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4. Heart/Lung Conditions & Stroke

Heart and Cardiovascular Disease

What is heart and cardiovascular disease?

While often thought of as the same thing, heart and cardiovascular disease are different, involving different parts of your body.

Heart disease refers only to diseases of the heart and the blood vessel system within the heart.

Cardiovascular disease refers to diseases of the heart and diseases of the blood vessel system (arteries, capillaries, veins) within a person's entire body, such as the brain, legs, and lungs. "Cardio" refers to the heart and "vascular" refers to the blood vessel system.

The heart is a strong, muscular pump slightly larger than your fist. It pumps blood continuously through the circulatory system, the network of elastic tubes that allows blood to flow throughout your body. The circulatory system includes two major organs, the heart and lungs, and blood vessels (arteries, capillaries, and veins). Arteries and capillaries carry oxygen- and nutrient-rich blood from the heart and lungs to all parts of the body. Veins carry oxygen- and nutrient-depleted blood back to the heart and lungs. Heart and blood vessel problems do not happen quickly. Over time, the arteries that bring blood to the heart and brain can become blocked from a buildup of cells, fat, and cholesterol (plaque). Reduced blood flow to the heart from blockages in the arteries causes heart attacks. Lack of blood flow to the brain from a blood clot, or bleeding in the brain from a broken blood vessel, causes a stroke.

Do women really need to worry about heart and cardiovascular disease?

Yes. Many women think heart disease is a man's problem, but heart disease is very much a woman's problem. Did you know that heart disease is the #1 killer of women, as well as men in America? And that stroke is the 3rd leading cause of death for American women (cancer is #2)? Heart disease affects women of all racial and ethnic groups, as well as women with other illnesses, such as diabetes. Black women are more likely to die of heart disease than white women are. Increasing age is also a factor in heart disease and with people age 65 and over being the fastest growing group in the U.S., heart disease is becoming a growing problem for women.

Almost twice as many women die from cardiovascular diseases than from all forms of cancer combined. Men have heart attacks and strokes more often than do women. But, the death rate for women from cardiovascular disease is higher. As women age, particularly after menopause, they become more at risk for cardiovascular disease. Lower levels of estrogen during and after menopause are thought to increase a woman's risk for cardiovascular disease. Early menopause, natural or surgical, can double a woman's risk for developing coronary heart disease (see next question for definition). Younger women are also at risk for cardiovascular disease if they smoke or have high blood pressure, diabetes, high cholesterol levels, and a family history of cardiovascular disease at young ages. Women with congenital heart disease (born with a heart defect) have a higher risk of having a baby with a heart defect.

What are the different types of heart and cardiovascular disease?

There are many forms of heart and cardiovascular disease, and what follows is a description of the most common of these diseases. The National Women's Health Information Center (NWHIC) has provided links at the beginning of this FAQ, as well as at the end, for further information.

Atherosclerosis. Atherosclerosis is a type of arteriosclerosis (or thickening and hardening of the arteries). As we age, some hardening of the arteries can occur naturally. When a person has atherosclerosis, the inner walls of the arteries become narrower due to a buildup of plaque. Plaque results from deposits of fat, cholesterol, and other substances. Blood clots form, blocking blood flow, which

can lead to heart attacks and strokes. High blood cholesterol, smoking, high blood pressure, diabetes, obesity, and not being physically active all put you at greater risk for atherosclerosis.

Coronary heart disease (or coronary artery disease). Coronary heart disease, the most common form of heart disease, affects the blood vessels (or coronary arteries) of the heart. It causes angina (chest pain) and heart attacks. Women over the age of 40 are more at risk for this disease because heart-related problems tend to increase with age. And, black women are more likely to die of coronary heart disease than are white women. The good news is that you can do something about preventing this disease. High blood pressure and cholesterol, smoking, obesity, and not being physically active all put you at greater risk for coronary heart disease.

Angina. A pain or discomfort in the chest that happens when some part of the heart does not receive enough blood. It feels like a pressing or squeezing pain, often in the chest under the breastbone, but sometimes in the shoulders, arms, neck, jaw, or back. The most common trigger for angina is physical exertion. Other triggers can be emotional stress, extreme cold or heat, alcohol, and smoking. Angina seldom causes permanent damage to the heart, like a heart attack can. A heart attack happens when the blood flow to a part of the heart is suddenly and permanently cut off.

Stroke. Lack of blood flow to the brain from a blood clot, or bleeding in the brain from a broken blood vessel, causes a stroke. Without a good blood supply, brain cells cannot get enough oxygen and begin to die. You can also have what are sometimes called "mini strokes," or transient ischemic attacks (TIAs), where no damage is done to the brain. But even though they do no damage, TIAs are serious and can put you at higher risk of having a full stroke. Not controlling high blood pressure, smoking, and diabetes all increase your risk for stroke.

High blood pressure (or hypertension). There are ways to measure blood pressure and medications to treat high blood pressure (by lowering it). A blood pressure reading measures the force of blood pumped from the heart against the walls of your blood vessels. It is recorded as two numbers: a top number of systolic pressure, or the pressure of blood in the vessels as the heart beats; and a bottom number of diastolic pressure, or the pressure of the blood between heart beats (when the heart rests). Although the average blood pressure reading for adults is 120/80, a slightly higher or lower reading (for either number) may not be a problem. High blood pressure is diagnosed when the reading consistently exceeds 140/90. It is often called a "silent" killer because it usually has no signs or symptoms. High blood pressure can cause heart failure in women, and can lead to stroke, kidney failure, and other health problems. More than half of all women over age 55 suffer from this serious condition. And, it is more common and more severe in black women. Talk to your health care provider and get your blood pressure monitored regularly. If you have high blood pressure, diet, exercise, and medicine can help you to lower and control your blood pressure.

Heart failure. Heart failure means that the heart is not able to pump blood through the body as well as it should. It does NOT mean that the heart literally stops. Heart failure develops slowly over time and can have a large impact on a person's life and ability to perform daily activities of living, such as dressing, bathing, and getting around.

Congestive heart failure is a term often used to describe heart failure. But congestion, or the buildup of fluid, is only one symptom of heart failure and does not occur in all people who have heart failure. There are two main categories of heart failuresystolic and diastolic and within each category, symptoms can differ from person to person. Systolic heart failure happens when the heart's ability to pump blood decreases. The heart cannot push enough blood into the circulatory system, causing blood coming into the heart from the lungs to back up and leak fluid into the lungs (called pulmonary congestion). Diastolic heart failure occurs when the heart has trouble relaxing or resting. The heart muscle becomes stiff and cannot fill with blood, causing fluid to buildup (most often in the feet, ankles, and legs) and lung congestion. Talk with your health care provider right away if you have any of the signs of heart failure. There are drugs to treat heart failure. Having a healthy diet and getting regular exercise can lower your risk for heart failure.

What increases my chances for getting heart and cardiovascular disease?

Many things can put a woman at risk for heart and cardiovascular disease. The more risk factors (or things that increase risk) a woman has, the greater the chance that she will develop heart or cardiovascular disease. There are some factors that you can't control such as getting older, family health history, and race. But you can do something about the three biggest risk factors for heart and cardiovascular disease smoking, high blood pressure, and high blood cholesterol. Stopping smoking will reduce your risk and you can get help, through support groups, special behavior change programs, and medication, to quit. High blood pressure and high blood cholesterol can be controlled through diet, exercise, and medication. Talk with your health care provider about developing a plan for heart and cardiovascular health.

Studies have shown that physical inactivity adds to a person's risk for getting heart and cardiovascular disease. People who are not active are twice as likely to develop heart and cardiovascular disease compared to those who are more active. Excess body weight in women is linked with coronary heart disease, stroke, congestive heart failure, and death from heart-related causes. The more overweight you are, the higher your risk for heart disease.

Diabetes, sometimes referred to as high blood sugar, is a serious condition that raises a woman's risk for heart and cardiovascular disease. Women with diabetes have a greater risk of heart disease and stroke than do women without diabetes. Diabetes, high blood pressure, high cholesterol, and obesity often go hand-in-hand, raising a person's risk for heart disease. And, diabetes has been found to double the risk of a second heart attack in women but not in men.

Being around tobacco smoke for large amounts of time, or all the time, can increase a person's risk for cardiovascular disease, even if you do not smoke. Today's low-dose birth control pills carry a much lower risk of heart disease and stroke than the higher-dose earlier pills did. But this is not the case for women who smoke or who have high blood pressure.

How can I reduce my risk for heart and cardiovascular disease?

Regular physical activity can help you reduce your risk of heart and cardiovascular disease. Being active helps women take off extra pounds, helps to control blood pressure, lessens a diabetic's need for insulin, and boosts the level of "good" cholesterol. Some studies show that being inactive increases the risk of heart attack. Other ways to reduce your risk include: Quit smoking talk with your health care provider if you need help quitting.

How much difference can diet and exercise really make on the health of my heart and cardiovascular system?

Having a low saturated fat, low cholesterol diet and getting regular exercise are excellent health habits for all women to have. These good health habits will lower blood pressure and keep blood sugar and blood cholesterol levels healthy. Studies have shown that being physically active decreases the risk of cardiovascular disease, high blood pressure, and diabetes.

