Congestive Heart Failure

Heart failure is a very common condition, affecting more than 5 million Americans. Your cardiologists can help you manage the condition with lifestyle changes and medications, leading to a longer, fuller life.

Our Advanced Heart Failure Program can also help with more serious cases of heart failure, with renowned doctors who specialize in the condition and use the latest surgeries, devices and other treatments. Learn more about our Advanced Heart Failure Program.

What is Congestive Heart Failure?

The heart squeezes blood through the circulatory system and also relaxes to accept blood returning from the body and lungs. 

Any disruption in this squeezing (systolic dysfunction) or relaxing (diastolic dysfunction) can lead to a failure of the heart to pump enough blood for your body or fill with enough blood. This condition is called heart failure, or congestive heart failure (CHF).

Heart failure is different than cardiac arrest, during which the heart actually stops beating. Still, heart failure requires medical attention. Two kinds exist:      

  • Heart failure with preserved ejection fraction (HFpEF): The heart cannot provide sufficient blood even though it squeezes normally.
  • Heart failure with reduced ejection fraction (HFrEF): The heart muscle is weak, so it has difficulty pumping blood to the rest of the body. 

Heart Failure Risk Factors

Certain factors make it more likely than you will develop heart failure:

  • Age: You have a greater risk if you are 65 or older. The heart weakens with age, and many patients have also endured diseases that lead to heart failure.
  • African-Americans: Heart failure is more common in African-Americans, as is the early onset of symptoms.
  • Weight: Too much weight strains the heart and also contributes to heart disease and diabetes, two heart failure causes.
  • Heart attack: A previous heart attack increases your risk.
  • Gender: Men are more likely to experience heart failure than women.

Heart Failure Causes

Most heart failure cases are caused by an underlying medical condition, such as:

Heart Failure Symptoms

Heart failure can produce a range of symptoms, including:

  • Fatigue
  • Shortness of breath
  • Swelling of the legs and feet
  • Swelling of the abdomen
  • Irregular heartbeat
  • Chest pain

Other conditions can cause similar symptoms. Please see one of our cardiologists for a proper diagnosis. Patients with more severe heart failure often feel symptoms even when resting. Learn more about our Advanced Heart Failure Program.

Heart Failure Classification

Functional capacity refers to the way heart failure patients feel when they engage in physical activity. This measure is used to classify heart failure into different stages:

  • Class I: No limits on activity; no shortness of breath, fatigue or chest pain with ordinary physical exertion
  • Class II: Slight limits on activity; mild symptoms when walking or performing other normal physical activity
  • Class III: Substantial limits on activity; shortness of breath and other symptoms occur with less-than-ordinary physical exertion
  • Class IV: Major limits on activity; unable to perform any ordinary physical activity without experiencing symptoms, or symptoms may occur at rest

Heart Failure Diagnosis

Early diagnosis of heart failure is the key to helping patients live longer, more active lives. We offer the latest tools and tests to provide for a prompt and accurate diagnosis. Learn more about our:

Heart Failure Treatment

The goals of heart failure treatment are to relieve symptoms and improve both the quality and length of life. In the earlier stages of the condition, treatment involves:

  • Lifestyle changes: Taking certain steps can help you feel better:
    • Eating a heart-healthy, low-salt diet (our dieticians can help)
    • Limiting the amount of daily fluid intake
    • Losing weight
    • Giving up smoking
    • Exercising
  • Medications: Medications can improve the heart’s function and your ability to live a normal life. Possible medications include:
    • Diuretics (water pills) to reduce fluid buildup
    • ACE inhibitors and ARBs to lower blood pressure
    • Beta blockers to slow your heart rate and lower your blood pressure
    • Aldosterone blockers to help prevent your body from holding onto fluids
    • Hydralazine/isosorbide to relax your blood vessels
  • Implantable cardioverter defibrillator (ICD): ICDs correct irregular heart rhythms, called arrhythmias.
  • Heart surgery: Possible surgeries for related heart problems can include coronary artery bypass graft (CABG) surgery or heart valve surgery.

More severe heart failure may require intervention from our cardiologists or surgeons specializing in advanced heart failure. Learn more about our Advanced Heart Failure Program.

For information or appointments, please call 855-463-3320.

Aortic Dissection Symptoms

A dissection is a tear in the lining of your aorta, the candy cane-shaped artery that delivers oxygen-rich blood from your heart. That allows the blood to leak from the inner layer (the intima) into the middle layer (the media). A new pathway (false lumen) is created for the blood, interfering with the aorta’s function. 

Dissections require medical attention — while blood pressure medication is enough to treat some, others can threaten your life and need repair. Early diagnosis and treatment is crucial, with our team providing expert care. Learn more about the renowned team at our Complex Aortic Center, or about our dissection treatment

Aortic Dissection Types: A and B

Some dissections are more dangerous than others, depending on the type:

  • Type A: These dissections often prove fatal in a day or two if not treated. They can involve the part of the aorta that leaves the heart (the ascending aorta), including the curve that turns back toward the chest and abdomen (the aortic arch). About two-thirds also go beyond the arch, into the descending aorta.
  • Type B: These dissections are found in the descending aorta in the chest, past the artery’s downward curve (the aortic arch). 

More dangerous dissections can:

  • Spread to other blood vessels, heart valves or the sac surrounding the heart
  • Rupture
  • Lead to additional aortic tears
  • Deprive organs of oxygen and vital nutrients 

Aortic Dissection Symptoms

There are several possible symptoms of an aortic dissection; some are classic and intense, while others lead to a more vague sense of feeling unwell:

  • Sudden and severe “knifelike” pain in the chest or upper back: the classic symptom, and the most common
  • Other pain, elsewhere in the back or in the limbs, neck, jaw, groin or abdomen
  • Fainting
  • Numbness, coolness or weakness in the limbs
  • Shortness of breath
  • Anxiety 

While you should still see a doctor, please keep in mind that other conditions can cause these symptoms, too — including abdominal diseases and heart problems. 

Aortic Dissection: Aneurysm and Other Causes

Many dissections are caused by an aneurysm, a bulge in the aorta (learn more about aortic aneurysms). There are other potential causes and risk factors, too:

  • Gender and age: Dissections mainly occur in men ages 60 to 80 — though women and other younger people can get the condition, too, especially those with risk factors.
  • High blood pressure (hypertension): the most important risk factor, tied to more than 70 percent of patients
  • Connective tissue disorders:
    • Marfan syndrome
    • Ehlers-Danlos syndrome
    • Turner syndrome
  • Inflammatory diseases that can damage blood vessels:
    • Giant cell arteritis
    • Takayasu arteritis
    • Rheumatoid arthritis
    • Syphilitic aortitis
  • Bicuspid aortic valve: two flaps (leaflets) instead of three
  • High-intensity weightlifting
  • Family history
  • Use of crack cocaine 

Aortic Dissection Diagnosis

Our doctors take several steps to diagnose an aortic dissection:

  • Medical history and physical exam:
    • Severity of pain and when it started
    • Other symptoms
    • Possible risk factors
    • Blood pressure evaluation
  • Imaging tests
    • X-ray: X-ray is usually the first test.
    • Computed Tomography (CT) Scan: This is typically the most used and reliable means of making a diagnosis. If the suspected dissection is not an emergency, the doctor is likely to use a CT as the second step.
    • Transesophageal Echocardiogram (TEE): In cases where a CT scan cannot be done (e.g., in the case of severe kidney disease) a TEE is often used to identify a dissection. This is done by placing an ultrasound probe down the esophagus.

Learn more about aortic dissection treatment.

Aortic Aneurysm Types

An aneurysm is a balloon-like bulge that forms in your aorta, the large artery that is shaped like a candy cane and delivers oxygen-rich blood from your heart. 

While smaller aneurysms are often monitored or treated with medication, larger bulges can rupture and threaten your life. Our doctors specialize in all types of aortic cases and can provide the care you need, whether through traditional, open surgery or a minimally invasive procedure. Learn more about the renowned team at our Complex Aortic Center, or about our aneurysm repair. 

We also have the tools to diagnose aneurysms before they become dangerous, and to screen those at greater risk. 

Thoracic and Abdominal Aneurysm Types

After leaving the top of your heart, your aorta curves back down, running through your chest and abdomen. Aneurysms are divided into three types, based on their location:

  • Thoracic Aortic Aneurysms (TAA): These bulges form in the part of the aorta that runs through the chest, above the diaphragm muscle that helps you breathe. They are further categorized by the specific section they are found:
  • Aortic Root: the point where the aorta leaves the heart, and where the aortic valve and coronary arteries are located
  • Ascending Aorta: after the root, but before the aorta makes its first turn and before the first blood-distributing branch
  • Aortic Arch: the curved part of the aorta, with three major branches supplying blood to the brain and arms
  • Descending Aorta: the part after the aortic arch that heads toward the abdomen
  • Abdominal Aortic Aneurysms (AAA): These bulges are found in the abdomen. They are the most common type, often found in men older than 60.
  • Thoracoabdominal Aortic Aneurysms: These bulges cross both the chest and the abdomen. 

In addition to internal bleeding from rupturing, aneurysms can:

  • Cause the aorta to split, another serious complication (learn more about aortic dissection)
  • Form blood clots
  • Press on nearby body parts
  • Block blood flow
  • Sometimes stop the aortic valve from closing properly (thoracic aneurysm only) 

Aneurysm Symptoms

Aneurysms can develop and then grow slowly for years without causing noticeable changes. They are often discovered during medical visits for different conditions. Other patients may experience certain symptoms, depending on the state of the aneurysm and its location. 

Ruptured Aneurysms

If you experience signs of a ruptured aneurysm, call 911. 

