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Heart Disease

Key points

Coronary artery disease is the most common type of heart disease.

There are many other conditions that affect the heart.

The term "heart disease" refers to several types of heart conditions.

Know your risk for heart disease so you can prevent it.

High blood pressure, high blood cholesterol, and smoking are key risk factors.

About 1 in 5 people in the United States died from heart disease in 2022.

What is heart disease?

The term "heart disease" refers to several types of heart conditions. The most common type of heart disease in the United States is coronary artery disease (CAD). CAD affects the blood flow to the heart. Decreased blood flow can cause a heart attack.

What causes heart disease?

The most common type of heart disease is coronary artery disease (CAD), and the leading cause of CAD is atherosclerosis, the buildup of cholesterol plaque inside the coronary arteries. Too much plaque limits blood flow through the arteries that supply blood to the heart. Restricted blood flow can cause chest pain or pressure (known as angina) and requires immediate medical attention. When plaque ruptures, it can form a blood clot that stops blood flow and triggers a heart attack.

The risk factors for atherosclerosis (and thus CAD) include:

high total blood cholesterol level

high level of LDL (bad) cholesterol

high levels of triglycerides

high levels of lipoprotein(a)

high blood pressure (hypertension)

diabetes

family history of heart disease

smoking

obesity

physical inactivityiInflammation

Symptoms

A variety of symptoms and signs may indicate heart disease. If you experience any of the following for no apparent reason, immediately report them to your doctor.

Fatigue. Fatigue can be caused by many illnesses and medicines. But constant, new fatigue can sometimes signal two kinds of heart disease: heart failure and coronary artery disease.

Unexplained aches or pains. Blockage of blood to the heart muscle can cause pain or pressure in the chest, shoulders, arms, back, jaw, or abdomen, primarily when pain in these locations occurs with exercise and disappears with rest.

Shortness of breath. Unexplained shortness of breath that occurs with small amounts of activity.

Swollen legs, feet, or ankles. The kind of swelling that leaves an indentation if you press your finger into it could be a sign of heart failure.

Heart palpitations. Palpitation refers to a heartbeat that feels irregular or rapid. Most palpitations may be caused by anxiety, caffeine intake, or dehydration. But sometimes they indicate a heart problem.

Sometimes heart disease may be "silent" and not diagnosed until a person experiences signs or symptoms of a heart attack, heart failure, or an arrhythmia. When these events happen, symptoms may include:

Heart attack: Chest pain or discomfort, upper back or neck pain, heartburn, nausea or vomiting, extreme fatigue, dizziness, and shortness of breath.

Arrhythmia: Fluttering feelings in the chest (palpitations).

Heart failure: Shortness of breath, fatigue, or swelling of the feet, ankles, legs, abdomen, or neck veins.

Conditions related to heart disease

Coronary artery disease, also called Coronary Heart Disease or ischemic heart disease, is the most common type of heart disease, but there are many other conditions that affect the heart.

Acute coronary syndrome is a term that includes heart attack and unstable angina.

Angina, a symptom of coronary artery disease, is chest pain or discomfort that happens when the heart muscle is not getting enough blood. Angina may feel like pressure or a squeezing pain in the chest. The pain also may occur in the shoulders, arms, neck, jaw, or back. It may feel like indigestion.

There are two forms of angina—stable or unstable:

Stable angina happens during physical activity or under mental or emotional stress.

Unstable angina is chest pain that occurs even while at rest, without apparent reason. This type of angina is a medical emergency.

Aortic aneurysm and dissection are conditions that can affect the aorta, the major artery that carries blood from the heart to the body. An aneurysm is an enlargement in the aorta that can rupture or burst. A dissection is a tear in the aorta, which is a medical emergency. For more information, see the aortic aneurysm information page.

Arrhythmias are irregular or unusually fast or slow heartbeats. Arrhythmias can be serious. One example is called ventricular fibrillation. This type of arrhythmia causes an abnormal heart rhythm that leads to death unless treated right away with an electrical shock to the heart (called defibrillation). Other arrhythmias are less severe but can develop into more serious conditions, such as atrial fibrillation, which can cause a stroke. see the arrhythmias information page

Atherosclerosis happens when plaque builds up in the arteries that supply blood to the heart (called coronary arteries). Plaque is made up of cholesterol deposits. Plaque buildup causes arteries to narrow over time.

Atrial fibrillation is a type of arrhythmia that can cause rapid, irregular beating of the heart's upper chambers. Blood may pool and clot inside the heart, increasing the risk for heart attack and stroke. For more information, see the atrial fibrillation information page.