Women, along with most Americans, are becoming more and more inactive. About 60% of American women do not engage in the recommended amount of physical activity needed to maintain health. The Surgeon General recommends getting 30 minutes of moderate activity on most, and preferably all, days of the week to protect heart and overall health. This includes activities such as brisk walking, bicycling, and gardening. You do not have to do the activity for 30 minutes in a row; you can divide it into shorter periods of at least 10 minutes each. Women who have had heart attacks might worry about exercising after their recovery. Studies have shown that people who include regular physical activity in their lives after a heart attack, improve their chances of survival. If you have had a heart attack, talk with your health care provider about developing an exercise plan.

How does high blood cholesterol affect my risk for heart and cardiovascular disease?

Over 25 percent of American women have blood cholesterol levels high enough to put them at risk for heart disease. Cholesterol is a waxy substance found in all parts of the body. It makes cell membranes, some hormones, and Vitamin D. Cholesterol comes from two sources: your body and the food you eat. Your liver makes all the cholesterol your body needs. Eating too much cholesterol in animal foods like meats, whole milk dairy products, egg yolks, poultry, and fish can make your cholesterol go up. However, saturated fat in your diet is the main culprit that causes your cholesterol to rise.

Cholesterol travels through the blood in packages called lipoproteins. Low density lipoprotein (LDL) and high density lipoprotein (HDL) are two types of lipoproteins. LDL is often called the "bad" type of cholesterol because it can cause buildup and blockage in the arteries that carry blood to your heart. HDL is known as "good" cholesterol because it helps remove cholesterol from the blood, preventing buildup and blockage in the arteries. The higher your cholesterol, the greater your risk for heart disease.

From the time women turn 20 years old, their blood cholesterol levels start to rise. From age 40, they rise sharply and increase until about age 60. Being overweight and physically inactive also can raise your level of bad (LDL) cholesterol and lower your level of good (HDL) cholesterol. Family history (genes) can also affect how your body makes and handles cholesterol. All women age 20 and over need to have their blood cholesterol checked. High blood cholesterol is an important risk factor for heart disease that you can help control with diet, exercise (which will increase HDL and lower LDL), and quitting smoking. In some cases, your health care provider might prescribe cholesterol-lowering medication.

I had my cholesterol checked but I do not understand the results. What do they mean?

Talk to your health care provider about the results of your cholesterol test. The following guidelines come from the National Cholesterol Education Program (NCEP) of the National Heart, Lung, and Blood Institute, National Institutes of Health. Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood.

You can also talk with your health care provider about what you can do to help control your cholesterol, including:

What makes my bad cholesterol levels go up?

The main cause of high blood cholesterol is eating too much fat, especially saturated fat. Saturated fats are found in animal products, such as meats, milk and other dairy products that are not fat free, butter, and eggs. Some of these foods are also high in cholesterol. Fried fast foods and snack foods often have a lot of fat.

Being overweight and not exercising can make your bad cholesterol go up and your good cholesterol go down. Also, after women go through menopause, their bad cholesterol levels tend to go up. There is also a rare type of inherited high cholesterol that often leads to early heart disease.

How can I lower my bad cholesterol level?

Reducing your LDL (bad) cholesterol and total blood cholesterol levels can greatly lessen the chances of getting heart disease. Most people can lower their blood cholesterol by changing their diet, losing excess weight, and exercising more. These changes can also help reduce your risk for diabetes and lower your blood pressure.

How can I plan meals that have low saturated fat and cholesterol levels?

Many packaged and processed foods are high in saturated fats and some also contain trans fats. Get in the habit of reading food labels. Look for the "Nutrition Facts" on the label and choose products that are lowest in fat. Also read product labels for cholesterol content.

It is usually easier to follow a diet low in saturated fat and cholesterol when preparing meals at home than when eating out. But it is possible to make careful food choices and avoid overeating whether you are eating in a restaurant or at home.

What kinds of exercise should I do to lower my high blood cholesterol?

Get at least 30 minutes of exercise most days of the week. Even low to moderately intensive activity, if done daily, can provide benefits. Talk to your health care provider about the safest and best ways for you to exercise. Some examples of good ways to exercise include walking, yard work, housework, and dancing.

More vigorous exercise can raise your HDL level and will improve the overall fitness of your heart. This kind of activity is called aerobic and includes jogging, swimming, jumping rope, or brisk walking or bicycling. Build up your activity level gradually over a period of several weeks.

Be sure to check with your doctor before starting a vigorous exercise program.

What else can I do to lower my risk of heart disease?

What if I need medicine for high cholesterol levels?

Medicine to lower your cholesterol levels, if needed, is used along with lifestyle changes. It is still very important to adopt a diet low in saturated fat and cholesterol, increase your physical exercise, and manage your weight.

The main goal of cholesterol-lowering treatment is to lower your LDL (bad cholesterol) level enough to reduce your risk of getting heart disease or having a heart attack. There are several types of drugs available for cholesterol lowering, including statins, bile acid sequestrants, nicotinic acid, and fibric acids. Your doctor will prescribe medicine for you if needed.

How do I know if I have heart or cardiovascular disease? Are there any tests?

Heart disease can often have no symptoms, which is why it is called a "silent" killer. But, there are some symptoms that can alert you to a possible problem. Chest or arm discomfort, especially while under stress or during activity, is a classic symptom of heart disease, and is a warning sign of a heart attack. You may also have fatigue (with no reason why), shortness of breath, dizziness, nausea, or abnormal heart beats (palpitations).

Talk with your health care provider if you think you may be having any symptoms of heart disease. Your health care provider will first take a complete medical history and do a physical exam. There are many tests for heart disease. The choice of which (and how many) tests to perform depends on a person's symptoms and history of heart problems. A health care provider will most often start with simple tests, which may lead to tests that are more complex. More than one test may be needed because each test gives different information. Tests can be either invasive or noninvasive. Invasive tests involve the insertion of needles, instruments, or fluids into the body; noninvasive tests do not.

What are the signs of heart attack and stroke?

Know that not everyone gets all of the following warning signs of heart attack or stroke. And, sometimes these signs can go away and return. Treatments are most effective if given within one hour of when the attack begins. If you have any of these symptoms, call 911 right away!

The signs of heart attack include:

As with men, women's most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to have some of the other warning signs, particularly shortness of breath, nausea, vomiting and back or jaw pain.

The signs of stroke include:

What are palpitations or "extra" heartbeats? Are they dangerous?

"Extra" heartbeats, also called palpitations, or premature ventricular contractions (PVCs) happen when there is irritation in the lower part of the heart's pumping chambers. PVCs interrupt the normal heart rhythm and cause an irregular beat that can feel like a "missed beat" or a "flip-flop" in the chest. This can be harmless or it may lead to problems that are more serious.

If a woman has palpitations and other symptoms such as dizziness or shortness of breath, she should tell her health care provider right away. The health care provider will take a complete medical history and perform a physical exam, and may order further tests to determine the cause of the palpitations. In some people, caffeinated products (coffee, candy bars), alcohol, and stress can cause palpitations. When a woman is in perimenopause (the time before menopause), changing hormone levels can also cause harmless palpitations.

What is an arrhythmia? Can you have a heart arrhythmia without having heart or cardiovascular disease?

Most people have felt their heart beat very fast, felt a fluttering in their chest, or noticed that their heart skipped a beat. Almost everyone has also felt dizzy, faint, or out of breath or had chest pains at one time or another. While these experiences of heart arrhythmias (a change in the regular beat of the heart) can create anxiety, they are, for most people, harmless. As adults age, they are more likely to get arrhythmias. Only a very small number of people have arrhythmias that are dangerous. Don't panic if you have a few flutters or your heart races once in a while. If you have questions about your heart rhythm or symptoms, talk with your health care provider.

Is it safe to take an aspirin a day to prevent heart disease?

If you have already had a heart attack, aspirin helps to lower the risk of having another one. It also helps to keep arteries open in those who have had a heart bypass or other artery-opening procedure such as coronary angioplasty. But, because of its risks, aspirin is NOT approved by the Food and Drug Administration for preventing heart attacks in healthy people. It may even be harmful for some persons, especially those with no risk of heart disease. Talk to your health care provider about whether taking aspirin is right for you. Be sure not to confuse aspirin with other common pain relieving products such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxyn sodium (Aleve).

Do birth control pills and hormone therapy (HT) increase a woman's risk for heart disease?

Birth control pills have little increased risk of heart disease for women who have not gone through menopause (when periods stop). But, they can pose heart disease risks for some women, particularly women with high blood pressure and women who smoke. Talk with your health care provider about whether birth control pills are best for you.

In the past, taking hormone therapy (HT) (estrogen plus progestin) was thought to help protect women against heart disease. But recent findings from the Women's Health Initiative (WHI) study, sponsored by the National Heart, Lung, and Blood Institute, showed that taking HT poses more risks than benefits. The study found that HT could increase a woman's risk for heart disease, stroke, and pulmonary embolism (blood clot in the lung), as well as breast cancer. Because of these findings, the U.S. Preventive Services Task Force recommends that women who have gone through menopause should not be given HT to prevent heart disease and other chronic conditions. For more information on this study, go to and click on "Postmenopausal Hormone Therapy," or call the number listed at the end of this FAQ, in the "For more information" section. The WHI is also looking at the effect of taking estrogen alone (this is given to women who have had a hysterectomy, or no longer have a uterus, or womb) on heart disease and other conditions; results should be available in the next few years, or sooner.

Earlier studies have also shown that women wh o have gone through menopause and who have heart disease, may have a greater risk of another cardiac event (like heart attack) after starting HT, at least in the short-term. For women who have had strokes, their risk for having another stroke goes up when they start taking HT. Hormones are not recommended for women with heart disease or for women who have had a stroke. If you have gone through menopause, talk with your health care provider about whether hormones are right for you. And, keep checking the NWHIC website home page ( for updates on postmenopausal hormone therapy.

