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  1. 1. What Is an Aneurysm?An aneurysm (AN-u-rism) is a balloon-like bulge in an artery. Arteries are blood vessels thatcarry oxygen-rich blood to your body.Arteries have thick walls to withstand normal blood pressure. However, certain medicalproblems, genetic conditions, and trauma can damage or injure artery walls. The force ofblood pushing against the weakened or injured walls can cause an aneurysm.An aneurysm can grow large and rupture (burst) or dissect. A rupture causes dangerousbleeding inside the body. A dissection is a split in one or more layers of the artery wall. Thesplit causes bleeding into and along the layers of the artery wall.Both rupture and dissection often are fatal.OverviewMost aneurysms occur in the aorta, the main artery that carries oxygen-rich blood from theheart to the body. The aorta goes through the chest and abdomen.An aneurysm that occurs in the chest portion of the aorta is called a thoracic (tho-RAS-ik)aortic aneurysm. An aneurysm that occurs in the abdominal portion of the aorta is called anabdominal aortic aneurysm.Aneurysms also can occur in other arteries, but these types of aneurysm are less common.This article focuses on aortic aneurysms.About 13,000 Americans die each year from aortic aneurysms. Most of the deaths result fromrupture or dissection.Early diagnosis and treatment can help prevent rupture and dissection. However, aneurysmscan develop and grow large before causing any symptoms. Thus, people who are at high riskfor aneurysms can benefit from early, routine screening.OutlookDoctors often can successfully treat aortic aneurysms with medicines or surgery if they’refound in time. Medicines may be given to lower blood pressure, relax blood vessels, andreduce the risk of rupture.Large aortic aneurysms often can be repaired with surgery. During surgery, the weak ordamaged portion of the aorta is replaced or reinforced.Types of AneurysmsAortic Aneurysms
  2. 2. The two types of aortic aneurysm are abdominal aortic aneurysm and thoracic aorticaneurysm. Some people have both types. Aortic AneurysmsFigure A shows a normal aorta. Figure B shows a thoracic aortic aneurysm, which is locatedbehind the heart. Figure C shows an abdominal aortic aneurysm, which is located below thearteries that supply blood to the kidneys.Abdominal Aortic AneurysmsAn aneurysm that occurs in the abdominal portion of the aorta is called an abdominal aorticaneurysm (AAA). Most aortic aneurysms are AAAs.These aneurysms are found more often now than in the past because of computedtomography (to-MOG-rah-fee) scans, or CT scans , done for other medical problems.Small AAAs rarely rupture. However, AAAs can grow very large without causing symptoms.Routine checkups and treatment for an AAA can help prevent growth and rupture.
  3. 3. Thoracic Aortic AneurysmsAn aneurysm that occurs in the chest portion of the aorta (above the diaphragm, a muscle thathelps you breathe) is called a thoracic aortic aneurysm (TAA).TAAs dont always cause symptoms, even when theyre large. Only half of all people whohave TAAs notice any symptoms. TAAs are found more often now than in the past becauseof chest CT scans done for other medical problems.With a common type of TAA, the walls of the aorta weaken and a section close to the heartenlarges. As a result, the valve between the heart and the aorta cant close properly. Thisallows blood to leak back into the heart.A less common type of TAA can develop in the upper back, away from the heart. A TAA inthis location may result from an injury to the chest, such as from a car crash.Other Types of AneurysmsBrain AneurysmsAneurysms in the arteries of the brain are called cerebral (seh-RE-bral)aneurysms or brain aneurysms. Brain aneurysms also are called berry aneurysms becausetheyre often the size of a small berry. Brain AneurysmThe illustration shows a typical location of a brain aneurysm in the arteries that supply bloodto the brain. The inset image shows a closeup view of the sac-like aneurysm.
