About Heart Disease

Heart Anatomy

Medical illustration of a heart showing the aorta, right coronary artery, left main coronary artery, circumflex coronary artery and left anterior descending coronary artery, which work together to pump blood around the body.The Heart Is a Pump

The heart is a muscle that pumps blood around the body through a series of pipes. These pipes are called arteries. The left side of the heart receives fresh, oxygen-rich blood from the lungs and then pumps it out a large artery called the aorta that branches into smaller arteries that go to all parts of the body.

The various parts of the body then take the oxygen out of the blood and the now stale, oxygen-poor blood is returned to the right side of the heart through pipes called veins. The right side of the heart pumps this stale blood to the lungs where it picks up more oxygen and the cycle begins again.

The Coronary Arteries

The heart muscle, like every other part of the body, needs its own oxygen-rich blood supply. Arteries branch off the aorta and spread over the outside surface of the heart. The Right Coronary Artery (RCA) supplies the bottom part of the heart. The short Left Main (LM) artery branches into the Left Anterior Descending (LAD) artery that supplies the front of the heart and the Circumflex (Cx) artery that supplies the back of the heart.

Heart Disease

Heart disease, also known as cardiovascular disease, is a general term for a variety of conditions that affect the heart and blood vessels. It is a chronic disease that can lead to serious events including heart attack and death. Heart disease is one of the leading causes of death in Canada and worldwide. The most common form of heart disease is coronary artery disease (CAD) caused by atherosclerosis.

Coronary Artery Disease: Patient and Family Information


Over time, plaque builds up on the inside wall of arteries. Plaque is made of several substances including cholesterol. This build up is called atherosclerosis or hardening of the arteries. It can start at an early age and is caused by a combination of genetic and lifestyle factors that are called risk factors. Atherosclerosis can cause a narrowing in the arteries to various parts of the body such that blood flow is slowed or blocked. Poor blood flow to the brain can cause a stroke. Poor blood flow to the arms or legs is called peripheral artery disease (PAD). Poor blood flow to the heart is called coronary artery disease (CAD) and can cause angina or a heart attack.


Plaque build up in the coronary arteries to the heart causes poor blood flow and the heart may not receive all the oxygen that it needs. This usually occurs when the heart has to work harder such as while walking, climbing stairs, or feeling worried or upset. When the heart isn’t getting enough oxygen, it can cause pain or pressure in the middle of the chest that may spread to the arms, neck, or jaw. Sometimes there may be shortness of breath, sweating, or nausea. This pain is called angina and usually goes away within two to 20 minutes by resting or taking a medication called nitroglycerin. It does not cause any heart damage.

Unstable Angina

Sometimes, the plaque in the artery can crack open suddenly. The blood forms a clot over the cracked plaque but this clot causes a sudden narrowing of the artery. The chest pain or angina may now occur more frequently, with less exercise, or last longer than usual. This change in the pattern of angina is called unstable angina.

Heart Attack

If the heart is starving for blood and not getting enough oxygen for more than 20 minutes, then a part of the heart muscle dies causing some permanent damage. This is called a heart attack or myocardial infarction (MI). Heart attacks are confirmed with blood tests and a test that shows the electrical activity of the heart called an electrocardiogram (ECG).

Some heart attacks involve only a small area of the heart and can be managed with standard medical treatment in hospital. Some heart attacks involve a larger area of the heart and have a specific pattern on ECG. These heart attacks are called ST-elevation myocardial infarctions (STEMI) and require immediate treatment with clot dissolving drugs or opening up the artery with balloon angioplasty and stents.

Chest Pain Angina Unstable Angina

Heart Attack

While Resting Rare Sometimes Common
Goes Away with Rest or Nitroglycerin Yes Yes Sometimes
Lasts More than 20 Minutes No No Yes
Causes Permanent Heart Damage No No Yes

Causes of Heart Attacks

Coronary Artery Disease: The majority of heart attacks are caused by Coronary Artery Disease. In most cases the plaque inside the artery has ruptured, causing a blood clot to form at the site of the rupture. If the clot is large enough it can get stuck in the narrowed artery, stopping blood flow through the artery.