Cardiomyopathy happens when the heart muscle becomes enlarged or stiff. This can lead to inadequate heart pumping (or weak heart pump) or other problems. Cardiomyopathy has many causes, including family history of the disease, prior heart attacks, uncontrolled high blood pressure, and viral or bacterial infections.

Congenital heart defects are problems with the heart that are present at birth. They are the most common type of major birth defect. Examples include abnormal heart valves or holes in the heart's walls that divide the heart's chambers. Congenital heart defects range from minor to severe.

Heart failure is often called congestive heart failure because of fluid buildup in the lungs, liver, legs, and feet. Heart failure is a serious condition that occurs when the heart can't pump enough blood to meet the body's needs. It does not mean that the heart has stopped but that muscle is too weak to pump enough blood. Most of heart failure cases are chronic, or long-term heart failures. The only cure for heart failure is a heart transplant. However, heart failure can be managed with medications or medical procedures. For more information, see the heart failure information page.

Marfan syndrome. Marfan syndrome is a genetic condition that affects connective tissue, which provides support for the body and organs. It can damage the blood vessels, heart, eyes, skin, lungs, and the bones of the hips, spine, feet, and rib cage.

Mental health disorders can be short- or long-term and can interfere with a person's mood, behavior, thinking, and ability to relate to others. Various studies have shown the impact of trauma, depression, anxiety, and stress on the body, including stress on the heart. see the mental health information page.

Peripheral arterial disease (PAD) happens when the arteries that supply blood to the arms and legs (the periphery) become narrow or stiff. PAD usually results from atherosclerosis, the buildup of plaque and narrowing of the arteries. With this condition, blood flow and oxygen to the arm and leg muscles are low or even fully blocked. Signs and symptoms include leg, calf, buttock, hip, or thigh pain, and numbness in the feet. see the Peripheral arterial disease information page

Pulmonary hypertension happens when the pressure in the arteries leading from the heart to the lungs is too high. There are many conditions that lead to pulmonary hypertension, including connective tissue disease, liver disease, emphysema, and chronic blood clots in the lungs. Symptoms of pulmonary hypertension include shortness of breath and fatigue.

Rheumatic heart disease is a complication of rheumatic fever. Rheumatic fever can develop after a sore throat caused by streptococcal bacteria. The infection can cause damage to the heart valves.

Valvular heart disease. Healthy heart valves can fully open and close during a heartbeat, but diseased valves cannot. If the heart valves are diseased, the heart can't effectively pump blood throughout the body and must work harder to pump. This can lead to heart failure, sudden cardiac arrest (when the heart stops beating), heart palpitations (rapid, fluttering, or pounding), shortness of breath, or swelling in your legs and feet.

Diagnosis

Heart diseases are the number one killer in the United States. They are also a major cause of disability. If you do have heart disease, it is important to find it early, when it is easier to treat. Blood tests and heart health tests can help find heart diseases or identify problems that can lead to heart diseases. There are several different types of heart health tests. Your health care provider will decide which test or tests you need, based on your symptoms (if any), risk factors, and medical history.

Tests

Many different tests are used to diagnose heart disease.

Blood tests. Certain heart proteins slowly leak into the blood after heart damage from a heart attack. Blood tests can be done to check for these proteins. A high-sensitivity C-reactive protein (CRP) test checks for a protein linked to inflammation of the arteries. Other blood tests may be done to check cholesterol and blood sugar levels.

Chest X-ray. A chest x-ray creates pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels. It can reveal signs of heart failure, as well as lung disorders and other causes of symptoms not related to heart disease.

Electrocardiogram (ECG or EKG). An electrocardiogram, also called an ECG or EKG, is a painless test that detects and records your heart's electrical activity. It shows how fast your heart is beating and whether its rhythm is steady or irregular. An EKG may be part of a routine exam to screen for heart disease. Or you may get it to detect and study heart problems such as heart attacks, arrhythmia, and heart failure. For the test, you lie still on a table and a nurse or technician attaches electrodes (patches that have sensors) to the skin on your chest, arms, and legs. Wires connect the electrodes to a machine that records your heart's electrical activity.

Holter monitoring. A Holter monitor is a portable ECG device that's worn for a day or more to record the heart's activity during daily activities. This test can detect irregular heartbeats that aren't found during a regular ECG exam.

Echocardiogram. Echocardiography, or echo, is a painless test that uses sound waves to create moving pictures of your heart. The pictures show the size and shape of your heart. They also show how well your heart's chambers and valves are working. Providers use an echo to diagnose many different heart problems, and to check how severe they are. There are several different types of echocardiography. For transthoracic echocardiography (the most common type), a technician applies gel to your chest. The gel helps sound waves reach your heart. The technician moves a transducer (wand-like device) across your chest. The transducer connects to a computer. It transmits ultrasound waves into your chest, and the waves bounce (echo) back. The computer converts the echoes into pictures of your heart.

