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I'm an M.D. and This is the #1 Sign You Have a Heart Problem

Know what to do should something go awry.

Your heart is the pump that keeps you alive. And like any pump, it can develop problems with its mechanical and electrical components. In the heart's case, we are talking specifically about the valves that regulate blood flow, the heart muscle that does the pumping, and the internal pacemaking electrical system that governs pump speed and coordination. For the next few paragraphs, I'll go over each of those systems and the more common things that can go wrong so you can be aware and knowledgeable should something go awry! Read on to find out more—and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.


What Can Go Wrong With the Valves

Medicine doctor and stethoscope touching icon heart and diagnostics analysis medical on modern virtual screen interface network connection

The heart's valves keep blood flowing forward, in a loop: From the body to the heart, then to the lungs, then back to the heart, and finally back to the body. When they malfunction, it is either by blocking the forward flow of blood (stenosis) or by leaking blood backward (regurgitation). Either of these conditions puts extra strain on the heart. If forward flow is blocked, the heart has to pump harder to develop more pressure to overcome the obstacle. If blood is leaking backward, the heart has to pump more blood with each stroke to compensate for the leaked amount. In either case, should the condition persist long enough and worsen enough, heart failure will result.

 Heart failure is a condition where not enough blood is being pumped to meet the body's needs. Heart failure shows up as shortness of breath (first only with exertion, but eventually all the time), swollen ankles and legs, and water weight gain. Activity levels decrease, and patients eventually become unable to do their daily living. Because these signs and symptoms can also come from other illnesses, it's important to see your doctor when they first become noticeable and have a complete check-up. The good news is that heart valves can be repaired or replaced very safely nowadays, and most patients will recover with normal heart function thereafter.

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What Can Go Wrong With the Pump


Man having a heart attack

The heart is a muscle. Although similar to other muscles in your body, heart muscle is special because it never tires (good thing!). If it does weaken significantly, however, heart failure will result. Generally speaking, heart failure due to pump problems can be divided into two categories: acute, which has a sudden onset and often resolves; and chronic, which develops more slowly and is steadily progressive.

 Acute heart failure is typically the result of a sudden event, such as a heart attack (myocardial infarction), an infection (Chagas disease, for example), or inflammation (myocarditis). In acute heart failure, the pumping ability of the heart decreases significantly and quickly. If the underlying cause is treated correctly, the heart will usually recover and normal function will usually resume. The signs of symptoms of acute heart failure are like those described above (shortness of breath, swollen legs, etc.), but are usually accompanied by chest pain caused by the underlying problem.

 A heart attack is caused by the sudden blockage of one of the blood vessels that feeds blood to the heart muscle (a coronary artery). The symptoms of a heart attack should be well known. Pain is the most common symptom felt, and usually follows the classic pattern of left-sided chest pain that radiates to the neck, jaw, or down the left arm. Other pain patterns are not uncommon, especially in women, and include indigestion; chest pressure; shoulder numbness; back, jaw, or neck pain; shortness of breath; and a sudden increase or decrease in heart rate. As a general rule, one should be highly suspicious of any unusual chest that appears suddenly and does not resolve over a few minutes.

 Chronic heart failure, on the other hand, is usually the result of multiple insults to the heart over a long time. Valve disease (discussed above) is one example, and if valve disease is left uncorrected for a very long time, the damage may be permanent. Multiple heart attacks can leave enough of the heart muscle damaged (scarred) that heart failure can result, and because the scar tissue never recovers this too is permanent. Chronic heart failure is usually painless.

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What Can Go Wrong With the Pacemaker

Heart activity on monitor in intensive care unit

The heart has its own internal pacemaker that coordinates pumping action and drives the heart rate (beats per minute). The study of the heart's electrical system is called electrophysiology, and it is quite complex! Broadly speaking, electrical problems appear as either pacemaker failure (no beat), blocked electrical impulses (slow or erratic beats), or extra beats (fast and/or erratic beats).

 If the heart pumps too slowly to meet the body's demands, or too quickly to allow blood to fill between beats, then heart failure symptoms will appear. If the heart beats erratically, for example with a run of very fast beats followed by a long pause, this will be felt as palpitations (thumping in the chest) or even chest pain and shortness of breath.

 The most common electrical problem of the heart by far is an irregular beating called atrial fibrillation, or afib. It is so common that more than 10% of people over 80 years old have afib! It very often has not only the symptoms described above, but has been associated with a feeling of dread or impending doom. Usually these symptoms can be controlled with medications that slow the heart rate or convert the heart back to a regular rhythm. Sometimes, if the symptoms are bad enough and medications fail to control them, more invasive procedures such as ablation may be needed to treat the afib.

 The most worrisome problem associated with afib is stroke. Strokes happen because the upper chambers of the heart, the atria, do not empty effectively in afib. Blood pools and clots in the atria, and these clots can dislodge and go to the brain. The risk of a stroke can be reduced significantly by taking blood thinners.

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A Word From The Doctor

Female doctor protecting a red heart with her hands

 The heart is a complex pump with mechanical and electrical components that work for a long time — every second of your life, for many years! The good news is that many of these problems can be treated successfully with medication or surgery. But everyone should be aware of the signs and symptoms that heart trouble may be brewing, and go to their doctor promptly when something appears.

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Dr. Adam Saltman is a triple board-certified cardiothoracic surgeon, former medical officer at the FDA, and current CMO of Eko. He's studied at Harvard and Columbia and is a fellow of the American College of Surgeons, the American College of Cardiology, the American College of Chest Physicians, and the American Heart Association. He has also published more than 100 peer-reviewed articles, served on editorial boards, and conducted competitively funded research projects.


Dr. Adam E. Saltman
Dr. Adam Saltman is a triple board-certified cardiothoracic surgeon, former medical officer at the FDA, and current CMO of Eko. Read more about Dr. Adam
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