If you are taking birth control pills or HT, watch for signs of trouble, such as abnormal bleeding, breast lumps, shortness of breath, dizziness, severe headaches, pain in your calves or chest, and report them to your health care provider right away. Also, talk with your health care provider about how often you should have an exam.

Diagnosing Heart Disease

Why should I be concerned about heart disease?

Many women are surprised to learn that heart disease is the leading cause of death for women. Heart disease is a general term for a wide variety of diseases and conditions that affect the function of the heart. For detailed information on the different types of heart disease, refer to the NWHIC FAQ on "Heart and Cardiovascular Disease" or click on the link above.

How can I find out if I have heart disease?

To diagnose heart disease, your doctor will first review your medical history, health behaviors, family history, and other risk factors for heart disease. Your doctor will ask you about having any chest pain, fatigue, shortness of breath, weakness, and swelling of the feet and ankles. These symptoms may mean that you could have heart disease.

Your doctor will then perform a physical exam and focus on your lungs, heart and all of the blood vessels near and around the heart. They will place a stethoscope on your chest to listen to your heartbeat and to other areas to hear the heart valves. They will also listen to your lungs for sounds that they could have fluid inside them (which can be the result of heart disease). Your doctor may order special heart tests to confirm or rule out heart disease, figure out the extent of disease, or help in planning a treatment that is best for you.

When a person develops heart disease, it is most often due to a number of risk factors (rather than a single factor). Some of the risk factors for heart disease are beyond your control, such as age, family history of heart disease, and prior heart disease. But, there are risk factors you can do something about. Risk factors you can control include smoking, high blood pressure, high blood cholesterol, overweight and obesity, physical inactivity, and diabetes. If you have one or more of these risk factors, talk with your doctor to find out how to reduce your risk of getting heart disease.

What is an ECG or an electrocardiogram?

An electrocardiogram ECG, also called an EKG, is a simple, painless test that records the electrical activity of your heart. It is done by placing patches with metal contacts (electrodes) on a person's arms, legs, and chest, which are hooked up to an ECG machine. These electrodes measure the electrical impulses in the heart and record them on a moving strip of paper. An ECG also gives information about the heart's rhythm and the size of the different heart chambers. A 12-lead ECG means that there are 12 tracings that can give a view of the heart from 12 different angles. With this type of ECG, your doctor can tell which part of the heart you are having a heart attack in.

How can a chest x-ray help diagnose heart disease?

A chest x-ray shows the size and shape of the heart, which can be larger than normal (or enlarged) in conditions such as congestive heart failure. The lungs are also looked at for fluid build-up, which is most often caused by heart failure.

What is an echocardiogram (echo)?

An echo provides moving pictures of the heart using sound waves. It is an ultrasound test, very similar to the test done on pregnant women to look at the growing fetus. An echo takes pictures of the heart chambers, valves and the major blood vessels running to and from the heart. It gives very detailed information about all areas of the heart and can detect abnormalities or problems with the heart's pumping action. Echos are not invasive (meaning there is nothing inserted into the body, such as needles, instruments, or fluids) and don't involve radiation.

How is an echocardiogram performed?

A standard echo procedure involves placing a small recording probe, called a transducer, on the chest. Before the echo is done, a technician or doctor will first place some clear jelly onto your chest to help the transducer, or wand, slide around easily to take pictures of different parts the heart. The image appears on a video screen and is recorded on videotape or paper.

What other tests might be performed with an echocardiogram?

A special exam, called the Doppler, can be done with an echo and gives information about the direction and speed of blood flow in the heart. From this, doctors can tell how heart valves are working, whether they are narrowed, and how much a valve is narrowed or leaking. Other types of echos include M-mode and 2-D echocardiograms. M-mode echos look at a one-dimensional view of a small section of the heart as it moves. 2-D echocardiograms produce a moving, two-dimensional slice of the heart.

In some cases, your doctor may do an echo in a slightly different way. This may include having you exercise while the echo is done (an exercise echo) or having medicine injected to increase your heart muscle's blood flow before the echo (a stress echo). These echos are a way to see whether or not your heart muscle gets enough blood flow and oxygen even when it is working its hardest.

I have heard many people talk about stress tests. What is a stress test?

Stress tests are done to diagnose many types of heart problems. They often look for blockages in the arteries that supply blood to the heart. A stress test most often involves monitoring your heart while you exercise. This is because the amount of exercise a person can endure, or handle, can tell a lot about heart disease and how severe it may be (when a person has heart disease). Your doctor may suggest this test if they feel that your arteries may be blocked. There are also stress tests for people who can't exercise.

What happens when a treadmill stress test is performed?

Before the treadmill stress test, an ECG will be performed and your blood pressure will be taken. A few plastic-coated wires will be taped to your arms and one leg, so that your heart's electrical pattern can be picked up while you exercise. Your heart rhythm and blood pressure are also watched the entire time the test is being done. You will be asked to walk on a treadmill for about 10 minutes. The speed and steepness of the treadmill will be increased a few times during the test. Your doctor or a technician will be with you during the test, and you should let them know if you feel any chest pain, shortness of breath, leg pain, or other symptoms that do not usually happen when you exercise. Ask to stop the treadmill if you think you can't keep on exercising.

What are some different types of exercise stress tests?

The exercise stress test has a person walk on a treadmill or pedal an exercise bike. This test will tell if your heart muscle gets enough blood flow and oxygen even when it is working its hardest, such as during exercise.

The exercise stress test can sometimes be combined with other techniques to take pictures of your heart before and after exercise. A stress echo is one such test where an echo is done before and after exercise to see if the heart muscle responds the way it should to exercise. Sometimes your doctor may order a small amount of a liquid radioactive material called thallium or sestamibi be injected through a needle into your blood stream before and after exercise. Pictures of the heart are then made after you lie down on an exam table that has a camera overhead. This test may also be called an exercise-thallium, thallium-stress, nuclear stress, or exercise-mibi test. Your doctor will talk with you about the type of stress test that is best for you.

What about stress tests for people who can't exercise?

When you have a stress test without exercising, a medicine called dobutamine or dipyridamole/adenosine is injected through a needle into your blood stream. This slowly makes the heart work harder, which simulates how your heart would function if you were exercising. Pictures of the heart are then taken, either with an echo or thallium test, to look at the heart's pumping action and whether there are any problems with blood supply to one of the heart's walls.

My heart often skips beats and my doctor ordered a Holter Monitor test. What is this?

A Holter monitor is a test that lets your doctor see whether there are changes in the heart's rhythm or electrical appearance over a longer period of time than can be observed during one office visit. A few stickers with attached plastic-coated wires are placed onto the skin of your chest, which connect to a small monitor that you wear. The monitor, a machine about the size of a purse that records your heart rhythm, is worn for 24 or 48 hours while you carry on with your normal daily activities. You will be given a small diary so you can write down any symptoms you may feel during the test, as well as the time they happened.

Another type of monitor, called an event monitor, is used for people who only have heart-related symptoms now and then. It is a small machine that you turn on only when you have a symptom that may be due to heart-rhythm changes. The event monitor may be kept for up to one month.

What is cardiac catheterization?

Cardiac catheterization is a common procedure that is done to detect problems with the heart and heart function. A small tube (catheter) is placed up into and around the heart through a blood vessel in the groin or arm. Moving x-rays (angiograms) are then taken to show any problems with the coronary (or heart) arteries, heart chambers, major blood vessels, heart valves, and congenital (at birth) heart defects. This test can also be used to treat blocked coronary arteries by blowing up a small balloon at the site of the blockage to create a larger opening, called an angioplasty. When a catheter is used to inject dye into the coronary arteries, the procedure is called coronary angiography or coronary arteriography.

How is a cardiac catheterization performed?

A doctor, called a cardiologist, usually does a cardiac catherization, using equipment and cameras in a special lab. During the test, you lie on your back and your heart is hooked up to a monitor. After local anesthesia is given, a catheter (thin plastic tube) is placed inside your body through a blood vessel in your groin or arm. The catheter is gently guided up into your body to reach the arteries around the heart. The doctor will most likely measure pressures within the chambers of the heart, take blood samples, and carefully move the catheter into the arteries that deliver blood to your heart (or coronary arteries). While the catheter is pointed into each of the coronary arteries, the doctor will inject a special dye into the blood vessels. Pictures are taken with an x-ray machine. The pictures will show if there are any blockages in the arteries and how severe these blockages are. Other than the brief sting of the numbing medicine and soreness in your groin or arm afterward, you are not likely to feel any pain. If blockages are found, your doctor will discuss treatment options with you.

Are CT scans or MRI tests used to diagnose heart disease?

Yes, CT (computed tomography, or CAT) scans and MRI (magnetic resonance imaging) tests may be used to detect any problems with the structure or position of the heart, lungs, or blood vessels. The CT scan and the MRI provide a much clearer picture of your organs than an x-ray. These tests are sometimes used to avoid the potential risk of other invasive heart tests, such as angiography. Some of these tests are done by injecting through a needle a small amount of radioactive material into a vein.

