability. If enough heart muscle is damaged, heart failure can result.

High blood pressure can put so much strain on the heart that the organ eventually enlarges in an attempt to compensate. This enlargement may in turn lead to damage to the heart muscle and, eventually, to heart failure.

This word covers a wide range of possible problems, all of which result in weakened heart muscle. Some of these problems cannot be prevented including infections of heart muscle by various viruses or genetic disorders that can cause abnormal thickening of heart muscle. (This is the condition that often causes sudden death in young athletes.) However, one condition we do have possible control over is excessive alcohol, which can result in a weakened heart.

When the valves that regulate the flow of blood through the chambers of the heart do not function normally, blood can back up in the heart, causing heart failure.
Since severe heart failure can dramatically compromise quality of life, basically making a person a housebound invalid, it is important to prevent the condition whenever possible by preventing the diseases that cause it.

Usually a combination of the symptoms and a person's medical history will point to the underlying problem of heart failure. However, there are many tests that can be used when necessary, including:
  Chest X-ray (which can show the backup of blood in the lungs).
  Echocardiogram (an ultrasound exam of the heart that can show how it is beating and how the valves are working).
  Angiographic and radioisotope studies of heart function
  Heart biopsy (which takes a sample of heart muscle for examination under the microscope).

Obviously the treatment for heart failure is directed at the underlying cause or causes whenever possible. However, when those causes are unknown or when permanent damage has already resulted, the goal of treatment is to help the heart to pump better and/or to reduce the strain on the damaged heart. There are many different medicines that can be used today to help people with heart failure lead longer and more normal lives. Two categories of drugs, beta blockers and ACE inhibitors have proven to be especially helpful. However, this is one of those conditions in which the expertise of a specialist can often make an enormous difference. Quite frankly, most primary care physicians are not equipped to effectively treat the most severe forms of heart failure; experts in heart failure are more likely to be found in major medical centers that have a lot of experience with this condition. In the most extreme cases of heart failure, the only answer may be a heart transplant or one of the artificial heart devices now being developed. Those devices fall into two main categories:
  assist devices, which basically help the failing heart without replacing it.
  artificial hearts, which replace the heart.