Heart disease is the leading cause of death in the US. Every 34 seconds, a person in the US dies from heart disease. The most common type of heart disease is coronary artery disease; over 20 million adults over age 19 have this condition. This article covers the most common types of heart disease, including symptoms and risk factors, and provides a functional medicine approach for reducing heart disease risk.
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Overview of How The Heart Works
A few points of heart anatomy must be covered in order to delve into the types and causes of heart disease.
The heart has four chambers: two upper chambers called atria and two lower chambers called ventricles. The heart is discussed in terms of the left side and right side. The left side of the heart, specifically the left ventricle, pumps blood to the brain and body through the aorta. The right side of the heart pumps blood to the lungs. There are four valves in the heart that open and close to allow blood to flow in the right direction at the right time. The heart sits inside a sac in the chest cavity called the pericardium or pericardial sac.
One of the most important things to understand about the heart is how it gets its blood supply. We know that the heart pumps blood to the rest of our body, including our brain, to provide oxygen and nutrients. But how does the heart muscle itself get blood? The heart is supplied by specialized blood vessels called the coronary arteries. When the heart relaxes after a contraction, blood flows backward from the aorta into the coronary arteries and delivers oxygen and nutrients to the heart muscle.
What is Heart Disease?
When most of us hear about heart disease, we think of plaque in the arteries, atherosclerosis, or a "heart attack." But heart disease is a vast topic that encompasses everything from heart defects present at birth to heart rhythm problems, heart inflammation, heart muscle disorders, and heart failure. This article will discuss heart disease in more detail, including signs and symptoms, possible causes, and a functional medicine approach to heart health.
What Are The Different Types Of Heart Disease?
Heart disease is a vast topic. Following is a list of the most common types of heart disease that will be covered in this article.
Arrhythmias
When the heart rhythm is erratic, too fast, too slow, or skipping beats, it is known as an arrhythmia. A common example is atrial fibrillation.
Coronary Artery Disease
When plaque builds up in the blood vessels that supply the heart, it leads to coronary artery disease. A common outcome of coronary artery disease is angina or a "heart attack" (myocardial infarction).
Cardiomyopathy
When the heart muscle is deformed and doesn't pump blood effectively, it is known as cardiomyopathy. This condition makes it hard for the heart to deliver blood to the body and can lead to heart failure. An example is hypertensive cardiomyopathy - an overgrowth of the left ventricular muscle in a person with longstanding high blood pressure.
Heart Failure
When the heart is no longer able to pump enough blood to meet the body's demands for nutrients and oxygen, it is known as heart failure. A common example is congestive heart failure leading to difficulty breathing and swelling of the ankles.
Myocarditis & Pericarditis
- Inflammation of the heart muscle is known as myocarditis.
- Pericarditis is inflammation of the sac surrounding the heart
- Myopericarditis is inflammation of both the heart muscle and the sac that surrounds it.
Valvular Disease
Any of the four valves in the heart can become diseased, leading to valve leakiness or narrowing. A common example of valvular disease is aortic stenosis, where the aortic valve becomes stiff and narrow.
Heart Disease Symptoms
Symptoms may vary depending on the type of heart disease present:
Arrhythmias
Heart rhythm disorders can be very unsettling because the heart can feel like it's racing, going too slow, fluttering, doubling up on beats, or skipping beats.
Other symptoms of arrhythmia include:
- Irregular pulse
- Lightheadedness or dizziness
- Confusion
- Loss of consciousness
- Chest pain
- Difficulty breathing
Cardiomyopathy
The symptoms of cardiomyopathy can be very different depending on the cause of the heart muscle damage.
Cardiomyopathy may present with symptoms like:
- Chest pain
- Shortness of breath
- Low energy
- Lightheadedness or dizziness
- Loss of consciousness
- Awareness of abnormal heartbeats
- Edema (fluid retention) in ankles or feet leading to swelling
However, hypertrophic cardiomyopathy, a predominantly genetic condition, can sometimes have no symptoms and result in sudden cardiac death, especially in young people during exercise.
*Note:
Your healthcare provider might recommend an echocardiogram if you have a family member with hypertrophic cardiomyopathy.
- Adolescents and competitive athletes should be screened once a year if there is a family history.
- Adults who don't compete in athletics should be screened every five years.
Coronary Artery Disease
A common symptom of coronary artery disease is chest discomfort (angina) that worsens with physical activity and is relieved by rest.
Often, a heart attack (myocardial infarction) is the first presentation of coronary artery disease. Symptoms of a heart attack include:
- Chest pain
- Shortness of breath
- Sweating
- Nausea
- Pain or tingling in the arm, shoulder, jaw, or back
- Loss of consciousness
Males who have erectile dysfunction have a higher likelihood of having coronary artery disease. So, although erectile dysfunction isn't a classic "symptom" of coronary artery disease, it is a condition that could prompt a discussion with your healthcare provider about heart health, as ED can be caused by lack of blood flow due to vascular disease.
Heart Failure
The most common symptoms of heart failure are shortness of breath and edema (fluid retention) at the feet and ankles.