CT scans use a unique x-ray machine that makes a circle around your body. Using measurements from every angle around this circle, the computer takes pictures, each showing a slightly different "slice" or "cross-section" of your body. MRI is often more costly and time-consuming, but it is preferred over other non-invasive heart tests. This is because MRI provides detailed pictures of the heart and blood vessels, shows the heart from many different views, clearly shows blood vessels, identifies structures (like clots) from moving blood, and helps to better understand findings from X-rays or CT scans. The main discomfort with CT scans and MRI is the closed in, or claustrophobic, feeling that some people have from being inside the scanner. An MRI may require you to lie still in the scanner for at least one hour. But, a technician watches you during the test and may enter the room to speak to you or may speak with you over an intercom in the MRI machine.

What is a MUGA scan and how is it performed?

The MUGA scan (Multiple Gated Acquisition scan) is a tool that looks at how the heart functions. It takes a moving picture of the beating heart, and from this image, the health of the cardiac ventricles (the heart's major pumping chambers) can be determined. If a person has had a heart attack or any other disease that affects the heart muscle, the MUGA scan can identify the part of the heart muscle that was damaged. It can also figure out the degree of the damage.

When having a MUGA scan, a radioactive substance called Technetium 99 is attached to red blood cells, which are then injected into the person's bloodstream. The person is then placed under a special camera (called a gamma camera), which picks up the low-level radiation being given off by the Technetium-labeled red cells. (The level of radiation to which a person is exposed during a MUGA scan is felt by experts to be quite small, it is in the same range as the level of radiation you get with a chest x-ray.) An image is produced by the gamma camera that outlines the chambers of the heart. The final image is like a movie of the heart beating.

There are so many tests to diagnose heart disease. How do I know which one is right for me?

Today, there are many tests to look at the heart and new tests are being developed. Your doctor will discuss the best test for you based on your symptoms, physical exam, health behavior, family history, and other risk factors. Remember also that new advances in the treatment of heart disease occur often, so it is important that you go to your doctor regularly for check-ups and to get any new or changing symptoms evaluated.

High Blood Pressure

What is high blood pressure and why is it so dangerous?

As blood is pumped from your heart through your body, the blood puts force or pressure against the blood vessel (or artery) walls. Your blood pressure is a reading, or measure, of this pressure. When that reading goes above a certain point, it is called high blood pressure, another name for hypertension. When you have high blood pressure, it is partly because your blood vessels become narrower, forcing your heart to pump harder to move blood through your body. These changes cause the blood to press on the vessels walls with greater force.

High blood pressure is called the "silent killer" because it usually has no signs or symptoms. It is dangerous because it makes the heart work too hard. If not controlled over time, high blood pressure can affect not only your heart and blood vessels but also other organs, making them function not as well as they should. The effects of uncontrolled high blood pressure include:

Stroke. High blood pressure is the most important risk factor for stroke. High blood pressure can cause a break in a weakened blood vessel in the brain. This can cause bleeding in the brain, which is a stroke. If a blood clot blocks a narrowed blood vessel, it can also cause another type of stroke.

Congestive heart failure.

High blood pressure is the number one risk factor for congestive heart failure, a serious condition where the heart is not able to pump enough blood to meet the body's needs.

While high blood pressure can't be cured, in most cases, it can be prevented and controlled with a healthy lifestyle and medication.

Should women be concerned about high blood pressure?

More than half of all women over age 55 suffer from high blood pressure, or hypertension. It is more common and more severe in black women. But this serious condition affects many Americans. In fact, 1 in 4 American adults have high blood pressure.

High blood pressure causes 3 of every 5 cases of heart failure in women. It can also lead to stroke, kidney failure, heart attack, and other health problems. Women who have both diabetes and high blood pressure are at an even greater risk of stroke and kidney problems than are women who have only high blood pressure.

What causes high blood pressure?

For the majority of people with high blood pressure, the cause is unknown. Narrowing of the arteries, a greater than normal volume of blood, or the heart beating faster or more forcefully than it should, will cause increased pressure against the artery walls. Why this occurs in some people may not be clearly understood.

Less than ten percent of cases of high blood pressure are caused by other medical problems or illnesses. This type of high blood pressure is often temporary, and cured when the original medical problem is corrected.

What are the risk factors that contribute to high blood pressure?

Risk factors are habits or traits that make a person more likely to develop a disease. There are some risk factors for high blood pressure that you can do something about. Risk factors that you can reduce include a high sodium (salt) intake and obesity (being overweight). A sedentary lifestylebeing inactive and not exercising regularly can increase a person's chances for high blood pressure. Heavy drinking of alcohol will raise blood pressure. If you do drink alcohol, try not to drink more than 1 drink per day for women. If you are pregnant, you should not drink at all.

There are some risk factors for high blood pressure that you can't change. Heredity is one of these factors because high blood pressure tends to run in families. Racial background is another factor. Blacks are more likely to have high blood pressure than whites. Gender also plays a role in high blood pressure risk. Men have a greater risk of high blood pressure than do women up until age 55, then the risks become similar for men and women. At age 75 and older, women are more likely than men to have high blood pressure. Age is a risk factor for both women and men. Blood pressure tends to increase with age, and older people are more likely to have high blood pressure than younger people.

How can I tell if I have high blood pressure? What are the signs I should be looking for?

High blood pressure the "silent" killer does not have any signs. That is why it is so important to have your blood pressure checked regularly by a health care provider.

How is blood pressure measured?

Blood pressure is a measure of the force of blood pumped from the heart against the walls of your arteries (or blood vessels). It reflects how high the pressure in your arteries is to raise a column of mercury (similar to the way your temperature raises mercury in a thermometer), and is recorded as millimeters of mercury (mmHg).

Blood pressure is read as two numbers: a top number (systolic pressure), or the pressure of blood in the vessels as the heartbeats; and a bottom number (diastolic pressure), or the pressure of the blood between heartbeats. Although the average blood pressure reading for adults is 120/80, a slightly higher or lower reading (for either number) may not be a problem. If you have heart disease or major risk factors such as smoking, high cholesterol, diabetes, family history of heart disease or high blood pressure, or have gone through menopause (stopped having periods), your health care provider will help you aim for a lower blood pressure.

High blood pressure (or hypertension) in adults is defined as blood pressure that consistently exceeds 140/90 normally. Ask your health care provider to tell you what your blood pressure number is and what this means to you. Talk with your health care provider about ways to prevent, and if needed, to lower your blood pressure and about how often you need to have your blood pressure rechecked.

Many older people develop a form of high blood pressure called isolated systolic hypertension (ISH), which occurs when the top (systolic) number is high but the bottom (diastolic) number is normal. This type of high blood pressure also requires monitoring and treatment by your health care provider.
Blood Pressure* Categories in Women (for women 18 years and older, who are not taking antihypertensive drugs, and are not acutely ill)
CategorySystolic Diastolic
Optimalless than 120andless than 80
Normalless than 130andless than 85
(High blood pressure)
Stage 1140-159or90-99
Stage 2160-179or100-109
Stage 3180 or higheror110 or higher
*Blood pressure level in mmHG

Can high blood pressure be prevented?

If you have high blood pressure, you can lower it and control it with proper treatment. If you don't have high blood pressure now, you can take steps to prevent it from developing. You can help to control and prevent high blood pressure by taking the following steps:

Talk with your health care provider if you need help with these steps or have any questions or concerns.

When I get my blood pressure checked in my health care provider's office it is always sky high! Can I check my own blood pressure at home?

Some people have high blood pressure only when they visit their health care provider's office. This condition is called white coat hypertension. If your health care provider thinks you may have this condition, you may be asked to wear a device called an ambulatory blood pressure monitor. It is usually worn for 24 hours in order to get an accurate understanding of your blood pressure.

There are over-the-counter blood pressure measuring devices you can purchase in pharmacies and discount chain stores that you can use at home. These include the blood pressure cuff and a stethoscope and electronic monitors, such as digital readout monitors. Always be sure the person who will use the device reads the instructions before taking blood pressure readings. Your health care provider or pharmacist can help you check the device and teach you how to use it. You can also ask for their help in choosing the right type of blood pressure device for you. If you take your blood pressure at home, keep a record of the numbers and take them with you each time you see your health care provider.

Here are some tips for what you can do to ensure as accurate a blood pressure reading as possible:

What medicines are used to treat high blood pressure?

For some people, lifestyle changes are enough to lower blood pressure. For others, particularly those with heart disease, medication may also be required. If you do require medication, make sure you continue your lifestyle changes. These changes help the medications work better, and over time, you may be able to reduce the medication.

There are many different types of blood pressure medications that work in different ways. You may be prescribed one or a combination of several drugs to help lower your blood pressure. Diuretics (or water pills) reduce the amount of fluid in the body. Beta blockers help the heart to beat less often and with less force. Alpha blockers relax blood vessels, allowing blood to flow more easily. Alpha-beta blockers work the same way alpha blockers do but also slow the heartbeat, as beta-blockers do. Vasodilators open blood vessels by relaxing the muscle in the vessel walls. Calcium channel blockers (CCBs) prevent calcium from getting into the muscle cells of the heart and blood vessels, relaxing the blood vessels. A somewhat new type of high blood pressure drug, called angiotensin antagonists, helps prevent the blood vessels from narrowing.

When you are prescribed medication, you may need to take it for a short or long time period. Be sure that you understand your health care provider's directions on how to take the drug. Know the amount you should take, if you should take it each day, and what time(s) you should take it during the day. If you are not sure about how to take the medicine, contact your health care provider. Write down the directions and keep them in a handy place.

Bear in mind that blood pressure medications may not work the same for everyone, so you may need to try a few of them before you find the one that works best for you. Likewise, different dosages (or amounts) of a drug can affect people differently. Your health care provider may also need to adjust, or change, the drug's dosage for you. It may take some time to find the best medication and best dosage for you.