Ruptured thoracic aneurysms can cause:

  • Pain that is sudden, severe, sharp or stabbing and that starts in your chest or upper back and moves down toward your abdomen
  • Chest, arm and neck pain
  • Shock — a steep drop in blood pressure that interferes with the function of vital organs like the brain and kidneys and is marked by:
    • Clammy, sweaty skin
    • Light-headedness
    • Rapid heart rate 

Ruptured abdominal aneurysms can cause:

  • Sudden, severe pain in your lower abdomen and back
  • Nausea
  • Constipation and urination problems
  • Clammy, sweaty skin
  • Light-headedness
  • Rapid heart rate upon standing
  • Shock 

Thoracic Aneurysm Symptoms

Before rupturing, thoracic aneurysms can cause:

  • Pain in your jaw, neck, back or chest 
  • Coughing and/or hoarseness
  • Trouble breathing or swallowing
  • Neck swelling
  • Clammy skin
  • Nausea and vomiting
  • Rapid heart rate
  • General sense that something is wrong 

Abdominal Aneurysm Symptoms

Before rupturing, abdominal aneurysms can cause:

  • A throbbing feeling in your abdomen
  • Pain deep in your back or on your side
  • Steady, gnawing abdominal pain that lasts for hours or days 

Aneurysm Causes and Risk Factors

Aneurysms can develop when normal blood flow pushes on a spot of the aortic wall that is weakened or injured. While some reasons for this damage remain a mystery, other potential causes and risk factors include: 

  • Gender (men are more susceptible than women)
  • Smoking and emphysema
  • High blood pressure (hypertension)
  • High cholesterol
  • Obesity
  • Atherosclerosis (hardening and narrowing of the arteries from plaque buildup)
  • Aging
  • Vasculitis and other diseases that inflame the arteries
  • Car accident or other chest trauma (less common, and thoracic aneurysms only)
  • Family history of aneurysms
  • Personal history of aneurysms in leg arteries
  • Certain genetic conditions that weaken the body’s connective tissue, cause thoracic aneurysms at a younger age and put patients at a greater risk for rupture and dissection:
  • Marfan syndrome
  • Loeys-Dietz syndrome
  • Ehlers-Danlos syndrome (the vascular type)
  • Turner syndrome

Learn more about congenital defects and disease.

  • Having an aortic valve with two flaps (leaflets) instead of three (bicuspid valve) 

Our doctors and other researchers continue to look for additional causes of aortic weakening, including genetic mutations. If you have any of these known risk factors, ask one of our doctors if you should be screened for an aneurysm. 

Aneurysm Screening and Diagnosis

Early diagnosis of aneurysms can help prevent ruptures and other complications. Since aneurysms might not cause symptoms right away, people at greater risk may benefit from routine screening. 

Aneurysm Screening

If you are on Medicare, you can get coverage for a one-time abdominal aneurysm ultrasound screening if you meet one of two conditions:

  • You have a family history of the condition
  • You are man age 65 to 75 who has smoked more than 100 cigarettes in your life 

If you do not meet these requirements but feel you are at risk, talk to your doctor and your insurance company.

Aneurysm Diagnosis

Diagnosing an aneurysm takes several steps:

  • Taking your medical history
  • Physical exam: If you have an abdominal aneurysm, your doctor may feel a throbbing mass or hear a rushing blood flow rather than the normal whooshing sound.
  • One or more imaging tests to determine the aneurysm’s size and location:
  • Ultrasound
  • Computed Tomography (CT) scan
  • Magnetic Resonance Imaging (MRI)
  • Angiography using dye and X-rays to look inside your aorta 

Learn more about aortic aneurysm treatment.

For information or appointments, please call 855-463-3320.

Learn about aortic aneurysm repair at MedStar Washington Hospital Center.

Cardio-Oncology Research

Our cardiologists are conducting important research about why certain types of cancer treatments compromise heart function. There may be ways to prevent damage to the heart while still undergoing these cancer treatments.  However, there is not a lot of data in this field, and so clinical research is critical.

Our Cardio-Oncology Program is building a database of patients, their cancer treatments and their heart complications, so we can help future patients and design better cancer drugs. This database also helps our current patients, because as we build a clinical practice model, we are making very informed decisions about your cardiac health as it relates to your cancer treatment.

Please contact us by calling 202-877-2162. You may also send an email to [email protected]

For Referring Physicians

The MedStar Heart Institute’s Cardio-Oncology Program is the first of its kind in our Greater Baltimore/Washington, D.C., metropolitan area. We are dedicated to the prevention and early detection of cardiac complications from chemotherapy or other cancer treatments.

Combining sophisticated and advanced cardiac testing with the skills of our specialized cardiologists, our program offers:

  •       Earlier diagnosis of heart problems
  •       Special monitoring of your patients with cancer who also have existing or potential cardiac issues

If you have a patient with cancer and these other conditions that may affect their care:

  •       History of cardiomyopathy or heart failure Hypertension
  •       High cholesterol
  •       Diabetes
  •       Other heart-related issues

Please contact us by calling 202-877-2162. You may also send an email to [email protected]

You can see one of our cardiologists with expertise in cancer treatment at MedStar Georgetown University Hospital by calling 202-444-5111.

Our experienced team maintains communication with you while we are caring for your patient.

Treatment and Management: Cardio-oncology

Some patients with  heart trouble or who are at risk for developing heart conditions because of certain types of cancer treatment, need specialized care.

At our Cardio-Oncology Program, our physicians are cardiologists who use advanced imaging to diagnose and evaluate a patient’s risk of developing a heart condition due to  certain types of cancer treatments. Our cardiologists also treat patients who are undergoing cancer treatment, but have developed heart conditions, in the hope of protecting their heart function as much as possible.

Evaluation of cardiac risk and heart conditions during cancer treatment

We use the latest tests and diagnostic criteria to help patients understand their risk factors for heart failure and other associated conditions. These include:

  • Echocardiography
  • Echo strain imaging
  • Cardiac biomarkers
  • Cardiac MRI

This state-of-the-art imaging allows our cardiologists a full view of the heart’s function, giving them critical real time information that helps them evaluate your potential risk for developing a cardiac condition while undergoing cancer treatment.  Your diagnosis also reveals if there is a way to receive these drugs safely, without damaging your heart.

If you already have a heart condition, these advanced images provide important information for the best possible treatment.

Treatment

If you have heart damage due to certain types of cancer drugs, or radiation treatment to the chest, we develop a specialized plan for you. Side by side with your oncologists, our cardiologists discuss your heart function and possible treatments, including other types of medication that may help and not interfere with your cancer treatment. We may also discuss other alternatives to your cancer treatment, including the use of drugs that may not affect your heart.

As an academic medical center, we are training tomorrow’s leaders in this field. The top experts in cardiology and oncology are doing cutting-edge cardio-oncology research, to build better ways to evaluate, protect and treat cancer patients who are at risk for cardiac conditions.

Our Physicians: Cardio-Oncology

Our cardiologists have a special interest in the prevention and early detection of cardiac complications from chemotherapy or other cancer treatments, like radiation therapy to the chest.

Cardiologists and cancer physicians working together

Our oncologists and cardiologists work together, using state-of-the-art imaging technology to determine the potential risks and provide the best treatment options for patients.

Our physicians are fellowship-trained and work at an academic medical center, and  have been exposed to the widest range of patient situations and the latest research in their field. Their goal is to diagnose and treat patients, and  also learn effective methods for fighting cancer without damaging or compromising heart function. Learn more about treatment and management and our cardio-oncology research.

Ana Barac, MD, who leads the program, has specialized expertise in this field, and an interest in building better paths for evaluating and treating these unusual patients. Together, she works with oncologists at our sister institutions, including Washington Cancer Institute and the Lombardi Cancer Center.

Meet our cardio-oncology team

 

What is Cardio-Oncology?

Cardio-oncology is the intersection of heart conditions in patients who have been treated for cancer. Cardiologists can assess patients for potential risk of developing heart conditions if patients  take certain types of cancer drugs, or following radiation treatment to the chest. They also help oncologists protect their patients during treatment by closely watching the heart and recognizing heart trouble early in treatment.

Cardio-Oncology Program at MHVI

At the MedStar Heart & Vascular Institute (MHVI) Cardio-Oncology Program, our physicians are cardiologists who use advanced imaging to diagnose and evaluate a patient’s risk of developing a heart condition due to  certain types of cancer treatments. Our cardiologists also treat patients who are undergoing cancer treatment, but have developed heart conditions, in the hope of protecting their heart function as much as possible.

Certain cancer drugs can weaken the heart or cause abnormal rhythms. We designed our Cardio-Oncology Program to provide cancer patients with excellent, multidisciplinary care. We combine advanced imaging and treatment protocols with a knowledgeable team of oncologists and cardiologists working together.

Goals of our Cardio-Oncology Program

Our cardiologists have developed a comprehensive program that aims to:

  •       Ensure better outcomes for  patients with cancer and cardiac issues
  •       Provide earlier detection of cardiac toxic side effects from  cancer treatments
  •       Prevent or reduce further cardiac damage—and when possible reverse it
  •       Monitor patients with potential cardiac issues who are receiving cancer treatments
  •       Better understand cardiac issues in patients with cancer by participating in research studies
  •       Eliminate cardiac disease as a barrier to effective cancer therapy

For more information or to schedule an appointment, please call 855-463-3320.

Related Information

For more information or to schedule an appointment, please call 855-463-3320.

Patent Foramen Ovales and Atrial Septal Defects

While most congenital defects of the heart require surgery, our doctors perform some procedures in the catheterization lab. These include patent foramen ovales and atrial septal defects.

Patent Foramen Ovales (PFO)

A (PFO) is a small opening in the dividing wall between the heart's upper two chambers. To close this hole, our cardiologists use a special PFO closure device, which opens like an umbrella to permanently close the hole in the heart. Once your doctor inserts the balloon-tipped catheter into an artery and places it at the defect, the catheter is inflated. The inflation produces an indent, which measures the size and shape of the defect. The umbrella device tightly seals the surrounding normal septal tissue to create a permanent closure of the defect.

Atrial Septal Defects (ASD)

In a patient with an ASD the atrial septum—the wall between the left and right atria (upper chambers of the heart)—fails to close. To repair it, our cardiologists use two small umbrella-shaped clamshell devices placed on the right and left side of the septum. The two devices, once attached, close the hole in the heart.

Learn more about structural heart disease.

For information or appointments, please call 855-463-3320.

Syncope

Syncope is a temporary loss of consciousness, commonly called fainting.

What causes syncope?

Syncope is caused by reduced blood flow to the brain, which results in loss of consciousness. When adequate blood flow resumes, you regain consciousness. Common causes of syncope are low blood pressure (hypotension) or slow heart rates. The brain simply does not receive adequate oxygen and glucose from the blood stream, causing you to pass  out.

While syncope alone is generally not life threatening, it may be a symptom of a more serious condition, and you should receive a prompt evaluation. Learn more about our treatments for arrhythmias.

Symptoms of syncope

Symptoms include:

  • Dizziness, sometimes after exercising
  • Feeling lightheaded
  • Irregular heartbeat (described as a fluttering in the chest)

Syncope diagnosis

Your doctor will want to investigate why you are experiencing syncope. Some diagnostic tests used to determine the cause include:

  • Blood tests: Your doctor will examine your sugar levels and make sure you are not dehydrated.
  • Electrocardiogram: An ECG or EKG records the electrical activity of the heart and shows abnormal rhythms (arrhythmias or dysrhythmias). Learn more about ECGs.
  • Tilt table test: During this test, you lie on a table that moves from side to side. We record your blood pressure and pulse as the table is tilted. This test will sometimes show an arrhythmia that contributes to the syncope.
  • Echocardiogram: This is an ultrasound of the heart as it beats. It may help to determine if there is an unusual cardiac rhythm. Learn more about echocardiograms.
  • Electrophysiology study: This is a catheter-based test of the heart’s electrical system.