Other symptoms include:
- Low energy
- Lack of appetite
- Increased heart rate
- Confusion
- Rapid weight gain due to fluid retention
Myocarditis & Pericarditis
Often, these inflammatory conditions of the heart and pericardial sac follow a viral infection. Symptoms of a viral illness like headache, body aches, fever, or fatigue may precede the actual heart symptoms.
Symptoms include:
- Chest pain
- Arrhythmia or rapid heart rate
- Lightheadedness or dizziness
- Loss of consciousness
- Low energy
- Edema (fluid retention) in ankles or feet leading to swelling
Pericarditis has some additional symptoms:
- Chest pain that:
- travels to the shoulder or neck
- is relieved when sitting up or leaning forward
- worsens with coughing, taking a deep breath, or lying flat
Valvular Disease
The symptoms of valvular disease vary depending on the valve affected and the type of valve damage (leaking vs narrowed).
In general, symptoms of valvular disease are very similar to any of the other heart conditions described above:
- Chest pain
- Shortness of breath
- Low energy
- Arrhythmia
- Lightheadedness
- Loss of consciousness
- Rapid weight gain due to fluid retention
What Causes Heart Disease?
The causes of heart disease are quite specific to the type of heart disease, although overlap is common.
Arrhythmias
Heart rhythm disorders are sometimes caused by heart scarring from a prior heart attack. Cardiomyopathy and valvular disease can also cause arrhythmias because the heart's structure has changed.
Other causes include:
- Medications
- Sleep apnea
- Thyroid dysfunction
- Alcohol use
- Caffeine (including caffeine in energy drinks)
- Smoking
- Drugs like cocaine or amphetamines
- Stress
- Electrolyte imbalance
- Infections like Lyme disease
- Inherited Arrhythmia Syndromes
Cardiomyopathy
There are a few types of cardiomyopathy: hypertrophic, dilated, and restrictive. Each has a distinct cause.
In general, causes of cardiomyopathy include:
- Inherited conditions
- A prior heart attack
- Chronic high blood pressure
- Autoimmune conditions (e.g., scleroderma)
- Iron overload (e.g. hemochromatosis)
- Excessive alcohol consumption
- Severe vitamin B-1 deficiency
- Some cancer medications (e.g., doxorubicin)
- Infections (e.g. Covid-19)
Coronary Artery Disease
Coronary artery disease (CAD) is predominantly a lifestyle disease promoted by an unhealthy diet, obesity, smoking, and metabolic disorders like high blood pressure and diabetes.
Novel Contributors to Coronary Artery Disease
A relatively new discovery linking heart health to the gut flora proposes that a metabolite called TMAO (produced by our gut bacteria after we eat a meal containing meat, eggs, or fish) is associated with an increased risk of death in people with coronary artery disease and other comorbidities.
Air pollution, especially traffic-related pollution less than 2.5 micrometers in diameter, accelerates plaque build-up in coronary arteries.
Heart Failure
Heart failure is preceded by injury to the heart, usually from one of the conditions discussed in this article, like coronary artery disease, a heart attack, longstanding high blood pressure, valvular disease, myocarditis, or arrhythmias.
Myocarditis & Pericarditis
Myocarditis occurs most frequently after an infection. Common infections include respiratory viruses like adenovirus and Covid-19. Bacteria like Staphylococcus, Streptococcus, and Borrelia (which cause Lyme disease) can also cause myocarditis.
Pericarditis can be caused by infection but also by a direct heart injury or kidney failure.
Inflammatory autoimmune diseases like lupus can cause both myocarditis and pericarditis.
Recently, an association between mRNA Covid-19 vaccines and myocarditis/pericarditis, occurring most often in younger males, has been discovered.
Valvular Disease
The causes of valvular disease vary depending on the valve affected and the type of valve damage (leaking vs. narrowed).
In general, causes of valvular disease include:
- Aging
- Calcium deposits on heart valves
- Chronic high blood pressure
- Plaque build-up near the aortic valve
- Rheumatic disease from untreated strep throat
- A blood infection that travels to the heart valves
- Autoimmune diseases like lupus
What are The Risks for Heart Disease?
As you can see from the list above, the risks for heart disease are disparate depending on the type of heart disease and the root cause.
Some common risk factors include:
- High blood pressure
- High cholesterol
- A diet high in processed foods, refined sugars, and trans fats
- Smoking
- Aging
- Obesity
- Diabetes
- A sedentary lifestyle
- Excess alcohol consumption
- Genetics
Functional Medicine Labs to Test for Those At Risk for Heart Disease
The first step when dealing with any heart-related concern is to see a qualified healthcare provider for a complete medical history, family history, medication history, and physical exam including blood pressure measurement.
Careful auscultation of the heart for murmurs or other sounds and palpation of the pulse for erratic rhythms can aid in diagnosing several heart conditions. An EKG is also important. Depending on your clinical picture, further testing with a chest x-ray, heart ultrasound (echocardiogram), stress testing, a Holter monitor, or an angiogram might be warranted.