Some over-the-counter medications or natural supplements may worsen blood pressure or interfere with prescription medications. You should inform your health care provider if you are regularly taking any over-the-counter medications. If you have any questions about whether you can take an over-the-counter medication when you are taking blood pressure medication, talk with your health care provider before you take the drug. Also, be sure to inform your health care provider about any other prescribed medications you are taking.

It is important to talk with your health care provider right away if you are having any problems with your medication. If you think you are having a side effect, do not stop taking the drug. Talk with your health care provider right away and she or he will give you advice about what to do.


What is atherosclerosis?

Atherosclerosis is the buildup of fatty deposits called plaque on the inside walls of arteries. Arteries are blood vessels that carry oxygen and blood to the heart, brain, and other parts of the body. As plaque builds up in an artery, the artery gradually narrows and can become clogged. As an artery becomes more and more narrowed, less blood can flow through. The artery may also become less elastic (called "hardening of the arteries"). Atherosclerosis is the main cause of a group of diseases called cardiovascular diseases of the heart and blood vessels.

Source of enlargement: Natiuonal Heart, Lung, and Blood Institute

Atherosclerosis can lead to clogged arteries in any part of the body. When the arteries to the heart are affected, angina (chest pain) or a heart attack may result. If arteries in the leg are affected, leg pain may occur. Atherosclerosis of the arteries to the brain can cause strokes.

Atherosclerosis is common in the United States. It often starts in childhood and the arteries become narrowed or clogged over many years.

What is plaque?

Plaque is a combination of cholesterol, other fatty materials, calcium, and blood components that stick to the artery wall lining. A hard shell or scar covers the plaque. Plaques have various sizes and shapes. Some plaques are unstable and can rupture or burst. When this happens, it causes blood clotting inside the artery. If a blood clot totally blocks the artery, it stops blood flow completely. This is what happens in most heart attacks and strokes.

What causes plaque to form in arteries?

Although many risk factors are well known, the exact causes of atherosclerosis are not clear. Too much cholesterol in the blood, damage to the artery wall, and inflammation appear to play important roles in plaque buildup. Researchers are studying why and how the arteries become damaged, how plaque develops and changes over time, and why plaque can break open and lead to blood clots. There may be other factors that prove to be important in causing atherosclerosis.

What are the symptoms of atherosclerosis?

There are usually no symptoms until one or more arteries are so clogged with plaque that blood flow is severely reduced. This reduced flow of blood and oxygen to some part of the body (such as the heart) is called ischemia and may cause pain or discomfort. Some people have no symptoms until a blood clot forms, completely blocks an already narrowed artery, and causes a heart attack or stroke.

The symptoms you have depend on which arteries are badly clogged and what part of the body is affected by the reduced flow of blood.

All of these conditions are serious and should not be ignored. Arteries taking blood to the intestines, the kidneys, or other organs can also become clogged by plaque. This can sometimes lead to a medical emergency similar to a heart attack or stroke. Atherosclerosis can also cause erectile dysfunction in men.

What risk factors raise my chances of having atherosclerosis?

These risk factors raise your chances of having atherosclerosis:

The more risk factors you have, the more likely it is that you have atherosclerosis. Talk with your health care provider about your risks for atherosclerosis and cardiovascular disease.

How is atherosclerosis diagnosed?

If you don't have any symptoms and have not been diagnosed with cardiovascular disease, it is not easy to tell if your arteries are becoming clogged with plaque. But if you have high blood cholesterol, are overweight and get little exercise, smoke, or have other risk factors, there is a good chance that you have atherosclerosis. Eventually it can lead to heart disease, a stroke or other problems.

There are a number of tests that doctors use in diagnosing cardiovascular diseases, including blood tests, electrocardiograms (ECG), stress testing, coronary angiography, ultrasound, and computed tomography (CT). If you are at high risk for cardiovascular disease, your health care provider may suggest that you be tested.

Researchers are studying new tools to help find cardiovascular disease in earlier stages, before symptoms appear. For example, the National Heart, Lung, and Blood Institute is sponsoring a ten-year study called the Multi-Ethnic Study of Atherosclerosis (MESA). The MESA study will help show which risk factors are the best predictors of future heart disease in men and women and in certain ethnic groups.

How is atherosclerosis treated?

If your atherosclerosis leads to symptoms, the symptoms (such as angina) can be treated. Medicines are usually the first step in treating cardiovascular diseases. Other treatments include angioplasty procedures to open up clogged arteries and surgery, such as bypass surgery.

If you have high blood pressure, diabetes, or high blood cholesterol, these conditions can be treated as well. Lowering your blood cholesterol level can slow, stop, or even reverse the buildup of plaque. Cholesterol lowering can reduce the cholesterol content in unstable plaques to make them more stable and less prone to rupture.

One of the most important ways to have healthier arteries is to make lifestyle changes. Adopt a healthy diet, balance healthful eating with regular physical activity, don't smoke, and lose weight if you are overweight. If you have high blood cholesterol, high blood pressure or diabetes, follow your treatment plan. Making lifestyle changes can also help control these health problems.

Can I prevent or reverse atherosclerosis?

Yes. You can't do anything about your genes, your gender or your age, but you can adopt a healthy lifestyle.


What is angina and how will I know if I have it?

Angina, or angina pectoris, refers to symptoms such as chest pain or discomfort caused by reduced blood flow to the heart. Angina is often the first sign of heart disease.

The heart is a muscle that gets blood from blood vessels called the coronary arteries. If one or more of your coronary arteries has a blockage that reduces blood flow to your heart from time to time, you may have angina.

Narrowed and blocked arteries are usually due to a gradual buildup of fatty deposits called plaque inside the arteries. This process is called atherosclerosis.

Source of enlargement: Natiuonal Heart, Lung, and Blood Institute

People with angina usually feel discomfort (often a pressure-like pain) in or around the chest, shoulders, jaw, neck, back or arms. It may feel like a squeezing, pressing sensation in the chest. Angina pain is usually caused and made worse by exercise and eased by rest. The pain usually lasts 2-5 minutes. If you have this kind of chest pain, you should contact your health care provider. You can take medicine that will help your angina. If you suspect you might be having a heart attack (see warning signs below), call or have someone else call 9-1-1.

Not all chest discomfort is angina. For example, acid reflux (heartburn) and lung infection or inflammation can cause chest pain.

Here are some signs that your angina is very serious and you may be having a heart attack. If you have any of these signs, call 9-1-1 immediately:

Does angina mean I'm having a heart attack?

Not necessarily. An episode of angina is not a heart attack, but it does mean that you have a greater chance of having a heart attack. Angina pain means that some of the heart muscle is not getting enough blood temporarily. A heart attack, on the other hand, occurs when the blood flow to a part of the heart is suddenly and permanently cut off, usually by a blood clot. This can lead to serious heart damage.

Is all angina the same?

No. There are two main kinds of angina common or stable angina and unstable angina. Both kinds of angina mean an increased risk of heart attack, but unstable angina is often a major warning sign that a heart attack can happen soon.

People with common or stable angina have episodes of chest discomfort that usually occur in an expected pattern. Common angina occurs when you are exerting more than usual activity (such as running to catch a bus) or are under mental and emotional stress. The level of activity or stress that causes the angina is somewhat predictable, and the pattern changes only slowly. Resting or relaxing usually eases the discomfort.

Unstable angina, instead of appearing gradually, may first appear as a very severe episode or as frequently recurring bouts of angina. The chest pain of unstable angina is unexpected and usually occurs at rest, or may wake a person in the night. Sometimes an established stable pattern of angina may change sharply. For example, it may be provoked by far less exercise than in the past. Unstable angina should be treated as an emergency because it can lead quickly to a heart attack, dangerous heart rhythms, or even sudden death.

Are there other types of angina besides stable (common) and unstable angina?

There are two other forms of angina. One, Prinzmetal's or variant angina, is quite rare, but causes discomfort almost always when a person is at rest. It is caused by a spasm that narrows the coronary artery and lessens the flow of blood to the heart. The other is called microvascular angina. This type of angina occurs in people who have chest pain but have no apparent coronary artery blockage. The pain from microvascular angina results from poorly functioning blood vessels. Microvascular angina can be treated with the same medicines as common angina.

How is angina diagnosed?

Health care providers can usually find out if you have angina by listening to you talk about your symptoms and their patterns. They may also order some tests to further evaluate your angina. Tests may include x-rays; an electrocardiogram (ECG or EKG) at rest, and during and after exercise; a nuclear stress test; and coronary angiography. Variant angina can be diagnosed using a Holter monitor. Holter monitoring gets a non-stop reading of your heart rate and rhythm over a 24-hour period (or longer). You wear a recording device (the Holter monitor), which is connected to small metal disks called electrodes that are placed on your chest. With certain types of monitors, you can push a "record" button to capture a rhythm when you feel the symptoms of angina.

What should I do if I start to have unexpected chest pains while resting?

If you have unexpected chest pain at rest, seek immediate medical help. Call or have someone else call 9-1-1. This kind of pain may mean that clots are forming in an artery and are about to cause a heart attack. Medicine is available at the hospital that can stop clots from forming and dissolve existing clots.

How is angina treated?

Lifestyle changes and medicine are the most common ways to control stable angina. Although angina may be brought on by exercise, this does not mean that you should stop exercising. In fact, you should keep doing an exercise program that has been approved by your health care provider.

