Stroke: The sudden death of brain cells due to lack of oxygen, caused by blockage of blood flow

or rupture of an artery to the brain. Sudden loss of speech, weakness, or paralysis of one side of
the body can be symptoms. A suspected stroke can be confirmed by scanning the brain with
special X-ray tests, such as CAT scans. The death rate and level of disability resulting from
strokes can be dramatically reduced by immediate and appropriate medical
care. Prevention involves minimizing risk factors, such as controllinghigh blood
pressure and diabetes. Abbreviated CVA. Also known as cerebrovascular accident.

Heart Disease and Stroke

Knowing the signs of a stroke is the first step in stroke prevention. Astroke,
sometimes called a "brain attack," occurs when blood flow to an area in the brain is
cut off. The brain cells, deprived of the oxygen and glucose needed to survive, die. If
a stroke is not caught early, permanent brain damage or death can result.

How Does a Stroke Occur?

There are two types of stroke.

Ischemic stroke is similar to a heart attack, except it occurs

in theblood vessels of the brain. Clots can form in the brain's
blood vessels, in blood vessels leading to the brain, or even
in blood vessels elsewhere in the body and then travel to the
brain. These clots block blood flow to the brain's cells.
Ischemic stroke can also occur when too much plaque (fatty
deposits and cholesterol) clogs the brain's blood vessels.
About 80% of all strokes are ischemic.
Hemorrhagic (heh-more-raj-ik) strokes occur when a
blood vessel in the brain breaks or ruptures. The result is
blood seeping into the brain tissue, causing damage to brain
cells. The most common causes of hemorrhagic stroke
are high blood pressure and brain aneurysms.
An aneurysm is a weakness or thinness in the blood vessel
wall.
 What Are the Symptoms of Stroke?
The most common symptoms of a stroke are:

Weakness or numbness of the face, arm, or leg on one side of the body
Loss of vision or dimming (like a curtain falling) in one or both eyes
Loss of speech, difficulty talking, or understanding what others are saying
Sudden, severe headache with no known cause
Loss of balance or unstable walking, usually combined with another symptom

What Should I Do If I Experience Stroke Symptoms?

Immediately call 911 if you or someone you know has symptoms of a stroke. Stroke
is a medical emergency. Immediate treatment can save your life or increase your
chances of a full recovery.

Is it Possible to Prevent a Stroke?

Up to 50% of all strokes are preventable. Many risk factors can be controlled before
they cause problems.

Controllable Risk Factors for Stroke:

High blood pressure

Atrial fibrillation
Uncontrolled diabetes
High cholesterol
Smoking
Excessive alcohol intake
Obesity
Carotid or coronary artery disease

What are the different types of stroke?

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Strokes are usually classified by what mechanism caused the loss of the blood supply, either
ischemic or hemorrhagic. A stroke may also be described by what part of the brain was affected
(for example, a right temporal stroke) and what part of the body stopped working (stroke affecting
the left arm).

Ischemic stroke
An ischemic stroke is caused by an artery in the brain being obstructed or blocked, preventing
oxygen-rich blood from being delivered to brain cells. The artery can be blocked in a couple of
ways. In a thrombotic stroke, an artery can narrow over time because of cholesterol buildup,
called plaque. If that plaque ruptures, a clot is formed at the site and prevents blood from passing
to brain cells downstream, which are then deprived of oxygen.

In an embolic stroke, the artery is blocked because of debris or a clot that travels from the heart
or another blood vessel. Anembolus or embolism is a clot, a piece of fatty material or other object
that travels within the bloodstream that lodges in a blood vessel to cause an obstruction.

Blood clots that embolize usually arise from the heart. The most common cause of these blood
clots is a heart arrhythmia called atrial fibrillation, where the upper chambers of the heart, the
atria, do not beat in an organized rhythm. Instead, the chaotic electrical rhythm causes the atria
to jiggle like a bowl of Jell-O. While blood still flows to the ventricles (the heart's lower chambers)
to be pumped to the body, some blood along the inner walls of the atrium can form small blood
clots. If a clot breaks off, it can travel or embolize to the brain, where it can cause a stroke.

The carotid arteries are two large blood vessels that provide the brain with blood supply. These
arteries can narrow, or develop stenosis, with cholesterol plaque that builds up over time. The
surface of the plaque is irregular and bits of debris can break off and embolize to block blood
vessels downstream in the brain.

Hemorrhagic stroke
When a blood vessels leaks and spills blood into brain tissue, those brain cells stop working. The
bleeding or hemorrhage is often due to poorly-controlled high blood pressure that weakens the
wall of an artery over time. Blood may also leak from an aneurysm, a congenital weakness or
ballooning of an artery wall or from an AVM (arteriovenous malformation), a congenital
abnormality where an artery and vein connect incorrectly. The bleeding can form
a hematoma that can put pressure on small vessels and decrease or shut off blood flow to brain
tissue.

Describing a stroke by anatomy and symptoms

There are four major arteries that supply the brain with blood.

The right and left carotid artery are located in the front of the neck and their pulse can be felt
with the fingers.

The right and left vertebral arteries are encased in bone as they run through the vertebrae in
the neck. As the two enter the brain, they join to form the basilar artery.

The carotid arteries and the vertebrobasilar arteries join to form the Circle of Willis at the
base of the brain and from this circle, arteries branch off to supply the brain with blood.

The left side of the brain controls the right side of the body and vice versa. Speech tends to be
located in the dominant hemisphere, most often the left brain.
The anterior and middle cerebral arteries provide blood supply to the front two-thirds of the brain,
including the frontal, parietal, and temporal lobes. These parts of the brain control voluntary body
movement, sensation, speech and thought, personality, and behavior.

The vertebral and basilar arteries are considered the posterior circulation and supply the occipital
lobe where vision is located, the cerebellum that controls coordination and balance, and the
brainstem that is responsible for the unconscious brain functions that include blood
pressure, breathing, and wakefulness.

Picture of brain anatomy.

Strokes are often described based upon the function of the body that is lost and by the area of
the brain that is affected. Most commonly in strokes that involve the brain, the symptoms involve
either the right or left side of the body. In strokes that affect the brainstem or the spinal cord,
symptoms may present on both sides of the body.

Motor function or the ability for the body to move may involve only a part of the body, like the
hand or arm, or the whole side (both extremities). Weakness on one side of the body is called
hemiparesis (hemi= half + paresis=weak) and paralysis is hemiplegia (hemi=half
+plegia=paralysis).

Similarly, sensory function, the ability to feel, can be localized to a hand or an arm or involve
more of the body.

Other symptoms like speech, vision, balance, and coordination help locate the part of the brain
that has stopped working and helps the health care professional make the clinical diagnosis of
stroke. This is an important concept since not all loss of neurologic function is due to stroke and if
the anatomy and physiology do not match the loss of body function, other diagnoses may be
considered that can affect both brain and body.

A lacunar stroke describes a single tiny penetrating artery branch that occludes with either debris
or a clot to cause the stroke. The area of the involved brain is small but can still cause significant
neurologic deficits, just like a stroke involving a larger blood vessel and more brain tissue. In
some cases, however, the stroke is silent, meaning that no obvious body function is lost and an
old lacunar stroke can be seen as an incidental finding on CT or MRI scans of the head done for
other reasons. The term lacune means empty space and a tiny empty space of an old lacunar
stroke can be seen on imaging where brain tissue has been lost

What causes a stroke?