Syncope treatment

Syncope is usually treatable. The cause of the syncope will determine the treatment. If you have cardiac arrhythmias, your cardiologist may recommend:

  • A pacemaker to treat slow heart beats
  • An implantable cardioverter defibrillator (ICD) to monitor and correct life-threatening rapid rhythms. Learn more about our arrhythmia treatments, including ICDs.

Your heart health is critical: Make an appointment with a cardiologist at the MedStar Heart and Vascular Institute today.



 

 

For information or appointments, please call 855-463-3320.

Palpitations

Palpitations are usually felt as an unusual pattern of heart beating, such as heart skipping, thumping or hard beats. This sensation can be very mild or quite uncomfortable.

Often, it is not a harmful condition. Usually the only treatment necessary is reassurance from our doctors or in some cases, medical therapy to relieve symptoms. Learn more about our treatments for arrhythmias.

In other cases, palpitations may signal the presence of a heart problem in need of treatment. The best approach to this condition is a thorough evaluation by an experienced cardiologist, who has expertise in evaluating and treating palpitations. Meet our electrophysiologists.

What causes palpitations?

Palpitations can be caused by any sustained cardiac arrhythmia, but they can also be caused by normal heart rhythm or extra heart beats that are not necessarily abnormal. Examples of causes of palpitations include:

  • Premature atrial complexes (PACs)
  • Premature ventricular complexes (PVCs)
  • Atrial fibrillation
  • Atrial flutter
  • Supraventricular tachycardia (SVT)
  • Ventricular tachycardia

Palpitations symptoms

Symptoms include:

  • Feeling that the heart is running or skipping
  • Chest pain
  • Shortness of breath
  • Dizzy spells
  • Fainting spells

Palpitations diagnosis

Your doctor will want to investigate why you are having palpitations. Some diagnostic tests used to determine the cause include:

  • Blood tests. Your doctor will examine your chemistry levels, blood counts and thyroid functions, as well as ensure that you are not dehydrated.
  • Electrocardiogram. An ECG or EKG records the electrical activity of the heart and shows abnormal rhythms (arrhythmias or dysrhythmias). Learn more about EKGs.

Palpitations treatment

If your palpitations are caused by abnormal heart rhythms, your doctor may recommend the following strategies:

  • Heart monitoring or electrophysiology study to identify the cause of the palpitations
  • Medications to control the palpitations
  • Lifestyle modifications to control stress
  • Catheter ablation, if necessary, to eliminate the source of the abnormal electrical rhythm

Your heart health is critical: Make an appointment with a cardiologist at the MedStar Heart and Vascular Institute today.



 

 

For information or appointments, please call 855-463-3320.

Advanced Heart Failure

Many patients find they can manage their heart failure and maintain their quality of life with lifestyle changes and basic medicines prescribed by our doctors.

But if the condition worsens, we also offer powerful medications, sophisticated devices to help the heart and even transplants. The cardiologists and surgeons in our Advanced Heart Failure Program have the expertise and experience needed to successfully offer these complex treatments.    

Our team will help you decide on the treatment plan that makes the most sense for you. We also work closely with family members and other caregivers. Learn more about the renowned team at our Advanced Heart Failure Program.

Advanced Heart Failure Symptoms

Advanced heart failure symptoms are similar to those experienced by patients with less serious disease. The difference is that symptoms can be felt with minimal exertion or even at rest. These include:

  • Fatigue
  • Shortness of breath
  • Swelling of the legs and feet
  • Swelling of the abdomen
  • Irregular heartbeat (learn more about cardiac arrhythmia)
  • Weight loss
  • Chest pain

 The severity of symptoms can still vary from day-to-day, or even within the same day.

 Learn more about heart failure

Advanced Heart Failure Treatment

Our doctors usually treat less-severe heart failure with lifestyle changes and more common medications. But more advanced heart failure often requires a deeper approach. Possible options include:

  • Inotropes: Medications that increase your heart’s squeezing capacity (only select centers like ours can send patients home on these powerful medications)
  • Cardiac resynchronization therapy (CRT) device: Ensures the right and left side of your heart contract at the same time (learn more about pacemakers)
  • Percutaneous valves: Repair or replacement of heart valves with a minimally invasive approach that avoids open-heart surgery
  • Left ventricular assist devices (LVAD): Devices that help the heart, either as permanent treatment or as a temporary measure before transplant
  • Heart transplant: Replacement of the heart with a donor organ 

For information or appointments, please call 855-463-3320.

Vascular Insufficiency

Venous insufficiency occurs when the veins do not efficiently return blood from the legs back to the heart, usually due to malfunctioning valves or a chronic blockage, both of which can occur after a deep vein thrombosis. Chronic venous insufficiency is one of the most common chronic conditions in the United States and worldwide.

Symptoms

  • Varicose veins
  • Swelling of the legs and pain in the extremities (dull aching, heaviness, or cramping)
  • Discoloration of the legs (often a brown discoloration)
  • Hard, thickened skin around the ankles
  • Ulceration of the skin around the ankle

Diagnosis

Chronic venous insufficiency is usually diagnosed by a history and physical examination. Duplex ultrasound is also commonly used for assessment of the veins.

Treatment

There are several treatment options for chronic venous insufficiency. In most cases, the initial treatment is conservative and nonoperative. This typically includes:

  • Compression garments or stockings
  • Unna's boots, which are gauze bandages coated with zinc oxide to create a semi-rigid boot
  • If conservative treatment is unsuccessful, a more invasive surgical treatment is pursued. This treatment is focused toward eliminating or lessening the effects of the damaged valve function in the veins. Options may include:
  • Sclerotherapy
  • Vein stripping
  • Valve replacement surgery
  • Endoscopic perforator ligation
  • Laser vein ablation

For information or appointments, please call 855-463-3320.

Vascular Malformations

The abnormal formation or development of blood vessels is generally referred to as vascular malformation. Abnormal blood vessel structure is usually congenital, meaning it is present at birth.

Abnormal blood vessels can prevent enough oxygenated blood from filling capillaries, the tiny blood vessels that connect the body's arteries and veins. In some people with vascular malformations, blood travels directly from the arteries into the veins without ever having reached the capillary system. When blood does not fill the capillaries, the blood tissues that would normally receive blood from them experience a lack of oxygen, as well as a buildup of waste products.

Types

The severity of these malformations varies greatly both within and among the following clinical groups:

  • Arteriovenous malformations
  • Capillary malformations (portwine stains)
  • Combined vascular malformations
  • Lymphatic malformations
  • Venous malformations

Vascular malformations are categorized as either slow flow or fast flow. These terms refer to the rapidity of blood flowing through the lesion.

  • Fast-flow lesions can lead to high output heart failure and may require specific treatment. Arteriovenous malformations are fast-flow lesions.
  • Capillary, lymphatic, and venous malformations are considered slow-flow lesions. Combined malformations may be either slow or fast flow.

Symptoms

When located in an extremity, vascular malformations might show as a birthmark, may stimulate the development of collateral blood vessels in the form of varicose veins, or can produce an enlargement of the limb or a lengthening of the limb by stimulating its bony growth centers.

The localized masses may be of various size, from small to huge, and at their surface the vessels may be vulnerable to injury and bleed or may break down and ulcerate.

Diagnosis

These lesions are diagnosed by both physical examination and by using a number of imaging techniques, including magnetic resonance imaging (Cardiovascular MRI) and ultrasonography. In some cases, an angiogram is needed to assist in detailed treatment planning.

Treatment

Vascular malformations posses a highly individual nature and, therefore, treatment is decided case-by-case, based on the exact location of any malformation and the specific symptoms and risks posed by the malformation. Some vascular malformations may only require monitoring or compression garments and drug therapy.

For lesions that are only superficial, laser therapy is commonly used. Lesions that are deep may, however, require surgical removal and other therapies such as sclerotherapy.

Vascular malformations that cause persistent pain, ulceration, bleeding, blood clots, obstruction of major vessels, progressive limb asymmetry by overgrowth, or that interfere with limb function should be treated, often with the following:

  • Surgery
    The surgeon ties off and removes the arteries that feed blood into the malformation and removes the malformation.
  • Embolization
    Catheters are advanced into the lesions, and the malformed vessels are blocked, or embolized, with a variety of injectable particles, substances, or devices such as polyvinyl foam, biological glues, and absolute alcohol.
  • Radiosurgery
    Highly focused radiation is aimed directly at the blood vessels that comprise the malformation and cause them to close.

For information or appointments, please call 855-463-3320.

Vascular Disease

Your vascular system is your network of blood vessels that includes your arteries and veins. When your vascular system is healthy, blood travels freely through blood vessels, carrying oxygen and nutrients to every cell in the body.

Any condition that affects your blood’s circulation is considered vascular disease—whether your vessels harden and narrow from a buildup of plaque, a condition called atherosclerosis, or they swell and their walls become thin and rupture.

Slowed, interrupted, or decreased blood flow can reduce life expectancy by causing a host of problems, including:

  • Heart attacks
  • Stroke
  • Ruptured blood vessels, secondary to aneurysm formation
  • Kidney failure due to restricted blood flow
  • Limb loss

Symptoms

An estimated eight million to 15 million Americans have vascular disease, and at least half do not experience symptoms. Symptoms, such as leg pain, may be mistaken for other conditions, such as arthritis. In many cases, vascular disease has no symptoms until it results in a stroke, mini-stroke, or ruptured aneurysm.

Risk Factors

Several conditions and lifestyle factors increase a person's risk, including:

  • High cholesterol and lipid levels
  • High blood pressure
  • Diabetes
  • Family history of atherosclerosis
  • Smoking
  • Being overweight
  • Sedentary (inactive) lifestyle
  • High-stress lifestyle
  • Over age 50 or post-menopausal (though it can occur at any age)

Read more about conditions considered vascular disease:

For information or appointments, please call 855-463-3320.

Varicose Veins

Varicose veins are recognized as the blue, enlarged veins seen near the surface of the skin. These superficial veins work with deeper veins in aiding blood flow. Blood normally moves from the superficial to the deep veins with a series of valves to keep the flow going in one direction. But when the valves weaken, the blood flow reverses, moving back to the superficial veins. With time, pressure on the superficial veins increases and they engorge with blood. Varicose veins can be painful and can make legs feel swollen, achy, itchy, or heavy. Legs also may tire easily or get cramps or sores. Left untreated, varicose veins can result in chronic swelling and leg ulcers.