Risk factors for coronary artery disease should be controlled, including high blood pressure, cigarette smoking, high blood cholesterol, and excess weight. By eating healthfully, not smoking, limiting how much alcohol you drink, and avoiding stress, you may live more comfortably and with fewer angina attacks. You may need medicine to help lower your blood pressure or your cholesterol.

Drugs are often used to control angina. The most commonly used drug for angina is nitroglycerin, which relieves pain by relaxing blood vessels. This allows more blood to flow to the heart muscle and also decreases the workload of the heart. Nitroglycerin is taken when discomfort occurs or is expected. Your health care provider may prescribe other drugs to be taken every day to help reduce the heart's workload. Two types of drugs often used are called beta-blockers and calcium channel blockers.

What lifestyle changes can help with angina?

Talk to your health care provider about changes you can make to improve your heart health and your angina. You may benefit from:

What if lifestyle changes and medicine fail to control angina?

If lifestyle changes and drugs fail to ease angina, or if your risk of heart attack is high, you may need additional tests and treatment. One common test is cardiac catheterization. This test involves inserting a catheter (a thin tube) into a forearm or groin artery and threading the catheter into the heart. A dye can be injected and tracked by computerized x-ray (coronary angiography or arteriography) to show where the arteries are blocked. Balloon angioplasty may be used to open up narrowed arteries. This procedure uses a tiny balloon that is inflated briefly inside the artery. Sometimes a stent (a tiny metal mesh tube) is put in to help keep the artery open.

Heart Attack

What is a heart attack?

A heart attack occurs when there is a severe blockage in an artery that carries oxygen-rich blood to the heart muscle. The blockage is usually caused by the buildup of plaque (deposits of fat-like substances, or atherosclerosis) along the walls of the arteries. The sudden lack of blood flow to the heart muscle deprives the heart of needed oxygen and nutrients. If the blockage is not opened quickly, the heart muscle is likely to suffer serious, permanent damage as areas of tissue die.

The medical term for a heart attack is acute myocardial infarction. Acute means sudden, myo refers to muscle, and cardia refers to heart. The myocardium is the medical name for the heart muscle. Infarct means that (heart) tissue has been destroyed or killed because of the clogging of the blood vessels that supply oxygen to the heart.

Do women have to worry about having a heart attack?

Heart disease the cause of heart attack is the #1 killer of both men and women in the United States. The onset of heart disease is later in women than men due to the protective effects of female hormones before menopause. Women are also more likely to have additional health conditions (such as diabetes and high blood pressure) that increase their risk for more heart attacks.

How can I tell if I am having a heart attack?

Every minute counts, even if the symptoms seem to disappear! Know that not everyone gets all of these warning signs. And, sometimes these signs can go away and return. Treatments are most effective if given within one hour of when the attack begins. If you have these symptoms, call 911 right away!

Signs of heart attack include:

As with men, women's most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to have some of the other warning signs, particularly shortness of breath, nausea, vomiting and back or jaw pain.

Why is prompt treatment so important?

The longer you wait to get medical treatment, the greater the likelihood that you will have severe, permanent damage to your heart or even die. The earlier the treatment, the more likely it is that damage to your heart will be kept to a minimum. Remember, treatments are most effective if given within one hour of when the attack begins.

How is a heart attack diagnosed?

Heart attacks are most often diagnosed by health care providers in an emergency room. Some of the tests that can de done to tell if you have had or are having a heart attack include:

Electrocardiogram (EKG or ECG) checks the heart's rhythm and can locate the part of the heart where a heart attack might be occurring (or has occurred).

How is a heart attack treated?

Once it is clear that a person is having a heart attack, immediate treatment usually includes drugs to help open the blocked artery, which restores blood flow to the heart muscle, and prevents clots from forming again.

If you suffer a heart attack and get to an emergency room quickly, a therapy called reperfusion might be done. The sooner you have any part of this therapy, the better your recovery will be. Reperfusion involves:

If I have had one heart attack, will I have another one?

The odds of both women and men having a second heart attack are relatively high. That is why it is important to continue with medical follow-up treatment, participate in cardiac rehabilitation if possible, and make needed lifestyle changes (such as quitting smoking and starting an exercise program) to reduce the risk of another heart attack. If you had an unhealthy lifestyle before your heart attack, it is time to change your ways! Talk to your health care provider about diet, weight control, exercise, managing stress, and controlling your blood pressure and cholesterol levels.

Is it safe to have sex after a heart attack?

Most heart attack survivors are able to return to their usual sexual activities after recovering from their heart attack, just as they are able to return to other kinds of physical activity and to work. Be sure to talk to your health care provider about when you should resume sexual activity. It is normal to have fears about having another heart attack during sex, but this isn't likely to happen if you have recovered and are following your medical treatment plan.

Why is exercise so important after a heart attack?

Exercise is good for your heart muscle and overall health. It can help you lose weight, keep your cholesterol and blood pressure under control, reduce stress, and lift your mood. If you participate in a cardiac rehabilitation program, you will learn how to exercise safely and regularly to strengthen your heart and body. When exercising, you will need to watch out for signs of problems such as chest pain, shortness of breath, feeling dizzy or weak, irregular heartbeats, or cold sweats. If you develop these symptoms, stop exercising and call 911 for help right away.

How can I prevent a heart attack?

There are many things you can do to prevent heart disease and stay healthy. You probably already know what they arenot smoking, eating a heart healthy diet, getting plenty of regular exercise, keeping your weight under control, getting regular medical checkups, managing stress in your life, and controlling your blood pressure and cholesterol. It is also important for women to control other diseases they may have, such as diabetes and high blood pressure. Daily aspirin therapy or other medical treatment may be an option for you to help prevent heart disease and heart attack. Talk to your health care provider about your risks for heart disease, appropriate screening tests, and ask what steps you can take to improve your heart health.


What is a stroke?

A stroke is sometimes called a "brain attack." A stroke can injure the brain like a heart attack can injure the heart. Stroke is the result of cerebrovascular disease - disease of the blood vessels in the brain.

There are two types of stroke:

Ischemic stroke, the most common type of stroke. This type of stroke happens when there is a sudden lack of blood flow to some part of the brain, usually due to a blood clot blocking an artery or blood vessel. Often the artery is already clogged with fatty deposits (atherosclerosis).

Hemorrhagic stroke. Bleeding in the brain from a broken or leaking blood vessel causes this type of stroke. A hemorrhagic stroke may be due to an aneurysm - a thin or weak spot in an artery that balloons out and can burst.

Either type of stroke can cause brain cells to die. This brain damage may cause a person to lose control of certain functions, such as speech, movement, and memory. Like a heart attack, a stroke is an emergency and should be treated as quickly as possible.

What is a "mini-stroke" or TIA?

A "mini-stroke" refers to a transient ischemic attack (TIA). In a TIA, there is a short-term reduction in blood flow to the brain. This causes temporary stroke symptoms (often just for a few minutes) such as weakness or tingling in an arm or leg. TIAs don't cause brain damage, but they are important warning signs that a person is at risk of having a stroke. If you have a TIA, you should seek medical care right away to prevent a full stroke.

What are the warning signs of stroke?

Know that not everyone gets all of the following warning signs of stroke.  And, sometimes these signs can go away and return.  Treatments are most effective if given within one hour of when the attack begins.  If you have any of these symptoms, call 911 right away!

What are the effects of stroke?

A person who has a stroke may suffer little or no brain damage and disability, especially if the stroke is treated promptly. But stroke can lead to severe brain damage and disability, or even death. The type of disability caused by a stroke depends on the extent of brain damage and what part of the brain is damaged.

Stroke may cause paralysis or weakness of one side of the body, memory problems, mood changes, trouble speaking or understanding speech, problems with eating and swallowing, pain, depression, and other problems. Rehabilitation and medical treatment can help a person recover from the effects of stroke and prevent another stroke from occurring.

Where can stroke occur in the brain and how does that affect the body?

The brain is a complex organ. Each area of the brain is responsible for a particular function or ability. The brain is divided into four main parts: the right hemisphere (or half), the left hemisphere, the cerebellum and the brain stem. A stroke in the right hemisphere of the brain often causes paralysis in the left side of the body. This is known as left hemiplegia. In addition, a stroke in this part of the brain may cause:

Someone who has had a left hemisphere stroke may have right hemiplegia, paralysis of the right side of the body. She may also have:

A stroke that takes place in the cerebellum can cause:

Strokes that occur in the brain stem are especially devastating. The brain stem is the area of the brain that controls all of our involuntary "life-support" functions, such as breathing rate, blood pressure and heartbeat. The brain stem also controls abilities such as eye movements, hearing, speech and swallowing. Since impulses generated in the brain's hemispheres must travel through the brain stem on their way to the arms and legs, patients with a brain stem stroke may also develop paralysis in one or both sides of the body.

Who is at risk for stroke?

Stroke risks are higher in people who have a family or personal history of stroke and for African Americans. African American women have a higher risk of disability and death from stroke than Caucasian women do. This is partly because more African American women have high blood pressure, a major stroke risk factor. Age is also a factor: the chance of having a stroke more than doubles for each decade of life after age 55. Women who smoke or who have high blood pressure, heart disease, or diabetes are at greater risk of having a stroke. Hormonal changes with pregnancy, childbirth, and menopause are also linked to an increased risk of stroke.

How is stroke prevented?

The more stroke risk factors you have, the greater the chance that you will have a stroke. You can't control some risk factors, such as aging, family health history, race and gender. But you can change or treat most other risk factors to lower your risk.