Thrombotic stroke
The blockage of an artery in the brain by a clot (thrombosis) is the most common cause of a
stroke. The part of the brain that is supplied by the clotted blood vessel is then deprived of blood
and oxygen. As a result of the deprived blood and oxygen, the cells of that part of the brain die
and the part of the body that it controls stops working. Typically, a cholesterol plaque in one of
the brain's small blood vessels ruptures and starts the clotting process.

Risk factors for narrowed blood vessels in the brain are the same as those that cause narrowing
blood vessels in the heart and heart attack (myocardial infarction). These risk factors include:

high blood pressure (hypertension),

high cholesterol,

diabetes, and

smoking.

Embolic stroke
Another type of stroke may occur when ablood clot or a piece of atheroscleroticplaque
(cholesterol and calcium deposits on the wall of the inside of the heart or artery) breaks loose,
travels through the bloodstream, and lodges in an artery in the brain. When blood flow stops,
brain cells do not receive the oxygen and glucose they require to function and a stroke occurs.
This type of stroke is referred to as an embolic stroke. For example, a blood clot might originally
form in the heart chamber as a result of an irregular heart rhythm, like atrial fibrillation. Usually,
these clots remain attached to the inner lining of the heart, but occasionally they can break off,
travel through the bloodstream (embolize), form a plug in a brain artery, and cause a stroke. An
embolism can also originate in a large artery (for example, the carotid artery, a major artery in the
neck that supplies blood to the brain) and then travel downstream to clog a small artery within the
brain.

Cerebral hemorrhage
A cerebral hemorrhage occurs when a blood vessel in the brain ruptures and bleeds into the
surrounding brain tissue. A cerebral hemorrhage (bleeding in the brain) causes stroke
symptoms by depriving blood and oxygen to parts of the brain in a variety of ways. Blood flow is
lost to some cells. Additionally, blood is very irritating and can cause swelling of brain tissue
(cerebraledema). Edema and the accumulation of blood from a cerebral hemorrhage increases
pressure within the skull and causes further damage by squeezing the brain against the bony
skull. This further decreases blood flow to brain tissue and its cells.

Subarachnoid hemorrhage
In a subarachnoid hemorrhage, blood accumulates in the space beneath the arachnoid
membrane that lines the brain. The blood originates from an abnormal blood vessel that leaks or
ruptures. Often this is from an aneurysm (an abnormal ballooning out of the blood vessel).
Subarachnoid hemorrhages usually cause a sudden severe headache, nausea, vomiting, light
intolerance, and stiff neck. If not recognized and treated, major neurological consequences, such
as coma, and brain death may occur.

Vasculitis
Another rare cause of stroke is vasculitis, a condition in which the blood vessels become
inflamed causing decreased blood flow to brain tissue.

Migraine headache
There appears to be a very slight increased occurrence of stroke in people with migraine
headache. The mechanism for migraine or vascularheadaches includes narrowing of the brain
blood vessels. Some migraineheadache episodes can even mimic stroke with loss of function of
one side of the body or vision or speech problems. Usually, the symptoms resolve as
the headache resolves

What are the risk factors for stroke?

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Overall, the most common risk factors for stroke are:

high blood pressure,

high cholesterol,
 smoking,

diabetes, and

increasing age.

Heart conditions like atrial fibrillation, patent foramen ovale, and heart valve disease can also be
the potential cause of stroke.

When stroke occurs in younger individuals (less than 50 years old), less common risk factors to
be considered include illicit drugs, such as cocaine or amphetamines, ruptured aneurysms, and
inherited (genetic) predispositions to abnormal blood clotting.

An example of a genetic predisposition to stroke occurs in a rare condition calledhomocystinuria,

in which there are excessive levels of the chemical homocystine in the body. Scientists are trying
to determine whether the non-hereditary occurrence of high levels of homocystine at any age can
predispose to stroke

What are the symptoms of a stroke?

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Symptoms of stroke depend upon where the brain function has stopped due to loss of its blood
supply. Often, the patient may present with multiple symptoms including the following:

Acute change in level of consciousness or confusion

Acute onset of weakness or paralysis of half or part of the body

Numbness of one half of the body

Partial vision loss

Double vision

Difficulty speaking or understanding speech

Difficulty with balance and vertigo

The symptoms of ischemic and hemorrhagic stroke may be the same but patients with
hemorrhagic stroke may also complain more of headache andvomiting.

Can strokes be prevented?

Prevention is always the best treatment, especially when the illness can be life-threatening or
life-altering. Ischemic strokes are most often caused byatherosclerosis, or hardening of the
arteries, and carry the same risk factors as do heart attacks (myocardial infarction,coronary
artery disease) and peripheral vascular disease. These include high blood pressure, high
cholesterol, diabetes, and smoking. Stopping smoking and keeping the other three under lifelong
control greatly minimizes the risk of ischemic stroke.

Patients who have had a transient ischemic attack (TIA) are often prescribed medications to
decrease their risk of a subsequent stroke. These include medications to lower blood cholesterol
levels and control blood pressure. In addition, antiplatelet medications may be prescribed to
make platelets less likely to promote blood clot formation. These includeaspirin, clopidogrel
(Plavix), anddipyridamole/aspirin (Aggrenox).

Patients with a TIA are usually evaluated for carotid stenosis or narrowing of the carotid artery.
Surgery to open critically narrowed arteries may decrease stroke risk.

Lifelong control of high blood pressure decreases the risk of hemorrhagic stroke.

Atrial fibrillation is the most common cause of embolic stroke. Ideally the heart rhythm can be
converted to normal sinus rhythm but in those patients whose hearts are chronically in atrial
fibrillation, anticoagulation or blood thinning minimizes the risk of blood clot formation in the
heart and subsequent embolization and stroke. Which drug that is used to thin the blood
depends upon the specific patient and their individual situation. Patients who are
prescribed warfarin (Coumadin), dabigatran (Pradaxa), and rivaroxaban (Xarelto) decrease the
chance of a stroke but are at risk for bleeding complications

What Is a Stroke?
A stroke occurs when a blockage to the brain's blood supply occurs. Stroke symptoms (for
example, loss of arm or leg function or slurred speech) signify a medical emergency because
without treatment, blood deprived brain cells quickly become damaged or die resulting in brain
injury, serious disability, or death. Call 9-1-1 if you notice stroke symptoms developing in
someone.
 Stroke Symptoms
Cal 9-1-1 if any of these symptoms occur in someone suddenly:

Difficulty speaking
Difficulty understanding or confusion, especially with simple tasks
Difficulty with muscle strength, especially on one side of the body
Difficulty with numbness, especially on one side of the body
Severe headache
Vision changes (in one or both eyes)
Difficulty with swallowing
Facial droop on one side
What Causes a Stroke
Common causes of stroke come from blood vessels both outside and inside the brain.
Atherosclerosis (hardening of the arteries) can occur when plaque (deposits of
cholesterol, calcium, fat, and other substances) builds up and narrows the vessel making
it easy for clots to form and further occlude the vessel. The clots can break free only to
occlude smaller blood vessels inside the brain. The blood vessels inside the brain itself
can accumulate this plaque. Occasionally, weakened vessels can burst and bleed into
the brain.

troke Risk Factors: Chronic Conditions

Common conditions that increase a person's risk for strokes include high blood pressure,
elevated cholesterol levels, diabetes, and obesity. People can reduce stroke risks by
addressing these problems in consultation with their doctor

Stroke Risk Factors: Behaviors

People can also reduce their stroke risk by altering some aspects of their lifestyle. For
example, people who stop smoking, begin a consistent exercise program, and limit their
 alcohol intake (two drinks per day for men, one per day for women) can decrease their
risk.