Coronary Artery Vasospasm: this type of heart attack occurs when the artery squeezes or spasms and blocks blood flow to part of the heart muscle. Factors that can contribute to this type of heart attack is using drugs such as cocaine and tobacco use.

Spontaneous Coronary Artery Dissection(SCAD): this is a rare emergency condition that occurs when a tear forms in one of the blood vessels in the heart. This tear can slow or block blood flow to the heart that can cause heart damage. For more information related to SCAD please go to Spontaneous Coronary Artery Dissection.


Takotsubo Cardiomyopathy(broken heart syndrome) is a condition often caused by an episode of severe stress. It can look and feel just like a heart attack. There is heart weakness but without blocked arteries. The heart strength usually returns to normal.

Heart Damage

Some heart attacks cause very little damage to the heart muscle and the heart can still pump strongly. Some heart attacks are larger and the muscle damage causes a weak heart. There are several heart tests that measure the strength of the heart such as an echocardiogram (an ultrasound of the heart that looks at the pumping strength of the heart and how the heart valves work), nuclear scans such as a MUGA scan, or a ventriculogram which is commonly done during an angiogram.


There are several tests that can check if plaques are blocking the coronary arteries to the heart. These include: treadmill test (fast walking on a treadmill while attached to an ECG machine), nuclear scans such as SPECT or PET scan, stress echocardiogram, CT angiography scan, or angiogram.


With this test, a small tube or catheter is inserted into an artery in the groin or wrist and guided to the heart. A dye is injected through this tube and into the coronary arteries so that they can be seen by an X-ray. This shows if there is plaque blocking the arteries and whether the blockages should be treated just with medications or if there is also need for an angioplasty or coronary artery bypass grafting (CABG) surgery. Sometimes dye is injected into the pumping chamber of the heart to check how strong the heart is and if there was any damage to the heart muscle. This is called a ventriculogram. The catheter is then removed.

Medical illustration of a heart showing the path for an angiogram catheter to the heart, after being inserted through the radial artery in the wrist or femoral artery in the groin.

Angioplasty and Stents

Sometimes blockages in the coronary arteries can be fixed with angioplasty. A small tube or catheter is inserted into an artery in the groin or wrist and guided to the heart as with the angiogram. In this procedure, a small balloon at the end of the catheter can be inflated for a short period of time to push the plaque back against the wall of the artery so that blood can flow better.

In many patients, a small metal mesh tube or stent, is placed over the balloon. When the balloon is deflated and removed, this stent stays permanently where the blockage was and lowers the risk of this area narrowing again. Some stents are metal alone (bare metal stents). Others have a medication coating on them (drug eluting stents).

Medical illustration showing a balloon catheter inserted into an artery and inflated to place a stent, in order to widen a narrowed artery of the heart.
A. The balloon catheter and collapsed stent are inserted into the narrowed artery.
B. The balloon is inflated to expand the stent.
C. The balloon catheter is removed leaving the stent in place.
Advantages of Angioplasty

Over 90% of angioplasties are successful immediately. Blood flow through the artery returns to normal or near normal. Some people may not have complete relief, but their symptoms are improved, allowing them to be more active and comfortable.

There is no incision as this is not surgery and you are not put to sleep (general anesthesia). Most people are up and walking on the same day. Some people go home the same day, but some patients are required to stay overnight and go home the following morning.

Disadvantages of Angioplasty

An artery may become narrow again after angioplasty. This is called restenosis. If the artery narrows enough, you may feel angina again. The use of stents has reduced the restenosis rate. Restenosis is usually treated with a second angioplasty, but occasionally bypass surgery is needed or medical therapy is used.

Risks of Angiogram and Angioplasty

Angiogram and angioplasty (with or without stent implantation) are common procedures. Your physician has carefully considered your clinical condition and believes that the benefits of the procedure outweigh the risks. However, since these procedures are invasive there are risks associated with them.