Here are some of the best ways to prevent stroke:

Eat a healthy diet low in saturated fat and rich in fruits, vegetables, and whole grains. Don't overeat, and keep your weight under control.

How is stroke diagnosed?

Before a stroke can be treated, diagnostic tests must be performed. Health care providers must find out what kind of stroke it is to treat it correctly. A person thought to be having a stroke may have a neurological exam, blood tests and an electrocardiogram.

Other kinds of tests used in diagnosing stroke include:

How is stroke treated?

Strokes caused by blood clots can be treated with clot-busting drugs such as TPA (tissue plasminogen activator). TPA must be given within 3 hours of the start of a stroke to be effective, and tests must be done first. This is why it is so important for a person having a stroke to get to a hospital fast.

Other medicines are used to treat and to prevent stroke. Anticoagulants such as warfarin and antiplatelet agents such as aspirin interfere with the blood's ability to clot and can play an important role in preventing stroke.

Surgery is sometimes used to treat or prevent stroke. For example, carotid endarterectomy is the surgical removal of fatty deposits clogging the carotid artery in the neck that could lead to a stroke. For hemorrhagic stroke, surgical treatment may include placing a metal clip at the base of an aneurysm or removing abnormal blood vessels.

What about stroke rehabilitation?

Rehabilitation is a very important part of recovery for many stroke survivors. The effects of stroke may mean that you must change, relearn or redefine how you live. Stroke rehabilitation is designed to help you return to independent living.

Rehabilitation doesn't reverse the effects of a stroke. Its goals are to build your strength, capability and confidence so you can continue your daily activities despite the effects of your stroke. Rehabilitation services may include:

Lung Disease Overview

Why are the lungs important?

Our lungs allow us to breath and get oxygen into the bloodstream and the cells of our bodies. During a normal day, we breathe nearly 25,000 times, and take in (or inhale) large amounts of air. The air we take in is mostly oxygen and nitrogen. But air also has things in it that can hurt our lungs - bacteria, viruses, tobacco smoke, car exhaust, and other air pollutants. Lung disease is not only a killer, it can be life-long (or chronic). More than 30 million Americans are now living with lung disease.

What types of diseases can affect the lungs?

There are many types of lung diseases. The following diseases that can affect the lungs are grouped according to how they affect the lungs.

Asthma, chronic bronchitis, emphysema, and cystic fibrosis. These all affect a person's airways and limit or block the flow of air in or out of the lungs.

Respiratory failure, pulmonary edema, pulmonary embolism, and pulmonary hypertension (high blood pressure). These are caused by problems with the normal gas exchange and blood flow in the lungs.

Pneumonia and tuberculosis (TB). Bacteria or viruses can cause these diseases that affect the membrane (or pleura) that surrounds the lungs. Other infections can also affect the pleura.

Lung cancer. The number one cause of lung cancer is smoking. And the number of women with lung cancer is rising, particularly in younger women. Lung cancer is the leading cancer killer of American women.

Stiffening and scarring of lungs. The spaces between the tissues of the lungs (called the interstitium) can become stiff and scarred. This can be caused by drugs, poisons, infections, or radiation.

Lung disorders from unusual atmospheric pressure. Atmospheric pressures that are not typical can cause lung disorders, or lung problems. This includes high altitudes (like in the mountains) where the air has less oxygen, or deep water where there is more atmospheric pressure and higher nitrogen levels in the blood.

Common symptoms, or signs, of lung disease include trouble breathing and shortness of breath, while feeling as if you are not getting enough air. People often complain of a long-term cough that will not go away, coughing up blood, and having pain when inhaling (breathing in) or exhaling (breathing out).

What causes lung disease?

Known causes of lung disease include:

Some lung diseases, such as tuberculosis (TB), put a person more at risk for lung cancer. Lung cancer tends to develop in the areas of the lung that are scarred from TB.

Which lung diseases are the most common in women?

The most common lung diseases in women include:

Asthma - a disease in which the lung airways are inflamed (swollen) and react easily to certain triggers like viruses, smoke, dust, mold, animal hair, roaches, or pollen. The inflamed airways get narrow and make it hard to breathe. You can have chest tightness, wheezing, shortness of breath, or a cough that never seems to go away or gets worse over time. More women than ever before are dying from asthma because more women have taken up smoking in the last 20 years.

Chronic obstructive pulmonary disease (COPD) - a term used to describe two closely related lung diseases, emphysema and chronic bronchitis. Often, people have these diseases together. Chronic bronchitis is an inflammation that ends up scarring the lining of the bronchial tubes (tubes that make up the inside of the lungs). Women have higher rates of chronic bronchitis than men. Emphysema causes the walls between the air sacs within the lungs to become weak and break, making it hard for you to feel like you get enough air. While more men suffer from emphysema than women, it is increasing in women. Symptoms can include a cough that never seems to go away or that gets worse over time, increased mucus, a frequent need to clear your throat, shortness of breath, or trouble exercising.

Lung cancer - when abnormal (malignant) cells divide with control in the tissues of the lung and also can invade nearby tissues or spread through the bloodstream and to other parts of the body. There are two types of lung cancer: non-small cell lung cancer (cancer cells form in the tissue of the lungs) and small cell lung cancer (most often found in people who smoke or who used to smoke cigarettes). See your health care provider if you have any of these signs of lung cancer: a cough that doesn't go away or gets worse over time; constant chest pain; coughing up blood; hoarseness or wheezing; on-going problems with bronchitis or pneumonia; swelling of the neck and face; loss of appetite or weight loss; and extreme fatigue.

How is asthma diagnosed and treated?

Asthma can de diagnosed with these tests: spirometry (measures how open your airways are); chest x-ray (looks at the condition of your lungs); and electrocardiogram (sees if heart disease is causing your symptoms).

While asthma cannot be cured, it can be managed. You can often control asthma by taking any prescribed medicines that open the lung airways and treat inflammation. Types of asthma medicines include bronchodilators (to prevent asthma attacks and to stop attacks after they have started) and anti-inflammatories (to help control airway inflammation and prevent attacks). Common anti-inflammatory drugs are cromolyn, nedocromil, and corticosteroids. Anti-leukotrienes are oral medicines used to treat chronic asthma by fighting the inflammatory response to allergies. If you have asthma, it is important to stay away from triggers and see your provider regularly.

If you are pregnant, it is very important to manage your symptoms to prevent an attack. Asthma tends to worsen in the late second and early third trimesters, but some women may have fewer symptoms during the last four weeks of pregnancy. Not taking care of your asthma can threaten your baby's growth and survival. Besides taking your medications and avoiding triggers, you can get a flu shot after the first three months of pregnancy, and exercise only moderately, under the supervision of your health care provider regularly.

How is chronic obstructive pulmonary disease (COPD) diagnosed and treated?

To diagnose COPD, your health care provider will ask you about your family and personal history, and do a physical exam. She or he may ask you to have pulmonary function tests, which find out: the amount of air in the lung (called lung volume); the rate of oxygen and carbon dioxide exchange; and the amount of oxygen and carbon dioxide in your blood. Lung volumes are measured by breathing into and out of a device called a spirometer. Researchers are still looking for a way to figure out a person's chances of developing COPD, because none of the current tests find the disease before lung damage that cannot be repaired occurs.

As COPD gets worse over time, it can cause you to become unable to carry out your daily routine. At the very least, it causes shortness of breath that can make you need oxygen. Treatments can include bronchodilators (drugs used to open up air passages in the lungs), antibiotics, and exercise to strengthen muscles. Women with COPD can also get help through pulmonary rehabilitation, a program that helps people to cope physically and mentally with the disease. When you have COPD, it is important not to smoke. Talk with your provider if you do smoke and need help with quitting. For individuals with severe symptoms, lung transplants may be an option. Lung volume reduction surgery (a number of different types of surgeries that removes part of the lung) also is showing promise for some individuals in the last stages of emphysema.

How is lung cancer diagnosed and treated?

Your health care provider will look at your medical history, smoking history, exposure to substances, and a family history of cancer. You will also have a physical exam and maybe a chest x-ray and other tests. Your provider may order a bronchoscopy. During this test, a special instrument is inserted into your bronchial tubes to view the tubes and take a biopsy (remove cells or tissue) to see if there are cancer cells present.

As with other types of cancer, lung cancer can be treated in a number of different ways, including surgery, radiation, and chemotherapy. The kind of treatment depends on the stage or extent of the cancer, the individual's age, and overall health. Most lung cancer is hard to treat. The best way to fight lung cancer begins when you are young and well - by making the decision never to smoke.

What can I do to lower my risk of lung disease?

You can reduce your risk for getting lung disease. Things you can do include:

See your health care provider right away if you are having trouble breathing, having pain in the lungs, are coughing up blood, or have any of the symptoms described in this FAQ.


What is asthma?

Asthma is a chronic disease of the lungs. You can have a mild or serious form of asthma. If you have asthma, you may have a bad cough, wheezing, a tight feeling in the chest, and trouble breathing. Asthma cannot be cured, but it can usually be controlled.

In an asthma attack, the airways (or bronchial tubes) in your lungs react to some stimulus or trigger. The airways become inflamed and swollen and make more mucus than usual. Muscles around the airways in your lungs tighten or constrict. The constriction and swelling make it hard to breathe and cause the other symptoms of asthma.