Signs and Symptoms

Varicose veins are recognized often as the blue, enlarged veins seen near the surface of the skin. These superficial veins work with deeper veins in aiding blood flow. Blood normally moves from the superficial to the deep veins with a series of valves to keep the flow going in one direction. But when the valves weaken, the blood flow reverses, moving back to the superficial veins. With time, pressure on these veins increases and they engorge with blood. Signs and symptoms you may experience include:
  • Aching pain, especially after long periods of standing or sitting
  • Throbbing or cramping in the thigh or calf
  • A feeling of heaviness in the leg(s)
  • Swelling in the lower leg or ankle
  • Itching in the affected limb
Left untreated, vein disease often progresses. Learn more:

Treatment

  • Endoluminal vein surgery is a minimally invasive procedure in which your vascular surgeon inserts a needle into the affected vein and closes the weak area using high frequency doses of light.
  • In a mini-incisional varicectomy, all the prominent varicosities are removed through several tiny (2.0-mm) incisions. The procedure is performed under local anesthesia and intravenous sedation on an outpatient basis. Patients can usually resume normal activities within 3-6 days depending on the extent of their varicose vein problem.

Other Treatment Options

At our Chevy Chase and Lafayette Centre locations, you will benefit from comprehensive treatment in a single visit. Importantly, you will have the personal attention, care and oversight of our experienced board-certified vascular surgeons who are part of the MedStar Heart & Vascular Institute. Misaki Kiguchi, MD, is a board-certified vascular specialist and Maria Litzendorf, MD, is a board-certified vascular specialist, both with a special interest and experience in treating vein disorders. As part of your evaluation and treatment plan, you’ll receive:
  • A comprehensive assessment through an ultrasound performed by a registered vascular technologist
  • One-on-one examination and consultation to discuss your specific condition and a proposed treatment plan that may include one or more of the following options.
  • Treatment Options:
    • Compression therapy—Prescription-strength hose for extra support and pressure to eliminate symptoms
    • Sclerotherapy—Chemical injections into the spider and varicose veins
    • Radiofrequency ablation—Heat, administered through a small catheter, to eliminate damaged veins
  • Follow-up appointments and post-procedure ultrasound

Risk and Prevention

Varicose veins generally run in the family. Pregnancy and weight gain also can lead to this problem. But there are ways to prevent varicose veins or to relieve the pressure. If you suffer from or are worried about varicose veins, try these tips:
  • Change positions often when standing or sitting.
  • Keep legs propped up while sitting and don't cross your legs.
  • Sleep with the foot of the bed elevated, with your feet higher than your head.
  • Avoid high heels and clothes that are tight around the waist and hips.
  • Keep a healthy weight.
  • Stretch your calves by going up on your toes.
  • Wear support stockings or pantyhose.
  • Exercise regularly. Walking is especially good.

For information or appointments, please call 855-546-0883 or:


Locations:

MedStar Washington Hospital Center
110 Irving Street, NW
Washington, DC 20010
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MedStar Georgetown University Hospital
3800 Reservoir Rd NW
Washington, DC 20007
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MedStar Health in Chevy Chase
5454 Wisconsin Avenue, Suite 1100
The Barlow Building, Chevy Chase, MD 20815
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MedStar Health at Lafayette Centre
Building 2
1133 21st Street, NW
Floor 7
Washington, DC 20036
Use parking garage entrance on 21st Street
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Thoracic Aortic Aneurysm

A thoracic aortic aneurysm is an abnormal widening or ballooning of a portion of the aorta caused by weakness in the wall of the artery. Atherosclerosis is by far the most common cause, although it may be caused by a variety of conditions, including high blood pressure, congenital disorders (such as Marfan's syndrome), trauma, or, less commonly, syphilis.

Symptoms

Most patients have no symptoms until the aneurysm begins to leak or expand. Most non-leaking thoracic aortic aneurysms are detected by tests, such as a chest X-ray or a chest computed tomography (CT) scan that are being run for other reasons. Chest or back pain may indicate acute expansion or leakage of the aneurysm.

Diagnostic Tools

  • Aortic Angiography
  • CT Scan
  • X-ray
  • Echocardiogram

Treatment

  • Ascending aorta or aortic arch surgery
  • Descending thoracic aorta surgery

Learn more about heart surgery at MedStar Heart & Vascular Institute.

For information or appointments, please call 855-463-3320.

Structural Heart and Valve Disease

If you have structural heart disease, abnormalities exist in your heart muscles, valves, or major blood vessels. These defects can affect heart function and blood flow. Some structural heart disease is congenital (present at birth), while other cases develop later in life, due to injury, infection, or aging.

The specialists at the MedStar Heart & Vascular Institute are leaders in the field. We focus on routine and complex structural heart defects to offer you the full range of surgical and nonsurgical procedures that will help you best manage your condition.

Structural Heart Defects

  • Septal defects - The septum is the critical muscle wall separating the four chambers of your heart. It functions as a barrier that prevents blood from passing from one side of your heart to the other. Occasionally, holes or other abnormalities occur in the septum. These septal defects can be ventricular (located between the lower two chambers) or atrial (located between the upper two chambers).
  • Patent foramen ovale (PFO) - PFO is a common septal defect that happens when a naturally occurring opening between atria does not close after birth. It has been associated with stroke and migraine headache.
  • Valvular defects - Normal blood flow depends upon fully functioning heart valves. The mitral, aortic, tricuspid and pulmonary valves play a key role in the flow of blood through the heart. When the valves become hardened and narrow (stenotic), they cannot open fully, and blood flow is restricted. If the valves are unable to close completely (incompetent), blood flows in the opposite direction. In its most severe form, valvular disease can lead to congestive heart failure.

Major Blood Vessel Defects

The major blood vessels pump blood from the heart to the body and return the blood from the body back to the heart. Defects in these critical arteries and veins can prevent oxygen-rich blood from reaching the rest of the body. Conversely, these abnormalities can sometimes cause too much blood flow to the lungs. Major blood vessel defects can seriously affect heart function and overall health.

Treatment

  • Closure Procedures - Our physicians perform atrial and ventricular septal defect closures and have vast expertise in performing patent foramen ovale (PFO) closures, when clinically indicated.
  • Valve Repair or Valve Replacement - Valve repair reduces complications and the need for future medication. Our physicians perform the highest percentage of valve repair procedures in the area and can replace valves that cannot be repaired.
  • Aortic Disease Management - Our physicians are skilled in both surgical and endovascular management of aortic disease. We treat the largest volume of patients with aortic disease in the area and strive to bring you the most minimally invasive procedures whenever possible.

Contact Us

To contact the Structural Heart and Valve Disease Center, call us at 855-463-3320.

Structural Heart Specialists

Find a physician who can help answer your questions.

Learn More

Meet Heart Valve Surgery Patient, Joanna Zimmerman:

Renal Artery Disease

Also called renal artery stenosis, renal artery disease occurs when the artery that supplies blood to the kidneys is narrowed or blocked, most commonly by atherosclerosis. Atherosclerotic renal artery stenosis is usually seen in older individuals who may have vascular disease in other areas as well (such as the heart or legs). It may also be caused by medial fibroplasia, also called fibromuscular dysplasia, which occurs with abnormal development of the artery wall.

Renal artery disease can cause hypertension, though it is a much less common cause than primary (no underlying cause) hypertension, and treating it can improve or even cure the hypertension. In other cases, renal artery stenosis may cause poor kidney function and correcting the narrowing may improve kidney function.

Treatment

While traditional surgical methods (renal artery bypass) are sometimes still used to treat this condition, a newer, less invasive procedure called renal artery stenting has become more common. This is done by threading a tiny, balloon-tipped catheter through a small puncture in the groin to the site of the arterial narrowing. The balloon is expanded to enlarge the artery and a stent (a small, balloon-expandable metal tube or scaffold) is put in place to optimize the angioplasty result and minimize recurrences.

For information or appointments, please call 855-463-3320.

Peripheral Vascular Disease (PVD)

Peripheral Vascular Disease (Peripheral Arterial Disease)

Peripheral vascular disease (PVD), also known as peripheral arterial disease (PAD), refers to diseases of any of the blood vessels outside of the heart and brain. PAD is a range of disorders that can affect the blood vessels in the legs, feet, arms, or hands, or body. PAD can include any vascular condition including aortic aneurysms.

Artherosclerosis

The most common form of PAD is atherosclerosis (hardening of the arteries). Atherosclerosis is a gradual process in which cholesterol and scar tissue build up to form a substance called plaque that clogs the inside of the artery.

This buildup causes a gradual narrowing of the artery, which will decrease the amount of blood flow. When the flow of blood decreases, it results in a decrease of oxygen supply to the body's tissues, which in turn causes pain or ulceration. When the arteries to the legs are affected, the most common symptom is pain, weakness, or cramping in the thigh, calf, foot, hip, or buttock especially when walking. In addition, ulcers can form in the toes and feet.

Diagnostic Tools

There are some relatively simple tests that can be done to determine if the arterial blood flow in your legs is normal.

  • Segmental pressure test - In this test, the blood pressure at several points in your arm or leg is checked using a blood pressure cuff and a Doppler. This will help determine if there is a difference in blood flow in the affected limb.
  • Ultrasound scan - The scan produces images of arteries on a screen and is used to visualize the blood flow and locate blockages.
  • Arteriogram - In this test, dye is injected into the arteries while X-rays are taken. The dye "lights up" the arteries, allowing the area of blockage to be accurately pinpointed.

Treatment

The best treatment for PAD depends on a number of factors, including your overall health and the location, size and cause of the blockage. In some cases, lifestyle changes can be enough to slow the progress and manage PAD. Others will need intervention to restore the blood flow to their legs. For that reason, your physician may recommend seeing a doctor who specializes in this condition to discuss methods of rechanneling blood flow around the obstructed arteries. Most of these methods are minimally invasive and do not require surgery or an incision. Find a vascular surgeon to discuss PAD.

For information or appointments, please call 855-463-3320.

WTOP Medical Intel

The Silent Killer: Peripheral Vascular Disease

Mesenteric Artery Disease

The mesenteric arteries supply blood to the small and large intestines; when these narrow or are blocked, blood flow is restricted and can cause abdominal pain, vomiting, and diarrhea. Two types exist:

  • Acute mesenteric artery ischemia is an emergency. Surgery is usually performed to remove the clot. In some cases, the surgeon must also create a bypass around the blockage.
  • Chronic mesenteric artery ischemia is treated by removing the blockage and reconnecting the arteries to the aorta. A bypass around the blockage can be created with a plastic tube graft.