Common risks include:

  • Bleeding at the catheter insertion site or other organs due to blood thinning medication (antiplatelet or anticoagulant)

Less common but potentially more serious risks include:

  • Heart attack
  • Stroke
  • Unknown dye allergy
  • Kidney problems, including kidney failure requiring dialysis
  • Emergency heart surgery
  • Death
  • Other rare and unpredictable complications

In 1% to 2% of angioplasty cases, the artery collapses or is damaged by the wire or balloon. A stent can often fix this, but sometimes patients need emergency coronary artery bypass surgery. At the Heart Institute, our operating rooms are close by if a patient needs surgery.

Discuss the risks and benefits of your procedure with your doctor.

Coronary Artery Bypass Grafting

Sometimes the blocked arteries cannot be fixed with angioplasty/stents and may require coronary artery bypass grafting (CABG) which is surgery that requires opening the chest. Arteries inside the chest, an artery from the wrist, or pieces of vein from the leg are used to go around the blockages in the coronary arteries. This surgery requires a recovery time of five to seven days in hospital and one to two months at home.

What to Expect During an Angiogram

Before Your Procedure

After a brief discussion with the nurse you will be taken into the Catheterization Lab and asked to
lie on a special X-ray table. The temperature in the room will be very cold. You will be attached to a heart monitor.

As this is a teaching hospital there may be other physicians, nurses and lab technologists involved in your procedure. All staff will be wearing gowns, masks and special aprons.

Your groin/wrist will be washed with a cold solution and sterile sheets will be placed over you. It is important that you neither move nor touch the top of the sheets once they are in place. You may be asked to lie with your arms above your head for a period of time. A nurse will be available to assist you.

During Your Procedure

You will be given medication to help you relax, but you will be awake during the procedure so that
you can follow instructions from the doctor and nurses. The doctor will administer freezing to your groin/wrist. A small catheter will be threaded through a blood vessel up to the heart. A contrast dye will be injected through this catheter to highlight the coronary arteries. Most patients experience a sensation of body warmth or the urge to empty their bladder as the dye is injected.

X-ray pictures will be taken throughout the procedure. The X-ray machine will move over you very close to your body.

During the procedure, you may be asked to take a deep breath and hold it for a few seconds, or to cough. It is not unusual to experience some chest pain. Inform the nurse if you experience any discomfort or have concerns.

The time for the procedure in the lab is usually between 30 to 90 minutes. If your condition is complex, your procedure will be longer.

Due to unforeseen circumstances there may be a lengthy wait in the lab waiting area or you may be
returned to your room until the lab is available.

After Your Procedure

You will leave the Catheterization Lab on a stretcher, and one of the following will happen:

  • After an angiogram: The catheter will be removed and a special clamp or manual pressure will be applied.
  • After an angioplasty: You will be transferred to a unit which specializes in catheter (sheath) removal if a groin insertion was used, or back to the sending unit if the wrist was used.

The nurse will frequently check your pulse, blood pressure, pulses in your feet or wrist, and the puncture site. If you are a patient in the Day Unit area, due to space constraints, only one family member or friend should be with you at a time. They may be asked to leave periodically in order for the staff to deliver care and allow the patient to rest.

Following a groin insertion:

  • If the doctor used your groin (femoral artery), you must remain on bed rest for up to 6 hours after the procedure.
  • It is important to keep your head on the pillow and your affected leg straight. You will be reminded frequently to do these two things to avoid bleeding from the puncture site.
  • If you experience back discomfort, you can be repositioned with the help of a nurse, keeping your affected leg straight. The head of your bed may be elevated slightly.
  • During this time you may sleep, read or rest. You will be given a snack.

Following a wrist insertion:

  • If the doctor used your arm (radial artery) you will have a clamp applied to your arm in the lab to prevent bleeding.
  • You will be on bed rest for approximately one hour after the procedure.
  • It is important to keep your arm on the pillow and refrain from twisting your wrist. You may move your fingers. Your nurse will be available to assist you while the clamp is in place.
  • During this time you may sleep, read or rest. You will be given a snack.