Stroke Risk Factors: Diet

One of the best ways to reduce stroke risk is to eat a diet that has low fat and low
cholesterol to reduce the chance of plaque formation in blood vessels. Foods high in salt
may increase blood pressure. Cutting back on calories can help reduce obesity. A diet
that contains a lot of vegetables, fruits, and whole grains, along with more fish and less
meat (especially red meat) is suggested to lower stroke risk.

troke Prevention: Medications

Medications are usually prescribed for people with a high risk of stroke. The medicines are
designed to lower risk by inhibiting clot formation (aspirin, warfarin and/or other antiplatelet
medicines). Also, antihypertensive medications can help by reducing high blood pressure.
Medications have side effects so discuss these with you doctor.

Stroke Prevention: Surgery

There are some surgical options for stroke prevention. Some patients have plaque- narrowed
carotid arteries. The plaque can participate in clot formation in the artery and can even shed clots
to other areas in the brains blood vessels. Carotid endarterectomy is a surgical procedure where
the surgeon removes plaque from the inside of the arteries to reduce the chance of strokes in the
future.
Complications
The excessive pressure on your artery walls caused by high blood pressure can
damage your blood vessels, as well as organs in your body. The higher your blood
pressure and the longer it goes uncontrolled, the greater the damage.

Uncontrolled high blood pressure can lead to:

Heart attack or stroke. High blood pressure can cause hardening and thickening
of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other
complications.
Aneurysm. Increased blood pressure can cause your blood vessels to weaken
and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-
threatening.
Heart failure. To pump blood against the higher pressure in your vessels, your
heart muscle thickens. Eventually, the thickened muscle may have a hard time
pumping enough blood to meet your body's needs, which can lead to heart
failure.
Weakened and narrowed blood vessels in your kidneys.This can prevent
these organs from functioning normally.
Thickened, narrowed or torn blood vessels in the eyes.This can result in
vision loss.
Metabolic syndrome. This syndrome is a cluster of disorders of your body's
metabolism, including increased waist circumference; high triglycerides; low high-
density lipoprotein (HDL) cholesterol, the "good" cholesterol; high blood pressure;
and high insulin levels. These conditions make you more likely to develop
diabetes, heart disease and stroke.
Trouble with memory or understanding. Uncontrolled high blood pressure may
also affect your ability to think, remember and learn. Trouble with memory or
understanding concepts is more common in people with high blood pressure.

Risk factors
High blood pressure has many risk factors, including:

Age. The risk of high blood pressure increases as you age. Through early middle
age, or about age 45, high blood pressure is more common in men. Women are
more likely to develop high blood pressure after age 65.
 Race. High blood pressure is particularly common among blacks, often
developing at an earlier age than it does in whites. Serious complications, such
as stroke, heart attack and kidney failure, also are more common in blacks.
Family history. High blood pressure tends to run in families.
Being overweight or obese. The more you weigh the more blood you need to
supply oxygen and nutrients to your tissues. As the volume of blood circulated
through your blood vessels increases, so does the pressure on your artery walls.
Not being physically active. People who are inactive tend to have higher heart
rates. The higher your heart rate, the harder your heart must work with each
contraction and the stronger the force on your arteries. Lack of physical activity
also increases the risk of being overweight.
Using tobacco. Not only does smoking or chewing tobacco immediately raise
your blood pressure temporarily, but the chemicals in tobacco can damage the
lining of your artery walls. This can cause your arteries to narrow, increasing your
blood pressure. Secondhand smoke also can increase your blood pressure.
Too much salt (sodium) in your diet. Too much sodium in your diet can cause
your body to retain fluid, which increases blood pressure.
Too little potassium in your diet. Potassium helps balance the amount of
sodium in your cells. If you don't get enough potassium in your diet or retain
enough potassium, you may accumulate too much sodium in your blood.
Too little vitamin D in your diet. It's uncertain if having too little vitamin D in
your diet can lead to high blood pressure. Vitamin D may affect an enzyme
produced by your kidneys that affects your blood pressure.
Drinking too much alcohol. Over time, heavy drinking can damage your heart.
Having more than two drinks a day for men and more than one drink a day for
women may affect your blood pressure.

If you drink alcohol, do so in moderation. For healthy adults, that means up to

one drink a day for women of all ages and men older than age 65, and up to two
drinks a day for men age 65 and younger. One drink equals 12 ounces of beer, 5
ounces of wine or 1.5 ounces of 80-proof liquor.

Stress. High levels of stress can lead to a temporary increase in blood pressure.
If you try to relax by eating more, using tobacco or drinking alcohol, you may only
increase problems with high blood pressure.
Certain chronic conditions. Certain chronic conditions also may increase your
risk of high blood pressure, such as kidney disease, diabetes and sleep apnea.
Sometimes pregnancy contributes to high blood pressure, as well.

Although high blood pressure is most common in adults, children may be at risk, too.
For some children, high blood pressure is caused by problems with the kidneys or
heart. But for a growing number of kids, poor lifestyle habits, such as an unhealthy
diet, obesity and lack of exercise, contribute to high blood pressure.
Causes
By Mayo Clinic Staff

There are two types of high blood pressure.

Primary (essential) hypertension

For most adults, there's no identifiable cause of high blood pressure. This type of
high blood pressure, called primary (essential) hypertension, tends to develop
gradually over many years.

Secondary hypertension
Some people have high blood pressure caused by an underlying condition. This type
of high blood pressure, called secondary hypertension, tends to appear suddenly
and cause higher blood pressure than does primary hypertension. Various conditions
and medications can lead to secondary hypertension, including:

Obstructive sleep apnea

Kidney problems
Adrenal gland tumors
Thyroid problems
Certain defects in blood vessels you're born with (congenital)
Certain medications, such as birth control pills, cold remedies, decongestants,
over-the-counter pain relievers and some prescription drugs
Illegal drugs, such as cocaine and amphetamines
Alcohol abuse or chronic alcohol use

Symptoms
Most people with high blood pressure have no signs or symptoms, even if blood
pressure readings reach dangerously high levels.

A few people with high blood pressure may have headaches, shortness of breath or
nosebleeds, but these signs and symptoms aren't specific and usually don't occur
until high blood pressure has reached a severe or life-threatening stage.

When to see a doctor

You'll likely have your blood pressure taken as part of a routine doctor's
appointment.

Ask your doctor for a blood pressure reading at least every two years starting at age
18. If you're age 40 or older, or you're age 18-39 with a high risk of high blood
pressure, ask your doctor for a blood pressure reading every year. Blood pressure
generally should be checked in both arms to determine if there is a difference. It's
important to use an appropriate-sized arm cuff. Your doctor will likely recommend
more frequent readings if you've already been diagnosed with high blood pressure or
have other risk factors for cardiovascular disease. Children age 3 and older will
usually have blood pressure measured as a part of their yearly checkups.