Mesenteric artery ischemia is often seen in conjunction with hardened arteries in other parts of the body (for example, those with coronary artery disease or peripheral vascular disease). The condition is more common in smokers and in patients with high blood pressure or blood cholesterol.

For information or appointments, please call 855-463-3320.

Long QT Syndrome

In a properly functioning cardiovascular system, certain proteins control the flow of potassium, sodium, magnesium, and other molecules through the heart’s cells. These molecules contribute to proper electrical activity in the heart and keep it beating in a steady pattern.

The QT interval is a way to measure the heart’s electrical recovery after each beat. Any problems—including genetic mutations to these proteins or medications that lengthen the QT interval—can disrupt this electrical activity and cause heart arrhythmia.

In Long QT Syndrome (LQTS), the heart takes longer to recover from each beat because its electrical activity is disrupted. If undiagnosed and untreated, LQTS can lead to fainting spells or torsades de pointes, a type of heart rhythm disturbance that causes sudden cardiac death.

Types

  • Inherited LQTS occurs in approximately 1 in 2,000 people.
    Medical experts have identified mutations in 13 different genes that cause LQTS. Each type of inherited LQTS has certain triggers that may be associated with arrhythmias. The most common types are:
    • LQTS 1: Exercise (especially swimming) or emotional stress
    • LQTS 2: Extreme emotions including fright, anger, pain, or surprise
    • LQTS 3: Arrhythmias triggered by a slow heart rate while asleep
  • Acquired LQTS is much less common and does not often cause serious arrhythmias, except in people with a genetic predisposition.

Symptoms

For some people, their first symptom is a sudden cardiac arrest. Others have symptoms that begin in childhood or early teens, including:

  • Fainting caused by torsades de pointes, especially during physical activity or emotional stress
  • Sudden, rapid heart arrhythmia that feels like fluttering in your chest       
  • Gasping or difficulty breathing during sleep
  • Accidents caused by fainting
  • Sudden cardiac arrest (heart stoppage because of arrhythmias caused by electrical problems) or death

Diagnosis and Treatment

If you have symptoms of LQTS, physicians can diagnose it with an ECG. But, it can be difficult to diagnose because the QT interval may not always be prolonged in affected people.

Testing tools that can detect LQTS include:

  • Standard electrocardiogram (ECG) to check for a prolonged QT interval in your heartbeat
  • Exercise ECG (or stress test) to detect heartbeat problems that may not appear on a standard ECG
  • Event monitor to record your heart’s electrical activity over days or weeks to detect heart arrhythmia
  • Genetic testing to look for the condition

Your physician may also diagnose LQTS after you have experienced a cardiac event. A family history of sudden death may signal the need for further evaluation.  If you or a family member are diagnosed with LQTS, it’s very important for other family members to be screened for the syndrome. Contact MedStar Health for more information on genetic screening for heart conditions.

Treatment goals for LQTS focus on preventing heart arrhythmia and sudden cardiac arrest. Our cardiac specialists may recommend any of these treatment options:

  • Lifestyle changes
    • Avoiding strenuous activity, especially swimming
    • Avoiding medications that can trigger heart arrhythmia
    • Controlling stressful situations
  • Medications such as beta blockers to help regulate heart arrhythmia
  • Surgery to implant a defibrillator that uses electric shocks to correct heart arrhythmia

For information or appointments, please call 855-463-3320.

Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is a genetic condition (occurring in about 1 of 500 people) that causes heart muscle tissue to thicken. If the muscle tissue thickens too much, it can block blood flow from the heart to the rest of the body.

HCM can also cause you to have arrhythmia, an irregular heartbeat. If your arrhythmia is potentially life threatening, your doctor may implant a defibrillator to protect your heart.

If medication does not reduce your symptoms, you may need to have open heart surgery. This procedure will cut out the thickened tissue and improve your blood flow. 

Other conditions, such as high blood pressure (hypertension) or extreme athletic conditioning, can cause heart muscle thickening. This abnormal tissue may resemble HCM, making a diagnosis more challenging.

Symptoms

Many people who have HCM may not realize it because they often have no symptoms. During a routine medical exam, your physician may discover a heart murmur or suspect HCM after an abnormal electrocardiogram (ECG). But sometimes, the first symptom is a sudden collapse or cardiac arrest.

Other symptoms that people with HCM may experience include:

  • Shortness of breath, most commonly during activity
  • Dizziness, light-headedness or fainting during or after physical activity
  • Chest pain
  • Fatigue
  • Heart palpitations (fluttering or pounding in your chest)

Diagnosis and Treatment

Your physician will perform a complete physical exam and listen for abnormal sounds in the heart. These sounds include an abnormal heartbeat or a heart murmur. At MedStar Heart & Vascular Institute, our cardiac team looks for thickened heart muscle and problems with blood flow or heart valves using the following tests:

  • Echocardiogram (most common) to diagnose and monitor HCM
  • Electrocardiogram (ECG)
  • Diagnostic imaging, including Cardiovascular MRI
  • Cardiac catheterization to evaluate the function of your heart's arteries, chambers and valves
  • Event monitor to record your heart rhythm over time
  • Genetic testing to detect mutations known to cause HCM

If your physician diagnoses you or a family member with HCM, screening of other family members is very important. We offer genetic screening for heart conditions.

For people with HCM, our treatment goals focus on controlling symptoms, managing related conditions and preventing sudden cardiac arrest. Our cardiac specialists may recommend one or more of these treatment options:

  • Medications such as beta blockers, calcium channel blockers or anti-arrhythmic drugs to help regulate heart contractions
  • Surgery to implant a pacemaker to regulate your heartbeat or a defibrillator to correct dangerous heart arrhythmia
  • Open-heart surgery to remove parts of the thickened muscle or replace heart valves
  • Cardiac catheterization for septal alcohol ablation to remove excess muscle tissue in the heart
  • Lifestyle changes, including avoiding very strenuous activity

For information or appointments, please call 855-463-3320.

Hypertension

High blood pressure, also called hypertension, occurs when the systolic pressure is consistently over 140 mm Hg, or the diastolic blood pressure is consistently over 90 mm Hg.

There are two categories of hypertension: essential and secondary. The majority of cases of high blood pressure are essential hypertension, a type of hypertension without specific reason, but caused because the body cannot regulate the blood pressure within normal range. Secondary hypertension is commonly caused by stenosis, or narrowing, of the renal (kidney) arteries.

Risk Factors

Most of the time, there is no identifiable cause for essential high blood pressure. Risk factors for high blood pressure (secondary hypertension) that results from a specific condition, habit, or medication may include:

  • Anxiety
  • Arteriosclerosis
  • Coarctation of the aorta
  • Diabetes
  • Drugs such as alcohol toxicity or cocaine
  • Excess sodium (salt) in the diet
  • Habitual alcohol use
  • Obesity
  • Pain
  • Renal artery stenosis
  • Renal disease
  • Stress

Symptoms

Patients with high blood pressure generally have no symptoms. If patients experience a mild headache along with any of the following systems, it may be a sign of dangerously high blood pressure (malignant hypertension) or a complication from high blood pressure:

  • Blood in urine
  • Chest pain
  • Confusion
  • Ear noise or buzzing
  • Headache
  • Heart failure
  • Irregular heartbeat
  • Nosebleed
  • Tiredness
  • Vision changes

Treatment

Changes in lifestyle such as weight loss, increased exercise, and a low fat diet with limited sodium intake may reduce hypertension. If these lifestyle changes do not work, medications for hypertension may include:

  • ACE inhibitors or angiotensin receptor blockers
  • Beta-blockers
  • Calcium channel blockers
  • Diuretics
  • Alpha receptor blockers

Prevention

Steps to prevent or to reduce the risk of high blood pressure include:

  • Eating a low fat diet rich in fruits and vegetables and low in animal fat
  • Exercising at least 30-60 minutes on most days of the week
  • Maintaining a healthy weight
  • Maintaining a proper diet
  • Modifying salt intake
  • Reducing alcohol consumption
  • Quitting smoking

Renovascular Hypertension

Renovascular hypertension, a form of secondary hypertension, occurs when the arteries that carry blood to the kidneys become narrow, usually because of a blockage.

For symptoms, treatment, and prevention see Hypertension above.

When medications and lifestyle changes do not work, surgical reconstruction of a damaged artery may be performed. Procedures, such as balloon angioplasty or stenting of the damaged artery may be used instead of surgery.

For information or appointments, please call 855-463-3320.

Mitral Insufficiency

Mitral/mitral regurgitation (acute mitral regurgitation) is a disorder in which the heart's mitral valve suddenly does not close properly, causing blood to leak (back-flow) into the left atrium (upper heart chamber) when the left ventricle (lower heart chamber) contracts.

Mitral Insufficiency Symptoms

  • Chest pain, unrelated to coronary artery disease or a heart attack
  • Cough
  • Palpitations
  • Rapid breathing
  • Shortness of breath

For information or appointments, please call 855-463-3320.

Tricuspid Insufficiency

Tricuspid insufficiency/tricuspid regurgitation is a disorder involving backward flow of blood across the tricuspid valve, which separates the right ventricle (lower heart chamber) from the right atrium (upper heart chamber). This occurs during contraction of the right ventricle and is caused by damage to the tricuspid heart valve or enlargement of the right ventricle.

Risk Factors

The most common cause of tricuspid regurgitation is not damage to the valve itself, but enlargement of the right ventricle, which may be a complication of any disorder that causes failure of the right ventricle.

Rheumatic fever, diet medications such as Phen-fen (phentermine and fenfluramine) or dexfenfluramine, and a congenital heart disease (Ebstein anomaly) are also risk factors for tricuspid regurgitation.

Rarely, tricuspid regurgitation is caused by an unusual tumor called carcinoid, which secretes a hormone that damages the valve. Other infrequent causes of tricuspid regurgitation include endocarditis, rheumatoid arthritis, radiation therapy, Marfan syndrome, and injury.

Symptoms

In the absence of high blood pressure in the lungs (pulmonary hypertension), tricuspid regurgitation is usually asymptomatic. If pulmonary hypertension and moderate-to-severe tricuspid regurgitation coexist, symptoms may include:

  • Active neck vein pulsations
  • Decreased urine output
  • Fatigue, tiredness
  • Generalized swelling
  • Swelling of the abdomen
  • Swelling of the feet and ankles
  • Weakness

For information or appointments, please call 855-463-3320.