  4. 4. Most brain aneurysms cause no symptoms until they become large, begin to leak blood, orrupture (burst). A ruptured brain aneurysm can cause a stroke.Peripheral AneurysmsAneurysms that occur in arteries other than the aorta and the brain arteries are calledperipheral (peh-RIF-eh-ral) aneurysms. Common locations for peripheral aneurysms includethe popliteal (pop-li-TE-al), femoral (FEM-o-ral), and carotid (ka-ROT-id) arteries.The popliteal arteries run down the back of the thighs, behind the knees. The femoral arteriesare the main arteries in the groin. The carotid arteries are the two main arteries on each sideof your neck.Peripheral aneurysms aren’t as likely to rupture or dissect as aortic aneurysms. However,blood clots can form in peripheral aneurysms. If a blood clot breaks away from the aneurysm,it can block blood flow through the artery.If a peripheral aneurysm is large, it can press on a nearby nerve or vein and causeOther Names for Aneurysm Abdominal aortic aneurysm Aortic aneurysm Berry aneurysm Brain aneurysm Cerebral aneurysm Peripheral aneurysm Thoracic aortic aneurysmWhat Causes an Aneurysm?The force of blood pushing against the walls of an artery combined with damage or injury tothe artery’s walls can cause an aneurysm.Many conditions and factors can damage and weaken the walls of the aorta and cause aorticaneurysms. Examples include aging, smoking, high blood pressure, and atherosclerosis (ath-er-o-skler-O-sis). Atherosclerosis is the hardening and narrowing of the arteries due to thebuildup of a waxy substance called plaque (plak).Rarely, infections—such as untreated syphilis (a sexually transmitted infection)—can causeaortic aneurysms. Aortic aneurysms also can occur as a result of diseases that inflame theblood vessels, such as vasculitis (vas-kyu-LI-tis).A family history of aneurysms also may play a role in causing aortic aneurysms.In addition to the factors above, certain genetic conditions may cause thoracic aorticaneurysms (TAAs). Examples of these conditions include Marfan syndrome, Loeys-Dietzsyndrome, Ehlers-Danlos syndrome (the vascular type), and Turner syndrome.
  5. 5. These genetic conditions can weaken the body’s connective tissues and damage the aorta.People who have these conditions tend to develop aneurysms at a younger age than otherpeople. They’re also at higher risk for rupture and dissection.Trauma, such as a car accident, also can damage the walls of the aorta and lead to TAAs.Researchers continue to look for other causes of aortic aneurysms. For example, they’relooking for genetic mutations (changes in the genes) that may contribute to or causeaneurysms.Who Is at Risk for an Aneurysm?Certain factors put you at higher risk for an aortic aneurysm. These factors include: Male gender. Men are more likely than women to have aortic aneurysms. Age. The risk for abdominal aortic aneurysms increases as you get older. These aneurysms are more likely to occur in people who are aged 65 or older. Smoking. Smoking can damage and weaken the walls of the aorta. A family history of aortic aneurysms. People who have family histories of aortic aneurysms are at higher risk for the condition, and they may have aneurysms before the age of 65. A history of aneurysms in the arteries of the legs. Certain diseases and conditions that weaken the walls of the aorta. Examples include high blood pressure and atherosclerosis.Having a bicuspid aortic valve can raise the risk of having a thoracic aortic aneurysm. Abicuspid aortic valve has two leaflets instead of the typical three.Car accidents or trauma also can injure the arteries and increase the risk for aneurysms.If you have any of these risk factors, talk with your doctor about whether you need screeningfor aneurysms.What Are the Signs and Symptoms of anAneurysm?The signs and symptoms of an aortic aneurysm depend on the type and location of theaneurysm. Signs and symptoms also depend on whether the aneurysm has ruptured (burst) oris affecting other parts of the body.Aneurysms can develop and grow for years without causing any signs or symptoms. Theyoften dont cause signs or symptoms until they rupture, grow large enough to press on nearbybody parts, or block blood flow.Abdominal Aortic Aneurysms
  6. 6. Most abdominal aortic aneurysms (AAAs) develop slowly over years. They often dont causesigns or symptoms unless they rupture. If you have an AAA, your doctor may feel athrobbing mass while checking your abdomen.When symptoms are present, they can include: A throbbing feeling in the abdomen Deep pain in your back or the side of your abdomen Steady, gnawing pain in your abdomen that lasts for hours or daysIf an AAA ruptures, symptoms may include sudden, severe pain in your lower abdomen andback; nausea (feeling sick to your stomach) and vomiting; constipation and problems withurination; clammy, sweaty skin; light-headedness; and a rapid heart rate when standing up.Internal bleeding from a ruptured AAA can send you into shock . Shock is a life-threatening condition in which blood pressure drops so low that the brain, kidneys, and othervital organs cant get enough blood to work well. Shock can be fatal if it’s not treated rightaway.Thoracic Aortic AneurysmsA thoracic aortic aneurysm (TAA) may not cause symptoms until it dissects or grows large. Ifyou have symptoms, they may include: Pain in your jaw, neck, back, or chest Coughing and/or hoarseness Shortness of breath and/or trouble breathing or swallowingA dissection is a split in one or more layers of the artery wall. The split causes bleeding intoand along the layers of the artery wall.If a TAA ruptures or dissects, you may feel sudden, severe, sharp or stabbing pain starting inyour upper back and moving down into your abdomen. You may have pain in your chest andarms, and you can quickly go into shock.If you have any symptoms of TAA or aortic dissection, call 9–1–1. If left untreated, theseconditions may lead to organ damage or death.How Is an Aneurysm Diagnosed?If you have an aortic aneurysm but no symptoms, your doctor may find it by chance during aroutine physical exam. More often, doctors find aneurysms during tests done for otherreasons, such as chest or abdominal pain.If you have an abdominal aortic aneurysm (AAA), your doctor may feel a throbbing mass inyour abdomen. A rapidly growing aneurysm about to rupture (burst) can be tender and verypainful when pressed. If youre overweight or obese, it may be hard for your doctor to feeleven a large AAA.