If you don't regularly see your doctor, you may be able to get a free blood pressure
screening at a health resource fair or other locations in your community. You can
also find machines in some stores that will measure your blood pressure for free.

Public blood pressure machines, such as those found in pharmacies, may provide
helpful information about your blood pressure, but they may have some limitations.
The accuracy of these machines depends on several factors, such as a correct cuff
size and proper use of the machines. Ask your doctor for advice on using public
blood pressure machines.

Definition
By Mayo Clinic Staff

High blood pressure is a common condition in which the long-term force of the blood
against your artery walls is high enough that it may eventually cause health
problems, such as heart disease.

Blood pressure is determined both by the amount of blood your heart pumps and the
amount of resistance to blood flow in your arteries. The more blood your heart
pumps and the narrower your arteries, the higher your blood pressure.

You can have high blood pressure (hypertension) for years without any symptoms.
Even without symptoms, damage to blood vessels and your heart continues and can
be detected. Uncontrolled high blood pressure increases your risk of serious health
problems, including heart attack and stroke.

High blood pressure generally develops over many years, and it affects nearly
everyone eventually. Fortunately, high blood pressure can be easily detected. And
once you know you have high blood pressure, you can work with your doctor to
control it.
Definition
By Mayo Clinic Staff

Anemia is a condition in which you don't have enough healthy red blood cells to carry
adequate oxygen to your tissues. Having anemia may make you feel tired and weak.

There are many forms of anemia, each with its own cause. Loss of blood is the most
common cause of anemia. Anemia can be temporary or long term, and it can range
from mild to severe.

Treatments for anemia range from taking supplements to undergoing medical

procedures. You may be able to prevent some types of anemia by eating a healthy,
varied diet.

See your doctor if you suspect you have anemia because anemia can be a sign of
serious illnesses.

Symptoms
By Mayo Clinic Staff

Anemia symptoms vary depending on the cause of your anemia but may include:

Fatigue
Weakness
Pale skin
A fast or irregular heartbeat
Shortness of breath
Chest pain
Dizziness
Cognitive problems
Cold hands and feet
Headache
Initially, anemia can be so mild it goes unnoticed. But symptoms increase as anemia
worsens.

When to see a doctor

Make an appointment with your doctor if you're feeling fatigued for unexplained
reasons. Some anemias, such as iron deficiency anemia or vitamin B-12 deficiency,
are common.

Fatigue has many causes besides anemia, so don't assume that if you're tired you
must be anemic. Some people learn that their hemoglobin is low, which indicates
anemia, when they go to donate blood.

Low hemoglobin may be a temporary problem remedied by eating more iron-rich

foods or taking a multivitamin containing iron. It may also be a warning sign of
bleeding in your body that may be causing you to be deficient in iron.

If you're told that you can't donate blood because of low hemoglobin, make an
appointment with your doctor.

Causes
By Mayo Clinic Staff

Anemia occurs when your blood doesn't have enough red blood cells. This can
happen if:

Your body doesn't make enough red blood cells

Bleeding causes you to lose red blood cells more quickly than they can be
replaced
Your body destroys red blood cells
What red blood cells do
Your body makes three types of blood cells white blood cells to fight infection,
platelets to help your blood clot and red blood cells to carry oxygen throughout your
body.

Red blood cells contain hemoglobin a red, iron-rich protein that gives blood its red
color. Hemoglobin enables red blood cells to carry oxygen from your lungs to all
parts of your body and to carry carbon dioxide from other parts of the body to your
lungs so that it can be exhaled.

Most blood cells, including red blood cells, are produced regularly in your bone
marrow a red, spongy material found within the cavities of many of your large
bones. To produce hemoglobin and red blood cells, your body needs iron, vitamin B-
12, folate and other nutrients from the foods you eat.

Causes of common types of anemia

Common types of anemia and their causes include:
 Iron deficiency anemia. Iron deficiency anemia is caused by a shortage of the
element iron in your body. Your bone marrow needs iron to make hemoglobin.
Without adequate iron, your body can't produce enough hemoglobin for red blood
cells.

This type of anemia is often caused by blood loss, such as from heavy menstrual
bleeding, an ulcer, cancer, a polyp somewhere in your digestive system, and
prolonged use of aspirin or drugs known as nonsteroidal anti-inflammatory drugs
(NSAIDs).

Vitamin deficiency anemias. In addition to iron, your body needs folate and
vitamin B-12 to produce sufficient numbers of healthy red blood cells. A diet
lacking in these and other key nutrients can cause decreased red blood cell
production.

Additionally, some people may eat enough B-12, but their bodies aren't able to
process the vitamin. This can lead to vitamin deficiency anemia, also known as
pernicious anemia.

Anemia of chronic disease. Certain chronic diseases such as cancer,

HIV/AIDS, rheumatoid arthritis, Crohn's disease and other chronic inflammatory
diseases can interfere with the production of red blood cells, resulting in
chronic anemia. Kidney failure also can cause anemia.
Aplastic anemia. This very rare life-threatening anemia is caused by a decrease
in the bone marrow's ability to produce red blood cells. Causes of aplastic anemia
include infections, drugs and autoimmune diseases.
Anemias associated with bone marrow disease. A variety of diseases, such
as leukemia, myelodysplasia or myelofibrosis, can cause anemia by affecting
blood production in your bone marrow. The effects of these types of cancer and
cancer-like disorders vary from a mild alteration in blood production to a complete
life-threatening shutdown of the blood-making process.

Other cancers of the blood or bone marrow such as multiple myeloma,

myeloproliferative disorders and lymphoma also can cause anemia.

Hemolytic anemias. This group of anemias develops when red blood cells are
destroyed faster than bone marrow can replace them. Certain blood diseases can
cause increased red blood cell destruction. You can inherit a hemolytic anemia,
or you can develop it later in life.
Sickle cell anemia. This inherited and sometimes serious anemia is caused by a
defective form of hemoglobin that forces red blood cells to assume an abnormal
crescent (sickle) shape. These irregular-shaped red blood cells die prematurely,
resulting in a chronic shortage of red blood cells.
 Other anemias. There are several other rarer forms of anemia, such as
thalassemia and anemias caused by defective hemoglobin.

Risk factors
By Mayo Clinic Staff

These factors place you at increased risk of anemia:

A diet lacking in certain vitamins. Choosing a diet that is consistently low in

iron, vitamin B-12 and folate increases your risk of anemia.
Intestinal disorders. Having an intestinal disorder that affects the absorption of
nutrients in your small intestine such as Crohn's disease and celiac disease
puts you at risk of anemia. Surgical removal of or surgery to the parts of your
small intestine where nutrients are absorbed can lead to nutrient deficiencies and
anemia.
Menstruation. In general, women who haven't experienced menopause have a
greater risk of iron deficiency anemia than do men and postmenopausal women.
That's because menstruation causes the loss of red blood cells.
Pregnancy. If you're pregnant, you're at an increased risk of iron deficiency
anemia because your iron stores have to serve your increased blood volume as
well as be a source of hemoglobin for your growing baby.
Chronic conditions. For example, if you have cancer, kidney or liver failure, or
another chronic condition, you may be at risk of anemia of chronic disease.
These conditions can lead to a shortage of red blood cells.