Each year, nearly 500,000 Americans are hospitalized and more than 5,000 die from asthma. Children are more likely to develop asthma than adults, especially inner-city children. African Americans are hospitalized for asthma and are more likely to die from asthma than other Americans.

Are women affected by asthma differently than men?

Yes. Although boys are more likely than girls to have asthma, adult women are more likely than men to have asthma. Women are more likely than men to be hospitalized or to die from asthma. Research shows that asthma may be linked to women's hormonal changes. For example, asthma attacks may take place just before or during a woman's period.

A side effect of steroid medicines used for asthma is loss of bone density, which can lead to osteoporosis. Talk to your health care provider about ways to keep bones strong.

What causes asthma?

The cause of asthma is not yet understood. Both genetic and environmental factors appear to play roles in asthma. Many people with asthma have allergic reactions to particles breathed in through the air, such as animal dander and pollen. These common substances are called allergens, meaning that they cause an allergic reaction. The tendency to react to allergens by having an asthma attack is probably genetic. There is no cure for asthma, although it can be controlled by learning to avoid asthma triggers and by taking medicine.

What can trigger an asthma attack?

People with asthma have airways that are very sensitive to certain allergens or other stimuli. The triggers vary from one person to another. Some common causes of asthma attacks include:

This is not a complete list of all the things that trigger asthma. People may have trouble with one or more of these triggers. Everyone is different.

How can I find out if I have asthma?

If you are coughing, wheezing, having trouble breathing, or your chest feels tight, see your doctor or health care provider. There are tests to find out if you have asthma.

How is asthma treated?

Asthma treatment includes avoiding asthma triggers and using asthma medicines. If you react strongly to certain triggers, do everything you can to avoid them. This can reduce your need for medicine to control your asthma. Anti-allergy medicine and allergy desensitization shots are sometimes useful for people with allergies.

Two kinds of medicines are often used for asthma - those used to relieve acute symptoms and those used on a long-term basis to control asthma.

If you have mild asthma, you may use only a bronchodilator as needed to relieve your symptoms. If you have more severe asthma, you may need both kinds of medicines. It is important to use your medicines exactly as your doctor tells you.

Many people with moderate or severe asthma use a device called a peak flow meter at home to measure lung function. The peak flow meter can help warn of a possible asthma attack even before you notice symptoms. You can then stop the attack by taking your medicine right away. The meter can also tell you how well you are responding to medicine.

If you have asthma, talk to your doctor about a treatment plan. Your plan may include:

What can I do to prevent an asthma attack?

Here are some ways you can help prevent an asthma attack. Remember, everyone is different. Some people have trouble with pollen, others have trouble with tobacco smoke, and others may have trouble with animal dander. Follow the steps that make sense for you.

How does asthma affect a pregnant woman? Can I take my asthma medicine?

Asthma may get better, get worse, or stay the same during pregnancy. Most women with asthma have safe and normal pregnancies. But it is important for you to follow your treatment plan and control your asthma when you are pregnant. Uncontrolled asthma seems to be more harmful than taking asthma medicines.

Many asthma medicines are safe for use during pregnancy. Inhaled medicines are generally preferred because they are less likely to be passed on to the baby than oral medicines. However, oral medicines may be needed to control the symptoms. Talk with your doctor to make sure that your medicines are safe to take during pregnancy. Taking your asthma medicine helps make sure that your baby gets enough oxygen.


I just found out that I'm pregnant. It's great news! I also found out that I have active tuberculosis (TB). I've been really tired, but I thought it was just my busy job. I also had this cough that wouldn't go away. Sometimes, blood would come out when I'd cough. My doctor gave me pills to take. I wanted to wait to take the pills until after I have the baby. But the doctor said the pills won't hurt my baby. She also said that if I don't take the pills, the baby could get sick. I've been taking them for a little while now. I think everything will be ok.

What is tuberculosis (too-burr-cue-low-sis) or TB?

TB is a disease caused by bacteria (bak-teer-ee-uh) or germs. It can hurt any part of your body. But it normally hurts your lungs.

How would I get TB?

TB is spread in the air. If someone with TB in their lungs or throat coughs or sneezes, people nearby who breathe in the germs may get TB.

TB is NOT spread in these ways:

sharing dishes and silverware with someone who has TB

What are the types of TB?

1. Inactive TB. You have the TB germs, but it doesn't make you sick.

People with inactive TB

Many carry the TB germs in their bodies and never get sick from them. But if someone who carries the germs becomes weak from other health problems, the TB germs may become active TB disease.

2. Active TB. You have the TB germs, and they are growing. If this happens in your lungs, you can have these symptoms:

Who is more likely to get TB disease?

You are more likely to get TB disease if you:

What are the tests for TB?

A skin test is the main way to find out if you have the TB germs. With a needle, a small amount of liquid is put under your skin on the lower part of your arm. After 2 or 3 days, if you have a hard bump on your arm, your doctor will measure the bump and tell you if your test is positive or negative. If your test is positive, you most likely have TB germs.

If your skin test is positive, these tests will be done to see if you have active TB disease: 

TB can be found in other parts of your body besides your lungs. So you may have other tests too.

Is there medicine for TB?

If you carry TB germs (inactive TB), your doctor may ask you to take a pill called Isoniazid for six to nine months. While nine months is preferred, six months may be enough. This is a long time and may not be easy to do, but it's best to protect your health. The pills will most likely prevent active TB disease, although this is not 100% sure. If you already have active TB disease, your doctor will prescribe pills for six months or longer. You must take all prescribed medicine to cure the disease and prevent it from spreading to others. If you do not take the medicines, you can die from active TB.

If I have TB disease, can I give it to other people?

If you have active TB in your lungs or throat, you can give it to other people. You need to stay home from work or school. Visit your doctor. Your doctor will give you tests and then tell you when it's ok to go back. That may be 2 to 3 weeks after you start taking the pills.

Protect your family. Take these steps to prevent giving TB to them:

I'm pregnant and found out I have TB. Is it safe to take medicine while I'm pregnant?

Yes, there are pills you can take for TB while you're pregnant. If you have active TB, you will need to take pills for 9 months. But do NOT take Streptomycin. It is NOT safe.

If you have inactive TB, your doctor probably won't give you pills until after you have the baby. Some women may have to take pills before the baby is born. It depends on when you got TB and if you have other health problems, like HIV.

Can I breastfeed if I am taking pills for TB disease?

Yes, it is safe to breastfeed your baby if you are taking pills for active TB. The small amount of medicine that gets into your breastmilk does not hurt your baby.

For more information

Act in Time to Heart Attack Signs Campaign
National Heart Attack Alert Program
National Heart, Lung, and Blood Institute (NHLBI)
Phone Number(s): (301) 592-8573
Internet Address:

American Academy of Allergy, Asthma, and Immunology
Phone Number (s): (800) 822-2762
Internet Address:

American Academy of Family Physicians
Phone Number(s): (913) 906-6000
Internet Address:

American College of Allergy, Asthma, and Immunology
Phone Number (s): (847) 427-1200
Internet Address:

American College of Cardiology
Phone: 1-800-253-4636
Internet Address:

American College of Obstetricians and Gynecologists
Phone Number(s): (800) 762-2264
Internet Address:

American Lung Association
Phone Number(s): 212-315-8700
Internet Address:

American Social Health Association
Phone Number(s): (800) 783-9877
Internet Address:

American Society of Echocardiography
Phone Number(s): 919-861-5574
Internet Address:

CDC National STD and AIDS Hotline
Phone Number(s): (800) 227-8922
Internet Address:

Centers for Disease Control and Prevention (CDC)
National Prevention Information Network
Phone Number(s): (800) 458-5231
Internet Address:

Heart Information Service
Phone: (800) 292-2221
Internet Address:

National Asthma Education and Prevention Program
Phone Number(s): (301) 592-8573
Internet Address:

National Center for HIV, STD and TB Prevention
Internet Address:

National Cholesterol Education Program
National Heart, Lung, and Blood Institute (NHLBI)
Internet Address:

National Cholesterol Education Program National Heart, Lung, and Blood Institute (NHLBI)
Internet Address:

National Heart, Lung, and Blood Institute, NIH, HHS
Phones: (301) 592-8573 (Information Office), (800) 575-9355 (Blood Pressure & Cholesterol Information)
Internet Address:

National High Blood Pressure Education Program
National Heart, Lung, and Blood Institute (NHLBI)
Internet Address:

National Institute of Allergy and Infectious Diseases
Internet Address:

Centers for Disease Control and Prevention
National Institute of Child Health and Human Development Clearinghouse
Phone Number(s): (800) 370-2943
Internet Address:

National Institute of Neurological Disorders and Stroke
Phone Number(s): (800) 352-9424
Internet Address:

National Prevention Information Network (NPIN)
Phone Number(s): 800-458-5231
Internet Address:

National Stroke Association
Phone Number(s): (800) 787-6537
Internet Address:

National Vaginitis Association
Phone Number(s) : (800) 428-6397
Internet Address :

Planned Parenthood Federation of America
Phone Number(s) (800) 230-7526
Internet Address:

Texas Heart Institute
Phone Number(s): (800) 292-2221
Internet Address:

The Heart Truth National Awareness Campaign for Women about Heart Disease
National Heart, Lung and Blood Institute (NHLBI)
Phone Number(s): (800) 793-2665
Internet Address:

The Heart Truth National Awareness Campaign for Women about Heart Disease National Heart, Lung and Blood Institute (NHLBI)
Internet Address:

Women's Heart Foundation
Phone Number(s): (609) 771-9600
Internet Address: