Rias Ali, MD, FACC

Normal artery on the left, artery in spasm on the right. The squeeze cuts blood flow to the heart muscle for minutes.

Healthy artery on the left, artery with plaque on the right. Plaque cuts blood flow to the heart muscle.

From large artery (left) to tiny capillary (right). In CMD, those small vessels stay too narrow — causing real chest pain even when the big arteries look normal.

Coronary artery ectasia: what dilated coronary arteries mean, how flow slows and clots form, and how it is treated and followed over time.

Left: a normal coronary artery runs on top of the heart muscle. Right: in myocardial bridging, a strip of muscle crosses over the artery. The artery dips into the muscle.

Viewed from above the aortic root: in this variant the circumflex artery starts from the right sinus, then runs behind the aorta.

Heart-related discomfort can be felt in the chest and also in the arm, jaw, neck, back, or upper belly. Because it does not always feel 'classic,' any new or severe chest discomfort should be checked.

A clot in a heart artery cuts off blood flow. The muscle it feeds starts to die. Opening the artery fast - usually with a stent - saves muscle and lives.

A partly narrowed heart artery may deliver enough blood at rest. With effort, the heart needs more - and the narrowing becomes the bottleneck. That mismatch is what causes angina.

Angioplasty opens a narrowed heart artery with a small balloon. A stent is left behind to hold it open and restore blood flow.

SCAD traps blood inside the artery wall, squeezing the channel shut from within — not a plaque blockage. Most patients heal without a stent.

DAPT pairs aspirin with a second antiplatelet drug to block two clotting signals at once. It keeps a balance between dangerous clots and unwanted bleeding.

Recovery has steps: go home, take your medicines, start cardiac rehab, build strength, and reach a stronger heart. Most of it is in your hands.

Nitrates relax and widen blood vessels so the heart works less. A fast dose stops an attack; a long-acting form prevents attacks.

Ranolazine calms an abnormal current inside heart-muscle cells, easing angina. Heart rate and blood pressure barely change — its defining trait.

Clopidogrel and ticagrelor both keep clots off a fresh stent. The best one for you balances clot risk, bleeding, cost, and daily life.

Returning to activity has stages: rest and heal, gentle walking, cardiac rehab, then a full, active life. Most people get all the way back.

Heart-attack warning signs show up in the chest and also in the arm, jaw, neck, back, or upper belly - and sometimes as breathlessness, nausea, or a cold sweat. When in doubt, call 911.

Recovery has steps: leave the hospital, protect your breastbone, take your medicines, start cardiac rehab, and reach a well-protected heart.

Recovery after a stent has two headline jobs: protect your access site in the first days, and take your DAPT medicine every day for the full course. Both keep the stent open and working.

Silent ischemia is a heart starved of blood with no chest pain to warn you. The danger is the same as painful angina, but the alarm never sounds.

In MINOCA the angiogram shows arteries that are not badly blocked, yet the heart attack is real. The work is finding the true, hidden cause.

One test scans 48 heart genes across five kinds of inherited heart conditions, with a special focus on the TTR gene.

Lipoprotein(a): the inherited cholesterol particle standard panels miss — who should be tested once, what high levels mean, and what you can do now.

Statins explained: how they lower cholesterol and stabilize plaque, real side-effect numbers, and why staying on one matters after a heart event.

Obstructive sleep apnea and your heart: how airway collapse raises blood pressure and AFib risk, sleep testing, CPAP, and other treatment options.

Statin-associated muscle symptoms: sorting real side effects from the nocebo effect, the rechallenge plan, and lower-risk ways to stay protected.

The real numbers on common ADHD stimulants: small average changes in blood pressure and heart rate for most patients. Plus the exact signs that mean call us or call 911.

Three pillars — supervised exercise, risk-factor education, psychosocial support — produce lower mortality, fewer hospitalizations, and better quality of life.

Adding a PCSK9 inhibitor on top of a statin drops LDL another 50-60%. Most patients fall well below the ASCVD goal of 70 mg/dL.

Adding ezetimibe to your statin drops LDL another 18 to 20%. And it is proven to cut heart attacks and strokes (the IMPROVE-IT trial).

Bempedoic acid skips your muscles. It is turned on only in the liver. Muscle pain is as rare as on a sugar pill, and CLEAR Outcomes showed it cuts heart attacks and strokes.

Diabetes damages large and small arteries throughout the body. Most people with type 2 diabetes die of heart disease. The newest drugs protect the heart even when blood sugar is already controlled.

Half plate vegetables and fruit. Quarter lean protein. Quarter whole grain. Olive oil on the side.

LDL carries cholesterol INTO artery walls. HDL carries it AWAY.

Heart-disease risk drops sharply after you quit. Within a year your risk of a heart attack is cut in half.

Heart rate zones for a 60-year-old. The green zone (50-70% max) is your daily exercise target.

Aspirin for prevention: who still benefits, who bleeds more than they gain, and how the advice changed for people without prior heart events.

Triglycerides above 500 mg/dL raise pancreatitis risk. Lifestyle is always the first step.

FH runs in families. One copy of the gene is enough to cause it. Each child of an affected parent has a 50% chance.

The three FH genes feed one diagnosis. One positive result lets the whole family get tested and protected early.

Excess weight harms the heart through five pathways: high BP, bad cholesterol, insulin resistance, sleep apnea, and inflammation. All five can be improved.

Any 3 of the 5 criteria equals a metabolic syndrome diagnosis. All 5 feed back to insulin resistance and visceral fat.

Inclisiran works inside liver cells. It silences the PCSK9 message, so more LDL receptors survive and pull more bad cholesterol out of the blood.

Prescription EPA helps clear a triglyceride-rich bloodstream. In the REDUCE-IT trial, adding it to a statin cut major heart events about 25 percent.

Four common cancer-treatment families can stress the heart. A team approach watches the heart closely so cancer care can continue safely.

When a statin truly cannot be used, these non-statin options lower LDL by a known amount. The goal stays the same. Only the tool changes.

Genetic testing finds inherited heart conditions. One positive result lets the whole family get tested and protected early.

Why daily heart medicines matter, what helps you stay on track, and the one rule: never stop certain heart drugs on your own.

Worn out and low on energy? This guide helps you tell heart-related tiredness from the many other causes — and shows the steps to find out.

Heart disease is the leading cause of death in women, and its warning signs reach beyond chest pain. Knowing how it can differ helps you act.

Heart care in later life balances four things — personalized goals, fewer and safer medicines, fall prevention, and staying active. Overall health and frailty guide the plan, not age alone.

The heart and kidneys work as a team. When one struggles, the other often does too. Today's medicines can protect both.

A home AED talks you through every step and places pads as pictured. It reads the heart and shocks only when the rhythm is shockable — never a normal heartbeat.

More than 70 percent of the sodium most people eat is hidden in packaged and restaurant food, not the salt shaker.

The old "red wine is good for your heart" idea is outdated. No amount of alcohol is proven to improve heart health. If you drink, less is better.

Stress and mood affect the heart, and heart disease affects mood. Caring for your mind is part of heart care.

Getting the flu stresses the heart; getting vaccinated lowers heart attacks and hospital stays. The flu shot is heart care.

Six core heart numbers and the general goal for each. Your doctor sets your personal target.

Three simple steps to a better visit: bring your medicines and logs, describe your symptoms clearly, and ask your questions.

Sex and heart disease: when it is safe to resume after a heart event, the effort level of intimacy, ED medicines and the dangerous nitrate interaction, and the emotional side.

A simple 3-step travel plan: get ready before you go, stay safe on the way, and know where care is at your destination.

A wheel of the fixable AFib levers — weight, sleep apnea, alcohol, blood pressure, stress, and stimulants. Pulling each one lowers how often AFib strikes.

A family tree showing cascade screening: the affected person is found first, then each first-degree relative is offered a targeted test.

Living well with HCM rests on five pillars: stay active, avoid the triggers, know your risk, screen the family, and keep follow-up. Most people with HCM live long, full lives.

GLP-1 drugs copy a gut hormone. They curb hunger, slow the stomach, and steady blood sugar — so you eat less, lose weight, and protect the heart.

The four biggest statin fears, each set next to what the studies actually show. The evidence is far more reassuring than the headlines.

Food comes first. A few supplements help a little, most don't, and some can harm. “Natural” does not mean proven or safe.

Most hearts need no antibiotic before the dentist; only the highest-risk hearts do. Daily brushing and flossing protect both your mouth and your heart.

As estrogen falls at menopause, heart risk rises - so this is a key window to act. Hormone therapy is for symptoms, not to prevent heart disease.

Healthy training changes (left) can look like disease (right) on a test. A sports-heart check tells them apart.

Lipfendra (enlicitide) is the first PCSK9 inhibitor you take as a once-daily pill instead of a shot. In studies it lowered LDL cholesterol by about 57%.