Slow, chronic blood loss from an ulcer or other source within your body can
deplete your body's store of iron, leading to iron deficiency anemia.

Family history. If your family has a history of an inherited anemia, such as sickle
cell anemia, you also may be at increased risk of the condition.
Other factors. A history of certain infections, blood diseases and autoimmune
disorders, alcoholism, exposure to toxic chemicals, and the use of some
medications can affect red blood cell production and lead to anemia.

Complications
By Mayo Clinic Staff

Left untreated, anemia can cause numerous complications, such as:

Severe fatigue. When anemia is severe enough, you may be so tired that you
can't complete everyday tasks. You may be too exhausted to work or play.
 Heart problems. Anemia can lead to a rapid or irregular heartbeat an
arrhythmia. Your heart must pump more blood to compensate for the lack of
oxygen in the blood when you're anemic. This can even lead to congestive heart
failure.
Death. Some inherited anemias, such as sickle cell anemia, can be serious and
lead to life-threatening complications. Losing a lot of blood quickly results in
acute, severe anemia and can be fatal.

Definition
By Mayo Clinic Staff

Heart rhythm problems (heart arrhythmias) occur when the electrical impulses that
coordinate your heartbeats don't work properly, causing your heart to beat too fast,
too slow or irregularly.

Heart arrhythmias (uh-RITH-me-uhs) may feel like a fluttering or racing heart and
may be harmless. However, some heart arrhythmias may cause bothersome
sometimes even life-threatening signs and symptoms.

Heart arrhythmia treatment can often control or eliminate fast or irregular heartbeats.
In addition, because troublesome heart arrhythmias are often made worse or are
even caused by a weak or damaged heart, you may be able to reduce your
arrhythmia risk by adopting a heart-

Symptoms
By Mayo Clinic Staff

Arrhythmias may not cause any signs or symptoms. In fact, your doctor might find
you have an arrhythmia before you do, during a routine examination. Noticeable
signs and symptoms don't necessarily mean you have a serious problem, however.

Noticeable arrhythmia symptoms may include:

A fluttering in your chest

A racing heartbeat (tachycardia)
A slow heartbeat (bradycardia)
Chest pain
Shortness of breath
Lightheadedness
Dizziness
Fainting (syncope) or near fainting
When to see a doctor
Arrhythmias may cause you to feel premature or extra heartbeats, or you may feel
that your heart is racing or beating too slowly. Other signs and symptoms may be
related to your heart not pumping effectively due to the fast or slow heartbeat. These
include shortness of breath or wheezing, weakness, dizziness, lightheadedness,
fainting or near fainting, and chest pain or discomfort. Seek urgent medical care if
you suddenly or frequently experience any of these signs and symptoms at a time
when you wouldn't expect to feel them.

Ventricular fibrillation is one type of arrhythmia that can be deadly. It occurs when
the heart beats with rapid, erratic electrical impulses. This causes pumping
chambers in your heart (the ventricles) to quiver uselessly instead of pumping blood.
Without an effective heartbeat, blood pressure plummets, cutting off blood supply to
your vital organs. A person with ventricular fibrillation will collapse within seconds
and soon won't be breathing or have a pulse. If this occurs, follow these steps:

Call 911 or the emergency number in your area.

If there's no one nearby trained in cardiopulmonary resuscitation (CPR), provide
hands-only CPR. That means uninterrupted chest compressions of about 100 a
minute until paramedics arrive. To do chest compressions, push hard and fast in
the center of the chest. You don't need to do rescue breathing.
If you or someone nearby knows CPR, begin providing it if it's needed. CPR can
help maintain blood flow to the organs until an electrical shock (defibrillation) can
be given.
Find out if an automated external defibrillator (AED) is available nearby. These
portable defibrillators, which can deliver an electric shock that may restart
heartbeats, are available in an increasing number of places, such as in airplanes,
police cars and shopping malls. They can even be purchased for your home. No
training is required. The AED will tell you what to do. They're programmed to
allow a shock only when appropriate.

Causes
By Mayo Clinic Staff

Many things can lead to, or cause, an arrhythmia, including:

A heart attack that's occurring right now

Scarring of heart tissue from a prior heart attack
 Changes to your heart's structure, such as from cardiomyopathy
Blocked arteries in your heart (coronary artery disease)
High blood pressure
Diabetes
Overactive thyroid gland (hyperthyroidism)
Underactive thyroid gland (hypothyroidism)
Smoking
Drinking too much alcohol or caffeine
Drug abuse
Stress
Certain prescription medications
Certain dietary supplements and herbal treatments
Electrical shock
Air pollution
What's a normal heartbeat?
Your heart is made up of four chambers two upper chambers (atria) and two lower
chambers (ventricles). The rhythm of your heart is normally controlled by a natural
pacemaker (the sinus node) located in the right atrium. The sinus node produces
electrical impulses that normally start each heartbeat.

From the sinus node, electrical impulses travel across the atria, causing the atria
muscles to contract and pump blood into the ventricles.

The electrical impulses then arrive at a cluster of cells called the atrioventricular
node (AV node) usually the only pathway for signals to travel from the atria to the
ventricles.

The AV node slows down the electrical signal before sending it to the ventricles. This
slight delay allows the ventricles to fill with blood. When electrical impulses reach the
muscles of the ventricles, they contract, causing them to pump blood either to the
lungs or to the rest of the body.

In a healthy heart, this process usually goes smoothly, resulting in a normal resting
heart rate of 60 to 100 beats a minute. Conditioned athletes at rest commonly have a
heart rate less than 60 beats a minute because their hearts are so efficient.

Types of arrhythmias
Doctors classify arrhythmias not only by where they originate (atria or ventricles) but
also by the speed of heart rate they cause:

Tachycardia (tak-ih-KAHR-dee-uh). This refers to a fast heartbeat a resting

heart rate greater than 100 beats a minute.
 Bradycardia (brad-e-KAHR-dee-uh). This refers to a slow heartbeat a resting
heart rate less than 60 beats a minute.
Not all tachycardias or bradycardias mean you have heart disease. For example,
during exercise it's normal to develop a fast heartbeat as the heart speeds up to
provide your tissues with more oxygen-rich blood. During sleep or times of deep
relaxation, it's not unusual for the heart beat to be slower.

Tachycardias in the atria

Tachycardias originating in the atria include:

Atrial fibrillation. Atrial fibrillation is a rapid heart rate caused by chaotic

electrical impulses in the atria. These signals result in rapid, uncoordinated, weak
contractions of the atria.

The chaotic electrical signals bombard the AV node, usually resulting in an

irregular, rapid rhythm of the ventricles. Atrial fibrillation may be temporary, but
some episodes won't end unless treated.

Atrial fibrillation may lead to serious complications such as stroke.