  7. 7. If you have an AAA, your doctor may hear rushing blood flow instead of the normalwhooshing sound when listening to your abdomen with a stethoscope.Specialists InvolvedYour primary care doctor may refer you to a cardiothoracic or vascular surgeon for diagnosisand treatment of an aortic aneurysm.A cardiothoracic surgeon does surgery on the heart, lungs, and other organs and structures inthe chest, including the aorta. A vascular surgeon does surgery on the aorta and other bloodvessels, except those of the heart and brain.Diagnostic Tests and ProceduresTo diagnose and study an aneurysm, your doctor may recommend one or more of thefollowing tests.Ultrasound and EchocardiographyUltrasound and echocardiography (echo) are simple, painless tests that use sound waves tocreate pictures of the structures inside your body. These tests can show the size of an aorticaneurysm, if one is found.Computed Tomography ScanA computed tomography scan, or CT scan , is a painless test that uses x rays to take clear,detailed pictures of your organs.During the test, your doctor will inject dye into a vein in your arm. The dye makes yourarteries, including your aorta, visible on the CT scan pictures.Your doctor may recommend this test if he or she thinks you have an AAA or a thoracicaortic aneurysm (TAA). A CT scan can show the size and shape of an aneurysm. This testprovides more detailed pictures than an ultrasound or echo.Magnetic Resonance ImagingMagnetic resonance imaging (MRI) uses magnets and radio waves to create pictures of theorgans and structures in your body. This test works well for detecting aneurysms andpinpointing their size and exact location.AngiographyAngiography (an-jee-OG-ra-fee) is a test that uses dye and special x rays to show the insidesof your arteries. This test shows the amount of damage and blockage in blood vessels.Aortic angiography shows the inside of your aorta. The test may show the location and sizeof an aortic aneurysm.
  8. 8. How Is an Aneurysm Treated?Aortic aneurysms are treated with medicines and surgery. Small aneurysms that are foundearly and aren’t causing symptoms may not need treatment. Other aneurysms need to betreated.The goals of treatment may include: Preventing the aneurysm from growing Preventing or reversing damage to other body structures Preventing or treating a rupture or dissection Allowing you to continue doing your normal daily activitiesTreatment for an aortic aneurysm is based on its size. Your doctor may recommend routinetesting to make sure an aneurysm isnt getting bigger. This method usually is used foraneurysms that are smaller than 5 centimeters (about 2 inches) across.How often you need testing (for example, every few months or every year) is based on thesize of the aneurysm and how fast its growing. The larger it is and the faster its growing, themore often you may need to be checked.MedicinesIf you have an aortic aneurysm, your doctor may prescribe medicines before surgery orinstead of surgery. Medicines are used to lower blood pressure, relax blood vessels, andlower the risk that the aneurysm will rupture (burst). Beta blockers and calcium channelblockers are the medicines most commonly used.SurgeryYour doctor may recommend surgery if your aneurysm is growing quickly or is at risk ofrupture or dissection.The two main types of surgery to repair aortic aneurysms are open abdominal or open chestrepair and endovascular repair.Open Abdominal or Open Chest RepairThe standard and most common type of surgery for aortic aneurysms is open abdominal oropen chest repair. This surgery involves a major incision (cut) in the abdomen or chest.General anesthesia (AN-es-THE-ze-ah) is used during this procedure. The term ―anesthesia‖refers to a loss of feeling and awareness. General anesthesia temporarily puts you to sleep.During the surgery, the aneurysm is removed. Then, the section of aorta is replaced with agraft made of material such as Dacron® or Teflon.® The surgery takes 3 to 6 hours; you’llremain in the hospital for 5 to 8 days.