LDL cholesterol measures how much cholesterol is carried. ApoB counts how many harmful particles carry it, which can reveal hidden risk.

High blood pressure made clear: what the numbers mean, home BP checks, lifestyle changes that work, medicines, and when to call us.

Isolated systolic hypertension means a high top number with a normal or low bottom number. The gap between them is the clue.

Side-by-side cross-sections compare a normal heart wall with a thickened one. Most LVH traces back to blood pressure, and most of it can be treated.

In the BaxHTN study, Baxfendy lowered the top blood pressure number about 10 points more than placebo after 12 weeks. Everyone was already on two or more blood pressure medicines.

When you stand up, gravity pulls about a pint of blood into your legs. In a healthy body, your heart speeds up and your vessels tighten within seconds. This keeps blood flowing to your brain.

The treatment ladder: start with 3 optimized drugs, add spironolactone, then consider 5th-drug options and device therapy.

Correct position: back supported, feet flat, arm at heart level, validated upper-arm cuff on bare skin.

Six system categories ring the BP cuff: kidney, sleep apnea, adrenal, pheo/Cushing, drugs, and coarctation. Finding the right cause points to the right cure.

Urgency vs emergency: both start at BP of 180/120 or higher — symptoms and organ damage decide which it is and where you need to be treated.

A catheter is guided into the kidney artery, where gentle energy quiets the overactive nerves that push blood pressure up. It is not surgery.

An ambulatory monitor: a cuff on the upper arm linked to a small recorder. It reads BP every 15-30 minutes by day and every 30-60 minutes at night.

A narrowed kidney artery cuts blood flow. The kidney senses this and releases hormones that raise blood pressure. Two main causes: plaque and FMD.

Two opposite problems at once: pressure too low standing, too high lying down. Care balances both — it does not chase one number.

Calcium channel blockers relax and widen arteries, so blood pressure falls. The heart-type pills also slow the heartbeat.

Weak heart on the left, stronger heart on the right. The 4-pillar GDMT regimen can lift your ejection fraction.

This picture shows the heart walls during the filling phase. In HFpEF, those walls are thick and stiff. The squeeze looks normal, but the heart cannot relax and fill. Fluid backs up into the lungs.

Amyloid protein deposits (waxy material) crowd between heart muscle cells, making the heart wall stiff and thick — diagnosis is now mostly non-invasive.

TZD diabetes pills (pioglitazone) and heart failure: why they cause fluid retention, who should avoid them, and safer alternatives for your heart.

Each bar shows how much KERENDIA lowered a key risk next to placebo. The trials had more than 13,000 patients with chronic kidney disease and type 2 diabetes. Teal bars are kidney results.

SGLT2 inhibitors have been tested in six major trials with more than 35,000 patients. The bars show how much each drug reduced key risks compared to placebo. Teal bars show death and kidney outcomes.

In the VICTORIA trial, 5,050 people with severe heart failure took vericiguat or a placebo.

Four Doppler patterns show how filling changes from Normal through Grades I, II, and III. Ejection fraction can be normal at any stage — that is why grade matters.

Heart failure progresses through Stages A to D. Stage D means symptoms persist despite optimal therapy — more options remain.

Cardiogenic shock is a medical emergency: the heart cannot pump enough blood. Rapid treatment — opening the blocked artery fast — breaks the downward spiral.

Beta-blockers put a gentle brake on the heart by blocking stress hormones. The heart beats slower and softer, and blood pressure falls.

ACE inhibitors and ARBs both turn down the system that tightens vessels. The result: lower pressure and protection for your heart and kidneys.

ARNI joins two jobs in one pill: it blocks stress hormones and protects the heart's own helpful hormones. The result is less strain on a weak heart.

Diuretics act on the kidney to flush out extra salt and water. Loop pills remove the most fluid; MRAs remove the least.

A weak pump with a low EF on the left. Caught early and treated, the EF can recover toward normal on the right.

A heart transplant replaces a failing heart with a healthy donor heart. It is for severe heart failure when all other treatments are not enough.

Breathlessness can come from the heart, the lungs, or other causes. Clues like worse-lying-flat, waking gasping, swelling, and effort point to the heart.

A normal ankle next to a swollen one. The first question is simple: one leg or both? The answer points to the cause.

Nighttime breathlessness has three common patterns. Orthopnea comes when you lie flat; PND wakes you gasping; look-alikes like sleep apnea have their own clues. The pattern points us to the cause.