Exercise tests or stress tests. Stress testing looks at how your heart works during physical stress. It can help to diagnose coronary artery disease, and to check how severe it is. It can also check for other problems, including heart valve disease and heart failure. For the test, you exercise (or are given medicine if you are unable to exercise) to make your heart work hard and beat fast. While this is happening, you get an EKG and blood pressure monitoring. Before or after the test, you might also have an echocardiogram, or other imaging tests such as a nuclear scan. For the nuclear scan, you get an injection of a tracer (a radioactive substance), which travels to your heart. Special cameras detect the energy from the tracer to craeate pictures of your heart. You have pictures taken after you exercise, and then after you rest.

Cardiac catheterization.
Cardiac catheterization is a medical procedure used to diagnose and treat some heart conditions. For the procedure, your provider puts a catheter (a long, thin, flexible tube) into a blood vessel in your arm, groin, or neck, and threads it to your heart. The provider can use the catheter to:

Do a coronary angiography. This involves putting a special type of dye in the catheter, so the dye can flow through your bloodstream to your heart. Then your provider takes x-rays of your heart. The dye allows your provider to see your coronary arteries on the x-ray, and to check for coronary artery disease (CAD). CAD is caused by plaque buildup in the arteries.

Take samples of your blood and heart muscle.

Examine your heart valves.

Do procedures such as angioplasty or minor heart surgeries to repair congenital heart defects or replace heart valves.

Heart CT scan, also called cardiac CT scan.
A cardiac CT (computed tomography) scan is a painless imaging test that uses x-rays to take detailed pictures of your heart and its blood vessels. Computers can combine these pictures to create a three-dimensional (3D) model of your whole heart. This test can help providers detect or evaluate various heart problems, including:

Coronary artery disease

Calcium buildup in the coronary arteries

Congenital heart defects

Problems with the aorta (the main artery that carries blood away from the heart)

Problems with heart function and valves

Pericardial diseases

Before you have the test, you get an injection of contrast dye. The dye highlights your heart and blood vessels in the pictures. The CT scanner is a large, tunnel-like machine. You lie still on a table that slides you into the scanner, and the scanner takes the pictures.

Heart magnetic resonance imaging (MRI) scan. Cardiac MRI (magnetic resonance imaging) is a painless imaging test that uses radio waves, magnets, and a computer to create detailed pictures of your heart. It can help your provider figure out whether you have heart disease, and if so, how severe it is. A cardiac MRI can also help your provider decide the best way to treat heart problems such as:

Congenital heart defects

Coronary artery disease

Heart valve problems

Pericarditis

Cardiac tumors

Damage from a heart attack

The MRI is a large, tunnel-like machine. You lie still on a table that slides you into the MRI machine. The machine makes loud noises as it takes pictures of your heart. Sometimes before the test, you might get an injection of contrast dye. The dye highlights your heart and blood vessels in the pictures.

Coronary Angiography. Coronary angiography (angiogram) is a procedure that uses contrast dye and x-ray pictures to look at the insides of your arteries. It can show whether plaque is blocking your arteries and how severe the blockage is. Providers use this procedure to diagnose heart diseases after chest pain, sudden cardiac arrest (SCA), or abnormal results from other heart tests such as an EKG or a stress test. You usually have a cardiac catheterization to inject the dye into your coronary arteries. Then the provider will take special x-rays while the dye is flowing through your coronary arteries. The dye lets your provider study the flow of blood through your heart and blood vessels.

Treatment and recovery

Heart disease treatment depends on the cause and type of heart damage. Treatment for heart disease may include:

Lifestyle changes such as eating a diet low in salt and saturated fat, getting more exercise, and not smoking.

Medicines.

A heart procedure.

Heart surgery.

Medications

You may need medicines to control heart disease symptoms and prevent complications. The type of medicine used depends on the type of heart disease.

Surgery or other procedures

Some people with heart disease may need a heart procedure or surgery. The type of treatment depends on the type of heart disease and how much damage has happened to the heart.

What is cardiac rehabilitation?

Cardiac rehabilitation is an important program for anyone recovering from a heart attack. This can also include heart failure, or some types of heart surgery.

Cardiac rehabilitation is a supervised program that includes

Physical activity.

Education about healthy eating.

Taking medicine as prescribed.

Ways to help you quit smoking.

Counseling to find ways to relieve stress and improve mental health.