  9. 9. If needed, repair of the aortic heart valve also may be done during open abdominal or openchest surgery.It often takes a month to recover from open abdominal or open chest surgery and return tofull activity. Most patients make a full recovery.Endovascular RepairIn endovascular repair, the aneurysm isnt removed. Instead, a graft is inserted into the aortato strengthen it. Surgeons do this type of surgery using catheters (tubes) inserted into thearteries; it doesnt require surgically opening the chest or abdomen. General anesthesia isused during this procedure.The surgeon first inserts a catheter into an artery in the groin (upper thigh) and threads it tothe aneurysm. Then, using an x ray to see the artery, the surgeon threads the graft (also calleda stent graft) into the aorta to the aneurysm.The graft is then expanded inside the aorta and fastened in place to form a stable channel forblood flow. The graft reinforces the weakened section of the aorta. This helps prevent theaneurysm from rupturing. Endovascular RepairThe illustration shows the placement of a stent graft in an aortic aneurysm. In figure A, acatheter is inserted into an artery in the groin (upper thigh). The catheter is threaded to theabdominal aorta, and the stent graft is released from the catheter. In figure B, the stent graftallows blood to flow through the aneurysm.
  10. 10. The recovery time for endovascular repair is less than the recovery time for open abdominalor open chest repair. However, doctors can’t repair all aortic aneurysms with endovascularrepair. The location or size of an aneurysm may prevent the use of a stent graft.How Can an Aneurysm Be Prevented?The best way to prevent an aortic aneurysm is to avoid the factors that put you at higher riskfor one. You can’t control all aortic aneurysm risk factors, but lifestyle changes can help youlower some risks.For example, if you smoke, try to quit. Talk with your doctor about programs and productsthat can help you quit smoking. Also, try to avoid secondhand smoke. For more informationabout how to quit smoking, go to the Health Topics Smoking and Your Heart article.Another important lifestyle change is following a healthy diet. A healthy diet includes avariety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish,beans, and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat,trans fat, cholesterol, sodium (salt), and added sugar.For more information about following a healthy diet, go to the National Heart, Lung, andBlood Institute’s (NHLBI’s) Aim for a Healthy Weight Web site, "Your Guide to a HealthyHeart," and "Your Guide to Lowering Your Blood Pressure With DASH." All of theseresources include general information about healthy eating.Be as physically active as you can. Talk with your doctor about the amounts and types ofphysical activity that are safe for you. For more information about physical activity, go to theHealth Topics Physical Activity and Your Heart article and the NHLBI’s "Your Guide toPhysical Activity and Your Heart."Work with your doctor to control medical conditions such as high blood pressure and highblood cholesterol. Follow your treatment plans and take all of your medicines as your doctorprescribes.Screening for AneurysmsAlthough you may not be able to prevent an aneurysm, early diagnosis and treatment can helpprevent rupture and dissection.Aneurysms can develop and grow large before causing any signs or symptoms. Thus, peoplewho are at high risk for aneurysms may benefit from early, routine screening.Your doctor may recommend routine screening if you’re: A man between the ages of 65 and 75 who has ever smoked A man or woman between the ages of 65 and 75 who has a family history of aneurysms
  11. 11. If you’re at risk, but not in one of these high-risk groups, ask your doctor whether screeningwill benefit you.What Is Atherosclerosis?Atherosclerosis (ath-er-o-skler-O-sis) is a disease in which plaque (plak) builds up insideyour arteries. Arteries are blood vessels that carry oxygen-rich blood to your heart and otherparts of your body.Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Overtime, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood toyour organs and other parts of your body.Atherosclerosis can lead to serious problems, including heart attack, stroke, or even death. AtherosclerosisFigure A shows a normal artery with normal blood flow. Figure B shows an artery withplaque buildup.Atherosclerosis-Related Diseases