In obstructive HCM the heart squeezes too hard and a thick wall blocks blood from leaving. Mavacamten calms the squeeze so the outflow opens.

A protein called transthyretin (TTR) can fall apart and build up as stiff deposits in the heart. Tafamidis holds that protein together so no new deposits form, slowing the disease.

Ivabradine acts only on the heart's natural pacemaker (the sinus node). It slows the heart rate without lowering blood pressure or weakening the squeeze.

In the MOMENTUM 3 trial, 58% of patients on the current HeartMate 3 pump were alive at 5 years, compared with 49% on the older-generation device.

The sensor (gold) sits inside the pulmonary artery — the vessel from the heart to the lungs. Battery-free and wireless.

The green/yellow/red action plan: green means stay the course, yellow means call the office, red means call 911. Know your zone every day.

A gauge dial showing the ejection fraction. A typical healthy heart sits in the green zone, about 55 to 70%.

Aldosterone strains and scars the heart. These pills block it, so the body sheds extra fluid, keeps potassium, and the heart is protected.

Atrial fibrillation explained: what AFib is, stroke risk and the CHA₂DS₂-VASc score, blood thinners, rate vs rhythm control, and ablation.

Rivaroxaban is prescribed at different doses for different conditions — the same drug name can mean 2.5 mg twice daily (for stable heart disease) or 20 mg once daily (for AFib or blood clots).

In the ARISTOTLE trial of 18,000 AFib patients, Eliquis (apixaban) beat warfarin on both stroke prevention and safety in one study. The green bars show how much less bleeding patients had.

Sotalol is dosed by the QTc on your ECG. Under 450 is the safe range to start, 450 to 500 means we watch closely, and 500 or higher means the dose comes down or the drug stops.

Whether these drugs are right for you depends on one question: is your heart structurally normal? That is what your echocardiogram and stress test were for.

You start dofetilide in the hospital so any bad rhythm can be caught and treated right away. Your first dose is set by how well your kidneys work.

The WCD vest has ECG sensors that read your heart rhythm continuously and therapy pads that can deliver a shock.

Four side-by-side chest schematics show the device options: a single-chamber pacemaker (one lead in the right ventricle), a dual-chamber pacemaker (right atrium + right ventricle), an ICD (with a…

Left: a cross-section of the left atrium showing the small LAA pouch and the Watchman device sealing it off — about 90% of AFib-related clots form inside this pouch.

An ICD detects and shocks deadly heart rhythms. CRT-D adds a third lead to help a failing heart pump in sync.

Side-by-side: normal sinus rhythm (left) vs ventricular fibrillation (right). VF is the most common cause of sudden cardiac arrest — the heart quivers instead of pumping.

Three patterns of heart electricity: normal (green), ventricular tachycardia or VT (fast and wide, orange), and ventricular fibrillation or VF (chaotic, red).

SVT causes a sudden fast, regular heartbeat of 150–250 bpm. Most episodes are not dangerous, but they feel alarming. Learn to stop one at home and when ablation can cure it.

Five ECG strips compare normal sinus rhythm, sinus bradycardia, 1st-degree AV block, Mobitz II (dangerous dropped beat), and complete (3rd-degree) heart block, each in a color-coded band.

PVCs are extra beats from the lower heart chambers — the most common cause of the skipped-beat feeling. Most are harmless. Learn the triggers and when to act.

The WPW heart has an extra electrical shortcut. It fires the ventricle early and makes the slurred 'delta wave' on the EKG. A short procedure can often remove it.

Left: a normal heartbeat recharges on time. Right: in long QT, the recharge runs late, and a trigger can tip it into torsades - a dangerous twisting rhythm.

Brugada syndrome shows up as a 'coved' ST pattern in the right chest leads (V1-V2). The heart muscle is normal; the problem is electrical.

A small monitor sits just under the skin over the heart and records your rhythm for up to 3 years. It can catch a long pause or silent atrial fibrillation that short tests miss.

Left: a traditional pacemaker sits in a chest pocket with a wire to the heart. Right: a leadless pacemaker is a tiny capsule placed inside the heart with no wire.

Two ways to carry a defibrillator. The transvenous ICD threads a wire into the heart. The S-ICD keeps the box and wire under the skin, with nothing inside the heart.

The left bundle carries each beat to the left side of the heart. When it is blocked, the signal takes a longer route and the QRS looks wider.