Ask your nurse for assistance as soon as you need to go to the bathroom. It is important not to sit up. The nurse will assist you in getting up once your bed rest is complete. You will be encouraged to walk around during the hour before discharge.


Following a groin (femoral) insertion:

  • Limit the amount of stair climbing as much as possible. Try to climb the stairs only once on the day of your procedure.
  • Do not lift anything heavy—greater than 10 lbs (4.5 kg) —for 48 hours.
  • Apply pressure to your groin if you have to sneeze or cough hard for 48 hours. The easiest way to apply pressure is to make a fist and place it firmly on the groin area over the band-aid.

Following a wrist (radial) insertion:

  • Do not lift anything greater than 10 lbs (4.5 kg) with the affected arm for 48 hours after the procedure. Avoid vigorous wrist movements of the affected arm.
  • You may elevate your arm on a pillow to help prevent swelling.
  • You may remove the clear dressing or band-aid the day after the procedure, and replace it with a new band-aid.
  • A small amount of dried blood on the old dressing and puncture site is normal.
  • You may take a shower the day after your test, but do not allow the dressing to stay wet.
  • Do not take a tub bath or cleanse the arterial puncture site for 48 hours after your test.
  • You may re-apply a dry band-aid for a few more days in order to keep the skin clean and reduce the risk of trauma or infection. The band-aid may be removed 72 hours after the procedure.
  • Try to avoid wearing tight or restrictive clothing over the puncture site.
Puncture Site

Examine the site every day and notify your nurse or physician if any of these problems develop:

  • An expanding lump or persistent area of redness and warmth
  • Yellow drainage from the wound site
  • Worsening numbness in the leg, hand, wrist, or arm
  • Severe discomfort at the puncture site

Mild discomfort at the procedure site or forearm is normal and may be treated with Tylenol or application of a warm, dry towel.


If any bleeding occurs while in hospital, please ring for your nurse immediately. If a small amount of bleeding occurs at the puncture site at home:

  • For a wrist site, sit down immediately and apply firm pressure to your wrist with your fingers for ten minutes.
  • For a groin site, lie down and apply pressure to your groin using a fist placed firmly on the groin area over the band-aid.

If the bleeding stops, remain quiet and keep your procedure leg/wrist immobile for two hours.

If recurrent bleeding occurs, notify your physician as soon as possible.

  • If you are unsure what action you should take, phone 613-696-7000, press 0 and ask for the Cardiology Nursing Coordinator.

If the bleeding does not stop or if there is a large amount of bleeding:

  • Lie down and hold firm pressure on the site until help arrives.

Risk Factors

At the University of Ottawa Heart Institute, you have received the best available cardiac care to treat and manage your heart condition, but your heart disease is not cured.

Heart disease is a chronic health condition and, like any health problem, it can bring uncertainty and changes into your everyday life.

You can respond to these changes in different ways. Research tells us that learning about your risk factors, taking charge of your heart health, and staying involved in your health and health care will help you to continue to do the things that you wish to do.

The following three-step plan will help you learn to take care of your heart and preserve your health:

Step 1 Get to know your own risk factors and plan how to manage them. Use the Modifiable Risk Factors table to help you to identify your risk factors and think about how you might set some health goals.
Step 2 Participate in a Cardiac Rehabilitation Program. Work with specialists in nutrition, physical activity, stress management, return-to-work counselling, and other social and emotional services to develop a plan that is tailored to your specific needs.
Step 3 Learn how to live and work with heart disease. Use the information here to help you get through the normal bouts of anxiety and emotional ups and downs so that you can renew your sense of well being.

Causes of Heart Disease

Coronary artery disease is caused by a combination of genetic and lifestyle factors. These are called risk factors.