  12. 12. Atherosclerosis can affect any artery in the body, including arteries in the heart, brain, arms,legs, pelvis, and kidneys. As a result, different diseases may develop based on which arteriesare affected.Coronary Heart DiseaseCoronary heart disease (CHD), also called coronary artery disease, is the #1 killer of bothmen and women in the United States. CHD occurs if plaque builds up in the coronaryarteries. These arteries supply oxygen-rich blood to your heart.Plaque narrows the coronary arteries and reduces blood flow to your heart muscle. Plaquebuildup also makes it more likely that blood clots will form in your arteries. Blood clots canpartially or completely block blood flow.If blood flow to your heart muscle is reduced or blocked, you may have angina (chest pain ordiscomfort) or a heart attack.Plaque also can form in the hearts smallest arteries. This disease is called coronarymicrovascular disease (MVD). In coronary MVD, plaque doesnt cause blockages in thearteries as it does in CHD.Carotid Artery DiseaseCarotid (ka-ROT-id) artery disease occurs if plaque builds up in the arteries on each side ofyour neck (the carotid arteries). These arteries supply oxygen-rich blood to your brain. Ifblood flow to your brain is reduced or blocked, you may have a stroke.Peripheral Arterial DiseasePeripheral arterial disease (P.A.D.) occurs if plaque builds up in the major arteries that supplyoxygen-rich blood to your legs, arms, and pelvis.If blood flow to these parts of your body is reduced or blocked, you may have numbness,pain, and, sometimes, dangerous infections.Chronic Kidney DiseaseChronic kidney disease can occur if plaque builds up in the renal arteries. These arteriessupply oxygen-rich blood to your kidneys.Over time, chronic kidney disease causes a slow loss of kidney function. The main functionof the kidneys is to remove waste and extra water from the body.OverviewThe cause of atherosclerosis isnt known. However, certain traits, conditions, or habits mayraise your risk for the disease. These conditions are known as risk factors.You can control some risk factors, such as lack of physical activity, smoking, and anunhealthy diet. Others you cant control, such as age and a family history of heart disease.
  13. 13. Some people who have atherosclerosis have no signs or symptoms. They may not bediagnosed until after a heart attack or stroke.The main treatment for atherosclerosis is lifestyle changes. You also may need medicines andmedical procedures. These treatments, along with ongoing medical care, can help you live ahealthier life.OutlookImproved treatments have reduced the number of deaths from atherosclerosis-relateddiseases. These treatments also have improved the quality of life for people who have thesediseases. However, atherosclerosis remains a common health problem.You may be able to prevent or delay atherosclerosis and the diseases it can cause. Makinglifestyle changes and getting ongoing care can help you avoid the problems of atherosclerosisand live a long, healthy life.What Causes Atherosclerosis?The exact cause of atherosclerosis isnt known. However, studies show that atherosclerosis isa slow, complex disease that may start in childhood. It develops faster as you age.Atherosclerosis may start when certain factors damage the inner layers of the arteries. Thesefactors include: Smoking High amounts of certain fats and cholesterol in the blood High blood pressure High amounts of sugar in the blood due to insulin resistance or diabetesPlaque may begin to build up where the arteries are damaged. Over time, plaque hardens andnarrows the arteries. Eventually, an area of plaque can rupture (break open).When this happens, blood cell fragments called platelets (PLATE-lets) stick to the site of theinjury. They may clump together to form blood clots. Clots narrow the arteries even more,limiting the flow of oxygen-rich blood to your body.Depending on which arteries are affected, blood clots can worsen angina (chest pain) or causea heart attack or stroke.Researchers continue to look for the causes of atherosclerosis. They hope to find answers toquestions such as: Why and how do the arteries become damaged? How does plaque develop and change over time? Why does plaque rupture and lead to blood clots?
