The heart cycle consists of alternate contractions and relaxations, known as systole and diastole. The average human heart beats 60 – 100 beats per minute, and ejects around 70 ml of blood with each contraction, making 5 liters of blood pumped every minute in the average person of 75 kg. The blood is ejected into the aorta, the biggest arterial blood vessel in a human body. Aortic branches, after that, provide blood delivery to the head, limbs, and organs. Coronary arteries, the first aortic branches, perfuse the heart.

Angina pectoris is a symptom of coronary arteries stenosis. Atherosclerosis obstructs the arteries by cholesterol plaques that are reducing the blood delivery to the myocardium. During the physical activity, insufficient oxygen delivery to the myocardium results in chest angina pain, which eventually subsides during the rest. The pain could spread up to the jaw or down the arm. That is stable angina pectoris. In advanced disease, chest pain will appear even during the rest. Now we are talking about unstable angina. If untreated unstable angina eventually results in myocardial infarction.

Myocardial infarction is a permanent heart muscle damage. It could develop suddenly, due to coronary arteries thrombosis or gradually during the chest angina.  Patients with myocardial infarction experience excruciating chest pain, sweating and fall in blood pressure, frequently followed by arrhythmias. If severe, infarction could result in a shock and sometimes death.

Myocardial damage is permanent, and symptoms in those who survive to depend on the infarction extent. Reduced physical activity, arrhythmias, heart failure, and mitral valve insufficiency are some severe complications.

High blood pressure, diabetes, high blood cholesterol, smoking, and positive family history are the major risk factors for atherosclerosis and coronary artery disease. Medications could stop atherosclerosis development to some degree, but without the lifestyle changes, the patient could not expect significant improvement. We couldn’t have an unhealthy lifestyle and wait for a magical pill to erase and turn over at once, the years of unhealthy living. Therefore, regular exercise, stress relief, smoking cutoff, and a healthy diet are the cornerstone of a patient well being. Diet should be reduced in red and fat meat, processed food, and cholesterol, but reach in sea fish, olive oil, vegetables, and omega-3-acids. Some physicians recommend a glass of red wine a day, but excessive alcohol intake could severely affect your health.

The Mitral valve is located between the left atrium and ventricle. Valve has two leaflets that are closed during the heart contraction providing the blood ejection in the aorta. During the heart relaxation, mitral leaflets open and let the blood to fill the left ventricle. That is how the mitral valve regulates the unidirectional blood flow through the left heart chambers. There two primary mitral valve dysfunctions. Leaflets open incompletely in the mitral valve stenosis,  while in mitral insufficiency their closure  is compromised.

The aortic valve is located between the left ventricle and the ascending aorta. The aortic valve has three tiny leaflets and opens during the ventricle contraction, allowing blood to ejection into the aorta. During the myocardial relaxation, valve closure prevents blood regurgitation back into the left ventricle. There are two main aortic valve dysfunctions, the aortic valve stenosis and insufficiency.

Aortic stenosis is a mainly degenerative disease that develops during the years in the same patients. Leaflets get rigid and less mobile and calcified eventually along with the aortic valve annulus. The heart compensates for increased pumping demands due to stenosis by myocardial hypertrophy. Patients are generally asymptomatic during this period. Symptoms onset is a sign that myocardium could not compensate the aortic stenosis anymore and are getting to fail.

Leaflet closure is compromised in the aortic valve insufficiency allowing the blood to regurgitate back into the left ventricle. Similar to other valve diseases, such a volume overload dilates the left ventricle that eventually fails. Patients better tolerate chronic aortic valve insufficiency compared to the aortic stenosis. Anyway, valve replacement or repair are treatments of choice.

Acute aortic insufficiency, along with a high temperature, is highly suspicious of bacterial endocarditis. This a severe, most frequently bacterial valve infection that requires immediate hospitalization, antibiotic treatment, and valve replacement surgery.   If a new-onset aortic valve insufficiency is followed by a sharp, excruciating chest pain that spreads from chest to the back or legs, the patient is probably suffering from an acute aortic dissection. That is, of course, a surgical emergency that has to be operated almost immediately to prevent fatal aortic rupture.

Around 75 % of heart tumors are benign, and approximately 50% of them are myxomas. Malignant tumors are rare and mostly secondary due to distant malignancy with heart metastasis.

Mixomas are the most common heart tumors. They are benign and could be present as an inherited disease in 5%, or as a sporadic form in 95% of cases. They are generally located and attached to a left atrium by a broad pedicle that allows them to float during the heart contractions. Mixomas are rarely symptomatic and therefore found accidentally during routine echocardiography check-up. Symptoms, if present, are caused by either embolization by tumor particles, or syncope due to valve orifice obstruction. Symptomatic myxomas are surgical emergency, while asymptomatic ones should be operated upon diagnosis to prevent future complications.

Fibroelastomas are small, frondlike tumors covered with tiny filaments that could detach and embolize elsewhere. They are generally located on heart valves that could be repared after tumor resection.