In right bundle branch block the left bundle keeps working, so each beat still reaches both sides. The signal just takes a slower route to the right ventricle.

Flutter is an organized sawtooth rhythm, unlike chaotic AFib. It carries the same stroke risk, and typical flutter is often cured by a focused ablation.

Palpitations mean feeling your own heartbeat. Most causes are harmless. Learn the triggers, the tests, and the red flags that mean call 911.

Bridging fills a short gap around a procedure: stop your usual thinner, use a short-acting shot, have the procedure, then restart. Most people do not need it.

Warfarin works only inside a narrow safe zone. The green band shows the usual INR goal of 2 to 3. Below it, blood clots too easily; above it, bleeding risk rises.

Every blood thinner switch has a safe, planned timing. The three paths above each have one rule — your team sets the exact day and dose.

Some rhythm drugs are started in the hospital on a heart monitor. We get a baseline EKG, then check the QT after doses while the drug builds up.

A patient with a chest device enters the MRI scanner.

Four strips compare a normal heartbeat with the three patterns of sick sinus syndrome: too slow, a long pause, and tachy-brady (fast, then a pause, then slow).

A simple map of the heart's wiring. The signal starts at the top, but heart block delays or stops it at the AV node before it reaches the pumping chambers below.

Amiodarone is taken in two steps: a higher loading dose for the first few weeks, then a lower daily dose for the long term.

Cardioversion resets a fast, irregular rhythm (left) back to a normal, steady beat (right) with a brief shock or medicine. A blood-thinner or TEE safety step always comes first to prevent a stroke.

Two chest views. Left: an old lead has scarred into the vein (gold bands grip it). Right: a sheath is slid over the same lead to free it from the scar so it can be removed.

Very frequent PVCs over a long time can weaken the heart's pump. When the PVCs are reduced, the heart often recovers.

Atrial tachycardia is a fast but regular rhythm from one spot in the atria. It is organized — not chaotic like AFib — and a focal AT is often fixed by ablation.

Left: a normal right ventricle with a healthy muscle wall. Right: ARVC, where patches of fat (gold) and scar (gray) replace muscle and the chamber bulges.

In IST the rhythm is normal, but the rate is too fast at rest — with no fever, anemia, or thyroid cause. It rarely harms the heart and usually improves with care.

Digoxin can slow a fast beat in AFib and gently strengthen a weak heart. Its safe window is narrow, so we keep your blood level low and check your kidneys and potassium to keep you safe.

A healthy heart climbs toward its target rate with activity (green). In chronotropic incompetence the rate flattens early (red) — the 'missing rise' that causes early fatigue.

A heart event can cause a sudden loss of control at the wheel. A short, safe pause lowers the risk. Your doctor decides when it is safe, and exact rules vary by state and DMV. Most people drive again.

Your device is built to fade into daily life. This guide covers the few real precautions and what to do if your ICD ever fires.

TAVR — transcatheter aortic valve replacement: who it helps, what procedure day is like, recovery, and lifelong follow-up.

Aortic stenosis: how a narrowed valve strains the heart, severity grading, why symptoms matter, and watchful waiting vs valve replacement.

Cross-section of the heart's upper-chamber wall. The PFO flap lets blood (and clots) cross right-to-left, which can lead to stroke.

A PFO is a flap between the upper chambers. It usually stays shut. Straining can push it open for a moment.

This view shows blood leaking backward (the arrow) through a faulty mitral valve. Some blood shoots back into the top chamber with each beat instead of flowing out to the body.

The wall between the two upper heart chambers normally sits flat. In atrial septal aneurysm, extra tissue makes it bow into one or both chambers, based on heart pressures.

Left: normal valve closes tight in diastole. Right: aortic regurgitation — blood leaks backward into the LV.

Tricuspid regurgitation: blood leaks backward from the right ventricle into the right atrium during each heartbeat, causing leg swelling, abdominal congestion, and right-heart failure.

Blood should flow freely from the left atrium (LA) through the mitral valve into the left ventricle (LV).

Atrial septal defect (ASD): the hole between the upper heart chambers — how it strains the right heart, who needs closure, and device vs surgery.

Cross-section of the heart showing a hole (VSD) in the wall between the right and left ventricles. Higher pressure on the left pushes extra blood into the right side and onward to the lungs.

The clip grasps both mitral leaflets, creating two smaller openings (double-orifice). Blood still flows forward while the backward leak is sharply reduced.

Two valve types — mechanical (left) and tissue (right) — shown side by side with their key tradeoffs.