  14. 14. What Are the Signs and Symptoms ofAtherosclerosis?Atherosclerosis usually doesnt cause signs and symptoms until it severely narrows or totallyblocks an artery. Many people dont know they have the disease until they have a medicalemergency, such as a heart attack or stroke.Some people may have signs and symptoms of the disease. Signs and symptoms will dependon which arteries are affected.Coronary ArteriesThe coronary arteries supply oxygen-rich blood to your heart. If plaque narrows or blocksthese arteries (a disease called coronary heart disease, or CHD), a common symptom isangina. Angina is chest pain or discomfort that occurs when your heart muscle doesnt getenough oxygen-rich blood.Angina may feel like pressure or squeezing in your chest. You also may feel it in yourshoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. The paintends to get worse with activity and go away with rest. Emotional stress also can trigger thepain.Other symptoms of CHD are shortness of breath and arrhythmias (ah-RITH-me-ahs).Arrhythmias are problems with the rate or rhythm of the heartbeat.Plaque also can form in the hearts smallest arteries. This disease is called coronarymicrovascular disease (MVD). Symptoms of coronary MVD include angina, shortness ofbreath, sleep problems, fatigue (tiredness), and lack of energy.Carotid ArteriesThe carotid arteries supply oxygen-rich blood to your brain. If plaque narrows or blocks thesearteries (a disease called carotid artery disease), you may have symptoms of a stroke. Thesesymptoms may include: Sudden weakness Paralysis (an inability to move) or numbness of the face, arms, or legs, especially on one side of the body Confusion Trouble speaking or understanding speech Trouble seeing in one or both eyes Problems breathing Dizziness, trouble walking, loss of balance or coordination, and unexplained falls Loss of consciousness Sudden and severe headache
  15. 15. Peripheral ArteriesPlaque also can build up in the major arteries that supply oxygen-rich blood to the legs, arms,and pelvis (a disease called peripheral arterial disease).If these major arteries are narrowed or blocked, you may have numbness, pain, and,sometimes, dangerous infections.Renal ArteriesThe renal arteries supply oxygen-rich blood to your kidneys. If plaque builds up in thesearteries, you may develop chronic kidney disease . Over time, chronic kidney diseasecauses a slow loss of kidney function.Early kidney disease often has no signs or symptoms. As the disease gets worse it can causetiredness, changes in how you urinate (more often or less often), loss of appetite, nausea(feeling sick to the stomach), swelling in the hands or feet, itchiness or numbness, and troubleconcentrating.How Is Atherosclerosis Diagnosed?Your doctor will diagnose atherosclerosis based on your medical and family histories, aphysical exam, and test results.Specialists InvolvedIf you have atherosclerosis, a primary care doctor, such as an internist or family practitioner,may handle your care. Your doctor may recommend other health care specialists if you needexpert care, such as: A cardiologist. This is a doctor who specializes in diagnosing and treating heart diseases and conditions. You may go to a cardiologist if you have coronary heart disease (CHD) or coronary microvascular disease (MVD). A vascular specialist. This is a doctor who specializes in diagnosing and treating blood vessel problems. You may go to a vascular specialist if you have peripheral arterial disease (P.A.D.). A neurologist. This is a doctor who specializes in diagnosing and treating nervous system disorders. You may see a neurologist if youve had a stroke due to carotid artery disease. A nephrologist. This is a doctor who specializes in diagnosing and treating kidney diseases and conditions. You may go to a nephrologist if you have chronic kidney disease .Physical ExamDuring the physical exam, your doctor may listen to your arteries for an abnormal whooshingsound called a bruit (broo-E). Your doctor can hear a bruit when placing a stethoscope overan affected artery. A bruit may indicate poor blood flow due to plaque buildup.
  16. 16. Your doctor also may check to see whether any of your pulses (for example, in the leg orfoot) are weak or absent. A weak or absent pulse can be a sign of a blocked artery.Diagnostic TestsYour doctor may recommend one or more tests to diagnose atherosclerosis. These tests alsocan help your doctor learn the extent of your disease and plan the best treatment.Blood TestsBlood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood.Abnormal levels may be a sign that youre at risk for atherosclerosis.EKG (Electrocardiogram)An EKG is a simple, painless test that detects and records the hearts electrical activity. Thetest shows how fast the heart is beating and its rhythm (steady or irregular). An EKG alsorecords the strength and timing of electrical signals as they pass through the heart.An EKG can show signs of heart damage caused by CHD. The test also can show signs of aprevious or current heart attack.Chest X RayA chest x ray takes pictures of the organs and structures inside your chest, such as your heart,lungs, and blood vessels. A chest x ray can reveal signs of heart failure.Ankle/Brachial IndexThis test compares the blood pressure in your ankle with the blood pressure in your arm tosee how well your blood is flowing. This test can help diagnose P.A.D.EchocardiographyEchocardiography (echo) uses sound waves to create a moving picture of your heart. The testprovides information about the size and shape of your heart and how well your heartchambers and valves are working.Echo also can identify areas of poor blood flow to the heart, areas of heart muscle that arentcontracting normally, and previous injury to the heart muscle caused by poor blood flow.Computed Tomography ScanA computed tomography (CT) scan creates computer-generated pictures of the heart, brain, orother areas of the body. The test can show hardening and narrowing of large arteries.A cardiac CT scan also can show whether calcium has built up in the walls of the coronary(heart) arteries. This may be an early sign of CHD.