Lifestyle Panel
An excellent test for assessing cardiac risk is a Lifestyle Panel. This panel consists of three tests used to identify multiple indicators of heart health. The three tests included are a basic lipid profile and two unique tests called the HDL Map and the Cholesterol Balance, all offered by BostonHeart Diagnostics.
With the information from the Lifestyle Panel, providers can determine a patient's individual cardiac risk and gain insight into treatment regimens.
Diabetic Risk
A diagnosis of diabetes doubles the risk of heart disease compared to those with normal glucose metabolism. Boston Heart offers several tests to evaluate glucose metabolisms, such as fasting insulin, fasting glucose, and hemoglobin A1c.
Boston Heart offers a Prediabetes Assessment that can automatically be performed on samples that have a fasting glucose in the pre-diabetic range. This assessment provides a highly accurate estimate of the 10-year diabetes risk.
Omega-3 Fatty Acids
Higher omega-3 fatty acid levels are associated with fewer cardiovascular problems. The red blood cell omega-3 & 6 blood test is a great way to determine levels and to provide personalized advice about increasing omega-3 intake via diet or supplementation.
TMAO
TMAO, a byproduct generated by our gut bacteria when certain animal foods are consumed, has been associated with an increased risk of heart disease. TMAO levels can be determined with a blood test. Individualized dietary advice can then be provided.
Electrolytes
Electrolytes should be evaluated for those at risk of arrhythmia or those experiencing palpitations or unusual heart rhythms.
- Sodium & potassium
- Calcium
- Magnesium
Comprehensive Thyroid Panel
Thyroid dysfunction can be associated with heart conditions, including arrhythmias. A comprehensive thyroid panel can assess thyroid function and associated conditions.
How To Prevent Heart Disease?
Here are the top functional medicine recommendations to prevent heart disease:
Nutrition
To date, the best evidence for preventing coronary artery disease is with a Mediterranean diet focusing on fresh fruits and vegetables, herbs, beans and legumes, whole grains, and fats from olives, nuts, seeds, and fish, like sardines.
Infrared Light Therapy
Far infrared light therapy may provide benefits for those who have high blood pressure and impaired blood flow through major arteries. This beneficial effect is likely due to increased nitric oxide production, as nitric oxide is a known vasodilator.
Elevated fasting blood sugar, a risk factor for heart disease, can be improved after far infrared light therapy.
Herbs & Supplements
The following herbs and supplements can be beneficial:
Omega-3
Higher omega-3 fatty acid levels are associated with fewer cardiovascular problems.
Fish oil is a popular way to supplement omega-3. For vegans or vegetarians who don't consume animal products, algae oil is an alternative to provide the long-chain omega-3 fatty acids DHA and EPA.
Magnesium
Low magnesium levels are associated with heart conditions like heart failure and arrhythmias. Many people don't get the recommended daily allowance of magnesium from diet alone, so supplementation with magnesium orotate may have heart health benefits.
Curcumin
This chemical is a main component of the spice turmeric and is often used as an anti-inflammatory. A recent systematic review and meta-analysis suggest that curcumin has favorable effects on the lipid profile (lowers triglycerides, LDL-cholesterol, and total cholesterol; raises HDL-cholesterol). Supplementing with curcumin is recommended for at least eight weeks to see increased efficacy.
Berberine
This compound has evidence suggesting benefits for heart health, improving insulin sensitivity and blood pressure.
Lifestyle Changes
Everyday lifestyle choices are the best way to prevent heart disease.
Quit Smoking
Tobacco remains one of the main risk factors for developing heart disease. Tobacco use leads to more viscous blood, inflammation, and damage to the endothelium.
There are many options to assist in quitting smoking.
Minimize Alcohol Use
Alcohol consumption increases fats in the blood (triglycerides), promotes arrhythmias and cardiomyopathy, can lead to obesity and elevates blood pressure. The American Heart Association recommends no more than two drinks per day for men and 1 for women. However, continued abstinence from alcohol is recommended for the best health benefits if you don't already drink.
Movement
Daily movement including walking is vital for heart health and overall longevity. A new study showed that getting between 8,000-9,000 steps daily was associated with fewer new cases of diabetes and high blood pressure, as well as a plethora of other health benefits. The American Heart Association recommends 150 minutes of moderate-intensity aerobic activity per week.
Physical activity and walking don't have to be performed in a single session to have health benefits. For instance, try parking farther away from locations, taking the stairs whenever possible, setting a timer to remind you to get up and walk every hour, and making your breaks active instead of sedentary. All of these tips can help you easily reach 8,000 steps a day.
Reduce Stress
Emotional stress increases the risk of cardiovascular disease. Lifestyle modifications, including mindfulness, meditation, and yoga, have been shown to help reduce stress and inflammation.
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Summary
Heart disease is the leading cause of death in the US. Understanding individual risk factors and making lifestyle modifications can help achieve better cardiac health. Nutrition, appropriate supplementation, optimizing metabolic and endocrine health, and modalities like infrared light therapy show promise for minimizing risks that contribute to heart disease.
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