The following risk factors are important to be aware of but are not considered to be controllable:

  • Your age
    • As you get older, your risk of heart disease increases
  • Your gender
    • Men over the age of 55 are at higher risk of heart disease
    • After menopause, a woman’s risk of heart disease gradually becomes the same as a man’s
  • Your heredity
    • Your risk of heart disease is increased if close family members—a parent, brother or sister—developed heart disease before age 55 or, in the case of female relatives, before menopause.
  • Your ethnicity
    • First nations people and people of African or Asian descent are at higher risk of developing heart disease

The risk factors that you can control are:

  • Smoking
  • Excess body weight, especially around your waist
  • High blood pressure (hypertension)
  • Abnormal blood cholesterol levels
  • Lack of regular exercise
  • Glucose control, prediabetes and diabetes
  • Excessive stress levels
  • Depression

These are referred to as modifiable risk factors.

Modifiable Risk Factors for Heart Disease

Risk Factor Target Goals Information


No exposure to second hand smoke





Ideal range: BMI of 18.5 – 25
If your BMI is 30 or above, aim for a 5 – 10% reduction of your total body weight.


Women: Below 35 in (88cm)
Men: Below 40 in (102 cm)

Heart Healthy Nutrition


Weight Management

High Blood Pressure

Less than 140/90 in your doctor’s office and less than 135/85 at home

If you have diabetes or kidney disease: less than 130/80 in your doctor’s office and less than 125/75 at home

Heart Healthy Nutrition


Blood Pressure


Safe Medications

High Cholesterol

Total Cholesterol: below 4.0 mmol/L
HDL Cholesterol: above 1.0 mmol/L
LDL Cholesterol: below 2.0mmol/L
Non-HDL Cholesterol: below 2.6mmol/L
Triglycerides: below 1.7mmol/L

Heart Healthy Nutrition



Physical Inactivity

Aim for 30 to 60 minutes of moderate exercise (example: brisk walking) on most days of the week

Healthy Physical Activity

If you have Diabetes

Fasting blood glucose and before meals: between 4.0 and 7.0 mmol/L

A1C: 7% or less

Heart Healthy Nutrition



If you have Prediabetes

Fasting blood glucose and before meals: 4.0 and 6.0 mmol/L

A1C: less than 6.0%


Manage stress



Manage depression




How Smoking Affects Your Heart

The nicotine in smoke causes the arteries of the heart to narrow. The carbon monoxide released from cigarettes causes damage to the walls of the arteries encouraging the build up of fat on those walls.

Smoking also:

  • Raises your LDL (lousy) cholesterol
  • Lowers your HDL (healthy) cholesterol
  • Speeds up your heart rate
  • Increases your blood pressure

Smoking after a heart attack or angioplasty greatly increases the chances of a second heart attack and/or restenosis (re-blocking) of the coronary arteries.

If You Smoke, Quit!
  • Quitting smoking is the single most important thing you can do to positively affect your heart health.
  • The benefits of quitting occur within 20 minutes of your last cigarette and at one year your risk of a heart attack is reduced by 50%.

The Heart Institute’s Quit Smoking Program is available to all smokers who are interested in quitting.

We use proven techniques and individualized counselling to help people quit. To register for the Quit Smoking Program, please call 613-696-7069. There are other options for quitting smoking in our region. It is up to you to decide which option is best.

Keep in mind this one important tip: most people find that the more support they get while trying to quit, the better.

More Information about Quitting Smoking

High Blood Pressure

Checking your own blood pressure at home
Click to enlarge (pdf)

How High Blood Pressure Affects Your Heart

High blood pressure makes your heart work harder, damages your blood vessels, and can also cause greater plaque build-up. All these factors eventually lead to heart damage. Controlling your blood pressure can reduce the progression of your heart disease and may reduce your risk of having a stroke.

To control your blood pressure:

  • Aim to make healthier food choices
  • Reduce intake of foods higher in sodium
  • Achieve and maintain a healthier body weight
  • Be active every day and follow your physical activity plan
  • Practice stress management techniques that work for you
  • Take your medications as prescribed
  • Become smoke free

More Information about High Blood Pressure

High Blood Cholesterol

Cholesterol and your heart infographic
Click to enlarge (pdf)

How Cholesterol Affects Your Heart

Cholesterol is a fat-like substance that is produced mostly in your liver, although some of the cholesterol in your blood comes from the foods you eat.