A team of people may help you through cardiac rehabilitation.

This may include

Your health care team.

Exercise and nutrition specialists.

Physical therapists.

Counselors or mental health professionals.

How can you prevent heart disease?

The best way to prevent heart disease is to adopt heart-healthy habits. These include managing blood pressure and cholesterol levels, eating a plant-based diet, adopting regular exercise, maintaining a proper weight, getting enough sleep, and not smoking.

Blood pressure. High blood pressure makes the heart work harder, which can weaken the heart muscle over time. Blood pressure is measured in millimeters of mercury (mm Hg) and is categorized as follows:

Normal: less than 120/80 mm Hg

Elevated: 120/less than 80 to 129/less than 80 mm Hg

Stage 1 hypertension: 130/80 to 139/89 mm Hg

Stage 2 hypertension: 140/90 mm Hg and above.

Cholesterol. There are two main types: "bad" low-density lipoprotein (LDL) and "good" high-density lipoprotein (HDL). Ideally, most adults should keep their LDL below 100 milligrams per deciliter (mg/dL) and their HDL above 40 mg/dL. However, your ideal numbers may differ based on your health, risk factors for heart disease, and individual goals, as determined in consultation with your doctor.

Diet. Following a plant-based diet is known to protect against heart disease. The plant diets that have been most studied for heart health are the Mediterranean diet and the DASH (Dietary Approaches to Stop Hypertension) diet. Each emphasizes eating foods associated with heart-healthy benefits, such as whole grains, fruits, vegetables, legumes, nuts and seeds, fatty fish, and healthy oils like olive oil, and reducing the intake of red meat and processed foods.

Exercise. Guidelines recommend that adults engage in at least 150 minutes of moderate-intensity aerobic activity per week, which breaks down to 30 minutes daily, five days a week. But this is the minimum. Evidence suggests that doing more is better.

Weight. About 30% of American adults are classified as overweight. While it's natural for people's weight to increase somewhat with age, even five to 10 pounds over your ideal number is associated with an increased risk of heart disease. Check with your doctor to determine your weight range for your gender, age, and body type.

Sleep. Experts recommend that adults get at least seven hours of sleep per night. Studies have found that less than this amount is associated with heart disease risk factors like higher stress levels, increased inflammation, high blood pressure, and weight gain.

Smoking. Smokers have a much higher heart disease risk than never-smokers, and two to three times the risk of early death. Certain medications and nicotine replacement therapies can help people quit. Speak with your doctor about these or other options.

Heart Disease Facts

Heart disease in the United States

In the United States:

Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups.

One person dies every 33 seconds from cardiovascular disease.

In 2022, 702,880 people died from heart disease. That's the equivalent of 1 in every 5 deaths.

Heart disease cost about $252.2 billion from 2019 to 2020. This includes the cost of health care services, medicines, and lost productivity due to death.

As reported by the CDC, in 2018 the states with the highest heart disease date rates are:

Oklahoma

Alabama

Mississippi

Arkansas

Louisiana

Tennessee

Kentucky

West Virginia

Michigan

Coronary artery disease (CAD)

Coronary heart disease is the most common type of heart disease. It killed 371,506 people in 2022.

About 1 in 20 adults age 20 and older have CAD (about 5%).

In 2022, about 1 out of every 5 deaths from cardiovascular diseases (CVDs) was among adults younger than 65 years old.

Heart attack

In the United States, someone has a heart attack every 40 seconds.

Every year, about 805,000 people in the United States have a heart attack. Of these, 605,000 are a first heart attack, and 200,000 happen to be people who have already had a heart attack.

About 1 in 5 heart attacks are silent—the damage is done, but the person is not aware of it.

Did you know?

Early action is important for heart attack. Know the warning signs and symptoms of a heart attack.
As plaque builds up in the arteries of a person with heart disease, the inside of the arteries begins to narrow, which lessens or blocks the flow of blood.

Who is affected

Heart disease deaths vary by sex, race, and ethnicity

Heart disease is the leading cause of death for people of most racial and ethnic groups in the United States. These include African American, American Indian, Alaska Native, Hispanic, and White men. For women from the Pacific Islands and Asian American, American Indian, Alaska Native, and Hispanic women, heart disease is second only to cancer.

Below are the percentages of all deaths caused by heart disease in 2021, listed by ethnicity, race, and sex.

Race or Ethnic Group	% of Deaths
American Indian or Alaska Native	15.5
Asian	18.6
Black (Non-Hispanic)	22.6
Native Hawaiian or Other Pacific Islander	18.3
White (Non-Hispanic)	18.0
Hispanic	11.9
All	17.4

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