Left: a double-disc occluder device sandwiching the atrial septum — RA disc, waist, LA disc. Right: the four-step stroke pathway a PFO enables, and how closure breaks it.

A vegetation (clump of germs) grows on a heart valve. Germs travel from the mouth, skin, or an IV line, into the blood, and onto the valve.

A normal valve has three leaflets; a bicuspid valve has two and opens like a fish mouth. Two leaflets wear faster and the nearby aorta can widen — so monitoring matters.

A normal valve closes flat; a prolapsing valve billows back into the upper chamber and may leak. How much it leaks, not the prolapse itself, guides the plan.

Rheumatic heart disease starts with an untreated strep throat. The immune system overreacts, causes rheumatic fever, and slowly scars the heart valves — most often the mitral valve — over many years.

A replacement heart valve is either mechanical (metal, lasts decades, needs a lifelong blood thinner) or tissue (wears out in 10-20 years, usually no long-term blood thinner).

Before and after: a thick wall blocking the outflow on the left, and a shrunk wall with freer blood flow on the right after ablation.

Two heart cross-sections: before, a thick septum blocks blood leaving the heart; after, the muscle is removed and flow opens up.

A paravalvular leak is a gap between a replacement valve and its tissue ring. Blood leaks around the valve, not through it.

A tissue heart valve usually lasts about 10 to 20 years before it wears out - the leaflets stiffen, calcify, or tear. A worn valve can often be fixed with a valve-in-valve TAVR, with no open surgery.

A mechanical heart valve is built to last decades, but only warfarin - never a newer blood thinner - keeps it working safely.

A tissue heart valve is often chosen for older age, avoiding lifelong warfarin, or a planned pregnancy. Blood thinners afterward are usually short-term, and durability is typically 10 to 20 years.

Recovery has steps: go home, protect your healing breastbone, start cardiac rehab, build strength, and reach a healed, working valve. Most of it is in your hands.

Your new valve is working right away. Recovery is about caring for the access site, taking the right medicine, and watching for warning signs as you heal.

Repair reshapes and reinforces your own valve with a support ring so the leaflets meet fully again - it does not replace the valve.

Two cross-sections side by side: a normal heart on the left, HCM with thick walls and narrow outflow tract on the right.

Pericarditis: why the sac around the heart gets inflamed, the chest pain pattern, colchicine and NSAID treatment, and avoiding recurrences.

The heart squeezed by extra fluid in its sac. When fluid builds up too fast, the heart cannot fill — that is tamponade.

Left: the normal heart squeezes evenly (green arrows). Right: in takotsubo, stress hormones stun the tip (apex). The base squeezes normally but the apex balloons out and stops contracting (red area).

Cross-section showing the pericardial sac (outer ring) filled with excess fluid (blue) that compresses the heart so it cannot fill normally.

Cross-section showing the pericardial sac (outer ring) thickened and calcified. The stiff scar stops the heart from filling — no excess fluid is needed.

Side-by-side cross-sections: a normal heart on the left with thick walls and a small cavity; DCM on the right with thin walls and an enlarged cavity.

Cross-section of the heart wall with swelling of the myocardium (muscle). Orange dots show immune cells in the muscle between the outer sac and the inner cavity.

Granulomas form in patches in the heart wall and can scar the muscle and wiring. That is why the disease shows up as heart block, a fast rhythm, or a weak pump.

The heart muscle can weaken around childbirth, lowering the ejection fraction. With treatment, about half to two-thirds of patients regain a normal pump.

Pregnancy makes the heart work harder. With a plan and a heart team, most women with heart disease can have a safe pregnancy.

Cross-section of the heart sac filled with extra fluid (blue). A thin needle, guided by ultrasound, enters under the breastbone to drain it.

Left: a normal heart relaxes and fills fully. Right: a stiff (restrictive) heart cannot relax, so it stays small and blood backs up.

Two views of the outflow tract: a wide-open path on the left, and a thick septum with the mitral valve pulled in (SAM) narrowing the path on the right.

Two cross-sections of the heart wall. Left: a smooth, solid normal wall. Right: a spongy wall with muscle ridges and deep grooves where blood can pool.

Colchicine is an old plant medicine that calms inflammation. Less inflammation means a calmer heart sac and fewer heart events.

Your heart keeps recovering for weeks after birth. Know the warning signs, watch your blood pressure, and choose heart-safe birth control.