Atrial flutter. Atrial flutter is similar to atrial fibrillation. The heartbeats in atrial
flutter are more-organized and more-rhythmic electrical impulses than in atrial
fibrillation. Atrial flutter may also lead to serious complications such as stroke.
Supraventricular tachycardia. Supraventricular tachycardia is a broad term that
includes many forms of arrhythmia originating above the ventricles
(supraventricular) in the atria or AV node.
Wolff-Parkinson-White syndrome. In Wolff-Parkinson-White syndrome, a type
of supraventricular tachycardia, there is an extra electrical pathway between the
atria and the ventricles, which is present at birth. However, you may not
experience symptoms until you're an adult. This pathway may allow electrical
signals to pass between the atria and the ventricles without passing through the
AV node, leading to short circuits and rapid heartbeats.
Tachycardias in the ventricles
Tachycardias occurring in the ventricles include:

Ventricular tachycardia. Ventricular tachycardia is a rapid, regular heart rate

that originates with abnormal electrical signals in the ventricles. The rapid heart
rate doesn't allow the ventricles to fill and contract efficiently to pump enough
blood to the body. Ventricular tachycardia can often be a medical emergency.
Without prompt medical treatment, ventricular tachycardia may worsen into
ventricular fibrillation.
Ventricular fibrillation. Ventricular fibrillation occurs when rapid, chaotic
electrical impulses cause the ventricles to quiver ineffectively instead of pumping
 necessary blood to the body. This serious problem is fatal if the heart isn't
restored to a normal rhythm within minutes.

Most people who experience ventricular fibrillation have an underlying heart

disease or have experienced serious trauma, such as being struck by lightning.

Long QT syndrome. Long QT syndrome is a heart disorder that carries an

increased risk of fast, chaotic heartbeats. The rapid heartbeats, caused by
changes in the electrical system of your heart, may lead to fainting, and can be
life-threatening. In some cases, your heart's rhythm may be so erratic that it can
cause sudden death.

You can be born with a genetic mutation that puts you at risk of long QT
syndrome. In addition, several medications may cause long QT syndrome. Some
medical conditions, such as congenital heart defects, may also cause long QT
syndrome.

Bradycardia a slow heartbeat

Although a heart rate below 60 beats a minute while at rest is considered
bradycardia, a low resting heart rate doesn't always signal a problem. If you're
physically fit, you may have an efficient heart capable of pumping an adequate
supply of blood with fewer than 60 beats a minute at rest. In addition, certain
medications used to treat other conditions, such as high blood pressure, may lower
your heart rate. However, if you have a slow heart rate and your heart isn't pumping
enough blood, you may have one of several bradycardias, including:

Sick sinus syndrome. If your sinus node, which is responsible for setting the
pace of your heart, isn't sending impulses properly, your heart rate may be too
slow (bradycardia), or it may speed up (tachycardia) and slow down
intermittently. Sick sinus syndrome can also be caused by scarring near the sinus
node that's slowing, disrupting or blocking the travel of impulses.
Conduction block. A block of your heart's electrical pathways can occur in or
near the AV node, which lies on the pathway between your atria and your
ventricles. A block can also occur along other pathways to each ventricle.

Depending on the location and type of block, the impulses between the upper
and lower halves of your heart may be slowed or blocked. If the signal is
completely blocked, certain cells in the AV node or ventricles can make a steady,
although usually slower, heartbeat. Some blocks may cause no signs or
symptoms, and others may cause skipped beats or bradycardia. Slower heart
rates or a conduction block may cause symptoms of fatigue, dizziness or fainting.

Premature heartbeats
Although it often feels like a skipped heartbeat, a premature heartbeat is actually an
extra beat. Even though you may feel an occasional premature beat, it seldom
means you have a more serious problem. Still, a premature beat can trigger a longer
lasting arrhythmia especially in people with heart disease.

Premature heartbeats are commonly caused by stimulants, such as caffeine from

coffee, tea and soft drinks; over-the-counter cold remedies containing
pseudoephedrine; and some asthma medications.

Risk factors
By Mayo Clinic Staff

Certain factors may increase your risk of developing an arrhythmia. These include:

Coronary artery disease, other heart problems and previous heart

surgery. Narrowed heart arteries, a heart attack, abnormal heart valves, prior
heart surgery, heart failure, cardiomyopathy and other heart damage are risk
factors for almost any kind of arrhythmia.
High blood pressure. This increases your risk of developing coronary artery
disease. It may also cause the walls of your left ventricle to become stiff and
thick, which can change how electrical impulses travel through your heart.
Congenital heart disease. Being born with a heart abnormality may affect your
heart's rhythm.
Thyroid problems. Having an overactive or underactive thyroid gland can raise
your risk for arrhythmias.
Drugs and supplements. Certain over-the-counter cough and cold medicines
and certain prescription drugs may contribute to arrhythmia development.
Diabetes. Your risk of developing coronary artery disease and high blood
pressure greatly increases with uncontrolled diabetes.
Obstructive sleep apnea. This disorder, in which your breathing is interrupted
during sleep, can increase your risk of bradycardia, atrial fibrillation and other
arrhythmias.
Electrolyte imbalance. Substances in your blood called electrolytes such as
potassium, sodium, calcium and magnesium help trigger and conduct the
electrical impulses in your heart. Electrolyte levels that are too high or too low can
affect your heart's electrical impulses and contribute to arrhythmia development.
Drinking too much alcohol. Drinking too much alcohol can affect the electrical
impulses in your heart and can increase the chance of developing atrial
fibrillation.
Caffeine or nicotine use. Caffeine, nicotine and other stimulants can cause your
heart to beat faster and may contribute to the development of more-serious
arrhythmias. Illegal drugs, such as amphetamines and cocaine, may profoundly
 affect the heart and lead to many types of arrhythmias or to sudden death due to
ventricular fibrillation.

Complications
By Mayo Clinic Staff

Certain arrhythmias may increase your risk of developing conditions such as:

Stroke. When your heart quivers, it's unable to pump blood effectively, which can
cause blood to pool. This can cause blood clots to form. If a clot breaks loose, it
can travel from your heart to your brain. There it might block blood flow, causing
a stroke.

Certain medications, such as blood thinners, can greatly lower your risk of stroke
or damage to other organs caused by blood clots. Your doctor will determine if a
blood-thinning medication is appropriate for you, depending on your type of
arrhythmia and your risk of blood clots.

Heart failure. Heart failure can result if your heart is pumping ineffectively for a
prolonged period due to a bradycardia or tachycardia, such as atrial fibrillation.
Sometimes controlling the rate of an arrhythmia that's causing heart failure can
improve your heart's function.

What is a heart attack?

A heart attack (also known as a myocardial infarction or MI) is the damage and death of heart
muscle from the sudden blockage of a coronary artery by a blood clot. Coronary arteries are
blood vessels that supply the heart muscle with blood and oxygen. Blockage of a coronary artery
deprives the heart muscle of blood and oxygen, causing injury to the heart muscle. Injury to the
heart muscle causes chest pain and chest pressure sensation. If blood flow is not restored to the
heart muscle within 20 to 40 minutes, irreversible death of the heart muscle will begin to occur.
Muscle continues to die for six to eight hours at which time the heart attack usually is "complete."
The dead heart muscle is eventually replaced by scar tissue

What causes a heart attack?