Tricuspid Stenosis

Diagnostic Tools

  • Cardiac Catheterization
  • X-ray
  • ECG
  • Echocardiogram

Treatment

  • Tricuspid valve repair surgery corrects tricuspid insufficiency; the damaged valve is strengthened and shortened to help the valve close more tightly.
  • Tricuspid valve replacement surgery corrects both tricuspid stenosis and insufficiency
  • Valve replacement with mechanical valves created from manmade materials, which require long-term blood thinning with warfarin medication
  • Valve replacement with biological (tissue) valves. Learn more about heart valve surgery.

For information or appointments, please call 855-463-3320.

Mitral Stenosis

Risk factors for mitral valve stenosis include rheumatic fever. Since rheumatic fever rates are declining in the United States, the incidence of mitral stenosis is also decreasing. Only rarely do other disorders cause this condition.

Symptoms

  • Chest discomfort
  • Cough
  • Difficulty breathing
  • Fatigue
  • Frequent respiratory infections
  • Palpitations
  • Swelling of feet or ankles

Diagnostic Tools

Treatment

  • Mitral valve repair surgery corrects mitral valve insufficiency; the damaged valve is strengthened and shortened to help the valve close more tightly
  • Mitral valve replacement surgery corrects both mitral stenosis and insufficiency
  • Valve replacement with mechanical valves created from manmade materials, which require long-term blood thinning with warfarin medication
  • Valve replacement with biological (tissue) valves

For information or appointments, please call 855-463-3320.

Heart Murmurs

The sound of your heart beating is the sound of the closure of your heart valves. When there is a problem with a valve (stenosis or regurgitation), the blood flow across the valves becomes turbulent. This causes a sound, which is heard as a murmur during an examination. Your doctor can usually hear the murmur while listening to your heartbeat using a stethoscope.

There are two types of heart murmurs: diastolic, when the heart muscle relaxes between beats, and systolic, when the heart muscle contracts to squeeze the blood through the chambers.

Diagnosis

Treatment

  • Medication
    • Valve surgery
    • Heart valve repair: May be preferable, as keeping your own tissue may be better than replacing a heart valve. This is most commonly performed in cases of mitral valve regurgitation (leakage) but may be possible in other situations, as well. Heart valve repair of the mitral valve is now possible using percutaneous (through the skin) treatments in certain cases. 
    • Heart valve replacement: Can be done using a variety of valves, including mechanical and tissue valves (pig or cow tissue). Learn more about heart valve disease and heart valve surgery

For information or appointments, please call 855-463-3320.

Aortic Insufficiency

Aortic insufficiency is a heart valve disease in which the aortic valve weakens or balloons, preventing the valve from closing tightly. This leads to backward flow of blood from the aorta (the largest blood vessel) into the left ventricle (the left lower chamber of the heart).

Risk Factors

In the past, rheumatic fever was the primary cause of aortic insufficiency. Now that antibiotics are used to treat rheumatic fever, other causes are more commonly seen, including

  • Ankylosing Spondylitis
  • Aortic Dissection
  • Endocarditis
  • High Blood Pressure
  • Marfan's Syndrome
  • Reiter's Syndrome
  • Syphilis
  • Systemic Lupus Erythematosus
  • Valve problems that are present at birth

Symptoms

  • Chest pain under the sternum may radiate; crushing, squeezing, pressure, tightness; pain increases with exercise, relieves with rest.
  • Shortness of breath and fainting
  • Fatigue
  • Irregular, rapid, racing, pounding, or fluttering pulse
  • Palpitations

For information or appointments, please call 855-463-3320.

Aortic Stenosis

Aortic stenosis is the narrowing or obstruction of the heart's aortic valve, which prevents it from opening properly and blocks the flow of blood from the left ventricle to the aorta.

Risk Factors

Aortic stenosis may be present from birth (congenital) or it may develop later in life (acquired). Other risk factors include valve calcification, being male, and rheumatic fever.

Symptoms

  • Breathlessness with activity
  • Chest pain, angina-type under the sternum, may radiate; crushing, squeezing, pressure, tightness; increased with exercise, relieved with rest
  • Dizziness
  • Fainting or weakness with activity
  • Palpitations

Diagnostic Tools

  • Cardiac Catheterization
  • X-ray
  • ECG
  • Echocardiogram

Treatment

Surgeons may consider replacing the original valve with either:

  • Mechanical valves, created from man-made materials, which require long-term blood thinning with warfarin medication.
  • Biological (tissue) valves

For information or appointments, please call 855-463-3320.

Heart Valve Disease

Dysfunction in one of the four heart valves—mitral, aortic, tricuspid, or pulmonary—leads to heart valve disease. Normally functioning valves ensure that blood flows in one direction. When dysfunction of the heart valves occurs, the valves may become narrow (valvular stenosis) or may leak (valvular regurgitation). This can lead to chronic heart problems including heart failure, shortness of breath and chest pain, or enlargement of the heart chambers.

Learn more about the types of heart valve diseases:

For information or appointments, please call 855-463-3320.

Deep Vein Thrombosis

Deep vein thrombosis (DVT) is a blood clot that forms in the large veins of the arms or legs. These clots can travel through the bloodstream to the brain or heart, and can cause a stroke or pulmonary embolism (PE).

Causes

  • Trauma to the vein's inner lining. These may include surgery, serious injury, inflammation or an immune response.
  • Blood flow is sluggish or slow. This can be caused by lack of movement for long periods of time, such as sitting on an airplane or in a car for many hours, or after surgery.
  • Thicker-than-normal blood. Certain genetic conditions can increase blood's tendency to clot.

Symptoms

  • Pain, tenderness, swelling, warmth, or discoloration of the leg
  • Dilation of the superficial veins in the affected limb
  • Shortness of breath or chest pain

Post-thrombotic Syndrome

Post-thrombotic syndrome (PTS) is a late-complication that occurs in 25-33 percent of patients with DVT. It typically occurs within two years of diagnosis, despite appropriate treatment with blood thinners. PTS consists of chronic leg pain (aching or cramping), leg heaviness, itching or tingling, swelling, redness, varicose veins and leg discoloration. These symptoms are typically more pronounced upon standing or walking for long periods and relieved upon rest. PTS can lead to venous stasis ulcers in some patients.

Treatment

Treatment options for acute DVT include anticoagulation with blood thinners (like heparin or warfarin) and pharmacomechanical thrombolysis, in which clot-busting drugs are delivered through a small catheter placed inside the blocked vein, followed by mechanical removal of the clot itself.

All patients with DVT should be treated with three to six months (or longer) of anticoagulation and wear elastic compression stockings, which have been shown to reduce the incidence of PTS.

For information or appointments, please call 855-463-3320.

Congenital Defects and Disease

Congenital heart disease is a term that describes a number of different conditions caused by abnormal or disordered heart development before birth. Although congenital heart disease, by definition, is present at birth, its effects may not be obvious nor may present for many years.

A congenital heart defect most often occurs as an isolated incidence and is generally not associated with other diseases, there are a few genetic and chromosomal syndromes that can also cause heart defects, including:

  • Down syndrome
  • Ellis-van Creveld syndrome
  • Marfan syndrome
  • Noonan syndrome
  • Trisomy 13
  • Turner's syndrome

Drugs, chemicals, and infections during pregnancy may also cause congenital heart abnormalities. In infants, fetal rubella, maternal alcohol use (fetal alcohol syndrome), and use of retinoic acid (for acne), may also cause of congenital heart disease. In addition, if a pregnant woman has congenital heart disease, she should notify her doctor so her fetus may be checked during the pregnancy.

Treatment

Surgical treatments are tailored to correct the specific congenital abnormality. The most common include closing a patent foramen ovale and/or an atrial septal defect (ASD).

 

Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)

In a properly functioning cardiovascular system, certain proteins operate ion channels, which control the flow of sodium, potassium, and calcium through the heart’s cells. These molecules are essential in the regulating the heart’s electrical activity.

CPVT is an inherited genetic condition that mutates these proteins, which disrupts this flow and the heart’s electrical activity, leading to arrhythmia during physical activity or emotional stress.

These ventricular arrhythmias may return to a normal heartbeat on their own. But sometimes, arrhythmias can worsen into a more dangerous heart arrhythmia called ventricular fibrillation. Without immediate medical treatment, this problem can lead to sudden cardiac death, especially in children and young athletes who are otherwise healthy.

Symptoms

CPVT usually starts in childhood, but may go undetected. The first sign of the disease may be sudden cardiac death. Signs and symptoms usually occur during physical activity or emotional stress and include:

  • Light-headedness, dizziness or fainting
  • Seizures
  • Heart palpitations (fluttering or pounding in your chest)
  • Sudden cardiac arrest (heart stoppage because of arrhythmias caused by electrical problems) or death

Diagnosis and Treatment

A standard electrocardiogram (ECG) generally will not detect CPVT. If your physician suspects the disease based on family history or symptoms, you will need further testing. Some diagnostic tools we use at MedStar Heart & Vascular Institute include:

  • Exercise ECG (or stress test) to detect heart arrhythmia that may not appear on a standard ECG
  • Event monitor to record your heart’s electrical activity over time to detect heart arrhythmia
  • Diagnostic imaging, including cardiovascular MRI and echocardiogram, to evaluate your heart’s structure for any other abnormalities
  • Genetic testing to look for defective genes associated with CPVT

If your physician diagnoses you or a family member with CPVT, screening for other family members is very important. We offer genetic screening for heart conditions.

At MedStar Heart & Vascular Institute, our cardiac specialists work to reduce the risks of dangerous heart arrhythmia and sudden cardiac arrest. Among the treatment options we offer are:

  • Medications such as beta blockers or anti-arrhythmic drugs to help regulate heart contractions
  • Surgery to implant a defibrillator to correct dangerous heart arrhythmia with electric shocks
  • Lifestyle changes including avoiding very strenuous activity

For information or appointments, please call 855-463-3320.

Carotid Artery Disease

Your carotid arteries extend from your aorta to your brain and supply your brain with blood. If the internal carotid artery is blocked (by plaque buildup as a result of atherosclerosis) blood supply to your brain is reduced and can cause a stroke. In fact, carotid blockages are responsible for more than half of all strokes.

Symptoms

Most patients do not know they have carotid artery disease because it is often asymptomatic, but even without symptoms, a stroke can occur. If symptoms or warning signs of a stroke are present, they are called transient ischemic attacks, and they include:

  • Weakness, numbness, or a tingling sensation on one side of the body
  • Loss of control or the movement of an arm or a leg
  • Vision loss in one eye (many people describe this sensation as a window shade coming down)
  • Losing the ability to speak clearly

Diagnosis

X-ray studies using special dyes, called carotid angiograms, can show the degree of blockage of the carotid arteries. Other tests, such as ultrasound and magnetic resonance angiography can visualize blockages in the carotid arteries.

