14 Nov Heart Disease
The heart is a very efficient, long-lasting, natural pump situated in the chest that pumps blood all the organs and tissues of the body. However, disease and old age can affect its function, with serious effects on the body. The most common disease affecting the heart is coronary heart disease, in which the blood vessels become scarred and thickened, reducing blood flow to the heart muscle, causing one or more of the following conditions:
- chest pain (angina)
- death of heart muscle (heart attack or myocardial infarct)
- gradual failure of the heart to pump properly (heart failure).
Coronary heart disease is common in people who smoke, who are overweight, who have a family history of the dosage, and/or who have hypertension, and high blood cholesterol, or any of these conditions. A person with heart disease may experience chest pain, dizziness, breathlessness, and/or fatigue.
How is heart disease diagnosed?
The doctor will usually suspect coronary heart disease from a patient’s account of the symptoms, plus their history. Further tests are usually necessary including an electrocardiogram (ECG), an exercise stress test, a heart scan, a chest X ray, and coronary angiography (an X-ray of the arteries after dye is passed through them). These tests can identify which arteries are blocked, and where, and give an indication of the heart’s function and how much heart muscle has been damaged. There are treatments that will help, but once the damage is done, it can’t be reversed. The best way to manage heart disease is to prevent it happening in the first place.
Coronary heart disease is less likely in people who:
- eat a low-fat diet
- don’t smoke
- exercise regularly
keep their weight down
- keep their blood pressure normal
- keep their blood cholesterol low.
So, to prevent heart disease, you should
- exercise regularly
- eat a diet low in saturated fat
- eat plenty of grains, fruits and vegetables
- don’t drink excessive amounts of alcohol
- make sure other conditions like high blood pressure and diabetes are well controlled
- don’t smoke.
Angina is a pain or feeling of discomfort in the chest. The pain is usually felt in the centre of the chest, but can spread to the neck or arms (especially the left one) and sometimes the shoulders or back. It can range in severity from mild to severe. Typically, it comes on during physical exertion and stops after resting, though it can come on at rest. Sometimes there’s no pain but a feeling of ‘tightness’ or ‘pressure’ instead. It is often accompanied by shortness of breath, sweating, palpitations (irregular heartbeat), fainting, or dizziness.
To diagnose angina, doctors will do an electrocardiograph (ECG) of the heart. This measures the heart’s electrical activity and can determine whether the pain is angina or some other cause of chest pain, and where the heart is affected. An ECG may be done after exercise on a machine: this is called a ‘stress test’. An X-ray may be taken of the arteries in the heart after dye is injected through the heart arteries via a catheter inserted in the groin. The dye travels to the arteries of the heart, revealing any narrowing or blockages. This is called coronary angiography.
Angina is often treated by medications which act by relaxing the arteries, or by drugs that reduce the pumping force of the heart. In more severe cases, surgery may be needed to widen arteries and improve blood flow to heart muscle. Often a tiny metal tube called a stent is inserted to keep the artery open. In other cases, coronary artery bypass grafting (CABG) may be performed, in which pieces of vein or artery from elsewhere in the body are used to bypass the damaged areas of artery and maintain blood flow.
Heart attack (myocardial infarction)
A heart attack occurs when a disruption of the supply of oxygen in the blood causes an area of heart muscle to die or become permanently damaged. The term myocardial infarction means ‘death of heart muscle’.
The typical symptoms are similar to these of angina, but in heart attack they prolonged and don’t go away. A heart attack is a medical emergency and anyone suspected of having a heart attack must get to hospital as soon as possible (call 000 for an ambulance in Australia). In hospital, there are several possible treatments. Medications that help dissolve clots in the arteries may be given by injection. Or surgery may be required; coronary angioplasty is a procedure that restores blood flow to the heart by using a special balloon to open a blocked artery. Often, a metal tube called a stent is inserted afterwards to keep the artery open. Coronary Artery Bypass Graft Surgery (CABG) is another operation in which pieces of artery or vein are taken from elsewhere in the body and used to make artificial arteries around the areas of diseased coronary arteries, to redirect blood flow around them. After a heart attack, rehabilitation will be needed to help recovery.
Heart failure happens when the heart isn’t able to pump effectively. It may occur gradually with no symptoms, or it may follow repeated episodes of angina or several successive heart attacks, with so much heart muscle damaged that the heart cannot continue to pump effectively. Blood ‘dam ups’ in the lungs, causing shortness of breath, and swelling occurs in the ankles and legs.
This is the term doctors use to describe and disease of the heart muscle. The most common cause is coronary artery disease but it can also be caused by other conditions such as a viral infection, prolonged heavy alcohol consumption, or rheumatoid arthritis or other diseases. In some cases, the cause is unknown. Some types of cardiomyopathy are inherited and run in families. In cardiomyopathy, the muscle of the heart may become inflamed, thickened and the heart may become enlarged and fail to function properly. If the heart is severely damaged, it may lead to heart failure (see above).
In some cases, (eg when caused by a virus), the heart may recover by itself. In other cases, for example where the damage is caused by alcohol, stopping the alcohol will help recover some function. In many cases though, there is no cure, especially where the damage is caused by coronary artery disease, following a series of heart attacks for example. But treatment can help the damaged heart to function better and this may keep a person leading an active, useful life, in some cases for many years.
The Heart foundation