A history of preeclampsia roughly doubles the future risk of heart disease and stroke, even when blood pressure returns to normal after delivery.

Blood clots (red) blocking the main lung arteries. PE cuts off oxygen and forces the right heart to work much harder — life-threatening.

This cross-section shows the right iliac artery sitting on top of the left iliac vein, pressing it flat like a finger on a garden hose.

Healthy leg veins use one-way valves to send blood UP to the heart (left). In CVI, leaky valves let blood pool in the lower leg (right).

A DVT is a blood clot that blocks a deep vein, usually in the leg. Left untreated, the clot can break free and travel to the lungs.

PAD narrows the arteries that carry blood to the legs. The same plaque buildup that causes heart attacks causes PAD.

Carotid artery disease puts the brain at risk. Knowing the warning signs — FAST — and getting the right treatment can prevent a stroke before it happens.

The aorta runs from the heart to the belly. An aneurysm can grow anywhere along it — most often just below the kidneys.

Left: healthy vein — valves close tight, pushing blood up. Right: varicose vein — leaky valves let blood pool and pressure builds.

Each blood thinner on the left has a matching reversal treatment on the right. Knowing your exact thinner lets the team act fast in an emergency.

Pulmonary hypertension means high pressure in the lung arteries — a mean pressure over 20 mmHg. It strains the right heart. Five groups, by cause, guide treatment.

Claudication is leg cramping that comes on when you walk and eases with rest. It means a leg artery is narrowed by plaque.

In the BEST-CLI trial, surgical bypass had a lower rate of a major leg event or death than endovascular treatment, but only in patients with a good vein available for bypass.

A normal D-dimer rules out a blood clot in low-risk patients. A high result means you may need a scan. It does not mean you have a clot. The test works best to rule clots out.

In a dissection, blood tears into the aortic wall and opens a false channel. Where the tear sits decides the treatment. Sudden tearing chest or back pain — call 911.

The thoracic aorta runs from the heart, up and over the arch, and down through the chest. An aneurysm is a bulge that most often forms on the ascending part.

An IVC filter is a tiny metal cage placed in the inferior vena cava — the big vein that carries blood from your legs back to your heart. It catches clots that break loose before they reach the lungs.

The ankle-brachial index divides ankle pressure by arm pressure. Around 1.00 is normal; a lower number points to narrowed leg arteries.

The aorta is narrowed just past the vessels to the head and arms. Pressure runs high above the narrowing and the leg pulse is weak below it.

Left: a clot in a surface vein, just under the skin — red, warm, tender. Right: a clot in a deep vein, hidden near the bone, which can travel to the lungs.

FMD makes the artery wall grow unevenly — small bulges and narrowings in a row, the classic 'string of beads.' It is not plaque, and it most often affects the kidney and neck arteries in women.

Dysautonomia and POTS: why your autonomic nervous system misfires, tilt-table testing, fluids and salt, compression, and medicines.

A trigger — long standing, pain, heat, or stress — sets off the vagus nerve. The heart slows and blood vessels widen. Blood pressure falls.

POTS causes your heart rate to jump 30 or more beats per minute when you stand up — without a drop in blood pressure. With the right plan, most people improve.

A trigger slows the heart and widens blood vessels. Blood pressure falls, the brain gets less blood, and you faint for seconds. Lying flat restores flow and you recover fully.

Every faint is sorted into one of three cause groups — reflex (usually harmless), orthostatic, or cardiac (the one we must not miss).

Dizziness comes in two main kinds. The faint, woozy feeling (presyncope) often points to the heart or blood pressure. The room-spinning feeling (vertigo) usually comes from the inner ear.

You lie flat, then the table tilts you upright to about 60-70 degrees and holds you there. Your heart rate, blood pressure, and symptoms are watched the whole time to see what makes you faint.

Midodrine tightens your blood vessels so your blood pressure is held up when you stand. The green line shows steadier standing pressure with the medicine.

A CT scanner takes a quick X-ray of the heart arteries - the LAD, LCx, and RCA. The scan finds plaque and shows narrow spots.

Radial artery occlusion after catheterization: why it happens, how we prevent it, what symptoms to watch for, and what it means for future procedures.

Transesophageal echocardiogram (TEE): why imaging from the esophagus sees more, how to prepare, sedation, and what we look for.

Fluids through an IV and using less dye are what protect your kidneys. Two treatments many patients still ask for were tested in 5,177 people and did not work.