Treatment

  • For less severe stenosis, treatment includes lifestyle modification, such as smoking cessation and medication, including aspirin and anti-cholesterol medications.
  • Carotid artery surgery (also known as carotid artery endarterectomy), is a surgical procedure to manually remove fat and cholesterol build-up from inside the carotid artery and restore adequate blood flow to the brain to help prevent a stroke.
  • Angioplasty with stenting is a less invasive procedure in which a catheter is inserted through a nick in the skin (usually in the groin) and threaded under X-ray guidance to the carotid artery. A balloon is inflated to compress the plaque against the wall of the blood vessel and open up the artery.

For information or appointments, please call 855-463-3320.

Cardiopulmonary Disease

Cardiac and pulmonary diseases are conditions that affect the lungs and heart. Cardiac rehabilitation may benefit those who have experienced a recent heart attack or cardiac surgery, as well as other heart-related health problems. Pulmonary rehabilitation may be beneficial to individuals with asthma, chronic bronchitis, chronic obstructive pulmonary disease (COPD), emphysema, or other lung conditions.

For information or appointments, please call 855-463-3320.

Cardiomyopathy

Cardiomyopathy is a weakening of the heart muscle or a change in heart muscle structure. It is often associated with inadequate heart pumping or relaxation or filling with blood. Cardiomyopathy can be caused by viral infections, heart attacks, valve disease, alcoholism, long-term severe high blood pressure, and sleep disorders that affect breathing.

Symptoms

  • Fatigue
  • Shortness of breath with exertion or at rest
  • Edema of feet and legs or abdominal swelling
  • Decreasing ability to tolerate physical exertion
  • Cough
  • Palpitations, rapid heartbeat, or irregular heartbeat
  • Loss of appetite or getting full easily

Diagnostic Tools

Treatment Options

  • ACE inhibitors
  • Beta blockers
  • Diuretics
  • Digoxin
  • Medicines that help the heart contract, such as hydralazine and nitrates.
  • Vasodilators

If medications alone do not work, physicians may consider the following treatment options:

In severe cases, surgeons may also consider the following procedures to sustain life until a transplant donor becomes available:

  • Coronary bypass surgery
  • Repair or replacement of heart valves
  • Left ventricular assist device (LVAD)

For information or appointments, please call 855-463-3320.

Cardiac Arrhythmia

Cardiac arrhythmias are disturbances in the normal rhythm of the heartbeat. Arrhythmias may be a sign of heart disease and can lead to other cardiac symptoms. Because arrhythmias can be life threatening, it is critical to have your heart evaluated by an expert cardiologist. Cardiologists who diagnose and treat patients for cardiac arrhythmias are known as electrophysiologists.

Watch the video to learn about Bill's experience with A-Fib:

 

 

Symptoms

  • Changes in the rate, rhythm or pattern of the pulse
  • Chest pain
  • Fainting
  • Fast or slow heart beat (palpitations)
  • Light-headedness, dizziness
  • Paleness
  • Shortness of breath
  • Skipping beats
  • Sweating

Risk Factors

  • Anti-arrhythmic medications
  • Blood chemistry imbalances
  • Caffeine
  • Illicit drug use
  • Endocrine abnormalities
  • Inappropriate use of amphetamines or other stimulants
  • Prior heart attack
  • Use of certain prescription medications

Types

Fast Heart Rhythms

A typical heart beats 60 to 100 times a minute. Faster than this is a fast heart rhythm, known as supraventricular tachycardia (SVT). This rapid, erratic beat can cause the body to receive an inadequate blood supply.

SVT Types

  • Atrial fibrillation keeps the heart from pumping blood efficiently, causing blood to pool inside the heart. Eventually this blood forms clots, setting up a dangerous situation where stroke, pulmonary embolism, or heart attacks can occur.
  • Paroxysmal Supraventricular Tachycardia (PSVT) is an abnormal heart rate that occurs sometimes. This form of SVT is caused by too many electrical signals in the heart at once. This causes overload, and the heart begins to beat too quickly.
  • Atrial Flutter occurs when the top two chambers of the heart beat too quickly and the lower two chambers-the ventricles-beat too slowly. This condition most often occurs in the elderly and is dangerous because it can cause a stroke.
  • Atrial Tachycardia is caused by too many electrical signals in the heart, specifically the atria; the two upper chambers of the heart. These signals cause the heart to beat too quickly, causing palpitations, breathlessness and possible anxiety.

Slow Heart Rhythms

Each day, a normal heart contracts 60 to 100 times a minute. Abnormally slow heart rates are typically those fewer than 60 beats a minute. These slow heart rhythms, referred to as bradycardias, can be life threatening.

Bradycardia is usually treated with an implantable cardiac device known as a pacemaker.

Palpitations

Palpitations are usually felt as an unusual pattern to a person's heartbeat, like skips or jumps. This sensation is usually uncomfortable for people and can sometimes signal that there is a heart problem. It is critical to be examined by a cardiologist with experience in evaluating and treating palpitations. Learn more about palpitations.

Syncope

Syncope is caused by a temporary loss of consciousness, known commonly as fainting. It is caused by low blood pressure—the heart cannot effectively pump enough blood to the brain, affecting the oxygen supply and causing the person to pass out.

While syncope alone is not life threatening, it may sometimes be a symptom of a more serious condition and should be evaluated as soon as possible. Learn more about syncope.

Diagnostic Tools

Treatments

  • Medical management
  • Implantable cardioverter defibrillators (ICDs)
  • Pacemakers
  • Implantable loop recorders

Catheter ablations, including:

  • Atrial fibrillation (A-Fib) ablation
  • Percutaneous epicardial ablation program
  • Ventricular tachycardia ablation
  • Intra-operative ablations
  • Laser lead extractions
  • Arrhythmia management in congenital heart disease

For information or appointments, please call 855-463-3320.

Brugada Syndrome

In a properly functioning cardiovascular system, certain proteins operate ion channels, which control the flow of sodium, potassium, and calcium through the heart’s cells. These molecules are essential in the regulating the heart’s electrical activity. If this flow is disrupted, the heart’s electrical activity is also disrupted, leading to arrhythmia.

Medical experts have identified genetic mutations in some of these proteins, which can lead to Brugada Syndrome, an inherited disorder of the heart’s electrical system that causes heart arrhythmia (erratic heartbeat).

If left untreated, Brugada syndrome can lead to:

  • Ventricular fibrillation: a rapid, uncoordinated heartbeat
  • Sudden cardiac death: heart stoppage because of severe arrhythmia

Symptoms

Brugada syndrome often shows no warning signs. Your physician may first find it during an electrocardiogram (ECG). Unfortunately, the first sign may be sudden cardiac arrest (heart stoppage because of severe arrhythmia) or death.

Other symptoms of Brugada syndrome include:

  • Fainting (most common symptom)
  • Seizure during rest or sleep
  • Disturbed sleep, including nightmares
  • Difficulty breathing, especially during rest or sleep
  • Heart palpitations (fluttering or pounding in your chest)

Diagnosis and Treatment

MedStar Health cardiac experts usually find Brugada syndrome during an electrocardiogram (ECG). However, people with the syndrome may sometimes have normal ECGs. If your physician suspects Brugada syndrome, further tests to confirm a diagnosis include:

  • Drug challenge using an intravenous sodium channel blocker to see whether the Brugada ECG pattern can be brought out
  • Genetic testing to look for defective genes
  • Diagnostic imaging, including Cardiovascular MRI and echocardiogram, to rule out other conditions
  • Electrophysiologic (EP) study, a cardiac catheterization procedure, to evaluate susceptibility to arrhythmias

If you or a family member are diagnosed with Brugada syndrome, screening of other family members is very important. We offer genetic screening for heart conditions.

At MedStar Heart & Vascular Institute, our cardiac team focuses on controlling heart arrhythmia and preventing sudden cardiac arrest. Currently, the only effective treatment for Brugada Syndrome is surgery to implant a defibrillator to correct dangerous heart arrhythmias with electric shocks.

Your physician may also recommend you avoid certain medications, as well as promptly treat any fevers.

For information or appointments, please call 855-463-3320.

Atrial Fibrillation Symptoms

Atrial fibrillation, or A-fib, is a type of sustained arrhythmia in which the heart beats irregularly or fast. It is often described to feel like "fish jumping in my chest," although many people feel no symptoms. A-fib affects nearly three million people in the U.S. There are four types of A-fib:

  • Paroxysmal, for which the irregular heartbeat lasts less than seven days, usually less than 24 hours and has recurred at least twice
  • Persistent, for which the irregular heartbeat lasts longer than seven days, but the abnormal rhythm can be stopped with treatment
  • Permanent, as defined when the arrhythmia lasts longer than one year and does not respond to treatment or treatment has not been attempted.
  • Lone, for which the irregular heartbeat is paroxysmal or persistent and occurs without another form of heart disease.

Although A-fib itself is not life threatening, it can have serious consequences. People with A-fib are at a much higher risk of stroke. Left untreated, A-fib can lead to heart failure.

MedStar Heart & Vascular Institute physicians achieve consistently high rates of success at controlling this highly challenging heart rhythm disorder that affects about one percent of the entire population and about 10 percent of people older than 80.

Risk Factors

  • High blood pressure
  • Coronary heart disease
  • Previous heart attack
  • Sleep apnea
  • Heart valve problems
  • Congenital heart defects
  • Diabetes
  • Other arrhythmias, including atrial flutter and ventricular fibrillation
  • Inflammation, such as after heart surgery (CABG)
  • Lung diseases, including pulmonary embolism
  • Excessive alcohol use
  • Viral infections
  • Obesity
  • Age: three to five percent of people over age 65 have A-Fib and up to 10 percent of people over age 80 have A-Fib

Diagnostic Tools

  • CG
  • Holter/Event Monitor
  • Loop Recorder

Treatment

  • Medicines: aspirin, warfarin, beta blockers, calcium channel blockers and anti-arrhythmic medicines to control heart rate and prevent stroke
  • Cardioversion: a procedure for people who are having A-Fib for the first time or need treatment right away
  • Ablation: for people with symptoms who have failed or not tolerated medicines
  • Surgery: for people who do not respond to medical therapy or ablation, often performed with other heart surgery
  • WATCHMAN device
  • Learn about treatment options at MedStar Washington Hospital Center

Convergent Atrial Fibrillation Ablation

  • Convergent Atrial Fibrillation Ablation is a minimally invasive hybrid procedure that aggressively treats this frequently frustrating heart rhythm disorder. It involves the teamwork of an interventional cardiac electrophysiologist and a cardiac surgeon.
  • Cardiac specialists at the Heart Institute are specially trained in performing this complex procedure. An interdisciplinary medical team will plan every step of your procedure and answer any questions you may have. The benefits of convergent A-Fib ablation include:
  • Minimally invasive—provides both endocardial and epicardial ablation without the need for chest incision or bypass
  • Intra-operative testing—we are able to ascertain the effectiveness of the therapy during the procedure itself.
  • Multidisciplinary care—experts in many areas of cardiac care are involved in your treatment.
  • Shorter hospital stay—less pain, a shorter hospital stay, and faster recovery times than traditional surgical methods.