Atherosclerosis
Atherosclerosis is a gradual process by which plaques (collections) of cholesterol are deposited
in the walls of arteries. Cholesterol plaques cause hardening of the arterial walls and narrowing
of the inner channel (lumen) of the artery. Arteries that are narrowed by atherosclerosis cannot
deliver enough blood to maintain normal function of the parts of the body they supply. For
example, atherosclerosis of the arteries in the legs causes reduced blood flow to the legs.
Reduced blood flow to the legs can lead to pain in the legs while walking or exercising, leg
ulcers, or a delay in the healing of wounds to the legs. Atherosclerosis of the arteries that furnish
blood to the brain can lead to vascular dementia (mental deterioration due to gradual death of
brain tissue over many years) or stroke (sudden damage and death of brain tissue).

In many people, atherosclerosis can remain silent (causing no symptoms or health problems) for
years or decades. Atherosclerosis can begin as early as the teenage years, but symptoms or
health problems usually do not arise until later in adulthood when the arterial narrowing becomes
severe. Smoking cigarettes, high blood pressure, elevated cholesterol, and diabetes mellitus can
accelerate atherosclerosis and lead to the earlier onset of symptoms and complications,
particularly in those people who have a family history of early atherosclerosis.

Coronary atherosclerosis (or coronary artery disease) refers to the atherosclerosis that causes
hardening and narrowing of the coronary arteries. Diseases caused by the reduced blood supply
to the heart muscle from coronary atherosclerosis are called coronary heart diseases (CHD).
Coronary heart diseases include heart attacks, sudden unexpected death, chest pain
(angina), abnormal heart rhythms, and heart failure due to weakening of the heart muscle.

Atherosclerosis and angina pectoris

Angina pectoris (also referred to as angina) is chest pain or pressure that occurs when the blood
and oxygen supply to the heart muscle cannot keep up with the needs of the muscle. When
coronary arteries are narrowed by more than 50 to 70 percent, the arteries may not be able to
increase the supply of blood to the heart muscle during exercise or other periods of high demand
for oxygen. An insufficient supply of oxygen to the heart muscle causes angina. Angina that
occurs with exercise or exertion is calledexertional angina. In some patients, especially in people
with diabetes, the progressive decrease in blood flow to the heart may occur without any pain or
with just shortness of breath or unusually early fatigue.
Exertional angina usually feels like a pressure, heaviness, squeezing, or aching across the chest.
This pain may travel to the neck, jaw, arms, back, or even the teeth, and may be accompanied
by shortness of breath,nausea, or a cold sweat. Exertional angina typically lasts from one to 15
minutes and usually is relieved by rest or by placing a tablet of nitroglycerinunder the tongue.
Both resting and nitroglycerin decrease the heart muscle's demand for oxygen, thus relieving
angina. Exertional angina may be the first warning sign of advanced coronary artery disease.
Chest pains that just last a few seconds rarely are due to coronary artery disease.

Angina also can occur at rest. Angina at rest more commonly indicates that a coronary artery has
narrowed to such a critical degree that the heart is not receiving enough oxygen even at rest.
Angina at rest infrequently may be due to spasm of a coronary artery (a condition called
Prinzmetal's or variant angina). Unlike a heart attack, there is no permanent muscle damage with
either exertional or rest angina although the angina is a warning sign that there is an increased
risk of a heart attack in the future.
Atherosclerosis and heart attack
Occasionally the surface of a cholesterol plaque in a coronary artery may rupture, and a blood
clot forms on the surface of the plaque. The clot blocks the flow of blood through the artery and
results in a heart attack (see picture below). The cause of rupture that leads to the formation of a
clot is largely unknown, but contributing factors may include cigarette smoking or
other nicotine exposure, elevated low-density lipoprotein (LDL) cholesterol, elevated levels of
blood catecholamines (adrenaline), high blood pressure, and other mechanical and biochemical
stimuli.

Unlike exertional or rest angina, heart muscle dies during a heart attack and loss of the muscle is
permanent, unless blood flow can be promptly restored, usually within one to six hours.

Heart Attack illustration - Myocardial Infarction

While heart attacks can occur at any time, more heart attacks occur between 4 A.M. and 10 A.M.
because of the higher blood levels of adrenaline released from the adrenal glands during the
morning hours. Increased adrenaline, as previously discussed, may contribute to rupture of
cholesterol plaques.

Only half of patients who develop heart attacks have warning symptoms such as exertional
angina or rest angina prior to their heart attacks, but these symptoms may be mild and ignored
as unimportant.
What are the symptoms of a heart attack?
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Although chest pain or pressure is the most common symptom of a heart attack, heart attack
victims may experience a variety of symptoms including:

Pain, fullness, and/or squeezing sensation of the chest

Jaw pain, toothache, headache

Shortness of breath

Nausea, vomiting, and/or general epigastric (upper middle abdomen) discomfort

Sweating

Heartburn and/or indigestion

Arm pain (more commonly the left arm, but may be either arm)

Upper back pain

General malaise (vague feeling of illness)

No symptoms (Approximately one quarter of all heart attacks are silent, without chest pain
or new symptoms. Silent heart attacks are especially common among patients with diabetes
mellitus.)

Even though the symptoms of a heart attack at times can be vague and mild, it is important to
remember that heart attacks producing no symptoms or only mild symptoms can be just as
serious and life-threatening as heart attacks that cause severe chest pain. Too often patients
attribute heart attack symptoms to "indigestion," "fatigue," or "stress," and consequently delay
seeking prompt medical attention. One cannot overemphasize the importance of seeking
prompt medical attention in the presence of new symptoms that suggest a heart attack.
Early diagnosis and treatment saves lives, and delays in reaching medical assistance can
be fatal. A delay in treatment can lead to permanently reduced function of the heart due to more
extensive damage to the heart muscle. Death also may occur as a result of the sudden onset of
arrhythmias such as ventricular fibrillation

What are the complications of a heart attack?

Heart Failure
When a large amount of heart muscle dies, the ability of the heart to pump blood to the rest of
the body is diminished, and this can result in heart failure. The body retains fluid, and organs, for
example, the kidneys, begin to fail.
Ventricular fibrillation
Injury to heart muscle also can lead to ventricular fibrillation. Ventricular fibrillation occurs when
the normal, regular, electrical activation of heart muscle contraction is replaced by chaotic
electrical activity that causes the heart to stop beating and pumping blood to the brain and other
parts of the body. Permanent brain damage and death can occur unless the flow of blood to the
brain is restored within five minutes.

Most of the deaths from heart attacks are caused by ventricular fibrillation of the heart that occurs
before the victim of the heart attack can reach an emergency room. Those who reach the
emergency room have an excellent prognosis; survival from a heart attack with modern treatment
should exceed 90%. The 1% to 10% of heart attack victims who later die frequently had suffered
major damage to the heart muscle initially or additional damage at a later time.

Deaths from ventricular fibrillation can be avoided by cardiopulmonary resuscitation (CPR)

started within five minutes of the onset of ventricular fibrillation. CPR requires breathing for the
victim and applying external compression to the chest to squeeze the heart and force it to pump
blood. In 2008, the American Heart Association modified the mouth-to-mouth instruction of CPR,
and recommends that chest compressions alone are effective if a bystander is reluctant to do
mouth-to-mouth. When paramedics arrive, medications and/or an electrical shock (cardioversion)
can be administered to convert ventricular fibrillation back to a normal heart rhythm and allow the
heart to pump blood normally. Therefore, prompt CPR and a rapid response by paramedics can
improve the chances of survival from a heart attack. In addition, many public venues now have
automatic external defibrillators (AEDs) that provide the electrical shock needed to restore a
normal heart rhythm even before the paramedics arrive. This greatly improves the chances of
survival.