  17. 17. Stress TestingDuring stress testing, you exercise to make your heart work hard and beat fast while hearttests are done. If you cant exercise, you may be given medicine to make your heart workhard and beat fast.When your heart is working hard, it needs more blood and oxygen. Plaque-narrowed arteriescant supply enough oxygen-rich blood to meet your hearts needs.A stress test can show possible signs and symptoms of CHD, such as: Abnormal changes in your heart rate or blood pressure Shortness of breath or chest pain Abnormal changes in your heart rhythm or your hearts electrical activityAs part of some stress tests, pictures are taken of your heart while you exercise and while yourest. These imaging stress tests can show how well blood is flowing in various parts of yourheart. They also can show how well your heart pumps blood when it beats.AngiographyAngiography (an-jee-OG-ra-fee) is a test that uses dye and special x rays to show the insideof your arteries. This test can show whether plaque is blocking your arteries and how severethe blockage is.A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upperthigh), or neck. Dye that can be seen on an x-ray picture is injected through the catheter intothe arteries. By looking at the x-ray picture, your doctor can see the flow of blood throughyour arteries.Other TestsOther tests are being studied to see whether they can give a better view of plaque buildup inthe arteries. Examples of these tests include magnetic resonance imaging (MRI) and positronemission tomography (PET).How Is Atherosclerosis Treated?Treatments for atherosclerosis may include lifestyle changes, medicines, and medicalprocedures or surgery.The goals of treatment include: Relieving symptoms Reducing risk factors in an effort to slow or stop the buildup of plaque Lowering the risk of blood clots forming Widening or bypassing plaque-clogged arteries Preventing atherosclerosis-related diseases
  18. 18. Lifestyle ChangesMaking lifestyle changes often can help prevent or treat atherosclerosis. For some people,these changes may be the only treatment needed.Follow a Healthy DietA healthy diet is an important part of a healthy lifestyle. Following a healthy diet can preventor reduce high blood pressure and high blood cholesterol and help you maintain a healthyweight.For information about healthy eating, go to the National Heart, Lung, and Blood Institutes(NHLBIs) Aim for a Healthy Weight Web site. This site provides practical tips on healthyeating, physical activity, and weight control.Therapeutic Lifestyle Changes (TLC). Your doctor may recommend TLC if you have highblood cholesterol. TLC is a three-part program that includes a healthy diet, physical activity,and weight management.With the TLC diet, less than 7 percent of your daily calories should come from saturated fat.This kind of fat is found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods.No more than 25 to 35 percent of your daily calories should come from all fats, includingsaturated, trans, monounsaturated, and polyunsaturated fats.You also should have less than 200 mg a day of cholesterol. The amounts of cholesterol andthe types of fat in prepared foods can be found on the foods Nutrition Facts labels.Foods high in soluble fiber also are part of a healthy diet. They help prevent the digestivetract from absorbing cholesterol. These foods include: Whole-grain cereals such as oatmeal and oat bran Fruits such as apples, bananas, oranges, pears, and prunes Legumes such as kidney beans, lentils, chick peas, black-eyed peas, and lima beansA diet rich in fruits and vegetables can increase important cholesterol-lowering compounds inyour diet. These compounds, called plant stanols or sterols, work like soluble fiber.A healthy diet also includes some types of fish, such as salmon, tuna (canned or fresh), andmackerel. These fish are a good source of omega-3 fatty acids. These acids may help protectthe heart from blood clots and inflammation and reduce the risk for heart attack. Try to haveabout two fish meals every week.You should try to limit the amount of sodium (salt) that you eat. This means choosing low-salt and "no added salt" foods and seasonings at the table or while cooking. The NutritionFacts label on food packaging shows the amount of sodium in the item.