The most important types of cholesterol in your blood are:

  • Low density lipoprotein cholesterol or LDL
  • High density lipoprotein cholesterol or HDL

L is for “Lousy”:

  • LDL cholesterol carries fats to your body organs to be stored away for future use.
  • It causes a build-up of cholesterol (plaque) on the walls of the arteries in your heart.
  • High levels of LDL can damage artery walls.
  • Eating heart healthy can help lower your LDL.
  • Maintaining a healthy weight can lower your LDL.

H is for “Healthy”:

  • HDL cholesterol is good because it carries excess fats away from your body organs for elimination.
  • The more HDL you have in your blood, the better protected you are against the build-up of plaque in your arteries.
  • Regular exercise and quitting smoking can help increase HDL.
How You Can Improve Your Cholesterol
  • Be aware of your cholesterol levels
  • Aim to make healthier food choices
  • Achieve a healthy body weight (see Appendix 2 - Rate Your Weight)
  • If you smoke, stop (see Smoking)
  • Be active every day and follow your Physical Activity Plan (see Physical Activity)
  • Attend a nutrition workshop (see More Information about Heart Healthy Nutrition)
  • Take your cholesterol medications as prescribed by your doctor

More Information about Cholesterol

Web Sites

If You Have Prediabetes or Diabetes

How Glucose Affects Your Heart

Type 2 diabetes is a progressive disease. Up to 10 years before diagnosis, insulin resistance occurs causing blood glucose levels to rise particularly after meals (Prediabetes). This can lead to insulin deficiency. Insulin is a hormone that unlocks our body’s cell doors so that glucose can be taken up as fuel. These abnormalities lead to an inflammatory response in the vessel wall which favour growth of the atherosclerotic plaque and may cause instability and plaque rupture.

Keeping Your Blood Sugar Levels Healthy
  • Take your medications as prescribed
  • Learn about managing glucose by attending a diabetes education program (see More Information below)
  • Monitor and keep track of your blood sugars
    • Target: blood glucose before meals between 4.0 and 7.0 mmol/L
    • Target: blood glucose two hours after meals between 5.0 and 10.0 mmol/L
  • Aim to make healthier food choices
  • Be active every day and follow your Physical Activity Plan (see Physical Activity)
  • Achieve and maintain a healthy body weight (see Appendix 2 -  Rate Your Weight)
  • Visit to your family doctor or diabetes specialist regularly
Additional Meal Planning Tips
  • Eat regular meals. Aim to eat every four to six hours. Include a healthy snack if meals are more than four to six hours apart.
  • Eat breakfast.
  • Limit sugars and sweets such as sugar, regular soft drinks, fruit drinks, desserts, candies, jam, syrup and honey.
  • If you are thirsty, drink water or sugar free drinks. Drinking regular soft drinks, sweetened drinks or fruit juices will raise your blood sugar level. If you have a condition requiring fluid restriction, follow your personalized recommendations.
  • More information in the Heart Healthy Eating section,

More Information about Diabetes

It’s natural to have questions about what food to eat. A registered dietitian can help you make healthier food choices. If you have diabetes and are taking insulin, speak with your family doctor. You may need to see an endocrinologist (a doctor specializing in diabetes).

Community Diabetes Education Program of Ottawa

  • For adults with prediabetes or type 2 diabetes who are controlled with diet, pills or just starting insulin; no major health problems related to their diabetes
  • Teaching is also available for people with prediabetes
  • Group and individual sessions on healthy eating, getting active, testing blood glucose, stress and emotions, delaying or preventing complications and foot care
  • In English, French and other languages
  • Online self referral can be accessed at Diabetes Ottawa or call 613-238-3722

Diabetes Education Programs (Outside Ottawa)

  • To locate a diabetes education program near you, see Diabetes Canada at 1-800-BANTING (226-8464) or at info@diabetes.ca


  • The Complete Diabetes Guide for Type 2 Diabetes, Karen Graham RD CDE 2011

Web sites