For information or appointments, please call 855-463-3320.

Learn more about the Center for Comprehensive Atrial Fibrillation Management at the MedStar Heart & Vascular Institute.

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)

ARVC is an inherited genetic disorder caused by mutations in genes responsible for certain proteins that connect heart cells. It caused heart muscle tissue—usually in the right ventricle (lower chamber)—to break down, replacing it with scar tissue and fat.

ARVC disrupts the heart’s normal electrical activity and causes heart arrhythmia (irregular heartbeat) in the ventricles. Arrhythmias are life threatening and can lead to sudden cardiac arrest and death, especially in young people and athletes who are otherwise healthy.

Symptoms

ARVC may not cause symptoms, especially in the early stages of the disease. In many people, the first signs are:

  • Heart palpitations (fluttering or pounding in your chest)
  • Fainting
  • Sudden cardiac death (heart stoppage caused by arrhythmia), usually during strenuous activity

Diagnosis and Treatment

Diagnosing ARVC can be problematic because symptoms are often difficult to detect. If your medical or family history suggests that you may have ARVC, your physician will confirm a diagnosis with further tests, which may include:

  • Standard electrocardiogram (ECG) to check for problems with your heartbeat
  • Exercise ECG (or stress test) to detect heartbeat problems that may not appear on a standard ECG
  • Event monitor to record your heart’s electrical activity over time to detect heart arrhythmia
  • Diagnostic imaging, including Cardiovascular MRI and echocardiogram, to evaluate your heart’s structure for any abnormalities
  • Electrophysiology (EP) study through cardiac catheterization to assess susceptibility to arrhythmia
  • Genetic testing to look for defective genes associated with ARVC. If you or a family member are diagnosed with ARVC, it’s very important for other family members to be screened for the syndrome.  We offer genetic testing for heart conditions.

At MedStar Heart & Vascular Institute, our treatment goals for ARVC focus on preventing sudden cardiac arrest by controlling heart arrhythmia. Treatment options we may recommend include:

  • Medications such as beta blockers or anti-arrhythmic drugs to help regulate heart contractions
  • Surgery to implant a defibrillator to correct dangerous heart arrhythmia with electric shocks

Lifestyle changes such as:

  • Avoiding very strenuous activity
  • Avoiding stimulants including caffeine, nicotine and certain decongestants

Angina

Angina is a specific type of chest discomfort caused by inadequate blood flow through the blood vessels of the heart muscle. The discomfort or pain is felt anywhere along the front of the body between the neck and upper abdomen and is relieved by rest or medication within a short period of time (usually 15 minutes). Chest pain of a longer duration or pain appearing with a lower level of effort than before, even at rest, should be considered unstable angina.

Diagnostic Tools

Treatments

AspirinBeta-blockersCalcium Channel BlockersEnhanced External Counterpulsation (EECP)NitroglycerinOral nitratesOther medications to control high cholesterol, high blood pressure, or abnormal heart rhythms.

If medications fail or in more severe cases, physicians may recommend one of the following treatment options:

Coronary Artery Disease

In coronary artery disease, the coronary arteries narrow from plaque, a substance made up of fatty deposit, building up on the coronary artery walls. Narrowing of the coronary arteries may cause the following symptoms:

  • Chest pain (angina)
  • Shortness of breath
  • Pain in the left arm or neck
  • Plaque can also rupture, causing a complete blockage of the artery and a heart attack.

Treatment

  • Medical, including a daily drug regimen
  • Percutaneous intervention, including the placement of stents to open any blockages
  • Surgical, including bypass surgery
  • Lifestyle modification, including a healthy diet, exercise and quitting smoking

MedStar Heart & Vascular Institute is a national leader in treating patients using the off-pump approach— heart surgeries done on beating hearts, as opposed to surgery while on cardiac bypass—and approximately half of coronary artery disease patients are operate d on this way. By using this technique, we may reduce potential adverse effects of cardio-pulmonary bypass.

Our cardiologists also use the latest technological advances in stents and catheter-based devices to treat coronary artery and valvular heart disease. Our advanced imaging techniques allow us to diagnose and treat a wide range of vascular and structural heart issues.

For information or appointments, please call 855-463-3320.

Heart Attack Symptoms

A heart attack, also known as a myocardial infarction, occurs when an area of heart muscle dies or is permanently damaged due to an inadequate supply of oxygen to that area.

Heart Attack Symptoms

  • Chest pain or other pain, which radiates from the chest to the arms or shoulder; neck, teeth, or jaw; abdomen or back. The pain can be intense and severe or quite subtle and confusing and can feel like:
    • Squeezing or heavy pressure
    • A tight band on the chest
    • An elephant sitting on your chest
    • Bad indigestion
    • Anxiety
  • Cough
  • Fainting
  • Feeling of impending doom
  • Lightheadedness or dizziness
  • Nausea or vomiting
  • Shortness of breath
  • Sweating, which may be profuse

Diagnostic Tools

  • Angiography
  • ECG
  • Echocardiogram
  • Stress Test

Treatment Options

Both medication and surgery are options for treating heart attack patients.

Contact Information

For information or appointments, please call 855-463-3320.

Related Information

Women may experience different symptoms than men. Read more about our Women’s Heart Program.

Aortic Disease (Dissection and Aneurysm)

The aorta, the body's largest artery, delivers blood from the heart to the rest of the body. When disease is present, the aorta can tear (dissect) or dilate to form an abnormal widening or ballooning called an aneurysm. These conditions may lead to rupture of the aorta, which may be life threatening.

Treating acute aortic disease requires the proper integration of surgical, interventional (stents), and medical techniques to achieve the best outcome possible for patients. MedStar Heart & Vascular Institute physicians are expertly trained, and have experience managing the most difficult cases of aortic dissection and aneurysm. We treat our patients with

  • A multidisciplinary approach with cardiologists, cardiovascular surgeons, and vascular surgeons
  • Surgical, endovascular, and medical management treatments, decided upon by a combined team on a case by case basis
  • Endovascular (minimally-invasive procedure that reduces recovery times and reduces the rates of infection) techniques with excellent outcomes

Aortic Aneurysm

Aortic aneurysms occur when the aorta wall, thinned and weakened from atherosclerosis, swells and balloons. The following types exist:

  • Thoracic aortic aneurysms are located in the upper aorta, in the chest, and are usually repaired with stent-grafts.
  • Abdominal aortic aneurysms (AAA) occur in the abdominal section of the aorta and often enlarge over time. Most do not cause symptoms and may be discovered during a routine examination or as part of a test performed for another condition. Occasionally, patients may feel abdominal or back pain. AAA in the thirteenth leading cause of death in the United States and is more common in males. Patients over the age of 65 who are prior or current smokers are particularly at risk. 
  • Peripheral aneurysms refer to those aneurysms that affect arteries other than the aorta. These are most commonly located in the legs. Most patients have no symptoms. Peripheral aneurysms generally do not rupture but may embolize (send) a clot from within the aneurysms to the arteries downstream. Occasionally, this is a limb-threatening condition.

Aortic Dissection

Aortic dissection is a condition in which there is bleeding into and along the wall of the aorta (the major artery from the heart).

There are two types of aortic dissections, depending on where the tear begins and ends:

  • Type A: This type is more common and more dangerous. In these cases, the tear occurs in the ascending aorta where it exits the heart and extends down through the descending aorta. The tear may extend into the abdomen. Type A cases usually require emergency surgery.
  • Type B: This type involves a tear in the descending aorta only, which may also extend into the abdomen. Depending on where the tear develops, our doctors may recommend medication or surgery.

Risk Factors

  • Chronic high blood pressure
  • Genetic conditions such as Marfan syndrome
  • Chest trauma
  • Aortic aneurysm

Symptoms

  • Back or chest pain
  • Changes in thinking ability, confusion, disorientation
  • Clammy skin, sweating
  • Cough
  • Decreased movement or sensation, any location
  • Dizziness, fainting, nausea, and vomiting
  • Dry skin/mouth, thirst
  • Excessive yawning
  • High blood pressure
  • Intense anxiety, anguish
  • Pallor (paleness)
  • Rapid pulse or weak/absent pulse
  • Shortness of breath

Diagnostic Tools

  • Angiography
  • Cardiovascular MRI
  • CT Scan
  • X-ray
  • Echocardiogram

Treatment Options

  • Medications, such as antihypertensives, drugs to lower blood pressure or cardiac medications such as beta-blockers
  • Surgery, including: 

Learn more about aortic dissection treatment.

Cardio-Oncology

If you are a patient with cancer and have heart problems , or you are a physician who needs to refer a patient for cardiac care, then you may know that help for these conditions is hard to find. Make an appointment or refer a patient.

MedStar Heart & Vascular Institute offers the first cardio-oncology program in the Greater Baltimore/Washington, D.C., metropolitan area.

Care for cancer and cardiac patients

Some chemotherapy and cancer treatments can worsen, or even cause heart problems in patients with cancer. Some patients also experience heart conditions after radiation treatment to the chest.

We offer a program designed to evaluate, diagnose and manage heart problems for patients who are being treated for cancer or who have already completed treatment. Our physicians can also determine if a patient with cancer may be at risk for developing a heart condition before or during cancer treatment. Further, we are doing important research in order to avoid drug complications in the future.

Learn more about cardio-oncology and our treatment and management.

Learn more about MedStar Heart & Vascular Institute's cardio-oncology program

Specially trained cardiologists with an interest in cancer treatment

Our cardiologists have a special interest in how cancer treatments may affect the heart. Our program includes a multidisciplinary approach where our cardiologists and oncologists (cancer physicians) work together to provide comprehensive care. Meet our physicians.

For referring physicians

If you have a cancer patient with cardiac issues, then please visit our For Referring Physicians page.

Make an appointment

Please contact us by calling 202-877-2162. You may also send an email to [email protected]

Learn more about cardio-oncology treatment at MedStar Washington Hospital Center.