Cardiac catheterization: wrist vs groin access, what the cath lab is like, the pictures we take, risks, and recovery at home.

Top: the MRI scanner — a wide tunnel where you lie still for 45 to 60 minutes while a powerful magnet (no X-rays, no radiation) takes detailed pictures of your heart.

An echo uses sound waves from a small probe to make a moving picture of your heart - the chambers, the valves, and the sac around the heart. No radiation, and no IV for a standard echo.

A stress test asks your heart to work hard - on purpose - so we can watch how it responds. Most are normal. When abnormal, the result tells us what to do next.

Your 10-year risk percentage sorts into one of four categories, and the category guides whether a statin makes sense for you.

Four calcium-score tiers (0, 1-99, 100-299, 300+) map to four risk levels and four action plans. The score itself is one number from a 5-minute CT scan.

A catheter travels from the wrist to the heart. Contrast dye reveals blockages in the LAD, LCx, and RCA — your coronary arteries.

Ambulatory ECG monitors capture your heart rhythm during everyday life — catching arrhythmias that come and go and may not appear during a brief office visit.

Catheters enter through groin veins to map and ablate the exact source of an abnormal rhythm — no chest incision needed.

The bloodless plan on one timeline: raise your blood count before surgery, protect it during, and let it recover after. The three pillars are shown below.

One donation is split into four products — red cells, platelets, plasma, and cryoprecipitate. Each helps a different need. The matching and screening behind every unit is what makes it safe.

A surgery timeline showing the main conservation tools by phase: build your blood before, save it during, and recover after. Most plans combine several tools.

A thin pressure wire crosses a blockage and reads the flow. A high score means leave it alone; a low score means stent it.

Left: an angiogram shows only the outline of the channel, while IVUS and OCT show a full slice through the wall — the open channel, the plaque, and the catheter.

Left: an artery 100% blocked by a chronic total occlusion, with no flow past the plug. Right: after CTO PCI, a stent holds the artery open and blood flow is restored.

At rest, blood flow is even all around the heart muscle. Under stress, an area that lights up less points to a flow-limiting blockage (ischemia).

An abnormal stress test is the start of a plan, not a verdict. It tells us to look closer at blood flow to your heart. Most next steps are calm and routine.

Left: the soft tube enters a vein (neck or groin), then floats with the blood through the right atrium and right ventricle out to the lung artery.

An abnormal EKG is a clue to sort out, not a verdict. Many tracings are minor, old, or false - and comparing to an earlier EKG is often what matters most.

Troponin is a protein your heart releases when it is injured. A high level is a real signal - but it does not always mean a heart attack. The next few hours find out why.

BNP and NT-proBNP rise when the heart's walls are strained. A high level is a clue to heart strain - usually heart failure - not a diagnosis by itself. The next steps are an echo and a careful exam.

When the heart's walls are stretched, they release BNP and NT-proBNP. A low level makes heart failure unlikely. A high level points to strain - but age, kidneys, and body weight all shift the number.

hs-CRP measures chronic low-grade inflammation - a separate risk pathway from cholesterol. High levels help guide statin and lifestyle decisions. Retest when well, not when sick.

An abnormal echo word is a starting point, not a verdict. Many findings are mild and just watched with a repeat echo. Severity and how you feel decide what comes next.

A murmur is the sound of blood moving through your heart. Most murmurs are innocent and need nothing. A painless ultrasound - an echo - tells us which kind you have.

A chest CT done for another reason found something on your heart. Most such findings are mild or age-related. Incidental does not mean emergency - but it does mean we follow up with a clear plan.

An ECG is a quick, painless recording of your heartbeat. Stickers on the skin pick up the signal and a machine draws it as a wave. No needles and no radiation.

Two ways to record your heart rhythm at home: the classic Holter with wires for 24–48 hours, or one waterproof patch sticker worn 7–14 days.

Cardiac clearance is a heart risk check and a plan before non-heart surgery - not a pass/fail stamp. Most active, stable patients need no extra heart test.

Recovery has three stages: heal the groin site in week 1, expect normal skips during the blanking period (up to ~3 months), and let your team judge success after healing.

Atrial enlargement means a top chamber of your heart has stretched, usually from long-standing pressure or volume. It is a marker to find and treat the cause - rarely an emergency by itself.

Cardiac rehab starts in a different place for each person. Your heart event sets your plan, your pace, and your safety rules. The three parts, and the payoff, are the same for everyone.

See what your BNP/NT-proBNP, D-dimer, or hs-CRP number means.