What are the risk factors for atherosclerosis and heart attack?
Factors that increase the risk of developing atherosclerosis and heart attacks include increased
blood cholesterol, high blood pressure, use of tobacco, diabetes mellitus, male gender (although
women may still be very much at risk -- see section at end of article), and a family history of
coronary heart disease. While family history and male gender are genetically determined, the
other risk factors can be modified through changes in lifestyle and medications.

High Blood Cholesterol (Hyperlipidemia). A high level of cholesterol in the blood is

associated with an increased risk of heart attack because cholesterol is the major
component of the plaques deposited in arterial walls. Cholesterol, like oil, cannot dissolve in
the blood unless it is combined with special proteins called lipoproteins. (Without combining
with lipoproteins, cholesterol in the blood would turn into a solid substance.) The cholesterol
in blood is either combined with lipoproteins as very low-density lipoproteins (VLDL), low-
density lipoproteins (LDL) or high-density lipoproteins (HDL). The cholesterol that is
combined with low-density lipoproteins (LDL cholesterol) is the "bad" cholesterol that
deposits cholesterol in arterial plaques. Thus, elevated levels of LDL cholesterol are
associated with an increased risk of heart attack. The cholesterol that is combined with HDL
(HDL cholesterol) is the "good" cholesterol that removes cholesterol from arterial plaques.
Thus, low levels of HDL cholesterol are associated with an increased risk of heart
 attacks. Measures that lower LDL cholesterol and/or increase HDL cholesterol (losing
excess weight, diets low in saturated fats, regular exercise, and medications) have been
shown to lower the risk of heart attack. One important class of medications for treating
elevated cholesterol levels (the statins) have actions in addition to lowering LDL cholesterol
which also protect against heart attack. Most patients at "high risk" for a heart attack should
be on a statin no matter what the levels of their cholesterol.
High Blood Pressure (Hypertension). High blood pressure is a risk factor for developing
atherosclerosis and heart attack. Both high systolic pressure (the blood pressure as the
heart contracts) and high diastolic pressure (the blood pressure as the heart relaxes)
increase the risk of heart attack. It has been shown that controlling hypertensionwith
medications can reduce the risk of heart attack.
Tobacco Use (Smoking). Tobacco and tobacco smoke contain chemicals that cause
damage to blood vessel walls, accelerate the development of atherosclerosis, and increase
the risk of heart attack.
Diabetes (Diabetes Mellitus). Both insulin dependent and noninsulin dependent diabetes
mellitus (type 1 and 2, respectively) are associated with accelerated atherosclerosis
throughout the body. Therefore, patients with diabetes mellitus are at higher risk for reduced
blood flow to the legs, coronary heart disease, erectile dysfunction, and strokes at an earlier
age than nondiabetic subjects. Patients with diabetes can lower their risk through rigorous
control of their blood sugar levels, regular exercise, weight control, and proper diets.
Male Gender. Men are more likely to suffer heart attacks than women if they are less than
75 years old. Above age 75, women are as likely as men to have heart attacks.
Family History of Heart Disease. Individuals with a family history of coronary heart
diseases have an increased risk of heart attack. Specifically, the risk is higher if there is a
family history of early coronary heart disease, including a heart attack or sudden death
before age 55 in the father or other first-degree male relative, or before age 65 in the mother
or other female first-degree female relative.

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Heart Attack (cont.)

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3. Take the Heart Disease Quiz!
Medical Author:

Daniel Lee Kulick, MD, FACC, FSCAI

Medical Editor:

Jay W. Marks, MD

Medical Editor:

Charles Patrick Davis, MD, PhD

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IN THIS ARTICLE
Heart attack facts
What is a heart attack?
What causes a heart attack?
What are the symptoms of a heart attack?
What are the complications of a heart attack?
What are the risk factors for atherosclerosis and heart attack?
How is a heart attack diagnosed?
What is the treatment for heart attack?
What are the risk factors for heart attack in women?
What are the symptoms of heart attack in women and how is heart attack diagnosed?
How is heart attack in women treated?
What about hormone therapy and heart attack in women?
What is new in heart attack?
Patient Comments: Heart attack - Symptoms
Patient Comments: Heart Attack - Treatments
Patient Comments: Heart Attack - Diagnosis
Heart Attack Index
What is the treatment for heart attack?
Reader Stories

Read 10 Stories
Share Your Story
The American College of Cardiology Foundation (ACCF) and the American Heart Association
(AHA) task force recommends a treatment guideline that they consider as a preferred strategy to
treat heart attacks; PCI (Percutaneous Coronary Intervention) or stenting is emphasized. For
details about PCI, please see reference 2.

The 2013 ACCF/AHA guidelines for treatment of a heart attack are summarized as follows:

1. Ideally, transport patient to a PCI capable hospital; if not PCI capable, transfer patient as
soon as possible and less than 120 min; if anticipated transfer is more than 120 min, give
fibrinolytic agent within 30 min of arrival

2. Send to cath lab

3. Diagnostic angiogram

4. PCI (Percutaneous Coronary Intervention) also termed stenting or stent placement

5. If reocclusion occurs or perfusion fails in a patient given a fibrinolytic, arrange transfer to a

PCI capable facility; for other patients treated with a fibrinolytic, transfer to a PCI facility
within about 3-24hrs

6. If step 5 occurs, step 3 should follow at a PCI capable facility were either medical therapy, a
PCI or a CABG should be done Patients who are not candidates for PCI therapy usually
undergo medical or surgical (CABG) therapy. For a more detailed presentation of the
medical treatments and CABG, read the heart attack treatment article.

What are the risk factors for heart attack in women?

Coronary artery disease (CAD) and heart attacks are erroneously believed to occur primarily in
men. Although it is true that the prevalence of CAD among women is lower before menopause,
the risk of CAD rises in women after menopause. At age 75, a woman's risk for CAD is equal to
that of a man's. CAD is the leading cause of death and disability in women after menopause. In
fact, a 50-year-old woman faces a 46% risk of developing CAD and a 31% risk of dying from
coronary artery disease. In contrast, her probability of contracting and dying from breast
cancer is 10% and 3%, respectively.

The risk factors for developing CAD in women are the same as in men and include:

increased blood cholesterol,

high blood pressure,

smoking cigarettes,

diabetes mellitus, and a

family history of coronary heart disease at a young age.

Smoking cigarettes
Even "light" smoking raises the risk of CAD. In one study, middle-aged women who smoked one
to 14 cigarettes per day had a twofold increase in strokes (caused by atherosclerosis of the
arteries to the brain) whereas those who smoked more than 25 cigarettes per day had a risk
of stroke3.7 fold higher than that of nonsmoking women. Furthermore, the combination of
smoking and the use of birth control pills increase the risk of heart attacks even further,
especially in women over 35.

Quitting smoking immediately begins to reduce the risk of heart attacks. The risk gradually
returns to the same risk of nonsmoking women after several years of not smoking.