  19. 19. Try to limit drinks with alcohol. Too much alcohol will raise your blood pressure andtriglyceride level. (Triglycerides are a type of fat found in the blood.) Alcohol also adds extracalories, which will cause weight gain.Men should have no more than two drinks containing alcohol a day. Women should have nomore than one drink containing alcohol a day. One drink is a glass of wine, beer, or a smallamount of hard liquor.For more information about TLC, go to the NHLBIs "Your Guide to Lowering YourCholesterol With TLC."Dietary Approaches to Stop Hypertension (DASH). Your doctor may recommend theDASH eating plan if you have high blood pressure. The DASH eating plan focuses on fruits,vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol,and salt.DASH also focuses on fat-free or low-fat milk and dairy products, fish, poultry, and nuts. TheDASH eating plan is reduced in red meats (including lean red meats), sweets, added sugars,and sugar-containing beverages. The plan is rich in nutrients, protein, and fiber.The DASH eating plan is a good heart healthy eating plan, even for those who dont havehigh blood pressure. For more information, go to the NHLBIs "Your Guide to LoweringYour Blood Pressure With DASH."Be Physically ActiveRegular physical activity can lower many atherosclerosis risk factors, including LDL ("bad")cholesterol, high blood pressure, and excess weight.Physical activity also can lower your risk for diabetes and raise your HDL cholesterollevel. HDL is the "good" cholesterol that helps prevent atherosclerosis.Talk with your doctor before you start a new exercise plan. Ask him or her how much andwhat kinds of physical activity are safe for you.People gain health benefits from as little as 60 minutes of moderate-intensity aerobic activityper week. For major health benefits, do at least 150 minutes (2 hours and 30 minutes) ofmoderate-intensity aerobic activity or 75 minutes (1 hour and 15 minutes) of vigorous-intensity aerobic activity each week. The more active you are, the more you will benefit.For more information about physical activity, go to the U.S. Department of Health andHuman Services "2008 Physical Activity Guidelines for Americans," the Health TopicsPhysical Activity and Your Heart article, and the NHLBIs "Your Guide to Physical Activityand Your Heart."Maintain a Healthy WeightMaintaining a healthy weight can lower your risk for atherosclerosis. A general goal to aimfor is a body mass index (BMI) of less than 25.
  20. 20. BMI measures your weight in relation to your height and gives an estimate of your total bodyfat. You can use the NHLBIs online BMI calculator to figure out your BMI, or your doctorcan help you.A BMI between 25 and 29.9 is considered overweight. A BMI of 30 or more is consideredobese. A BMI of less than 25 is the goal for preventing and treating atherosclerosis. Yourdoctor or health care provider can help you set an appropriate BMI goal.For more information about losing weight or maintaining your weight, go to the HealthTopics Overweight and Obesity article.Quit SmokingIf you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels and raiseyour risk for atherosclerosis. Talk with your doctor about programs and products that canhelp you quit. Also, try to avoid secondhand smoke.If you have trouble quitting smoking on your own, consider joining a support group. Manyhospitals, workplaces, and community groups offer classes to help people quit smoking.For more information about how to quit smoking, go to the Health Topics Smoking and YourHeart article and the NHLBIs "Your Guide to a Healthy Heart."Manage StressResearch shows that the most commonly reported "trigger" for a heart attack is anemotionally upsetting event—particularly one involving anger. Also, some of the wayspeople cope with stress—such as drinking, smoking, or overeating—arent healthy.Learning how to manage stress , relax, and cope with problems can improve your emotionaland physical health. Having supportive people in your life with whom you can share yourfeelings or concerns can help relieve stress.Physical activity, medicine, and relaxation therapy also can help relieve stress. You may wantto consider taking part in a stress management program.MedicinesTo slow the progress of plaque buildup, your doctor may prescribe medicines to help loweryour cholesterol level or blood pressure. He or she also may prescribe medicines to preventblood clots from forming.For successful treatment, take all medicines as your doctor prescribes.Medical Procedures and SurgeryIf you have severe atherosclerosis, your doctor may recommend a medical procedure orsurgery.
  21. 21. Angioplasty (AN-jee-oh-plas-tee) is a procedure thats used to open blocked or narrowedcoronary (heart) arteries. Angioplasty can improve blood flow to the heart and relieve chestpain. Sometimes a small mesh tube called a stent is placed in the artery to keep it open afterthe procedure.Coronary artery bypass grafting (CABG) is a type of surgery. In CABG, arteries or veinsfrom other areas in your body are used to bypass (that is, go around) your narrowed coronaryarteries. CABG can improve blood flow to your heart, relieve chest pain, and possiblyprevent a heart attack.Bypass grafting also can be used for leg arteries. For this surgery, a healthy blood vessel isused to bypass a narrowed or blocked artery in one of the legs. The healthy blood vesselredirects blood around the blocked artery, improving blood flow to the leg.Carotid endarterectomy (END-ar-ter-EK-to-me) is surgery to remove plaque buildup from thecarotid arteries in the neck. This procedure restores blood flow to the brain, which can helpprevent a stroke.